Date of Award

5-2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Carole Myers

Committee Members

Katherine Newnam, Robin Harris, Kathy Brown

Abstract

Research has shown that patients who are successfully engaged in self-care for a chronic illness have a higher quality of life and reduced hospitalizations than those who are not. According to the National Center for Health Statistics, transitional care in the home setting has seen a 51% increase in mortality over the last 15 years (Reeder et al., 2015). This finding contrasts with the reported decline in hospital readmissions for chronic illnesses. With the lack of agreement on best practices for patient discharge education, transitional care has proven to be a weakness in chronic illness care that requires further research.

The first purpose of this study was to determine whether the intervention—consisting of four brief, nurse-directed motivational interviewing (MI) sessions administered face to face within 48 hours of discharge and during scheduled telephone follow-ups at 48 hours, 10–14 days, and 21–days post-discharge—in addition to standard discharge practice, significantly increased self-care in chronically ill HF patients living in rural Appalachia. The second purpose was to determine if participants who received the intervention had a different 30-day hospital readmission rates compared to patients who received only the standard discharge practice.

In this study, the sample (n=78) was randomized to a control group (n=38) and an experimental group (n=40). Both groups received standard HF discharge care provided by the facility, and completed the Self-Care in Heart Failure Index version 6.2 (SCHFI) and a demographic questionnaire. Both groups completed the post-discharge SCHFI at 21 days.

Data analysis, performed with a one-way Analysis of Covariance (ANCOVA), showed that the experimental group had statistically significant increases in self-care maintenance (p=.010) and self-care management (p=.002) after controlling for educational level and number of comorbidities. The difference in 30-day hospital readmission rates between the groups was not statistically significant (p=.100). While further research is needed to examine best practices for encouraging effective HF self-care in the transition period between hospital and home, this study’s MI intervention showed promise in this area.

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