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Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure

Clark, Angela P. PhD, RN, ACNS-BC, FAAN, FAHA; McDougall, Graham PhD, RN, FAAN, FGSA; Riegel, Barbara PhD, RN, FAHA, FAAN; Joiner-Rogers, Glenda PhD, RN, ACNS-BC; Innerarity, Sheri PhD, RN, ACNS-BC, FNP; Meraviglia, Martha PhD, RN, ACNS-BC; Delville, Carol PhD, RN, ACNS-BC; Davila, Ashley MSN, ACNS-BC

Journal of Cardiovascular Nursing:
doi: 10.1097/JCN.0000000000000169
Articles
Abstract

Background: The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination.

Objective: The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants’ subjective perceptions of the intervention.

Methods: This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points—baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention’s effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study.

Results: The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale).

Conclusions: An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Author Information

Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin.

Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa.

Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia.

Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin.

Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin.

Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin.

Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin.

Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin.

Funding source: NIH/NINR 5R03NR009503 (primary investigator, A.P. Clark).

The authors have no conflicts of interest to disclose.

Correspondence Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA, The University of Texas at Austin, 1700 Red River, Austin, TX 78701 (apclark@mail.utexas.edu).

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