Research on the nursing management of patients with congestive heart failure to be concluded 12/2011

1. Patient‐Centered Intervention:
Symptom Management in Older Heart Failure Patients
Sandra K Plach, PhD, RN, Principal Investigator; Susan M. Heidrich, PhD, RN, Co‐Investigator
Background Purpose Sample Preliminary Results
• Heart failure (HF) - an escalating health problem The overall goal of this study is to develop and Sample
that disproportionately affects older adults test a theoretically‐based nursing intervention • Target Sample Size: N=60
• Leading cause of hospitalization among persons (HEART‐IRIS) to improve symptom self‐
management in older patients with HF • Recruitment: flyers/posters - physician
> 65 years offices, community centers & newsletters
• Associated with diminished quality of life, • Current enrollment: n=31
frequent health care encounters, and
considerable health care costs Current Demographics
Gender: Male (n=16), Female (n=15)
• More Medicare dollars spent for the treatment of
HF than for any other Medicare diagnosis-related
group
• More than 5 million Americans have HF and over Primary Aims
500,000 new cases are reported yearly • Refine a manualized protocol
• Improvement of recognition and monitoring of HF for HEART-IRIS
symptoms and initiation of self-management when • Test the feasibility of HEART-IRIS
symptoms worsen can prevent hospitalizations,
• Examine the short-term effects
minimize complications, and maintain life quality
of the intervention on symptom
• A gap exists between information given to patients distress, symptom management,
with HF and their understanding and management quality of life, and health care
of symptoms, resulting in help-seeking delay, utilization
particularly among older adults
Secondary Aims
• It may be that older individuals incorrectly interpret
• Explore beliefs about HF
symptoms of HF as normal age-related symptoms
symptoms and barriers to self care
or as symptoms of other coexisting health conditions
of symptoms in older adults FLEURTY01
• Determine the cost related to
implementation of HEART-IRIS HEART‐IRIS Intervention
Theoretical Framework • An individualized psychoeducational teaching
Representational Approach to Patient Education
Method program for symptom management in older
patients with HF
(Donovan & Ward, 2001)
Design • Consists of counseling interview conducted by
• Focuses on assessing an individual’s • 16‐week, two‐group repeated‐measures masters-prepared RN
representations (beliefs) of symptoms in order to with a wait‐list control group • Steps of the Intervention
identify and replace beliefs that interfere with - Assessment of subject's representations/
effective/appropriate symptom self‐management • Random assignment to group
beliefs of symptoms Conclusion
• Symptom distress assessed at baseline, - Discussion of effect of beliefs on ability to
• Underpinnings
at 2, 4, 6 weeks, at the end of the manage symptom and to enjoy life
‐ Common sense model (CSM) of illness
intervention (8 weeks), and at follow‐up - Discussion of symptom management (SM) This study focuses on symptom self‐management of
representations (Leventhal & Diefenbach,1991; a chronic health condition (HF) in a population that is
Leventhal, Meyer, & Nerenz, 1980) (4 months after baseline) - SM plan created by nurse and subject
highly vulnerable for multiple chronic health
• Wait‐list control subjects offered the - Plan written, copy sent to subject, copy conditions, symptom management difficulties,
‐ Conceptual change theory retained by nurse diminished quality of life, and increased health care
intervention after the 4‐month follow‐up
• IRIS – Individualized Representational Intervention - Telephone reinforcement sessions utilization.
assessment • Biweekly for 8 weeks
for Symptoms (Heidrich, Egan, & Brown, 2006) By addressing the correct interpretation of
symptoms, which will improve self‐management
strategies in response to symptoms, the HEART‐IRIS
intervention has potential to reduce symptom
This study is in‐progress (2008‐2011) distress, improve quality of life, prevent HF
The project is funded by a grant from the National Institutes of Health,
exacerbations and hospitalizations in older adults
with HF, and decrease subsequent costs of care.
National Institute of Nursing Research, 1P20NR010674‐01
SURF Awardee: Jacque Conarchy, BSN , BS,MGT
Dr. Sandra K. Plach is a Center Scientist with the Self‐Management Science Center,
College of Nursing‐ Graduate Student College of Nursing, University of Wisconsin‐Milwaukee
Faculty Mentor: Sandra K Plach, PhD, RN
www.nursing.uwm.edu