The Heart Failure Patient Foundation Position Statement on Research and Patient Involvement

BACKGROUND

Heart Failure (HF) is a growing global public health problem affecting approximately 64 million people worldwide.

OBJECTIVES

The Heart Failure Patient Foundation developed a position statement to advocate for adult patients with HF to be an active participant in research and for HF leaders to integrate patients throughout the research process.

METHODS

A review of the literature and best practices was conducted. Based on the evidence, the HF Patient Foundation made recommendations regarding the inclusion of adult patients with HF throughout the research process.

RESULTS

Healthcare clinicians, researchers and funding agencies have a role to ensure rigorous quality research is performed and implemented into practice. Inclusion of adult patients with HF throughout the research process can improve the lives of patients and families while advancing HF science.

CONCLUSIONS

The HF Patient Foundation strongly advocates that patients with HF be involved in research from inception of the project through dissemination of findings to improve patient outcomes.

Nurses’ Personal Perceptions of Clinical Work Adaptation During COVID-19

Background

Objective

Methods

Results

Conclusion

Providers' accuracy in decision-making with assessing NYHA functional class of patients with heart failure after use of a classification guide

BACKGROUND

Correct assignment of New York Heart Association Functional Classification (NYHA-FC) I-IV is essential in applying guideline directed care.

OBJECTIVE

Examine the validity, reliability, and accuracy of HF and primary care (PC) provider's assignment of NYHA-FC using the NYHA-FC Guide.

METHODS

Study utilized a cross-sectional, quasi-experimental known-groups design with validated vignettes. Providers (n = 75) used the Guide to assign NYHA-FC. Known-group validity comparisons (HF specialist/Non-HF specialist - PC provider) and interrater reliability were used to evaluate validity and reliability of the NYHA-FC Guide.

RESULTS

HF provider's accuracy total mean scores were significantly higher compared to PC (M = 6.0 vs. 5.4, p = 0.020). HF (62%) and PC providers (80%) reported that the Guide assisted them with deciding HF class.

CONCLUSION

The NYHA-FC Guide showed promise for facilitating accuracy of assignment. Further research to evaluate the accuracy of using the NYHA-FC Guide compared to the gold standard six minute walk test is warranted.

Perceptions of Changes in Practice Patterns and Patient Care among Heart Failure Nurses During the COVID-19 Pandemic

Background

The Coronavirus (COVID-19) had a profound impact on the delivery of care in both hospital and outpatient settings across the United States. Patients with heart failure (HF) and healthcare providers had to abruptly adapt.

Objective

To describe how the COVID-19 pandemic affected practice patterns of HF nurses.

Methods

Practicing HF nurses completed a cross-sectional, anonymous, web-based survey of perceptions of HF practice. Analyses involved descriptive and comparative statistics.

Results

Of 171 nurses who completed surveys, outpatient HF visits decreased and 63.2% added telehealth visits. Despite spending about 29 min educating patients during visits, 27.5% of nurses perceived that the pandemic decreased patients’ abilities to provide optimal self-care. Nurses reported decreased ability to collect objective data (62.4%; n = 78), although subjective assessment stayed the same (41.6%; n = 52).

Conclusion

Nurses’ practice patterns provided insight into patient care changes made during COVID-19. Most core components of HF management were retained, but methods of delivery during the pandemic differed.

Providers' assignment of NYHA functional class in patients with heart failure: A vignette study

BACKGROUND

Accuracy of New York Heart Association Functional Classification (NYHA-FC) I-IV assessment is critical to promoting guideline directed care.

OBJECTIVE

Examine providers' accuracy when diagnosing NYHA-FC I-IV in patients with heart failure (HF).

METHODS

A web-based survey using validated vignettes was conducted with 244 physicians, nurse practitioners (NP), clinical nurse specialists (CNS) and physician assistants (PA) who provide care to patients with HF.

RESULTS

Providers comprised of 65% NPs, 19% physicians, 14% CNSs, 2% PAs with an average of 15 years working with HF patients. Accuracy ranged from 36.9% for Class IV to 78.7% for Class I. Increased HF patient volume seen (p=0.024), physician vs. NP/PA/CNS (p=0.021), and typically assigned a HF stage (p<0.001) were associated with increased total correct score accuracy in multivariable modeling.

CONCLUSION

It is critical that NYHA-FC is accurately assigned to promote optimal outcomes. Research in the future should focus on improving accuracy in assigning NYHA-FC.

Nursing research in heart failure care: a position statement of the american association of heart failure nurses (AAHFN)

BACKGROUND

Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.

OBJECTIVES

A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.

METHODS

A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.

RESULTS

Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.

CONCLUSIONS

Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.

Students' Perspectives of Same-Day Clinical Assignments: A Qualitative Descriptive Study

The clinical experience is essential to the nursing education process, but the process by which students are assigned patients has remained unchanged for decades. The purpose of this qualitative descriptive study was to determine the acceptability of a same-day clinical assignment process from the perspective of pre-licensure nursing students. Students' (n = 104) perceptions of the same-day clinical assignment process were collected via focus groups. Two themes emerged that may assist educators in implementing new methods for clinical assignments.

Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure

BACKGROUND

Heart failure self-care requires confidence in one's ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors.

AIMS

To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups.

METHODS

Heart failure patients (N=117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient's perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months.

RESULTS

Family functioning was related to self-care confidence for diet (p=0.02) and autonomous motivation for adhering to their medications (p=0.05) and diet (p=0.2). The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months, whereas patient-family education group and usual care did not change.

CONCLUSION

Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes.

Family context influences psychological outcomes of depressive symptoms and emotional quality of life in patients with heart failure

BACKGROUND

Although family influences in heart failure (HF) care are considered important, little evidence is available regarding relationships between the family context and specific outcomes for patients with HF.

OBJECTIVE

The aim of this study was to examine the relationships of patient perceptions of family functioning, autonomy support, and perceived criticism, as well as their family member's (FM) HF knowledge, with patient outcomes of depressive symptoms and HF quality of life (QOL).

METHODS

Participants (n = 117) with HF were enrolled in a family partnership intervention study. Self-report questionnaires measuring the HF patient's perceptions of family context and the FM's knowledge were analyzed relative to the HF patient's outcomes using correlations and sequential multivariate regression analyses. Only preintervention, baseline data are reported here.

RESULTS

Age, ethnicity, Charlson comorbidity index, global family functioning, and FM's HF knowledge accounted for 37.8% (P < .001) of the variance in the patient's depressive symptoms. An additional moderating effect of ethnicity on the association between global family functioning and patient's depressive symptoms was significant (change R2 = 0.06, P = .001), resulting in a final model that accounted for 43.3% of depressive symptom variance. Age, ethnicity, global family functioning, and autonomy support accounted for 24.9% (P < .001) of the variance in emotional HF QOL. An additional moderating effect of ethnicity on the association between global family functioning and patient's emotional HF QOL was significant (change R2 = 0.05, P = .009), resulting in a final model that accounted for 28.9% of emotional QOL variance.

CONCLUSIONS

This study underscores the importance of the patient's perspective on family functioning and autonomy support, along with FM's HF knowledge, on HF patient outcomes moderated by ethnicity. Future interventions could target the modifiable patient-family context relationships for improving depressive symptoms and QOL in HF patients. These findings point to the need for greater family assessment to identify those at risk for worse outcomes and to guide family focused interventions.

Diastolic heart failure in women: expanding knowledge about self-care practices

Heart disease is the leading killer of U.S. women, and one type of heart disease that affects a large majority of women is diastolic heart failure (DHF), a chronic, progressive condition that contributes to morbidity and mortality and affects women's quality of life as they age. Women's health nurses are at the forefront of assessment, detection, treatment, education and advocacy for women with DHF. This column takes a second look at two studies in which researchers evaluated the effects of exercise on total sleep time, depression and quality of life of women with DHF, as well as the gender and multicultural differences of individuals diagnosed with heart failure.

How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis

PURPOSE

Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners.

METHODS

A three-group pretest-posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision-making process.

FINDINGS

Nurse practitioners had modest insight into their clinical decision-making process.

CONCLUSION

Self-insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses.

IMPLICATIONS FOR NURSING PRACTICE

Self-insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.

Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center

Technology and improved care coordination models can help diabetes educators and providers meet national care standards and provide culturally sensitive diabetes education that may improve diabetes outcomes. The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program (Comprehensive Diabetes Management Program, CDMP) for poorly controlled Hispanic type 2 diabetes (T2DM) patients in an urban community health center setting. Patients were randomized to the intervention condition (IC; n = 21) or an attention control condition (AC; n = 18). IC and AC conditions were compared on rates of adherence to national clinical practice guidelines (blood glucose, blood pressure, foot exam, eye exam), and levels of diabetes distress, depression, and treatment satisfaction. IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC (-1.6% ± 1.4% versus -0.6% ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC = 28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%), and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression. The CDMP intervention was more effective than an attention control condition in helping patients meet evidence-based guidelines for diabetes care.

Understanding how nurse practitioners estimate patients' risk for coronary heart disease: a judgment analysis

AIM

This paper is a report of a study to examine how nurse practitioners combine information when estimating patient risk of coronary heart disease.

BACKGROUND

In the United States of America and other countries, nurse practitioners are increasingly working alongside physicians in primary healthcare settings. Given this role, nurse practitioners represent an important resource in early detection of numerous diseases. Understanding how nurse practitioners use patient characteristics (cues) to form estimates of patient risk for disease may improve general disease prevention efforts.

METHOD

Social judgment theory and its lens model analysis are concerned with the correspondence between a person's judgments and the environment. This approach was applied to examine how 15 nurse practitioners weighted eight risk factors for coronary heart disease, how accurate practitioners were in assessing patient risk for coronary heart disease, and how much self-insight practitioners had into their own risk estimation processes. The data were collected in 2006.

RESULTS

Nurse practitioners showed moderate to high accuracy and evinced a variety of cue-weighting strategies. Insight into their own judgment policies was modest. The lens model analysis revealed that most practitioners had lower values on knowledge of the ecology than they did on cognitive control.

CONCLUSION

Educational efforts aimed at improving detection of patients at risk for diseases might do better to target increasing clinicians' understanding of cue-criteria relationships, than to stress themes of consistency in evaluating patients.