Abstract
Background Symptom management in heart failure (HF) is the cornerstone to improve outcomes in this complex population. Rehospitalization rates due to HF sequelae are high and symptom management remains an ongoing issue. Focused Nurse Practitioner (NP) visits with evidence-based patient education will enhance engagement and self-care management of HF. Ultimately, this will improve HF outcomes for participants in the PACE program. Purpose The purpose of this quality improvement project was to evaluate the efficacy of focused NP visits on improving HF related outcomes among participants of the PACE program in western Florida. Methods The project was based on the Information, Motivation, Behavioral skills theoretical model with patient engagement as the key mediator to achieve improved HF self-management. The NP saw each participant twice. The first visit established baseline data through questionnaires. The second visit was to discuss the evidence-based HF patient education booklet created by this author and complete the post-intervention questionnaires. Table 1 describes the outcome measures and instruments used. The outcomes evaluated included HF knowledge, quality of life, HF self-care and symptom burden, demographic data, medical history, and clinical variables. The questionnaires used included the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Atlanta HF Knowledge Test (AHFKT), the Self-Care of HF Index questionnaire (SCHFI), the Symptom Status Questionnaire - Heart Failure (SSQ-HF). Results The results for the AHFKT were statistically significant (p = .037) indicating the evidence-based education provided was effective. The self-efficacy and knowledge portion of the KCCQ was statistically significant (p = .047) indicating the education and focused NP visits increased participant knowledge and ability to effectively manage their HF. The result of the AHFKT surmises the evidence-based education provided was effective, which is supported by the results from the KCCQ on knowledge and self-efficacy. In evaluation of the symptom severity questions, it was determined that participants were more self-aware of their HF symptoms after the HF education, thus providing responses to the KCCQ that showed an inverse relationship. Conclusion The clinical implications for this practice change indicates the evidence-based education booklet is an effective tool in the management of HF when combined with focused NP visits. The NP visits showed improved outcomes and would be beneficial to HF patients ongoing. In terms of sustainability, the evidence-based education booklet has been adopted for all HF patients.
Published Version
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