Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-management

Weiss, Daniel J. DNP, RN, CHPN; Robertson, Sue PhD, RN; Goebel, Joy R. PhD, RN, FPCN

Journal of Hospice & Palliative Nursing: December 2019 - Volume 21 - Issue 6 - p 475–481
doi: 10.1097/NJH.0000000000000597
Symptom Management Series

Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting heart failure symptoms to their providers in a timely manner. Self-management tools with color-coded zones (green = “all clear,” yellow = “caution,” red = “take action”) help patients recognize and respond to heart failure symptoms and reduce readmissions. The purpose of this quality improvement project was to develop, implement, and evaluate a low-literacy zone tool for heart failure self-management with home-based palliative care patients. An interdisciplinary palliative care team developed this zone tool. Health literacy was prescreened with the Newest Vital Sign instrument. Nurses provided the zone tool to patients and caregivers and instructed them in use of this tool for daily self-monitoring. In postimplementation surveys, participants rated the zone tool as easy to understand and helpful in recognizing and reporting symptoms. This project demonstrated feasibility of a new zone tool for heart failure self-management, resulting in a practice change for this home-based palliative care program. The interdisciplinary team eventually developed similar zone tools for cancer, cirrhosis, chronic obstructive pulmonary disease, dementia, and frailty self-management.

Daniel J. Weiss, DNP, RN, CHPN, is clinical nurse, Sharp HospiceCare Transitions Program, La Mesa, California, and lecturer, California State University San Marcos, School of Nursing.

Sue Robertson, PhD, RN, is associate professor, School of Nursing, California State University Fullerton.

Joy R. Goebel, PhD, RN, FPCN, is professor, School of Nursing, California State University Long Beach.

Address correspondence to Daniel J. Weiss, DNP, RN, CHPN, Sharp HospiceCare Transitions Program, 8881 Fletcher Pkwy, Suite 336, La Mesa, CA 91942 (

The authors have no conflicts of interest to disclose.

Online date: September 19, 2019

© 2019 by The Hospice and Palliative Nurses Association.