Document Type

Final Project

Graduation Date

Spring 5-6-2023

Degree Name

Doctor of Nursing Practice

First Advisor

Windy Alonso, PhD, RN, FHFSA

Abstract

Background

Heart failure (HF) readmission rates are high and influenced by self-care practices and self-efficacy for managing chronic disease. Using digital education via tablet can help improve the discharge education process and may increase self-care knowledge.

Objective

The purpose of the study is to assess the current discharge processes implemented for HF patients in cardiovascular units at a Midwestern academic medical center.

Methods

Participants for this two-phase study were recruited from two inpatient cardiovascular units within a 700-bed, Midwestern academic medical center. Phase one used a pre-post quasiexperimental design to evaluate a discharge educational intervention using the teach-back method in changing HF knowledge, measured with the Atlanta Heart Failure Knowledge Test (AHFKT), and self-efficacy, measured with the Self-Efficacy for Managing Chronic Diseases 6-item scale (SEMCD-6). Due to our limited sample size, a related-samples Wilcoxon signed rank test was used to analyze changes in scores from pre-test to post-test for HF knowledge and self-efficacy. Phase two used a descriptive survey to evaluate RN use and satisfaction with video-based HF education (HF Emmi™) and bedside tablets for discharge education. The 15-item survey included eight multiple choice questions, a 5-point Likert scale ranging from 0 to 4, and six open-ended questions. Descriptive statistics were reported for Emmi™ video satisfaction and responses to the open-ended questions were aggregated and analyzed for the presence of common threads.

Results

Between September 2022 and November 2022, four participants enrolled and completed the initial intervention for phase one. Two were later lost to follow-up. Data analysis demonstrated that AHFKT scores and SEMCD-6 scores were not significantly different from pre-intervention to 30-days post discharge (p = 0.18). From November 2022 and the end of December 2022, 24 nurses enrolled and completed phase two. Nurses reported mean satisfaction of the HF Emmi™ video and beside tables at 2.33 (SD = 0.92). Common threads in open-ended survey responses demonstrated difficulty accessing the HF Emmi™ video and lack of knowledge regarding the HF Emmi™ video.

Conclusions

HF knowledge and self-efficacy for chronic disease management scores did not demonstrate statistical significance from pre-intervention to 30-days post discharge. Nurse surveys indicated a neutral response for use and satisfaction of the HF Emmi™ video. Findings from phase one indicate future studies are necessary to evaluate the impact of the teach-back method and digital discharge education in adults with HF. Findings from phase two indicate a need for further nurse training on the use of tablets for digital discharge education and methods for implementation to workflow.

Keywords: heart failure, teach-back, video education

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