Improving outcomes for older adults with heart failure: a randomized trial using a theory-guided nursing intervention.

Newly discharged older adults with heart failure continue to experience frequent hospital readmissions, lower quality of life, and decreased satisfaction with health services. A theory-guided intervention delivered by home health nurses via the telephone was studied using a randomized controlled trial to assess its feasibility and inform further studies. Findings generated a profile of older adults with heart failure, utilization by patients and nurses, operational issues, and preliminary data on intended outcomes. Implications for further study are presented.

Research challenges and lessons learned from a heart failure telehomecare study.

Examining the benefits of nursing interventions through research significantly contributes to both professional nursing and quality healthcare, yet few benefits of home healthcare have been rigorously studied. Research challenges and lessons learned during a clinical trial of heart failure patients receiving home health nursing services are presented with recommendations.

Dimensions of caring: psychometric evaluation of the caring assessment tool.

The increase in relationship-centered professional practice models has expanded the interest in the measurement of caring. Using a cross-sectional descriptive study of 557 adults from 5 acute care institutions, a factor analysis and reliability statistics were used to revise the Caring Assessment Tool. Eight independent factors (mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, affiliation needs, and basic human needs) explained 62.6% of the variance in caring. The findings provide insight into patients' assessment of caring in nursing and offer a baseline evaluation of the psychometric properties of the Caring Assessment Tool.

Improvement in the outcome indicator of readmission of patients with heart failure: a case analysis.

This article describes the process used by one performance improvement committee to analyze comprehensive assessment data, including OASIS data, and relate it to nursing activities described in the clinical nursing notes. The end goal was to improve, or decrease, the hospital readmission rate of their patients with heart failure. The fit between patient characteristics and the plan of care described and delivered in two groups was evaluated. Differences in patient characteristics and nursing documentation of outcomes provided the data for remediation and for testing of a new intervention.

Development and testing of a caring-based intervention for older adults with heart failure.

The clinical and cost burdens of heart failure (HF) continue to rise, creating an immediate need for cost-effective interventions geared toward improving health outcomes. This article describes the development and testing of a caring-based nursing intervention for older adults with advanced HF who have been recently discharged from acute care. The developmental process and components of the intervention are presented. A methodology for testing the intervention is also introduced. Through a phased development process including research, this intervention can be refined and used to guide clinicians, administrators, and policymakers in the provision of high-quality care to older adults with HF.

Nonpharmacological strategies for improving heart failure outcomes in the community: a systematic review.

The purpose of this systematic review was to synthesize current evidence regarding nonpharmacological approaches to heart failure (HF) management. Following a literature search, identified studies were coded using the Heart Failure Study Assessment Scale (HFSAS) developed by the authors. Results included high-quality ratings, a predominance of multidisciplinary disease management studies, decreased readmission rates, and some improvement in quality of life. Implications for practice, leadership, education, and research are described.

The Quality-Caring Model: blending dual paradigms.

Evidence supports associations between professional nursing and quality health outcomes. Yet, what specifically accounts for those linkages remains buried in the daily practice of nursing. The Quality-Caring Model exposes and demonstrates the value of nursing within the evidence-based practice milieu of modern health care. It favors a process, or way of being, that challenges modernist conventions and highlights the power of relationships. By reaffirming the nature of nursing's work as relationship-centered, the blended model describes the 2 dominant relationships that comprise professional encounters. Relationships characterized by caring are theorized to influence positive outcomes for patients/families, health care providers, and health care systems. Model components are clarified, assumptions described, and propositions stated. Conceptual-theoretical linkages in the model are identified and ties to empirical indicators provide the logical consistency necessary for validation. Clinical practice and research applications of the model are offered. The Quality-Caring Model helps to translate the hidden work of nursing into objective terms that can be tested. Scientifically demonstrating its worth will advance professional nursing while simultaneously improving the quality of health care.