Transitioning from hospital to reality: Do newly diagnosed heart failure patients benefit from a Heart Failure Clinical Nurse Specialist providing focused education at discharge?

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Authors
Reeves, Emma
Author ORCID Profiles (clickable)
Degree
Master of Nursing
Grantor
Eastern Institute of Technology (EIT)
Date
2018
Supervisors
Marshall, Bob
Searle, Judy
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
New Zealand
heart failure
Heart Failure Clinical Nurse Specialist
patient education
self-management
randomised control trial
Citation
Reeves, E. (2019). Transitioning from hospital to reality: Do newly diagnosed heart failure patients benefit from a Heart Failure Clinical Nurse Specialist providing focused education at discharge? (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand https://hdl.handle.net/10652/6050
Abstract
BACKGROUND Heart failure is a complex and progressive condition in which cardiac muscle or the myocardium is impaired in its ability to maintain optimal cardiac output to provide sufficient oxygenated blood to meet the metabolic requirements of the body. Heart failure is one of the most common diagnoses of hospital admissions and it is predicted that globally up to 20% of the population will develop heart failure over their life span. This is largely credited to people living longer due to more effective treatments in cardiac care and a reduction in mortality from coronary events. Heart failure can be managed with educational interventions, medications and lifestyle modifications to help improve function, reduced hospitalisations and mortality. Approximately 50% of patients hospitalised with heart failure will be readmitted with exacerbations within six months; therefore efforts to reduce hospital readmissions are a priority for planning and funding work streams of District Health Boards. AIM This study examines the effect of a focused heart failure pre-discharge education session by a heart failure clinical nurse specialist versus usual care involving pre-discharge education by the ward nurses on self-monitoring of heart failure symptoms and adherence to medications. The research question was “What effects does a brief intervention by a Heart Failure CNS emphasising self-checks for weight changes, oedema or breathing changes prior to discharge have on patient adherence to medication, ongoing symptom monitoring and self-management?”. METHODOLOGY An experimental quantitative research design was implemented in the form of a randomised controlled trial. Recruitment was over a three month period. Thirty patients who were newly diagnosed and admitted to hospital with heart failure consented to participate in this study. Half were randomised to Usual Care and half to the Intervention group. Participants in Usual Care received heart failure education prior to discharge by the ward nurses and participants in the Intervention group received an additional focused education session by the Heart Failure Clinical Nurse Specialist. The brief education intervention emphasised self-checks for weight changes, oedema or breathing changes prior to discharge and how this influences patients’ adherence to medication, ongoing symptom monitoring and self-management using a weight diary resource. A questionnaire asked participants following discharge about self-monitoring principles, follow up, adherence to medications and changes to heart failure symptoms. Participants were questioned within 48 hours of discharge and at a two week clinic review. Data was stored and analysed using Excel. RESULTS Results showed all participants had collected their medications on discharge and 47% of Intervention and 53% of Usual Care participants had an appointment for follow up with their GP. Most participants (100% Intervention, 93% Usual Care) over both groups were able to stand on the scales and record their weight daily at the initial survey and the results were similar at the two week clinic review. All participants in the Intervention group were found to be adherent to medications at the phone call and clinic review. There was a slight improvement in medication adherence in the Usual Care participants from 87% to 93%. Participants in the intervention group reported fewer symptoms of heart failure; however the difference between each group was only one or two participants. The majority of participants had NYHA two functional symptoms of heart failure: therefore they were comfortable at rest, but there was slight limitation with shortness of breath, fatigue or palpitations during physical activity. CONCLUSION There were no statistical differences between usual care and the intervention group, perhaps due to the number of participants in the study. Results were slightly better for the intervention group when it came to the symptoms participants had at the 48 hour phone call follow up and two week clinic visit, but otherwise there was no difference between the Intervention and Usual Care participants. Patients appeared to receive thorough education prior to discharge by the ward nurses. This study has highlighted the importance of empowering patients to self-monitor and adhere to medications with their new heart failure diagnosis in order to promote their health and stability of condition.
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