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OPTIMIZING INPATIENT HEART FAILURE EDUCATION TO SUPPORT SELF-CARE AFTER DISCHARGE:
A Case Study

A Capstone Project Proposal

STUDENT NAME: Maryanne Crowther
STUDENT NUMBER: XXXXXXXXX
DEPARTMENT: Doctor of Nursing Practice
Content: Capstone Proposal

Advisor/Mentor: Cheryl Holly, EdD Amy Sirkn, DNP

DATE OF SUBMISSION: June 6, 2010
CONTENTS
ABSTRACT 3 introduction/Background 5 problem 7 Existing Program 7 The Innovation............................................................................................................................................................. 9 Inquiry Question 17
OBJECTIVES AND AIMS 17 Overall Objective 179 Specific Aims 17
Review of the Literature 18
THEORETICAL MODEL............................................................................................................................................ 23
Project design and methods 25 Design 25 Setting 26 Study Participants.................................................................................................................................................... 27 Sources of Data 28 Data Analysis 28 Ethics and Human Subjects Issues 29 Timeframes 29
Strengths and Weaknesses of the Study 30
Health Disparities or Cultural Competence Significance 31 references 32
Appendices 38 Appendix 1: 41 Appendix 2: 39 Appendix 3: 41 Appendix 4: 42 APPENDIX 5.............................................................................................................................................................. 43 APPENDIX 6 .................................................................................................................................................................44

ABSTRACT

Background: Heart Failure is the only cardiovascular disease that is increasing in prevalence and incidence. The syndrome accounts for recurrent illness, hospital readmissions and reduced



References: Adams, K. F., Lindinfield, J., Arnold, J.M.O., Baker, D. W., Barnard, D.H., Baughman, K. L., Boehmer, J.P., et al. (2006). HFSA 2006 comprehensive heart failure practice guidelines, Journal of Cardiac Failure, 12(1), e1-e122. Aghababian, R.V. (2002). Acutely decompensated heart failure: opportunities to improve care and outcomes in the emergency department. Revues in Cardiovascular Medicine, 3(suppl 4): S3-S9. American Heart Association “Get With The Guidelines” Performance Achievement. Retrieved on March 11, 2009, from http://www.americanheart.org/downloadable/heart/ 1236384888173mar2009.pdf Anderson, C., Deepak, R.V., Amoateng-Adjepong, Y., & Zarick, S Artinian, N.T., Magnan, M., and Lange, W. (2002). What do patients know about their heart failure? Applied Nursing Research, 15: 200-208. Braunwald, E., Zipes, D. and Libby, P. (2001). Heart Disease: A Textbook of Cardiovascular Medicine, Philadelphia: Saunders. Carlson, B., Riegel, B., Moser, D.K. (2001). Self-care abilities of patients with heart failure. Heart & Lung, 30: 351-359. Chin, M.H., Walter, A.E., Cook, S.C., & Huang, E.S. (2007). Interventions to reduce racial and ethnic disparities in health care. Medical Care Research and Revue, 64:5 suppl): 7S-28S. Crowther, M., Maroulis, A., Shafer-Winter, N., & Hader, R. (2003). Evidenced Based Development of a Heart Failure Center, Evidence-based Nursing. 6(1), 4-6. Dickson, V.V., Deatrick, J.A. & Riegel, B. (2007). A typology of heart failure self-care management in non-elders. European Journal of Cardiovascular Nursing, 7: 171-181. Ducharme, A., Doyan, O., White, M., Rouleau, J.L., & Brophy, J.M. ( 2005). Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial. Journal of the American Medical Association, 173(1): 40-45. Fawcett, J. (1989). Analysis and Evaluation of Conceptual Models of Nursing, 2nd ed., Philadelphia: Davis. Fiscella, K., & Williams, D. R. (2004). Health disparities based on socioeconomic inequities: implications for urban health care. Academic Medicine, 79, 1139-1147. Fleischman, A.R. & Barondess, J.A. (2004). Urban health: a look out our windows. Academic Medicine, 79(12). Retrieved from OVID online. Friedman, M.M., & Quinn, J.R. (2008). Heart failure patients’ time, symptoms, and actions before a hospital admission. Journal of Cardiovascular Nursing, 23(6): 506-512. Grady, K.L., Dracup, K., Kennedy, G., Moser, D.K., Piano, L., Stevenson, W., & Young, J.W. (2000). Team management of patients with heart failure, Circulation, 102:2443-2456. Hershberger, R., Ni, H., Nauman, D.J., Burgess, D., Toy, W., Wise, K. Dutton, D., et al. (2001). Prospective evaluation of an outpatient heart failure management program. Journal of Cardiac Failure, 7: 64-74. Hodges, P. (2009). Factors impacting readmissions of older patients with heart failure. Critical Care Nursing Quarterly, 32(1): 33-43. Hugli, O., Braun, J.E., Kim, S., Pelletier, A.J., & Camargo, C.A. (2005). United States emergency department visits for acute decompensated heart failure, 1992 to 2001. American Journal of Cardiology, 96: 1537-1542. Hunt, S.A., Abraham, W.T., Chin, M.H., Feldman, A.M., Francis, G.S., Ganiats, T.G., Jessup, M., et al. (2005). ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult. Circulation, 112:e154-e235. Jaarsma, T., Halfens, R., Senten, M., Tan, F., Saad, H., & Dracup, K. (1998). Developing a supportive-educative program for patients with advanced heart failure within Orem’s general theory of nursing. Nursing Science Quarterly, 11(2): 79-85. Jaarsma, T., Halfens, R., Tan, F., Saad, H., Dracup, K., & Diedericks, J. (2000). Self-care and quality of life in patients with advanced heart failure: The effect of a supportive educational intervention. Heart & Lung, 29(5): 319-330. Jaarsma, T., Saad, H. H. A., Dracup, K., & Halfens, R. (2000). Self-care behavior of patients with heart failure. Scandinavian Journal of Caring Sciences, 14: 112-119. McEwen, B.S. (1998). Protective and damaging effects of stress mediators: Allostasis and allostatic load. New England Journal of Medicine, 338:171-179. Morgan, A.L., Masoudi, F.A., Havranek, E.P., Jones, P.G., Peterson, N., Krumholz, H.M., Spertus, J.A., et al. (2006). Difficulty taking medications, depression, and health status in heart failure patients. Journal of Cardiac Failure, 12(1): 54-59. Moser, D.K., Doering, L.V., & Chung, M.L. (2005). Vulnerabilities of patients recovering from an exacerbation of chronic heart failure. American Heart Journal, 150: 984. Orem, Dorothea (2001). Nursing: Concepts of Practice. Philadelphia: Mosby. Reid, M., Clark, A., Murdoch, D.L., Morrison, C., Capewell, S., & McMuray, J. (2006). Patient strategies for managing medication for chronic heart failure. International Journal of Cardiology, 109: 66-73. Riegel, B., Dickson, V.V., Goldberg, L.R., & Deatrick, J.A. (2007). Factors associated with the development of expertise in heart failure self-care. Nursing Research, 56(4): 235-243. Rogers, A.E., Addington-Hall, J.M., Abery, A.J., McCoy, A.S.M., Bulpitt, C., Coats, A.J.S., and Gibbs, S.R. (2000). Knowledge and communication difficulties for patients with chronic heart failure: qualitative study. British Medical Journal, 321: 605-607. Rogers, E.M. (2003). Diffusion of Innovations, 5th ed. New York: Free Press. St. Joseph’s Healthcare system, (2009). Retrieved on 5/29/09, from http://www.stjosephshealth.org/index.php/healthcare-highlights/mission-vision-and-values St St. Joseph’s Regional Medical Center, internal document, 2009. Swedberg, K., Cleland, J., Dargie, H., Drexler, H., Follath, F., Komajda, M., Tavazzi, L., et al., (2005). Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005). European Heart Journal 26: 1115-1140. The Joint Commission. Retrieved on March 11, 2009, from http://www.jointcommission.org/CertificationPrograms/Disease-SpecificCare The Joint Commission (2009) Tu, W., Morris, A.B., Li, J., Wu, J., Young, J., Brater, C. & Murray, M.D. (2005). Association between adherence measurements of metoprolol and health care utilization in older patients with heart failure. Clinical Pharmacological Therapy, 77(3): 189-201. Wu, J., Moser, D.K., Chung, M.L. and Lennie, T.A. (2008). Objectively measured, but not self-reported, medication adherence independently predicts event-free survival in patients with heart failure. Journal of Cardiac Failure, 14(3): 203-210. Yin, R. K. (2009). Case Study Research, 4th ed. Los Angeles: SAGE. | |that must be in place in order for an organization to provide high-quality care, treatment and | | |services (2010 Disease Specific Certification Manual, p | |guidelines for evaluation and management of chronic heart failure in adults, 2001). | |Newly devised process of providing patient |Nurse-led interdisciplinary process of initial and ongoing assessment of patient educational | | |lifestyle changes that support self-management regimens and addressing one’s educational needs | | |related to heart failure self-care (2010 Disease Specific Certification Manual, p |Standard |Statement that defines the performance expectations, structures, or processes that must be | | |substantially in place in an organization to enhance the quality of care (2010 Disease Specific |

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