Distractions when viewing in-hospital heart failure self-care videos and change in heart failure self-care knowledge.

BACKGROUND: When viewing in-hospital heart failure (HF) education videos, internal and external distractions could interfere with understanding of educational content. OBJECTIVE: To examine if distractions when learning are associated with HF knowledge. METHODS: HF self-care knowledge was assessed using a validated HF knowledge instrument. Research nurses recorded distractions during video viewing. Patient characteristics were retrieved from a database. Demographics and change in knowledge scores were compared overall and by distraction groups using comparative statistics. RESULTS: Among all 60 participants, distractions were not associated with patient characteristics. Pre- and post-video education, HF standardized knowledge scores were 72.5 ± 10.7 and 77.7 ± 10.5 respectively, p<0.001 and 5 (of 20) item scores increased post-video viewing. HF self-care knowledge scores were not associated with distraction frequency, but scores were highest in patients without internal distractions (p = 0.025). CONCLUSION: In-hospital video education was associated with higher HF knowledge despite internal (primarily fatigue) or external (primarily nursing caregiver interruption) distractions.

Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure.

The purpose of this study was to determine perceptions of heart failure quality of life and its relationship to self-care as moderated by anxiety and depression. Older adults (n = 85) were surveyed using Kansas City Cardiomyopathy Questionnaire-12, Self-Care of Heart Failure Index V6.2, and Patient Reported Outcomes Measurement Information System Anxiety and Depression Short Forms 4a. As quality of life and anxiety or depression scores increased jointly, their self-care management scores decreased (p < 0.001). However, higher heart failure quality of life, and lower anxiety and depression scores showed an increase in self-care management. Our findings highlight the need for nursing interventions and research targeting heart failure symptom recognition among older adults. Identification of anxiety and depression in older adults with heart failure may be an important first step for improving self-care management for this population.

Integration and Standardization of Clinical Nurse Specialists in a Multihospital System: Exemplars in Practice.

PURPOSES/OBJECTIVES: In 2013, our multihospital system began the process to integrate and standardize clinical nurse specialist (CNS) practice. The goal was to standardize work and to increase collaboration as part of one system. DESCRIPTION OF THE PROJECT/PROGRAM: An overall job description was established to provide a framework inclusive of the broad areas of practice. Clinical nurse specialists were positioned to support medical-surgical, critical care, or women and children's services offered at community-based hospitals. Main campus and community-based CNSs led significant system integration efforts such as the standardization of nursing policies and procedures across the health system. System CNSs were created to address the needs of specialties common to all hospitals. As an example, a system CNS collaborated with the main campus and community-based CNSs to improve the delirium screening process. OUTCOME: Clinical nurse specialists across the system have been integrated into a single team and report to 1 central director. Efforts to leverage expertise included the creation of a CNS-led practice council, increased communication via regular departmental meetings, and the sharing of resources using electronic platforms. There is now a CNS at hospitals that previously did not have one. The group values the structure and opportunities it provides as evidenced by favorable engagement surveys. CONCLUSION: Our integration efforts improved collaboration and could be modified to benefit other care settings.