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The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals.
Diabetes, a common chronic condition, effects many individuals causing poor quality of life, expensive medical bills, and devastating medical complications. While health care providers try to manage diabetes during short office visits, many patients still struggle to control their diabetes at home. Lack of diabetes self-management (DSM) is a potential barrier for people with diabetes having to maintain healthy hemoglobin A1cs (HgA1c).
In hopes of addressing this concern, an evidenced-based intervention; diabetic education and phone calls, using the chronic care model as its framework was implemented. The intervention targeted people with type II diabetes at a transitional care setting. Measured variables included HgA1c and DSM. Statistically significant improvements were seen in reported physical activity. Average improvements were seen in HgA1c and DSM after three months of diabetes self-management education (DSME). Attrition, cultural sensitivity, and increasing DSME hours should be further evaluated for future projects.
Methods: A project was undertaken at an outpatient behavioral setting in urban Arizona to determine the use and effectiveness of a mental health app called insight timer to reduce anxiety symptoms. Adult clients with anxiety symptoms were provided with the insight timer app to use over a period of eight weeks. Anxiety was evaluated with the GAD-7 scale initially and after the eight weeks of app use. Usability and the quality of the app were assessed with an app rating scale at the end of the eight weeks.
Results: Findings of the Wilcoxon Signed Ranks test indicated changes in pre and posttest assessment scores as significant (p = .028), which is a significant reduction in anxiety among seven clients who completed the 8-week intervention. the mean TI score was 15.57 (SD = 4.9), and the mean T2 score was 7.71 (SD = 5.7). Besides, Cohen's effect size value (d = 1.465) suggested large clinical significance for GAD7 in pre and posttest.
Discussion: Evidence suggests that the use of an evidence-based app can effectively reduce anxiety symptoms and improve the quality of life. The use of mental health apps like insight timer could reduce health care costs associated with unnecessary hospital admissions as well as re-hospitalizations. The routine use of apps such as the insight timer may also be beneficial to all the clients who have anxiety symptoms in outpatient as well as inpatient settings.
Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.
Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.
Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.
Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.
Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.
There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management is largely to blame for many HF exacerbations. Current evidence supports utilizing both verbal and written education with an emphasis on self-care and education delivered in a group setting or individual setting showed equal impact on self-care and HF knowledge ( Hoover, et. al., 2017; Ross et. al., 2015; Tawalbeh, 2018).
An outpatient VA clinic located in a suburb of the large metropolitan identified there was no consistency on how a HF patient was educated, managed, or tracked and the registered nurses (RNs) lacked knowledge of HF. As a results of these findings this Evidence Based Project (EBP) was implemented. RNs were educated on HF and completed a self-assessment questionnaire evaluating their knowledge pre and post education. The RNs, as part of a multidisciplinary team, educated HF patients on signs and symptoms of HF as well as on how to manage the disease. Patients completed, the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and the Self Care Heart Failure Index (SCHFI) to assess knowledge of HF and self-management skills.
These questionnaires were completed initially and at 30 and 60 day intervals. The RNs self-assessment of their knowledge and ability to educate patients increased in all areas. The patient’s KCCQ and SCHFI score improved at 30 days and 60 days when compared to their initial score. Larger EBPs are needed over a longer period of time to assess the impact on hospital readmissions and same day clinic visits for HF exhibitions.
Methods: Twenty-four members of a PD specific wellness center in the United States were recruited to participate in a nurse navigation program for a 12-week period. The intervention period included an initial needs assessment, ten individual 45-minute sessions focused on specific aspects of PD wellness, and a concluding visit. Results: There was a significant decline in quality of life based on average PDQ-39 scores for the participants in January 2019 (M =24.44, SD=16.66) compared to January 2018 (M=20.11, SD =12.78) where higher scores signify worse quality of life; t(23)-4.329 p=0.025. Average self-efficacy for managing chronic disease pre-intervention scores (M=6.58, SD=1.70) verses post-intervention scores (M=7.44, SD=1.48) showed a significant increase in self-efficacy with a medium effect size; t(23)-0.854 p=0.016, d=0.54. Additionally, unique satisfaction surveys showed high satisfaction with nurse navigation throughout the participant sample and wellness center staff members.
Conclusions: A nurse navigation program focusing on specific aspects of PD management can help improve participant’s confidence in self-management of PD despite disease progression. Additionally, nurse navigation for people with PD was associated with high satisfaction among participants and staff members of a PD wellness center.
Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014).
If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems.
Methods: The quality department at a large children’s hospital in the southwestern United States approved the project as a practice change and parent consent was not required. The project design was a randomized controlled group: pretest-posttest design, quality improvement method. Participants were chosen by convenience sample. Required diagnoses were headache or migraine. Each group had 18 participants, for a total of 36 participants. Ages ranged from four to 18 years of age, with legal guardians present for the intervention group only. New and follow-up patients were included in the project. Demographics for each group were statistically similar. Questionnaires were used to assess knowledge pre and post implementation of teach back tool. Self-management was measured by a follow-up phone call after their appointment to inquire regarding implementation of the headache diary. Charts were reviewed for both groups regarding the number and type of phone calls received by the office.
Outcomes: Paired sample t-test was used to evaluate mean differences in knowledge from pre and post questions of teach back tool. Data analysis concluded a statistical increase in knowledge of triggers and prevention techniques. Cohen’s d for triggers was 2.21 and 1.87 for prevention. Self-management of behavior was measured by use of headache diary and determined by a percentage. Sixty-seven individuals started to use the headache diary. Independent t-test was used to compare number of phone calls from each group. Data concluded a decrease in phone calls. However, due to a small sample size, statistical significance could not be established.
Conclusion: Teach back encourages caregiver/patient and provider interaction, which increases health literacy retention and increases self-management behaviors. Future research should focus on patients with headaches with unknown triggers for their headaches.