Rural nurse knowledge of heart failure self-care principles

Abstract

Heart failure is one of the leading causes of death in the United States and the most common reason for hospital admission among the elderly. It was estimated that in 2010, heart failure cost the U.S. $39.2 billion. The number of people with heart failure is predicted to increase by 25% by 2030 and the total direct costs may increase by 215%. In addition, in 2013, the Centers for Medicare and Medicaid Services began withholding 1% of all Medicare payments to hospitals for excess readmission rates for heart failure, pneumonia, and myocardial infarction. Those rates will increase to 2% in 2014 and 3% in 2015. One of the ways to decrease the human and financial cost of heart failure is to provide patients with the necessary education to effectively care for their disease. Heart failure self-care includes medication compliance, dietary restrictions, monitoring weight, monitoring for the signs and symptoms of heart failure, and exercise. Nurses are largely responsible for patient education but studies have shown that they may not be knowledgeable about heart failure. A descriptive study using a convenience sampling of nurses working at Critical Access Hospitals was undertaken to determine the extent of knowledge that they have regarding heart failure self-management guidelines. A 20-question instrument was used in an internet-based survey to discover nurses' overall knowledge of heart failure with the secondary aim of assessing knowledge in diet, fluids or weight, signs or symptoms of worsening condition, medications, and exercise. Seventy-seven completed surveys were returned. Baccalaureate- and masters-prepared registered nurses with more than 20 years nursing experience scored the highest on the questionnaire while licensed practical nurses, associate/diploma-prepared nurses, and those with less experience scored the lowest. The majority of respondents scored highest in areas concerning symptom recognition and had the most difficulty with questions regarding weight monitoring, using salt substitutes, and whether or not hypotension is concerning. Nurses may not have the information necessary to effectively educate their patients on heart failure self-care principles, and recommendations were made for adding targeted information to nursing education activities in the areas of weight monitoring, salt substitutes, and hypotension.