Research article

An exploration of learning needs: identifying knowledge deficits among hospitalized adults with heart failure

  • Received: 08 May 2019 Accepted: 15 July 2019 Published: 02 August 2019
  • The current study examined the learning needs of hospitalized patients with chronic heart failure (CHF) by identifying their current CHF self-care behaviors and knowledge levels, while identifying relationships between clinical variables, and their learning needs. A descriptive, cross-sectional design was utilized to examine a convenience sample of 42 hospitalized patients with CHF. Self-care behaviors and knowledge levels were measured using the Self Care of Heart Failure Index V. 6.2, and the Japanese Heart Failure Knowledge Scale. Descriptive statistics were used to describe the learning needs and sociodemographic data and Pearson product moment correlation examined relationships between the learning needs and clinical variables. The mean scores of self-care were 38.6% (maintenance), 41.6% (management) and 17.8% (confidence). The participant’s mean knowledge level score was 74.9%. Multiple CHF hospital readmissions had a significant negative correlation with CHF knowledge scores (r = −0.358, p < 0.05), suggesting the lower the knowledge score, the higher the prevalence of CHF readmissions. There were significant positive correlations between self-care maintenance (r = 0.525, p < 0.05), management (r = 0.435, p < 0.05), confidence (r = 0.366, p < 0.05), knowledge level (r = 0.752, p < 0.05) and not living alone. Thus, indicating that living with family support is correlated with better self-care and greater knowledge. The presence of multiple comorbidities revealed significant positive correlations (p < 0.05) with self-care scores (maintenance [r = 0.391], management [r = 0.438], and confidence r = 0.504), indicating a higher number of comorbidities, yielded lower self-care behaviors. Findings revealed poor self-care behaviors in all three areas (maintenance, management, confidence). These findings suggested that patients had difficulty implementing knowledge into self-care. By identifying knowledge deficits and contributing factors to suboptimal self-care, the chronic care model can be used as a guideline for ideal CHF education and management. Improving self-care behaviors can be obtained by initiating an active engagement between health care teams and the patient.

    Citation: Erika Raines, Sabrina L. Dickey. An exploration of learning needs: identifying knowledge deficits among hospitalized adults with heart failure[J]. AIMS Public Health, 2019, 6(3): 248-267. doi: 10.3934/publichealth.2019.3.248

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  • The current study examined the learning needs of hospitalized patients with chronic heart failure (CHF) by identifying their current CHF self-care behaviors and knowledge levels, while identifying relationships between clinical variables, and their learning needs. A descriptive, cross-sectional design was utilized to examine a convenience sample of 42 hospitalized patients with CHF. Self-care behaviors and knowledge levels were measured using the Self Care of Heart Failure Index V. 6.2, and the Japanese Heart Failure Knowledge Scale. Descriptive statistics were used to describe the learning needs and sociodemographic data and Pearson product moment correlation examined relationships between the learning needs and clinical variables. The mean scores of self-care were 38.6% (maintenance), 41.6% (management) and 17.8% (confidence). The participant’s mean knowledge level score was 74.9%. Multiple CHF hospital readmissions had a significant negative correlation with CHF knowledge scores (r = −0.358, p < 0.05), suggesting the lower the knowledge score, the higher the prevalence of CHF readmissions. There were significant positive correlations between self-care maintenance (r = 0.525, p < 0.05), management (r = 0.435, p < 0.05), confidence (r = 0.366, p < 0.05), knowledge level (r = 0.752, p < 0.05) and not living alone. Thus, indicating that living with family support is correlated with better self-care and greater knowledge. The presence of multiple comorbidities revealed significant positive correlations (p < 0.05) with self-care scores (maintenance [r = 0.391], management [r = 0.438], and confidence r = 0.504), indicating a higher number of comorbidities, yielded lower self-care behaviors. Findings revealed poor self-care behaviors in all three areas (maintenance, management, confidence). These findings suggested that patients had difficulty implementing knowledge into self-care. By identifying knowledge deficits and contributing factors to suboptimal self-care, the chronic care model can be used as a guideline for ideal CHF education and management. Improving self-care behaviors can be obtained by initiating an active engagement between health care teams and the patient.


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    Conflict of interest



    All authors declare no conflicts of interest in this paper.

    [1] Yancy CW, Jessup M, Bozkurt B, et al. (2013) ACCF/AHA Guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 128: e240–e327.
    [2] Mozaffarian D, Benjamin EJ, Go AS, et al. (2015) Heart disease and stroke statistics-2016 update. Circulation 133: e38–e360.
    [3] Center for Disease Control and Prevention. (2016) Heart Failure Fact Sheet|Data & Statistics|DHDSP|CDC. Available from: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm.
    [4] Ross JS, Chen J, Lin Z, et al. (2010) Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 3: 97–103. doi: 10.1161/CIRCHEARTFAILURE.109.885210
    [5] Clarkson JN, Schaffer SD, Clarkson JJ (2017) The effect of an interprofessional heart failure education program on hospital readmissions. J Healthcare Qual 39: 78–84. doi: 10.1097/JHQ.0000000000000027
    [6] Wan TT, Terry A, Cobb E, et al. (2017) Strategies to modify the risk of heart failure readmission, Health Services Research and Managerial Epidemiology, Springer, Cham 4: 1–16.
    [7] Boyde M, Song S, Peters R, et al. (2012) Pilot testing of a self-care education intervention for patients with heart failure. Eur J Cardiovasc Nurs 12: 39–46.
    [8] Marti CN, Georgiopoulou VV, Giamouzis G, et al. (2012) Patient-reported selective adherence to heart failure self-care recommendations: A prospective cohort study: The Atlanta Cardiomyopathy Consortium. Congest Heart Fail 19: 16–24.
    [9] Schnell-Hoehn KN, Naimark BJ, Tate RB (2009) Determinants of self-care behaviors in community-dwelling patients with heart failure. J Cardiovasc Nurs 24: 40–47. doi: 10.1097/01.JCN.0000317470.58048.7b
    [10] Ter Maten-Speksnijder AJ, Dwarswaard J, Meurs PL, et al. (2016) Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study. J Clin Nurs 25: 3219–3228.
    [11] Case R, Haynes D, Holaday B, et al. (2010) Evidence-based nursing: The role of the advanced practice nurse in the management of heart failure in patients in the outpatient setting. Dimensions. Crit Care Nurs 29: 57–62. doi: 10.1097/DCC.0b013e3181c92efb
    [12] Kim SM, Han H (2013) Evidence-based strategies to reduce readmission in patients with heart failure. J Nurs Pract 9: 224–232. doi: 10.1016/j.nurpra.2013.01.006
    [13] Simpson M (2014) A quality improvement plan to reduce 30-Day readmissions of heart failure patients. J Nurs Care Qual 29: 280–286. doi: 10.1097/NCQ.0000000000000038
    [14] Centrella-Nigro A, Bognar L, Burke K, et al. (2016) The readmitted patient with heart failure. Medsurg Nurs 25: 163–167.
    [15] Vesterlund M, Granger B, Thompson TJ, et al. (2015) Tailoring your heart failure project for success in rural areas. Qual Manage Health Care 24: 91–95. doi: 10.1097/QMH.0000000000000055
    [16] Bocutti C, Cassilas G (2015) Aiming for fewer hospital U-turns: The Medicare hospital readmission reduction program. Kaiser Fam Found.
    [17] Bos-Touwen I, Jonkman N, Westland H, et al. (2015) Tailoring of self-management interventions in patients with heart failure. Curr Heart Failure Rep 12: 223–235. doi: 10.1007/s11897-015-0259-3
    [18] Heart Failure Society of America (2010) HFSA 2010 comprehensive heart failure practice guideline. J Card Failure 16: e1–e2. doi: 10.1016/j.cardfail.2010.04.004
    [19] Buonocore D, Wallace E (2014) Comprehensive guideline for care of patients with heart failure. AACN Adv Crit Care 25: 151–162. doi: 10.1097/NCI.0000000000000018
    [20] Riegel B, Dickson VV, Faulkner KM (2016) The situation-specific theory of heart failure self-care. J Cardiovasc Nurs 31: 226–235. doi: 10.1097/JCN.0000000000000244
    [21] Lee KS, Lennie TA, Dunbar SB, et al. (2015) The association between regular symptom monitoring and self-care management in patients with heart failure. J Cardiovasc Nurs 30: 145–151. doi: 10.1097/JCN.0000000000000128
    [22] Moser DK, Dickson V, Jaarsma T, et al. (2012) Role of self-care in the patient with heart failure. Curr Cardiol Rep 14: 265–275. doi: 10.1007/s11886-012-0267-9
    [23] Boyde M, Peters R (2014) Education material for heart failure patients: What works and what does not? Curr Heart Fail Rep 11: 314–320. doi: 10.1007/s11897-014-0200-1
    [24] Dickson VV, Melkus GD, Dorsen C, et al. (2015) Improving heart failure self-care through a community-based skill-building intervention. J Cardiovasc Nurs 30: S14–S24. doi: 10.1097/JCN.0000000000000161
    [25] Evangelista LS, Shinnick MA (2008) What do we know about adherence and self-care? J Cardiovasc Nurs 23: 250–257. doi: 10.1097/01.JCN.0000317428.98844.4d
    [26] Ong S, Foong PP, Seah JS, et al. (2018) Learning needs of hospitalized patients with heart failure in singapore. J Nurs Res 26: 250–259. doi: 10.1097/jnr.0000000000000239
    [27] Boyde M, Peters R, New N, et al. (2017) Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial. Eur J Cardiovasc Nurs 17: 1–8.
    [28] Soufer A, Riello RJ, Desai NR, et al. (2017) A blueprint for the post discharge clinic visit after an admission for heart failure. Prog Cardiovasc Dis 60: 237–248. doi: 10.1016/j.pcad.2017.08.004
    [29] Cyrille NB, Patel SR (2017) Late in-hospital management of patients hospitalized with acute heart failure. Prog Cardiovasc Dis 60: 198–204. doi: 10.1016/j.pcad.2017.05.003
    [30] Di Palo KE, Patel K, Assafin M, et al. (2017) Implementation of a patient navigator program to reduce 30-day heart failure readmission rate. Prog Cardiovac Dis 60: 259–266. doi: 10.1016/j.pcad.2017.07.004
    [31] Howlett JG, Mann EO, Baillie R, et al. (2009) Heart failure clinics are associated with clinical benefit in both tertiary and community care settings: Data from the improving cardiovascular outcomes in Nova Scotia (ICONS) registry. Can J Cardiol 25: S306–S311. doi: 10.1016/S0828-282X(09)70141-2
    [32] Jackevicius CA, De Leon NK, Lu L, et al. (2015) Impact of a multidisciplinary heart failure post-hospitalization program on heart failure readmission rates. Ann Pharmacother 49: 1189–1196. doi: 10.1177/1060028015599637
    [33] Koser KD, Ball LS, Homa JK, et al. (2018) An outpatient heart failure clinic reduces 30-day readmission and mortality rates for discharged patients. J Nurs Res 26: 393–398. doi: 10.1097/jnr.0000000000000260
    [34] Cheng HY, Chair SY, Wang Q, et al. (2016) Effects of a nurse-led heart failure clinic on hospital readmission and mortality in Hong Kong. J Geriatr Cardiol 13: 415–419.
    [35] GESICA Investigators (2005) Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ 331: 425–427.
    [36] Blood AJ, Fraiche AM, Eapen ZJ (2017) Is an admission for decompensated heart failure inevitable? Prog Cardiovasc Dis 60: 171–177. doi: 10.1016/j.pcad.2017.07.003
    [37] Lambrinou E, Protopapas A, Kalogirou F (2014) Educational challenges to the health care professional in heart failure care. Curr Heart Failure Rep 11: 299–306. doi: 10.1007/s11897-014-0203-y
    [38] McEntee ML, Cuomo LR, Dennison CR (2009) Patient-, provider-, and system-level barriers to heart failure care. J Cardiovasc Nurs 24: 290–298. doi: 10.1097/JCN.0b013e3181a660a0
    [39] Granger BB, Sandelowski M, Tahshjain H, et al. (2009) A qualitative descriptive study of the work of adherence to a chronic heart failure regimen. J Cardiovasc Nurs 24: 308–315. doi: 10.1097/JCN.0b013e3181a4be30
    [40] Siabani S, Leeder SR, Davidson PM (2013) Barriers and facilitators to self-care in chronic heart failure: a meta-synthesis of qualitative studies. SpringerPlus 2: 1–14. doi: 10.1186/2193-1801-2-1
    [41] Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness. JAMA 288: 1775–1779. doi: 10.1001/jama.288.14.1775
    [42] Bekelman DB, Plomondon ME, Sullivan MD, et al. (2013) Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial. BMC Cardiovasc Dis13: 1–6.
    [43] Willemse E, Adriaenssens J, Dilles T, et al. (2014) Do telemonitoring projects of heart failure fit the chronic care model? Int J Integr Care 14: 1–14.
    [44] Centers for Disease Control and Prevention. CDC-About BRFSS. (2014) Available from: https://www.cdc.gov/brfss/about/index.htm.
    [45] Riegel B, Moser DK, Anker SD, et al. (2009) State of the science: Promoting self-care in persons with heart failure: A scientific statement from the American Heart Association. Circulation 120: 1141–1163. doi: 10.1161/CIRCULATIONAHA.109.192628
    [46] Vellone E, Riegel B, Cocchieri A, et al. (2013) Psychometric testing of the self-care of heart failure index version 6.2. Res Nurs Health 36: 500–511.
    [47] Kato N, Kinugawa K, Nakayama E, et al. (2013) Development and psychometric properties of the japanese heart failure knowledge scale. Int Heart J 54: 228–233. doi: 10.1536/ihj.54.228
    [48] Kato NP, Kinugawa K, Sano M, et al. (2016) How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence 10: 171–181.
    [49] Strömberg A (2005) The crucial role of patient education in heart failure. Eur J Heart Failure 7: 363–369. doi: 10.1016/j.ejheart.2005.01.002
    [50] Harkness K, Spaling MA, Currie K, et al. (2015) A systematic review of patient heart failure self-care strategies. J Cardiovasc Nurs 30: 121–135.
    [51] Andrikopoulou E, Abbate K, Whellan DJ (2014) Conceptual model for heart failure disease management. Can J Cardiol 30: 304–311. doi: 10.1016/j.cjca.2013.12.020
    [52] Caldwell MA, Peters KJ, Dracup KA (2005) A simplified education program improves knowledge, self-care behavior, and disease severity in heart failure patients in rural settings. Ame Heart J 150: 983.e7–983.e12.
    [53] Hope CJ, Jingwe W, Tu W, et al. (2004) Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am Soc Health-Syst Pharm 61: 2043–2049. doi: 10.1093/ajhp/61.19.2043
    [54] Wang S, Lin L, Lee C, et al. (2011) Effectiveness of a self-care program in improving symptom distress and quality of life in congestive heart failure patients. J Nur Res 19: 257–266. doi: 10.1097/JNR.0b013e318237f08d
    [55] Grafton T, Bassett A (2017) The role of confidence in self-care of patients with a diagnosis of heart failure. Medsurg Nurs 26: 263–268.
    [56] Cocchieri A, Riegel B, D'Agostino F, et al. (2015) Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care. Eur J Cardiovasc Nurs 14: 126–136. doi: 10.1177/1474515113518443
    [57] Salyer J, Schubert CM, Chiaranai C (2012) Supportive relationships, self-care confidence, and heart failure self-care. J Cardiovasc Nurs 27: 384–393. doi: 10.1097/JCN.0b013e31823228cd
    [58] Cameron J, Worrall-Carter L, Page K, et al. (2010) Self-care behaviours and heart failure: Does experience with symptoms really make a difference? Eur J Cardiovasc Nurs 9: 92–100. doi: 10.1016/j.ejcnurse.2009.10.004
    [59] Britz JA, Dunn KS (2010) Self-care and quality of life among patients with heart failure. J Am Academy Nurs Pract 22: 480–487. doi: 10.1111/j.1745-7599.2010.00538.x
    [60] Dracup K, Moser DK, Pelter MM, et al. (2014) Rural patients' knowledge about heart failure. J Cardiovasc Nurs 29: 423–428. doi: 10.1097/JCN.0b013e31829cbcf3
    [61] Jaarsma T, Cameron J, Riegel B, et al. (2017) Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Curr Heart Failure Rep 14: 71–77. doi: 10.1007/s11897-017-0324-1
    [62] Chriss PM, Sheposh J, Carlson B, et al. (2004) Predictors of successful heart failure self-care maintenance in the first three months after hospitalization. Heart Lung J Acute Crit Care 33: 345–353. doi: 10.1016/j.hrtlng.2004.03.004
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