Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Feasibility Study of a Nurse-Led Heart Failure Education Program

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Feasibility Study of a Nurse-Led Heart Failure Education Program

Article excerpt

Introduction

More than 6 million Americans suffer from heart failure (HF) which contributes to approximately 287,000 deaths in the US each year (Emory Healthcare, 2014). The prevalence of HF is projected to increase 25% by 2030 (Butler & Kalogeropoulous, 2012). Globally, it is estimated that 23 million people are living with HF worldwide. HF hospitalizations contribute to an estimated cost of $39 billion annually for the American health care system and individuals with HF experience the highest frequency of 30-day readmissions in the US (Butler & Kaloger-opoulous, 2012; Kirby, Dennis, Jayasinghe, & Harris, 2010; Vreeland, Rea, & Montgomery, 2011).

HF-related réadmissions result in more than $15 billion in annual US Medicare expenditures. The US Centers for Medicaid and Medicare Services have recently redesigned its Inpatient Prospective Payment System (IPPS), with the goal of reducing annual Medicare expenditures for 30day readmissions (Averill et al., 2009). The resulting IPPS metrics, designed to penalize hospitals for readmissions within 30-days of discharge, reducing of the hospital's inpatient payments by up to 20% from the US Medicare system (Averill et al., 2009; Bhalla & Kalkut, 2010). Debilitating symptoms associated with HF include breathlessness, fluid retention, and chronic fatigue (Fonarow, 2011; Joynt, Orav, & Jha, 2011a, 2011b). Exacerbation of these symptoms is associated with frequent hospitalizations and serves as key indicators of worsening disease. This underscores the importance of developing programs targeted to improve care after hospital discharge and reduce hospital readmission for individuals living with HF.

Evidence-based guidelines highlight the importance of using a nurse-led education program focused on promoting patient self-care (SC) behaviors for individuals living with HF (Baptiste, Groff-Paris, Mark, & Taylor, 2014; Buck et al., 2012; Riegel et al., 2009; Riegel, Carlson, & Glaser, 2000). The literature is abundant with recommendations for patient SC activities for managing HF that include weight monitoring, adherence to a strict medication regimen and low-salt diet, self-monitoring of symptoms, exercise, and regular provider visits (Buck et al., 2012; Koelling, Johnson, Cody, & Aaronson, 2005; Riegel et al., 2009) These SC activities, in isolation, have proven to be insufficient in improving HF outcomes and reducing readmissions B (Riegel et al., 2000; Riegel et al., 2009). Inadequate SC is identified as a major contributor to recurrent hospitalizations and poor health outcomes for HF patients (Davis et al., 2012). Challenges to SC are evident in HF patients, especially those with experiencing worsening symptoms, decompensation, and frequent hospitalizations (Buck et al., 2012; Davis et al., 2012; Riegel et al., 2009). The authors will describe a nurse-led intervention, targeted to improve SC and reduce 30day readmissions for HF patients. Findings of this feasibility study identified strategies and barriers will be discussed.

Previous studies have concluded that interventions focused on patient SC result in fewer 30day readmissions and improve SC behaviors in patients.(Cameron, Worral-Carter, Driscoll, & Stewart, 2009; Chriss, Sheposh, Carlson, & Riegel, 2004; Jovicic, Holroyd-Leduc, & Straus, 2006; Krumholz et al., 2002; Riegel et al., 2009; Shively et al., 2013) Additionally, the literature identifies that the more severe the HF, the greater the challenge to maintain SC (Chriss et al., 2004; Nagy & Wolfe, 1984). Individuals with more severe HF symptoms face challenges in SC maintenance, SC management, and SC confidence associated with the lack of energy to self-manage HF symptoms (Cameron et al., 2009; Chriss et al., 2004; Jovicic et al., 2006; Riegel et al., 2009). The use of a valid and reliable instrument to measure SC behaviors during and after hospitalization is recommended (Baptiste et al., 2014; Buck et al. …

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