Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Steven Heatherly; Brenda Stephens; Brandi Scott

Committee Member

Dr. Sheila Melander

Abstract

Background: An increased national and local prevalence of heart failure fostered a review of the evidence to identify best practice interventions focusing on improving self-care and knowledge. Heart failure remains a leading cause of 30-day readmission in the United States and in Madisonville, Kentucky, the site of study. A review of the literature emphasized improving transitions from hospital to home with a multi-dimensional approach. Self-care and knowledge were identified as major determinants to adequately prepare a patient to manage this chronic disease. A pre- and post quasi experimental study was performed at a rural hospital in Kentucky. Objective: The goal of this study was to assess changes in knowledge and self-efficacy in heart failure with a focus on 30-day readmission rates. Methods: The Atlanta Heart Failure Knowledge Test (AHFKT) and the Self-Care of Heart Failure Index (SCHFI) were measured at baseline, 30-day, and 60-day in relation to an American Heart Association telephone follow up. Results:The study lasted 160-days. The sample included 15 patients presenting to the Baptist Health Madisonville heart failure clinic that completed all requirements of the study. A p-value of less than 0.05 was used to quantify if data was statistically significant. The results revealed a significant increase in knowledge (F=15.6; p < .001), self-efficacy maintenance (F=10.7; P=0.002), and self-efficacy confidence (F=10.8; P= 0.002). Self-efficacy management was found to be increased but not found to be statistically different. The study resulted in three out of 15 patients to be readmitted within 30 days. Also, five out of 15 (33.3%) patients required a preventative diuretic. The patients who received an extra diuretic had a decreased a 60% decreased risk of readmission. Self-care teaching should emphasize edema monitoring because all the readmitted patients in the study were positive for edema at one or more of the time points. Furthermore, the change in weight over time was only marginally increased (F=3.6; p=.057). This is thought to be related to recent diuresis during inpatient hospitalization. Conclusions: This study reinforces heart failure clinic transitioning plus an added telephone follow-up intervention. However, it is hard to separate the two components because the in-office education and the telephone interventions were not measured separately. The results of this study suggest incorporating the validated AHFKT and SCHFI tools into current heart failure clinic education. To enhance this research, future studies regarding health literacy, remote monitoring, and/or a flexible diuretic scale are recommended in a larger sample size.

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