Congestive heart failure (CHF) is the most common indication for hospital admission and the most common discharge diagnosis in patients older than 65 years of age (Hoyt & Bowling, 2001). An estimated 5 million Americans are affected by heart failure with an estimated 550,000 new cases diagnosed each year (Porth, 2005). According to Hoyt and Bowling lack of knowledge and adherence to medical regimen including both diet and medication are the most common reasons for hospital readmission in CHF patients. Approximately 30-40 % of patients with heart failure are readmitted within six months of hospitalization. Studies also suggest that 40 % of those readmissions could be prevented. The prevalence of heart failure has resulted in an annual expenditure of billion for diagnosis and treatment.
Aging of the population and prolongation of the lives of cardiac patients by modern therapeutic innovations has led to an increasing incidence of heart failure.
Considering the prevalence of heart failure as well as the cost associated with readmissions, as an advance practice nurse one must explore opportunities within the
domain of nursing to reduce readmissions. The goals of treatment include treating the underlying disease, relieving stress on the heart and minimizing symptoms and risks of worsening heart failure. The advanced practice nurse should utilize the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines for evaluation and management of heart failure, educate the patient and family incorporating a multi-disciplinary team approach on topics such as diet, exercise, medications, daily weights, weight loss if needed, smoking cessation if applicable, and limit alcohol consumption if applicable.
STATEMENT OF PURPOSE
The purpose of this project is to examine the effect of a “heart failure medication patient
education program” on the knowledge level of cardiovascular nurses responsible for discharge teaching on a telemetry unit.
THEORETICAL/CONCEPTUAL FRAMEWORK
DEFINITION OF TERMS
Heart Failure Medication Patient Education Program
Theoretical Definition: The “Heart Failure Medication Patient Education Program” consists of didactic and interactive components. Major topics in the didactic section include: (1) Characteristics of heart failure as a clinical syndrome with definitions, (2) Therapy, (3) Diastolic dysfunction, and (4) Implementation of practice guidelines. The interactive portion of the program will focus on the use of role-playing scenarios to help participants learn how to teach patients about medication commonly used in the treatment of heart failure, i.e., type, purpose, dose, side effects, schedule for taking medications. The program will be approximately 60 minutes in duration. The education program will be congruent with the “American College of Cardiology and the American Heart Association” (ACC/AHA), 2001 practice guidelines.
Operational Definition: For the purpose of this project, the operational definition was the implementation of the educational program on heart failure medications.
Knowledge Level
Theoretical Definition: Peterson and Bredlow (2004) note “clients demonstrate self-care action when they develop and use self-care knowledge and self-care resources” (p.86). “According to Erickson, Tomlin, and Swain (1993) “through self-care action the individual mobilizes internal resources and acquires additional resources that will help the individual gain, maintain and promote optimal level of holistic health” (as cited in Peterson & Bredlow, p. 48). The train-the-trainer education program will help nurses teach responsible self-care heart failure medication principles and practice to patients. It is expected that there will be increased knowledge, which is movement from lower levels of understanding to higher levels in these domains.
Operational Definition: Scores from the “Knowledge of Heart Failure Medication” tool (Risher, 2006). This tool will be used as a pretest and posttest.
SIGNIFICANCE OF PROJECT FOR PROFESSIONAL NURSING
A study conducted by Hope, Wu, Tu, Young, and Murray (2004) examined the relationship between medication knowledge, skills, medication adherence and the number of emergency department (ED) visits among older patients with congestive heart failure. . Findings related to medication knowledge revealed that approximately 50% of participants were able to answer questions correctly pertaining to dosage and frequency, but only 20% answered correctly as to indication of medication. This study supports the proposed theory that the lack of medication knowledge contributes to non-adherence and this results in increased ED visits and/or hospitalization.
Therefore one must conclude there is a need for ensuring heart failure patients are not only receiving the proper medications according to the ACC/AHA guidelines but have a good understanding of those medications as well. To close the gap of lack of knowledge and adherence of heart failure medications the goal of this project will be to educate telemetry nurses responsible for discharge teaching so they will be better prepared to educate their patients. This is significant for the profession of nursing so that we can provide better patient care resulting in better patient outcomes. Theoretically if heart failure patients have a better understanding of their medications indications, actions, dosage, and the importance of adherence they will be more compliant. As an end result decreasing ED visits and/or hospitalizations, this in turn will decrease healthcare cost.
Credit:ivythesis.typepad.com
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