Date of Award

Spring 5-21-2016

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Dr. Shelley Hawkins

Second Advisor

Dr. Scot Nolan

Third Advisor

Dr. Robert Stein

Abstract

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior theory. Education was initiated prior to discharge followed by STS weekly for 6 weeks. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), was administered prior to discharge and again at 30 days to measure quality of life score improvement.

The practice change project included 5 participants. One participant dropped out for a planned surgical procedure. The remaining 4 participants completed the program without any HF 30-day readmissions. There was a 23% improvement in mean MLHFQ scores 30 days after the practice change.

Evidence-based HF self-care transition programs have the potential to assist HF patients to successfully transition from hospital to home, demonstrating improved quality of life and reduction in readmissions. The advanced practice nurse possesses the knowledge base and skill set to meet the individual HF patient needs by incorporating education and self care. A successful practice change that is sustainable can yield significant financial implications for the healthcare system.

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