Sebastian, Julianne Pierre RLE 7.

4 Medical-Surgical Nursing August 30, 2014

Relationship between Improvements in Heart Failure Patient Disease Specific Knowledge
and Clinical Events as Part of a Randomized Controlled Trial
by Naga V.A. Kommuri, Monica L. Johnson, Todd M. Koelling

I. Rationale
This study mainly focuses on patient education that can bring better results for those
patients who have heart failure. As we know, there is a difference between the knowledge of a
patient and a healthcare provider. I chose this study because this is great contribution on how
and what should be taught not only to those patient who have heart failure but also to those who
are chronically and terminally ill individuals. For better implementation and alleviation of health
status, patients, as individuals, should participate in their health care. Through patient-centered
and disease-specific education, the patients will be more knowledgeable and independent for
themselves.

II. Background of the Study
Various researches have studies the effects of discharge education to heart failure patients
in combination with different post discharge programs. From different studies, discharge
education has already been proved to be effective in improving the clinical outcomes of most
patients. Still, there were no researches that study the association among knowledge
acquisition, subsequent self-care behavior and clinical outcomes. Since then, patient education
has already been considered to be significant in the care of every patient. Unlike patients
receiving handouts as part of the regular discharge process, a face-to-face patient education to
heart failure patients prior to discharge showed to have lower post discharge readmissions.

III. Statement of the Problem
No studies have been to find out the relationship among heart failure knowledge, self-care
behavior and clinical outcomes. With heart failure knowledge, there may have improve
effectiveness and efficiency in the health. The patients self-care behavior will be towards
responsibility and participation. Clinical outcomes for the patient will be more positive. Also,
most patients are just being readmitted to the hospital after just few months of post discharge.
Furthermore, there is also an increase in the expenses for the patient.

IV. Summary
667 subjects were screened for selection. 402 of the subjects were not selected from the
screening leaving 265 participants as the subjects of the study. After taking an informed consent
from them, the patients were randomly grouped. 137 patients received the usual care (regular
discharge process) while 128 patients received the usual care with 1-hour nurse education. The
educational program is primarily focused on the heart failure. The health education consists of
the: Basic principles of heart failure, dietary sodium, significance of limiting fluid intake as well
as the function of diuretics. The Health Failure Knowledge Questionnaire (HFKQ), developed by
the researchers, was used 3 months post hospital discharge. 15 questions are about Disease
Management Knowledge (DMK) and another 15 questions are about Dietary and Sodium
Knowledge (DSK). Using an SPSS software, the data were expressed as median and
interquartile range. Clinical events (death or readmission) within 3 months were found to be
inversely related to HFKQ scores. Those who have experience this have significantly low
scores. Through the comparison of the HFKQ scores, patient who received usual care with 1
hour nurse education has significantly improved their disease specific knowledge compared to
patients who just received only the usual care.

V. Findings
The control group (usual care) did not show any improvement in DMK within the 3 months of
follow-up. However, the nurse education group showed significant improvement in their DMK.
Neither of the 2 groups showed any improvements DSK throughout the study. The education
group had higher HFKQ scores within the 3 months. Furthermore, patients who are compliant
daily weight monitoring, specific dietary sodium restriction and fluid restriction, and plans on
what to do when symptom worsened showed significantly higher scores on HFKQ.

VI. Conclusion (paraphrase)
Patients who have received 1 hour nurse education has significantly improved the disease
specific knowledge compared to patients who just received only the usual care. Findings from
the study have showed that heart knowledge is directly related to compliance to self-care. Also,
at the 3 month follow up, the knowledge of patients from the nurse education group was
showed. Heart failure knowledge improved appropriate self-care behaviors. Furthermore, the
study also showed that patients with high HFKQ scores are less likely to be readmitted to the
hospital over at the 6 month follow up further reducing the expenses for the patients.

VII. Implications

a. Nursing Practice Along with the regular discharge process and information, at least
1 hour of nurse education will also be done. The health teaching is focus on the
primarily on the disease and also on management and diet.

b. Nursing Administration The nursing administration is encourage to enhance nurse
education to decrease the consequences for the patients after their discharge.
Educational sessions should be given more focus especially as a part in the
discharge process.

c. Nursing Education The patients should be taught disease-specific knowledge for
them to not only have knowledge but also the capacity to participate in their own
health care and develop self-care behaviors after their discharge.

d. Nursing Research For the future researchers, there is a need research further on
the dietary and sodium knowledge to improve the health education for the heart
failure patient. Also, this is to determine whether dietary education should be
separated from nurse education or just further improvement of the nurse education.

e. Nursing Theory The aim of health education on heart failure specific knowledge is
to find its relationship with self-care behavior and clinical outcomes. In line with this
program is Lydia Halls Theory of Care, Core and Cure. In this theory the care is
focus on the core (the patient) and cure is the action or attention given by the nurse
to the core. The cure here is the heart failure disease-specific education.

VIII. References