Nurse-Patient Interaction and Rehospitalization Among Older Persons with Heart Failure in a Skilled Nursing Facility in New York, USA

Abstract

Background: There has been a gap in the literature about the prevalence of heart failure (HF) among older adults in the skilled nursing facility (SNF). Also, the evaluation of interventions to manage symptoms of heart failure is limited. Nurses' role in the promotion, prevention, and management of heart failure is significant. The study aimed to evaluate the outcomes of a Nurse-led interdisciplinary Heart Failure Team NLI-HFTP Program (NLI-HFTP) on the nurse-patient interaction and rehospitalization rate among older adults in a SNF.

Methods: This study was a post-test one-group design, descriptive, and correlational study. The three main variables were NLI-HFTP, nurse-patient interaction, and 30-day rehospitalization rate. A descriptive and correlational analysis was performed.

Results: In this study, 46 participants were mostly young-old age approximately 65–74 elderly group of African American, Non-Hispanic women. Clinical characteristics of older adults with heart failure in the SNF include a primary diagnosis of heart failure which was not unspecified (70%; n=32), had a Class I Mild symptoms NYHA classification (61%; n=28), and a primary heart failure with reduced ejection fraction (46%; n=21). The associated comorbidities were hypertension (89%; n=41), coronary heart disease (72%; n=33), and arrhythmia (46%; n=21). Primarily line of treatment used includes beta-blockers and diuretics. Nurse-patient interaction median is 8.4. Based on the median score, the participants reported a high level of nurse- patient interaction based on a scale of 1-10. The participants reported that their interaction with the nurses makes them feel good. Nurses asking how they are doing made a difference in their reports of nurse-patient interaction. Also, respondents believe that their interaction with nurses is very important for them to thrive. There was a significant decrease in the 30-day rehospitalization rate among patients with heart failure in this facility after implementing the program. Correlational analyses reported a significant and a very strong association between NYHA classification and the 30- day rehospitalization. No significant association between nurse-patient interaction and 30-day rehospitalization was found in this study.

Conclusion: The findings are congruent with the theoretical assumptions based on the Quality Care Model that caring relationships are linked through a professional encounter of the nurse and patient. The study reported a high level of nurse-patient interaction between the patient and the heart failure team. This encounter can make a significant difference and contribution to the health outcomes of older adults with heart failure. Furthermore, this result provided evidence that a nurse-caring model can organize patient care delivery. Also, the study showed that teamwork and collaboration among healthcare providers is a way to engage and relate to provide the best care for the patient. Finally, this study demonstrated that the NLI- HFTP is a feasible intervention that can be implemented by skilled nursing facilities that can reduce the 30-day rehospitalization rate decreasing heart failure exacerbation incidence among the older adults in the SNF.