The Effects of an Advanced Practice Nurse-led Telephone-based Intervention upon Hospital Readmissions, Quality of Life, and Self-Care Behaviors of Heart Failure Patients
Abstract
Heart failure (HF) is a chronic condition that has become a major public health problem. The effects of HF pose daily challenges for those living with this debilitating illness. Frequent hospitalization related to HF exacerbation and a lack of knowledge concerning self-care requisites are barriers that individuals face when diagnosed with heart failure. Consequently, a poor quality of life (QOL) is often reported by HF patients. Based upon Orem’s (2001) self-care deficit nursing theory, this study sought to determine the effect of an advanced practice nurse (APN)-led telephone-based intervention on hospital admissions, QOL, and self-care behaviors of HF patients. A pretest, post test experimental design was utilized for this study. Participants were randomly assigned to either an experimental group that received the APN-led telephone-based intervention or a control group that received usual care. Data were analyzed using a mixed model ANOVA with a pre-test, post-test repeated measures factor on readmissions, QOL, or self-care behaviors and then an independent group’s factor with the advanced practice nursing care versus standard care. Additionally, one way ANOVAs and t-tests were analyzed to determine if selected demographic variables were related to readmissions, QOL, or self-care behaviors. The results revealed a significant interaction in HF-related hospital readmissions over time in the APN-led telephone-based intervention versus standard care (F = 7.63, p = .013) and a significant interaction in self-care behaviors over time in the experimental group versus the control group (p < .001). Additionally, there was a significant relationship (p = .016) between New York Heart Association HF classification and quality of life indicating that QOL worsened with increasing severity of heart failure. The results of this study support the idea that APNs positively impact HF patient outcomes, particularly by decreasing HF-related hospital readmissions and improving self-care behaviors. Therefore, implementation of an APN-led telephone-based intervention warrants consideration in the care of patients living with heart failure.