Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, Phd, DNP, CRNA

Second Advisor

Caroline Etland, PhD, RN


Background: A transitional care program was developed at a southern San Diego hospital to guide patients dealing with heart failure from an inpatient to an outpatient setting to decrease hospital readmissions. Although, very successful with a quarterly readmission average of 9%, patients that are considered end-stage heart failure categorized by ejection fraction less than 30% and have greater than one visit in a thirty day period do not qualify for transitional care. These patients’ readmission rates average 50%. The literature shows that patients who will not significantly improve within six months would benefit from palliative and hospice care, thus a palliative care referral process was created by the education director to better capture patients that fall into the advanced heart failure category. Evidence indicates that palliative care supports the best possible quality of life in patients and families facing serious illness.

Purpose: The purpose of this evidence-based project is to utilize a palliative or hospice care referral process for end-stage heart failure patients that don’t meet transitional care criteria in an attempt to improve quality of life evidenced by QOLI questionnaire.

Method: Members of the transitional and palliative care team will send a list of de-identified patients using only financial numbers via Microsoft outlook to the DNP student; he will then access the patient’s chart and ask if they are willing to participate in a two part questionnaire. A convenience sample of 10 patients with a primary or secondary heart failure diagnoses discharged from a suburban southern San Diego, California, hospital that did not meet transitional care criteria where presented with a Ferrans and Powers Quality of Life Index (QOLI) cardiac version. The first questionnaire will be presented during their hospitalization or within five days of discharge and the second will be presented at thirty days after discharge.

Results: Utilizing the Ferrans and Powers Quality Index tool patients indicated a 19.25% increase in the perception of quality of life as well as an increase of 53.6% in their health and function score.

Implications for Practice: The information gathered from this project can be utilized by physicians and nurse practitioners practicing at an inpatient hospital setting to help assess a patient’s needs, illness management, and quality of life related to heart failure. Utilizing the new referral process has potential to influence patient’s self-management, improve social support, and ultimately improve quality of life in patients with end-stage heart failure.

Included in

Nursing Commons