Date of Award
Evidence-Based Project Report
Doctor of Nursing Practice (DNP)
Theresa A. Kessler
Heart failure (HF) affects an estimated 5 million Americans, with 550,000 new patients diagnosed yearly (American Heart Association, 2004). Despite advancements, readmissions for HF remain high. Management is especially important due to recent legislation that penalizes hospitals with excessive readmissions. The purpose of this evidence-based project (EBP) was to determine if a chronic disease HF management program with advance practice nurse, home care, and telehealth would affect hospital readmission 4 weeks post-discharge. Orem’s Self-Care Deficit Nursing Theory and the Iowa Model guided this system change. The project used a longitudinal experimental pre- and post-test design with convenience sample from two hospitals in the Midwest. An algorithm guided the EBP that began while hospitalized and continued 30 days. The Self-Care of Heart Failure Index (SCHFI) was administered pre- and post-intervention to measure changes in self-care. Descriptive statistics were compared to a chart audit of patients with HF utilizing homecare and telehealth in 2011. Paired-samples t test were used to compare the mean pre- and post-test scores in all SCHFI domains. Mean maintenance pre-test scores (M = 56.43; SD = 27.77) and post-test scores (M = 89.01;
SD = 6.88) were significantly different; (t (13) = -4.415, p < .001). Mean pre-test
management scores (M = 25.00; SD = 13.22) and post-test scores (M = 73.33; SD =25.16) were significantly different (t (2) = -6.653, p < .02). Mean confidence pre-test scores (M = 88.14; SD= 19.76) and post-test scores (M = 100; SD = .00) were significantly different (t (13) = -2.245. p < .04). There were no readmissions in the EBP participants compared to 2 (16%) readmissions in 2011. The implementation of the evidence-based HF chronic disease management program resulted in improved self-care and reduced readmissions. Replication of this EBP has been adopted by the Project Coordinator's (PC) institution.
Kurpela, Sandra M., "Reducing Heart Failure in an Era of Reform" (2013). Evidence-Based Practice Project Reports. 43.