Nurses' Use of the TBM for Heart Failure Patients' Self-Care Management after Hospital Discharge

Heart failure (HF) currently affects 6.5 million adults in the United States and its prevalence is projected to increase by 25% by 2030. The Centers for Medicare & Medicaid Services has mandated reporting of hospital-level 30-day readmission rates and possible penalties for HF in an effort to improve outcomes. Heart failure patients also lack self-care management at home and this plays a critical role in hospital readmissions. The problem is that there is an abundance of information that supports the fact that heart failure patients leave the hospital unprepared for self-care management at home resulting in patient safety issues and possibly preventable hospital readmissions. The American Heart Association and Joint Commission have guidelines in place promoting the benefit of education to prevent hospital readmissions but there is a lack of a specific and effective teaching method for HF patients. After examining the literature for existing patient teaching methods, the TBM has been found to be an evidence-based teaching approach. The purpose of this project was to teach nurses the use of the TBM to help educate heart failure patients with self-care management after hospital discharge. Out of four local hospitals contacted to determine the heart-failure patient readmissions and teaching method for HF self-care management, only one qualified for conducting this training effort. Cardiac and medical-surgical nurses not currently using the TBM with HF patients was trained in this teaching method to incorporate it into their patient care. Three training sessions were conducted. There was a pre-training questionnaire compared to a post-training one month questionnaire for each group of nurses. Evaluation of the results of nurses using the TBM will provide new insight for those nurses who have not used this method for teaching heart failure patients. Findings of this DNP project was contributed via a poster presentation at the Idaho Nurse Educator's Conference in April 2015.