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The Effect of a Heart Failure Nurse Navigator on 30-Day Hospital Readmissions of Older Adults
Title
The Effect of a Heart Failure Nurse Navigator on 30-Day Hospital Readmissions of Older Adults.
Creator
Leavitt, Mary Ann M., Hain, Debra J., Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
Across the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual...
Show moreAcross the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual care. The HFNN is a home health RN with specialized training in HF care. The HFNN visited intervention group (IG) participants once in the hospital, followed by weekly home visits for one month. Control group (CG) participants received usual care, consisting of discharge teaching by their primary nurse and follow-up with their primary care provider (PCP) or cardiologist. Using a sequential mixed methods research design, this experimental randomized controlled trial measured HF knowledge, HF self-care, and HF quality of life (QOL) at enrollment and one month after discharge. Hospital readmissions and/or ED visits were tracked in both groups. IG participants were interviewed using semi-structured questions, findings of which were analyzed using conventional content analysis. There were fewer all-cause hospital readmissions in the IG (3 of 19) than the CG (6 of 21.) CG participants were 2.2 times more likely to be readmitted than the IG participants. [x(1)=.935, p=.334 O.R.=2.2219]. Due to limited enrollment, these results were underpowered and not statistically significant. There was improvement in HF knowledge (p=.06) and HF self-care maintenance (p=.07), approaching significance. HF self-care maintenance improved in both groups, although the IG was not significantly better (p=.48). There was significant improvement in the IG for HF confidence (p=.002) and HF QOL (p<.001). The qualitative findings revealed two main categories from the IG: (1) personal clarification of patient education, especially related to diet, exercise, and medications and (2) feelings of support, reassurance, and safety. The HFNN may be one role to meet the triple aim of improving patient quality care and health outcomes at a reduced cost, especially in areas where a comprehensive HF management program is not available.
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Date Issued
2017
PURL
http://purl.flvc.org/fau/fd/FA00004986, http://purl.flvc.org/fau/fd/FA00004976
Subject Headings
Dissertations, Academic -- Florida Atlantic University, Heart failure--Nursing., Hospitalization--economics., Home Health Nursing.
Format
Document (PDF)
Effects of a Story-Sharing Intervention on Depression and Well-Being in Older Adults Transitioning to Long-Term Care
Title
Effects of a Story-Sharing Intervention on Depression and Well-Being in Older Adults Transitioning to Long-Term Care.
Creator
Sullivan, Gail J., Hain, Debra J., Florida Atlantic University, Christine E. Lynn College of Nursing
Abstract/Description
The purpose of this randomized control trial (RCT) was to investigate the effects of a story-sharing intervention on older adults transitioning to long-term care (LTC). The specific aims were (1) to determine the effects of story sharing on the health transition outcomes of depression and well-being of adults transitioning to LTC; and (2) to determine if the sociodemographic characteristics (age, gender, ethnicity, marital status, level of education (LOE), months living at LTC facility,...
Show moreThe purpose of this randomized control trial (RCT) was to investigate the effects of a story-sharing intervention on older adults transitioning to long-term care (LTC). The specific aims were (1) to determine the effects of story sharing on the health transition outcomes of depression and well-being of adults transitioning to LTC; and (2) to determine if the sociodemographic characteristics (age, gender, ethnicity, marital status, level of education (LOE), months living at LTC facility, choice to move, and health problem(s) that may have resulted in the move) predict depression and/or well-being. Story sharing was defined as the respectful space where one tells and listens to stories of others (Heliker, 2009) while being guided by another (the investigator). Meleis’ middlerange theory of transitions (MMRTT) (Meleis et al., 2000) was used as a guide to understand the transitioning process. A convenience sampling design was used to recruit 100 participants from 11 LTC facilities in Broward County, located in Southeast Florida. The sample included adults, age 65 years and older, who were transitioning to a LTC facility within the past two years. Participants were randomly assigned to the control group (n = 52), who received standard care, or to the intervention group (n = 41), who received story-sharing and standard care. The results indicated there was no significant greater improvement to suggest an Intervention and Time effect for depression and/or well-being. Overall, predictive ability of the sociodemographic variables for depression and well-being were not statistically significant. However, LOE (junior college) did account for a significant portion of unique variance for increased depression, and time, marital status, ethnicity, LOE, and choice to move did account for a significant proportion of unique variance for well-being. Months living in LTC (more months) and marital status (all but divorced) were significant for improved well-being while ethnicity (Hispanic), LOE (high school and junior college), and choice to move (no choice) were significant for reduced well-being. Similar studies using a larger sample size, including non-English speaking participants; lengthier storysharing sessions; and measuring for pain, health, and bereavement may offer additional insights to healthy transition outcomes for this population.
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Date Issued
2017
PURL
http://purl.flvc.org/fau/fd/FA00004827
Subject Headings
Loneliness--Psychological aspects., Depression in old age., Older people--Communication., Older people--Mental health services., Nursing home patients--Mental health., Nursing homes--Recreational activities., Recollection (Psychology)
Format
Document (PDF)