A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure

Abstract

Background: Heart failure affects more than 6 million Americans and an estimated 23 million people worldwide. Inadequate self-care is associated with readmissions and are identified as a marker for poor health outcomes. Nurse-led heart failure inpatient hospital education has been demonstrated to improve knowledge, self-care behaviors and in some studies to reduce 30-day readmissions.

Aims/Objectives: To evaluate the impact of nurse-led heart failure patient education on knowledge, self-care behaviors, and all cause 30-day hospital readmission.

Design: Quasi-experimental pre-test and post-test on a convenient sample on two cardiac units at a large urban facility in the North East region of the United States.

Methods: An evidence-based standardized heart failure patient education program based on the American Colleges of Cardiology and American Heart Association guidelines was implemented with a telephone follow-up at 7, 30, and 90 days post-discharge. The duration of the study was from September 2015 to February 2016. A convenience sample of (N = 29) individuals diagnosed with heart failure was asked to complete Dutch Heart Failure Knowledge Scale and Self-care Heart Failure Index.

Results: A significant difference was found in knowledge at 7 day (P ≤ .001) and 90 day (P ≤ .032), self-care maintenance at 7 day (P ≤ .000) and 30 day (P ≤ .000), self-care management at 7 day (P ≤ .001) and 30-day (P≤.013). A statistically significant difference was found in self-care confidence at 30-day (P ≤ .017) but not at 7 day follow-up call. A statistically significant improvement in 30-day readmission was not found (P ≥ .05).

Conclusion: Findings suggest the importance of developing patient education programs that are focused on improving knowledge and self-care behaviors for heart failure patients. Nurses are uniquely qualified to implement such programs that can improve health outcomes and need to accommodate evidence-based recommendations to global practice settings.

Keywords:

• heart failure
• patient readmission
• knowledge
• self-care
• nurse-led education
• readmission

Acknowledgements

We would like to thank the following groups: (1) Dr Lisa Boyle Chief Medical Officer at Medstar Georgetown University Hospital; the Case Management Department Alma Ray RN, Pat Murley RN, Ruth Adonizio RN, Edith Simmons at Medstar Georgetown University Hospital; Nursing staff and patients at Medstar Georgetown University Hospital; Quality Improvement Department Hanan Foley RN, Elizabeth Freedman MPH at Medstar Georgetown University Hospital; (2).Dr Laura Samuel, Dr Leah Jager, Ms. Denise Rucker, Dr Deborah Finnell, Dr Nancy Goldstein, and Dr Deborah Baker at the Johns Hopkins School of Nursing; (3) and Dr van der Wal, who provided guidance with scoring for the Dutch Heart Failure Knowledge Scale. MA served as the PI, carried out the study, participated in the conception, design, and coordination, acquisition of data, interpretation of data, performed statistical analysis, drafted and revised the manuscript. AR helped in the study implementation period and provided logistical guidance. PMD provided writing assistance, critically revised the manuscript for important intellectual content. DB participated in the design, coordination, and interpretation of data, statistical analysis of data, and helped draft and revised the manuscript. CDH participated in the design, coordination, and interpretation of data, and helped draft and revised manuscript.