Introduction
Education of patients with congestive heart failure has proved to be an effective intervention that improves self-care and reduces cases of readmission (Boren, Wakefield, Gunlock, & Wakefield, 2009). Treatment and management of congestive heart failure are of great significance to the health care system because White, Garbez, Carroll, Brinker, and Howie-Esquivel (2013) state that about 5.8 million people in the United States suffer from congestive heart failure, while approximately 670,000 cases occur annually. Such statistics show that congestive heart failure is increasingly becoming a challenge to the health care system. Owing to educational deficit among patients with heart failure, Stromberg (2005) recommends the use of education as an effective intervention, which enhances knowledge and skills of self-care and consequently improves the management of congestive heart failure. The implementation of a customized educational program will use three strategies to target improvement of self-care, enhancement of patient satisfaction, and reduction of readmission rates. The three strategies comprise improving adherence to medication, maintenance of proper diet and nutrition, and performance of the physical activity. As a thesis statement, ‘the proposal asserts that customized education of patients with congestive heart failure enhances patients’ knowledge and skills, improves satisfaction with health care services and reduces the rates of readmissions due to congestive heart failure.’ In this view, the research paper proposes to establish the impact of customized educational programs on patients’ knowledge and skills, their satisfaction with health care services, and subsequently on reducing readmission rates.
Sample
The participants of the study will be patients with congestive heart failure who attend the hospital. The inclusion criteria are that the patients must have congestive heart failure, be between the ages of 18 and 80 years, and must be admitted to the critical care unit for congestive heart failure. In contrast, as the exclusion criteria, patients who are below 18 years and above 80 years, patients in the outpatient unit, and those who have additional health complications are ineligible to participate. Since the hospital has a few patients with congestive heart failure, the study will employ convenience sampling to attain a valid sample of participants. According to Chin and Lee (2008), convenience sampling increases both the external and internal validity of research findings. Moreover, convenience sampling is not only cheap but also enhances the attainment of the required sample size. Through convenience sampling, the study will encourage participation among patients by explaining the essence of the study and assuring confidentiality of research data. To attain an appropriate sample size, the study will conduct power analysis and determine the sample size, attrition rate, and identify relationships that exist within the target population.
Outcome
One of the outcomes of the customized educational program is improved self-care and enhanced management of congestive heart failure. The improved self-care and enhanced management happen because customized education promotes knowledge and skills among patients with congestive heart failure, thus enabling them to manage their conditions effectively. Inadequate knowledge and skills necessary to manage congestive heart failure are the major cause of increased readmissions of patients with congestive heart failure in various health care centers (Stromberg, 2005). Given that different educational strategies exist, they have different impacts on the knowledge and skills that patients have. In this view, customized education aims at enhancing knowledge and skills among patients, which enable them to perform rationalized self-care and management interventions. Therefore, improved self-care and enhanced management is important outcome of the customized educational program of patients with congestive heart failure.
Patient satisfaction is a critical parameter that measures the quality of healthcare from the perspective of patients. Since education enhances knowledge and skills about the treatment and management of congestive heart failure, it promotes quality of health care and subsequently enhances outcomes, thus increasing patient satisfaction. Insufficient knowledge and skills about congestive heart failure among patients usually cause dissatisfaction because they cannot perform self-care and management interventions effectively. Boren, Wakefield, Gunlock, and Wakefield (2009) assert that patient satisfaction reflects the prognosis of congestive heart failure. On this basis, customized education empowers patients to take control of their respective management interventions, which consequently improve outcomes and enhance their satisfaction with health care services. Thus, patient satisfaction is an important outcome of the customized educational program.
A decrease in the readmission rates of patients with congestive heart failure is an overall outcome of the customized educational program. Kociol et al. (2012) state that a reduction in readmission rates among patients with congestive heart failure within a 30-day period is national precedence. Readmissions of patients normally increase medical costs and worsen the prognosis of patients with congestive heart failure. Hence, since a customized educational program aims at equipping patients with the appropriate knowledge and skills necessary for self-care, it will have a significant impact on reducing the readmission rates of patients with congestive heart failure.
Data Collection Methodology and Measurement
In assessing the impact of customized education on patients’ knowledge and skills, the study will administer the sample of the questionnaire shown in appendix A to patients who agree to participate in the study. The questionnaire assesses patients’ knowledge and skills regarding congestive heart failure, treatment, and management interventions. The questionnaire has multiple-choice questions; thus collecting qualitative data that the study can analyze and establish the impact of customized educational programs on patients’ knowledge and skills. Clark, Freydberg, McAlister, Tsuyuki, Armstrong, and Strain (2009) assert that knowledge and skills that patients possess determine how they apply treatment and management interventions, which are critical in reducing readmissions of patients with congestive heart failure. The questionnaire of the study is the Atlanta Heart Failure Knowledge Test (AHFKT-V2), which has a Cronbach’s value of 0.765. Thus, the study will administer questionnaires among patients with the view of determining the impact of customized educational programs on their knowledge and skills.
Since the satisfaction of patients is an outcome of customized education, the study will collect data using questionnaires. The questionnaires will have questions structured into a five Likert scale so that patients can easily answer them and provide a level of their satisfaction with the health care services that they receive. The Likert scaled questionnaires will provide quantitative data that researchers can easily analyze using statistical tools. Concerning validity and reliability of the questionnaire, the study uses the Patient Satisfaction Questionnaire (PSQ-18), which has Cronbach’s value of 0.765. The design of the questionnaire sample is attached in appendix B. Patient satisfaction is an important parameter that indicates how patients perceive health care services and ultimately the adoption of treatment and management interventions (Boren, Wakefield, Gunlock, & Wakefield, 2009). In this case, assessment of patient satisfaction will indicate the impact of customized educational programs on patient satisfaction with treatment and management interventions for congestive heart failure.
Examination of secondary sources in terms of medical records is another method of collecting data about the impact of customized educational programs on the readmission rates of patients with congestive heart failure. The study will collect data from medical records in the hospital before and after implementation of the educational program to establish if there is any significant reduction in readmission rates as expected. Since medical records have ample information about readmission rates, their analysis provides robust data about the trends of readmissions in a given period. Thus, the analysis of records can effectively indicate the trends of readmissions before, during, and after the implementation of the customized educational program.
Cultural Considerations
Cultural factors such as literacy level and language determine the effectiveness of implementing the customized educational program. Since the literacy level is a cultural factor that varies from one community to another, the study needs to customize its educational program to cater to the unique literacy needs of a given community. According to Barbareschi, Sanderman, Leegte, Veldhuisen, and Jaarsma (2011), the level of education influences how patients cope and manage congestive heart failure. On this basis, it implies that literacy level is a factor that explains the differential impact of congestive heart failure on patients from different communities. Additionally, as language is a cultural factor that influences the education of patients, the educational program needs to customize its strategies to ensure that patients do not experience discrimination due to their language.
Given that the management of congestive heart failure entails the use of lifestyle changes in terms of diet and physical activity, the study should consider dietary requirements because they vary from one community to another according to cultural beliefs and traditions. Across all communities, there is a variation in diet, which influences what people eat and how they maintain their body weights. Purnell (2013) asserts that cultural beliefs and traditions determine the diet that people take, which ultimately influences their predisposition to major chronic diseases. Since diet and nutrition are applicable as effective interventions in the management of congestive heart failure, patients need to adopt healthy lifestyles in spite of their cultural beliefs and traditions. Hence, the study will consider diet and nutrition as cultural variables that influence the impact of the educational program on the treatment and management of congestive heart failure.
Ethical and HIPAA Considerations
As the study deals with human subjects, it must adhere to the ethical requirements of good clinical practice. The major ethical issue in this study is obtaining informed consent from the participants. The study will employ convenience sampling, which implies that it requires all the available patients with congestive heart failure to participate. Encouraging and convincing all patients to take part in the study is a daunting task because all of them must have informed consent before they take part in the study. Shalowitz and Wendler (2006) argue that informed consent is imperative in research that deals with humans as it provides autonomy to potential participants so that they can choose whether to participate or not in any clinical study. Therefore, the study will ensure that all participants provide informed consent before they become participants.
The study also will consider the privacy of patients and the information that they will provide. The Health Insurance Portability and Accountability Act (HIPAA) provides a privacy rule. The HIPAA privacy rule stipulates that all studies that deal with human subjects should provide a mechanism of confidentiality to protect participants from the undue invasion of their private life (Shalowitz & Wendler, 2006). Thus, the study will ensure that the participants do not provide their real details during the study. During the examination of the patients’ medical records, the study will also code their names using serial numbers that do not have any specific meaning or association with a given patient. Ultimately, the study will also limit the application of the generated data to its purposes, and thus will not be available for other researchers to manipulate.
Dissemination
The findings of the study will be of great significance; hence, requires appropriate means of dissemination within the healthcare fraternity. The study will publish the findings in magazines, brochures, presentations, and journals so that healthcare providers can easily access them. To enhance the dissemination of the findings, the study will submit the findings to the American Heart Association (AHA), the Heart Failure Society (HFS), and the American Association of Heart Failure Nurses (AAHFN). Additionally, the study will seek to publish its findings in the Journal of Cardiac Failure, a monthly peer-reviewed journal. Therefore, the publication of the findings in various forms of publications will enhance their dissemination and utilization of evidence-based practices.
Conclusion
Congestive heart failure poses a significant challenge to the healthcare system because it increases the medical burden and mortality rates. Although numerous interventions for reducing increasing readmission rates of patients exist, education has proved to be an effective intervention. Mere education of patients without consideration of their unique educational needs reduces the effectiveness of education. Hence, the study supports the use of the customized educational program as an intervention of enhancing patients’ knowledge and skills, promoting patient satisfaction with health care services, and reducing readmission rates. In the assessment of the impact of the customized educational program, the study will administer questionnaires to establish patients’ knowledge and skills as well as their satisfaction. Cultural consideration of factors such as literacy, language, diet, nutrition, as well as compliance with ethical and HIPAA regulations is imperative in the study. Eventually, appropriate dissemination of the findings will enhance their utilization in evidence-based practices.
References
Barbareschi, G., Sanderman, R., Leegte, L., Veldhuisen, J., & Jaarsma, T. (2011). Educational level and the quality of life of heart failure patients: A longitudinal study. Journal of Cardiac Failure, 17(1), 47-53.
Boren, S., Wakefield, B., Gunlock, T., & Wakefield, D. (2009). Heart failure self–management education: a systematic review of the evidence. International Journal of Evidence–Based Healthcare, 7(3), 159-168.
Chin, R., & Lee, B. (2008). Principles and practice of clinical trial medicine. New York: Elsevier.
Clark, M., Freydberg, C., McAlister, A., Tsuyuki, T., Armstrong, W., & Strain, L. (2009). Patient and informal caregivers’ knowledge of heart failure: Necessary but insufficient for effective self-care. European Journal of Heart Failure, 11(2), 617-621.
Kociol, et al. (2012). National survey of hospital strategies to reduce heart failure readmissions: Findings from the get with the guidelines-heart failure registry. Circulation Heart Failure, 5(6), 680-687.
Martin, et al. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189-199.
Purnell, D. (2013). Transcultural Health Care. Philadelphia, PA: F.A. Davis Company.
Shalowitz, D., & Wendler, D. (2006). Informed consent for research and authorization under the health Insurance Portability and Accountability Act Privacy Rule: An integrated approach. Annals of Internal Medicine, 144(9), 685-688.
Stromberg, A. (2005). The crucial role of patient education in heart failure. European Journal of Heart Failure, 7(3), 363-369.
White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel, J. (2013). Is ‘teach-back’ associated with knowledge retention and hospital readmission in hospitalized heart failure patients? The Journal of Cardiovascular Nursing, 28(2), 137-146.
Appendices
Appendix A: Atlanta Heart Failure Knowledge Test (AHFKT-V2)
According to your knowledge and skills learned during customized educational program, kindly select appropriate answer from the following questions. The correct answers are marked with an asterisk.
- Heart failure is a problem in which:
- There is too much blood in the body
- The heart is unable to pump enough blood *
- The blood vessels in the heart are clogged
- The heart skips beats
- Which of the following statements about heart failure is TRUE?
- It can be cured with drugs and other treatments.
- A person with heart failure cannot live a normal life.
- Heart failure cannot be cured but it can be controlled.*
- Heart failure means the heart has stopped beating.People with heart failure can do many things to help themselves. Think about each of these activities and decide if they would be helpful for someone with heart failure.
- ACE inhibitors (ex. Capoten, Vasotec, Lisinopril, or Zestril) are medicines used to treat heart failure. These drugs help the heart pump stronger by:
- Removing extra fluid and salt from the body
- Causing blood vessels to get smaller
- Blocking the harmful effects of stress hormones*
- Improving blood counts (reducing anemia)
- People who have heart failure take diuretics (Lasix, “water pills”) so that:
- Their kidneys will make more urine and pass more water*
- Their heart will beat more steady
- The blood vessels in their body will widen or relax
- Their heart will pump stronger
- People with heart failure who are taking a diuretic (“water pill”) need to:
- Know if they need to take extra potassium with their water pill*
- Take the diuretic after 3-4 pm in the day
- Not worry about signs and symptoms of dehydration
- Drink lots of water to replace lost fluid
- If a person with heart failure gains 2-3 pounds in a few days, this usually means he/she:
- Is eating too many calories and gaining weight
- Has extra water in the body*
- Needs to drink more fluid
- Needs to be getting more exercise to burn calories
- How often should a person with heart failure weigh themselves?
- Every day*
- Every week
- Every month
- Once in a while
- The best time of day for persons with heart failure to weigh themselves is:
- At bedtime
- Upon awakening in the morning*
- At or around lunchtime
- When they remember to do it
- Persons with heart failure should call their doctor if they have which of the following symptoms?
- Weight gain of 2-5 pounds in 1-2 days
- Increased swelling of the ankles and/or stomach
- More shortness of breath
- All of the above*
- How often should a person with heart failure exercise?
- Every week
- Every day*
- Several times a day
- 2-3 times per week
- A person with heart failure should stop and rest when doing physical activity if:
- They feel short of breath or winded
- They have chest pain or discomfort
- They feel dizzy or lightheaded
- All of the above*
- Which is a big source of sodium (salt) in the diet?
- Processed foods (such as tv dinners)
- Smoked or cured meats
- Table salt
- All of the above*
- Which has the LOWEST amount of sodium (salt)?
- Fresh fruits*
- Canned vegetables
- Reduced sodium soup
- Frozen dinners
- Which food has the MOST sodium (salt)?
- Sliced tomato
- Broiled fish
- Baked ham*
- Skim milk
- Which dessert has the LOWEST amount of sodium?
- Hot fudge sundae
- Baked apple*
- Low fat instant pudding made with skim milk
- Chocolate cake made from a mix
- Select the fast food with the LOWEST amount of sodium.
- Fried chicken
- Cheeseburger
- Baked potato with sour cream and chives*
- Taco salad
- Some people with heart failure are told by their doctor to limit fluids. Which of the following count as fluids?
- Water and clear liquids
- Milk, ice cream, and yogurt
- Jello, pudding, and soups
- All of the above*
- If a person with heart failure has a headache or pain, which would be the best medicine to take?
- Aspirin
- Tylenol (Acetaminophen)*
- Advil® or Motrin® (Ibuprofen)
- Anacin Regular Strength or Excedrin
- The recommended total daily amount of sodium that persons with heart failure should eat is:
- 3,000 milligrams
- 2,500 milligrams
- 2,000 milligrams*
- 500 milligramsUse the picture of the soup label, to answer questions:
- A person with heart failure who is trying to limit their fluids may reduce symptoms of thirst by:
- Chewing gum or sucking hard candy*
- Cutting back on their medications
- Drinking small amounts every 30-60 minutes to prevent thirst
- Warming fluids before drinking
- If a person with heart failure forgets to take their medicine, they should:
- Take their medicines as usual the next day
- Take the medicines as soon as remembered*
- Take double the dose the next day
- Call their doctor immediately
- It is important for a person with heart failure to:
- Make sure they get the flu shot every year
- Receive the pneumovax vaccination to prevent pneumonia
- See their heart failure doctor regularly
- All of the above*
Appendix B: Patient Satisfaction Questionnaire (PSQ-18)
During your visit to the healthcare center, you received healthcare services. Provide your feelings, opinions, and expectations about healthcare services you received by indicating how you agree or disagree with the following statements