Semester

Spring

Date of Graduation

2013

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Family/Community Health

Committee Chair

Susan McCrone

Committee Co-Chair

David Bush

Committee Member

Lisa Hardman

Abstract

The health of a population is influenced by the physical, social, cultural, and economic environment. Limited access to care has been cited as a reason why the Appalachian region of Kentucky has one of the highest rates of cardiovascular disease in the developed world. Kentucky ranked seventh in the nation for heart failure (HF) death rates 2007-2009. The objectives of this project were to evaluate the effectiveness of a structured telephone support program for HF management to improve self-care behaviors and quality of life and to reduce anxiety, 30 day readmission rates, and mortality rates in rural patients with heart failure. A quasi experimental one group pretest, posttest design was used to determine the effectiveness of a structured telephone program. A convenience sample of thirty patients admitted to 3 hospitals in rural Kentucky with a diagnosis of heart failure participated in the program. Prior to discharge from the hospital, patients were asked to complete the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Self-care of Heart Failure Index (SCHFI), which consists of 3 sections (A, B, C) designed to measure self-care maintenance, management, and confidence, and the state anxiety (S-Anxiety) scale of the State-Trait Anxiety Inventory (STAI). Approximately 72 hours after discharge and weekly for 4 weeks, patients were called by the project coordinator. During these calls, an evidence based script was used as a guide to provide patient education and clinical advice. During the last call, the MLHFQ, the SCHFI, and the S-Anxiety were repeated. Paired samples t-testing was performed to evaluate the impact of the program on participant's MLHFQ, SCHFI, and S-Anxiety scores. There was a significant decrease in scores on the MLHFQ from the pretest (M = 48.23, SD 8.74) to the posttest (M= 40.4667, SD 9.878), t (29) = 11.056, p < .005. There was a significant increase in SCHFI B scores from pretest (M = 44.80, SD 19.120) to posttest (M = 55.40, SD 15.540), t (24) = 5.338, p < .005. There was a significant increase in SCHEFI C scores from pretest (M = 57.077, SD 19.022) to posttest (M = 61.340, SD 17.322), t (29) = 4.490, p < .005. While overall scores on the SCHFI improved, scores did not meet the cut off score of 70 to be considered adequate for self-care behavior. There was a significant decrease in S-Anxiety scores from pretest (M = 39.5667, SD 9.073) to the posttest (M = 36.8333, SD 8.469), t (29) = 5.634, p < .005. There was a significant increase in SCHEFI A scores from pretest (M = 50.438, SD = 13.353) to posttest (M = 59.661, SD = 12.993), t (29) = 7.733, p < .0005. Seven study participants (23%) were readmitted to the hospital within 30 days. The average facility 30-day readmission rate for hospitals included in this study is 27.15%. The national 30- day readmission rate for heart failure is 24.7%. None of the study participants died during the study. The average 30-day mortality rate for hospitals included in the study is 6.6%. The national 30-day mortality rate for heart failure is 11.6%. A structured telephone support program was effective in improving quality of life, self-care behaviors, and in reducing anxiety, 30-day readmissions, and mortality in patients with heart failure. Additional intervention is needed to insure adequate self-care behavior.

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