A Nurse-Led Heart Failure Education Program to Improve Knowledge and Self-Care and Reduce 30-Day Readmission

Sunday, 30 July 2017

Martha Sissay Awoke, DNP, MSN, RN
Department Case Management, Medstar Georgetown University Hospital, Washington, DC, DC, USA
Diana Lyn Baptiste, DNP, MSN, RN
Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA


Heart failure is a burdensome condition that affects more than 6 million Americans and an estimated 23 million people worldwide. Individuals living with heart often experience breathless, edema, and fatigue leading to frequent hospital admission. The purpose of this quality improvement program was to standardize a nurse-led heart failure patient education and evaluate its impact on knowledge, self-care behaviors, and all cause 30-day hospital readmission at a large urban academic medical center.  



We implemented an evidence-based standardized heart failure patient education program with telephone follow-up at 7, 30 and 90 days post-discharge. A convenience sample of (N=19) Individuals who were hospitalized with diagnosis of heart failure completed two questionnaires: 1) the Dutch Heart Failure Knowledge Scale (DHFKS) and, 2) the Self-care Heart Failure Index (SCHFI).


Descriptive statistics were analyzed using SPSS® version 23 to provide demographic characteristics for the sample. The mean age for the sample is 68, with ranging from 54-90, almost evenly distributed gender, and most of the sample size reported they were unemployed, retired, or disabled. Nine participants (47%) had an ejection fraction less 40% and 47% had an NYHA IV classification. Among (n=19) participants, baseline knowledge scores ranged from 9-15. The mean score was 12.21 SD=1.548, which is comparable to scores reported in previous studies which were mean 11.4 and 12.6, respectively.

Self-care maintenance shows (n=4) participants scoring between 40-50% and another 4 patients scoring between 70-80%. Six participants scored between 50-70%, 1 participant scored 100% and 2 patients each scored between 20-40% and 80-90%. Self-care management score describes a normal distribution curve in which the majority of the responders were under the bell curve. Answers ranged from “I did not recognize symptoms” to “I recognize the symptom of heart failure quickly.” Of the (n=19) participants, 11 stated that they “did not recognize HF symptoms”. However, when asked about how likely they were to try some of the remedies (reduce fluid intake, reduce salt intake, call your doctor or nurse) if they experienced trouble breathing or ankle swelling, 13 patients stated they are “very likely” to try one of the remedies.


Implications from this study suggest the importance of developing education programs that are focused on improving knowledge, self-care maintenance, self-care management and self-care confidence for heart failure patients. Those who score lower self-care behavior scores after the intervention may benefit from additional education, resources, and support. Nurses are uniquely qualified to implement such programs that can improve health outcomes and need to accommodate evidence-based recommendations to global practice settings.