Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Ruth A. Bush, PhD, MPH; Jane M. Georges, PhD, RN


Dose intervention, Heart failure, Nurse coaching, Self-care, Self-care management, Telemonitoring


Heart failure (HF) affects over 5.1 million people in the United States resulting in poor clinical outcomes, early mortality, and increased readmission rates despite advances in technology and treatment modalities. Healthcare costs are projected to rise from $31 billion in 2012 to $70 billion by 2030. Telemonitoring (“technology”) allows self-monitoring of daily weight, blood pressure, and clinical symptoms. Remote access to patient data facilitates communication and timely follow-up between healthcare teams and patients. However, older adults with HF often lack appropriate training and support when introduced to new technology and may not recognize or interpret early HF-related symptoms due to poor self-care behavior or lack of skill-building. Nurse coaching (“touch”) reinforces HF education and promotes self-care behavior. Telemonitoring and nurse coaching combined demonstrate potential benefits; however, both care transition approaches are costly with mixed results. No studies have explored dose effects of technology and touch on self-care, self-care confidence, and clinical outcomes.

The purpose of this study was to examine relationships among selected patient characteristics, dose intervention of technology and touch, self-care, self-care confidence, and 30-day outcomes in older adults with HF. A descriptive correlation design using secondary analysis of data collected for the Better Effectiveness After Transition – Heart Failure Randomized Clinical Trial was used. Measures included sociodemographic and clinical characteristics, Self-Care of Heart Failure Index scores, dose intervention of technology and touch, and 30-day readmission rates. Descriptive findings are presented. Statistical analyses included chi square, t-tests, and analysis of variance. Four dose intervention subgroups were identified: Low Tech Low Touch (LTLT), Low Tech High Touch (LTHT), High Tech Low Touch (HTLT), and High Tech High Touch (HTHT). Dose intervention was significantly associated (p < .05) with race/ethnicity, education level, employment status, household income, and New York Heart Association status. The LTHT subgroup demonstrated the most improvement in self-care maintenance scores (p < .05) compared to the HTLT and HTHT subgroups. Implications for nursing practice, education, research, and health policy are discussed. Understanding the balance of nursing intervention and telemonitoring is key to maximizing the effectiveness of technology and improving self-care behavior and patient outcomes.

Document Type

Dissertation: USD Users Only