Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Lacey Buckler

Committee Member

Dr. Chizimuzo Okoli

Abstract

Purpose: The Smart Heart Self-Care First Pilot Program (SHSCF) offers a transitional care intervention focusing on the self-care of hospitalized heart failure patients who are discharged home. It utilizes assessment, communication and education components to encourage behavior modification (improved self-care) through telehealth methodology.

Background and Significance: Heart failure related admissions, as a primary or secondary diagnosis, are among the leading causes of hospitalizations in the United States (Emory Healthcare, 2016). Surprisingly, of those patients discharged with a primary diagnosis of heart failure, 20% are readmitted to the hospital within thirty days (Feltner et. al, 2014). Heart failure related re-hospitalizations highlight a growing need for transitional care from the inpatient setting to the home. Thus, heart failure self-management programs focusing on self-care skills and education are becoming increasingly popular among institutions (Baker et al., 2011).

Procedures: Twenty participants were enrolled into this randomized controlled trial. Twelve patients received the usual or standard of care based on Heart Failure Core Measures and the other 8 participants received the text messaging intervention. Assessment of self-care, depression symptoms and anxiety symptoms was obtained at baseline and at the 30-day follow-up time frame. For those patients in the intervention group, the delivery of text messages was daily for thirty days after discharge. Additional outcomes evaluated post intervention included hospital readmissions and quality of life.

Results: The sample was primarily male (70%), Caucasian (85%), urban (60%), mostly middle aged (mean age= 49.1, SD= 14.9) and not currently married (60%). On average, participants had mild depression and anxiety symptoms (mean PHQ-9=7.2, SD=5.1; mean GAD-7=5.3, SD=5.6) of which 25% of the intervention and 33.3% of the control group had moderate to severe depression symptom scores. There were no significant differences in self-care, depression symptoms, or anxiety symptoms between the control and intervention groups pre and post intervention. There was a readmission rate of 25% in both the intervention and control groups.

Implications for Nursing Practice: Self-management programs offer hope to providers and patients as they transition from an acute care facility to home. Specifically, telehealth methods show promise in increasing provider and patient communication as well as access to specialty care. This program highlights how the routine screening for depression and anxiety symptoms in addition to education could be beneficial in the HF population, encompassing a holistic approach to care through the evaluation of emotional and not just physical health.

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