Patients often misunderstand the diagnosis of heart failure and think it is fatal, according to Sharron Coffie, MS, RN, CNS-BC at Froedtert Hospital in Milwaukee. Having taught numerous patients with heart failure about self care, Coffie said clear communication about symptoms, weight monitoring, sodium and dietary restrictions, medication adherence, provider follow-up and family involvement is key.
"Nurses need to be very clear in explaining the difference between a heart attack and heart failure so patients have an accurate perspective," she said, adding that misinterpreted information can have a negative effect on patients' outcomes. Coffie and other nurses who work with these patients recently shared their best practice ideas with ADVANCE.
Recognizing & Reporting of Symptoms
"Patients sometimes lack the words to communicate their symptoms," said Coffie, who explained that 78 percent of people who enter the healthcare system have low proficiency in understanding healthcare information. "We want to make sure they don't just call and say 'I'm sick.' We're teaching patients to recognize and report sick days."
One tool Froedtert provides is a refrigerator magnet of a stoplight, designed to help patients identify and describe symptoms. The yellow light is depicted at the top, representing caution.
"Shortness of breath, inability to lie flat, increased abdominal girth, swelling in lower extremities, having to sleep on more than two pillows, coughing at night, difficulty sleeping, loss of appetite, decreased alertness, and decreased level of activity are symptoms all written in terms that are very clear for the patient," she said.
Jean Addis, MSN, BS, RN, administrative director of patient care services at Alexian Brothers Medical Center in Elk Grove Village, IL, said the facility's multidisciplinary team approach enables patients to report to their healthcare provider using telehealth when appropriate.
"Our education includes a dietary visit, a smoking cessation program and, if they will be homebound, then we connect them with telehealth," Addis said. Patients are taught to report their weight and blood pressure to the healthcare team.
At that point, nurses should identify issues that would prevent a patient from adhering to discharge instructions, too, according to Coffie. For example, patients without a scale are unable to weigh themselves, and individuals without an income cannot buy medication.
Sorting Through The Information
A challenge with teaching patients about self care is that the onslaught of information may be overwhelming.
Tonya Reese, MSN, RN, FNP, at Rockford Memorial Healthcare Systems, said her facility's approach is for nurses to spend longer visits with patients, teaching them about their condition and carefully explaining medication use.
Coffie shared these effective methods for sharing information:
- Utilize appropriate adult teaching methods - validate with the patient his perception of the information and the ability to translate that information after discharge.
- Chunk the information -offer information in small amounts and allow the patient to teach back. Offer the information throughout the hospital stay as well as the day of discharge, and start the outpatient discussion as soon as possible.
She also emphasized the importance of providing clear medication instructions. "Patients will often fill in the blanks themselves," she said. For example, a patient may have several medications for blood pressure and and then make decisions about usage. "They might cut pills in half to save money, or they might decide they only need one of the medications, so we need them to understand how to take them, when to take them and how to participate in medication administration."
Encouraging Family Members Beneficial
In situations where patients have the support of a caregiver or family member at home, Coffie said nurses should also bring those parties into the loop.
"When a loved one is involved, patients tend to do better with self care," she said.
Addis said dietitians meet with the primary cook of the patient's family, and Reese agreed it's beneficial to communicate with family members about concerns.
"Sometimes patients feel they are bothering us," Reese said. "But we would rather they call us right away with concerns. We schedule a time to sit down with the family, and have them be a part of the discussions and come to follow up. We remind them our goal is to keep patients out of the hospital."
Romi Herron is a frequent contributor to ADVANCE.