Doctor of Nursing Practice (DNP) Projects

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Embargo Period

8-15-2011

Degree Program

Doctor of Nursing Practice

Degree Track

Family Nurse Practioner

Year Degree Awarded

2011

Month Degree Awarded

May

Keywords

Heart Failure, Heart Failure Disease Management, Heart Failure Pilot Program

Advisor

Joan P. Roche

DNP Project Chair

Joan P. Roche

DNP Project Member Name

Jean E. DeMartinis

DNP Project Outside Member Name

Doreen M. Hutchinson

Abstract

Background: Heart Failure (HF) disease management programs (DMP) have shown to improve outcomes. The aim of this heart failure pilot program is an evaluation program. Measurement of functional capacity utilized the Duke Activity Status Index (DASI) questionnaire. Since the DASI uses the patient’s ability to perform a set of common activities of daily living to gauge functional capacity based on the known metabolic cost of each activity in MET units, it is thought to be well suited for population studies in which assessment of functional capacity during follow-up is needed.

Setting: Rural Critical Access Hospital (CAH) with outpatient cardiology services.

Methods: This HF pilot is a program evaluation which involved a one group, pre-test and post-test design. Five additional variables were analyzed to determine if any relationship occurred with O2 uptake change as noted in changes in DASI. The five variables included key items for the pilot program: HF education, teach back method, inpatient nutrition consult, DC time out, and follow-up with a Nurse Practitioner (NP).

Results: There were a total of 17 patients who received the inpatient pilot program throughout their hospital stay until discharging home. Eleven of the 17 patients benefitted from the entire program (inpatient & outpatient) with continued care in the outpatient cardiology department. Thirteen patients completed the inpatient and outpatient Duke Activity Status Index (DASI). Paired T-Test was conducted to compare inpatient vs. outpatient of O2 uptake. There was no significant difference in scores for inpatient (M = 20.99, SD = 6.42) and outpatient (M = 19.26, SD 5.28), t (12) = .94, p = .36 (two-tailed). Wilcoxson Signed Rank Test, non-parametric test of differences, demonstrated no statistical difference between inpatient and outpatient oxygen (O2) uptake; [z = -.839a, p = .40]. An independent-samples t-test was conducted to compare O2 uptake changes based on gender. Difference between males’ and females’ ages was not statistically significant (p = .403; two-tailed). Pearson correlation or Spearman correlation was used to give the direction and strength of the relationship between variables. A moderate correlation was detected with age and O2 uptake change from outpatient vs inpatient, (p < 0.05). An independent-samples t-test was conducted to compare O2 uptake changes based on age. Average O2 uptake decreased by 7 for patients 70 or under (M = 7.00, SD = 4.82), and increases by 3 for those over 70 (M = 2.77, SD = 4.19); t (11) = 3.91, p = < 0.01. Explanations for this inverse detection are multi-factorial.

Five pilot program variables were analyzed to determine if any relationship occurred with O2 uptake change as noted in changes in DASI. “Teach back methoddemonstrated that two patients were unable (M = 7.5, SD = 5.16); 11 patients were able (M = -3.41, SD = 5.49); (t (11) = 2.60, p = .024 [two tailed]). This is statistically higher at p < 0.05. Especially surprising about this result is that average O2 uptake change of 7.5 for 2 patients who were “unable to teach back” is significantly higher, than average O2 uptake change of -3.4 for 11 patients who were “able to teach back”. The scores of the 2 patients that “were unable” went up, while those that “were able”, went down on average.

Conclusion: The usefulness for clinical decision making regarding lower O2 uptake scores for those under 70 compared those over 70 cannot be fully described or understood given the nature of this result. The fact that other clinical factors are also independent predictors of functional capacity indicates that an uncomplicated course of inpatient heart failure designated care is not, in of itself, sufficient to guarantee an optimal functional outcome. This particular notion may also be apparent within the “teach-back” variable and O2 uptake change.

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