July 11, 2015
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Educating patients with HF requires multidisciplinary approach

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NEW ORLEANS — When educating patients with HF, engaging and activating them in self-care is essential. There are many factors to consider and no one single approach will work for all, according to a presenter at the AAHFN annual meeting.

Kismet Rasmusson

Kismet Rasmusson

“We’re in a time of patient-centered care, and we need to individualize our education to patients living with chronic illness like HF and provide it in a meaningful manner,” Kismet Rasmusson, NP, of Intermountain Healthcare in Salt Lake City, told Healio.com.

But educating patients with HF in a meaningful manner is a “complex endeavor” that requires not only meeting the unique needs of patients, but also considering their families or caregivers, she said. 

“We have to tailor education to any given patient based on their current knowledge, their health literacy and preferred method of learning,” Rasmusson said. “Cultural, ethnic, racial and gender differences must be considered. We also need to think about their social support and socioeconomic challenges.”

Diverse discussions, multidisciplinary approach

With 17 years of experience in the field, Rasmusson highlighted several areas of focus when working to activate patients with HF to take responsibility in the success of their own care.

“We need to provide patients with definitions of HF, to discuss the etiologies of HF, to talk about the types of HF such as reduced or preserved ejection fraction, to help patients understand the terminology, diagnosis, testing and the treatments, including medications, interventions, surgeries and devices,” she said. “We also need to teach them about the comorbid conditions that can occur with HF.”

Rasmusson underscored the need for patients to take on the self-monitoring and self-management of their condition every day.

“This revolves around following an HF-specific diet — typically low-salt and fluid-restricted — maintaining an active lifestyle, weight-tracking and taking medications as prescribed,” she said.

Symptom recognition is another critical component of patients taking charge of their self-care, according to Rasmusson.

“HF is a clinical syndrome when patients have symptoms of fatigue and/or shortness of breath that manifests as activity intolerance; it’s important for patients to track their trends,” she added. Recognizing problematic or changing symptoms, and connecting with a care team, is critical to avoid urgent or emergent situations that could require hospitalization.

“Often if you can catch symptoms early, you can possibly intervene in a clinic setting or over the phone and try and get patients back to a place where their symptoms are stable,” Rasmusson said.

With a 5-year mortality rate of approximately 50%, it is key for providers and nurses to focus on disease progression. “Patients need to understand the chronicity of this condition.”

Among the other topics essential to address are coping with this chronic illness, advanced directives and, in a select population, end-stage therapies including the prospects of heart transplant or mechanical assist devices, or alternatively palliative care, then hospice.

“There are many topics, and there are pieces of that education that will be done over time,” Rasmusson said. “Education can’t happen in one setting or at one time period. It has to be ongoing — in hospitals, clinics, with primary care, cardiologists, HF specialists, nurses and others. It’s really important to have that multidisciplinary team.”

AAHFN stance, standardizing care  

A position paper in Heart & Lung — developed by Rasmusson and colleagues, reviewed by members of the AAHFN Patient Education Committee and approved by the organization’s 2014-2015 board of directors — was central in the session held June 27 on integrating recommendations into practice.

“This paper helps the health care community understand the importance and complexity of educating patients using effective and evidence-based methods,” Rasmusson said.

Besides outlining the key topics to consider when educating patients, the report reviews evidence-based and theoretical approaches, and it offers specific recommendations for institutions and HF nurses, as well as resources.

“Approaches that have been used in the literature such as the teach-back method are very important.” Rasmusson said. The technique uses provider–patient dialogue to solidify understanding of action steps.

Attempting to educate patients upon hospital discharge presents a host of challenge, but studies and a survey conducted among AAHFN members show a potential solution.

“Typically, HF education has been called ‘discharge instructions,’ and we know this time is hectic, people want to get home, and there is a lot going on,” Rasmusson said. “There has been a reduction in readmissions when 60 minutes of HF patient education has been provided in the hospital setting.”

As laid out in the paper, the nurses’ and team approaches include family and caregivers in patient care, Rasmusson said. Further, community-based education is important to consider as a carry-over to the outpatient setting where patients reside.

Cultivating a strong institutional approach to HF patient education is critical, Rasmusson said.

“Administrations, hospitals and clinics need to support educating patients and, operationally, need to allow the time for education to occur,” she said.

Commitments to provide resources ensure that “education can happen in a consistent and standardized way across care settings in the hospitals and in the clinics,” Rasmusson said.

This ranges from having knowledgeable staff, opportunities for furthering their own education and having educational tools on-hand, she said.

Rasmusson shared the approach used within Intermountain’s 22-hosptial system to teach the five most important things patients with HF must understand: medications, activity, weight trends, diet and symptoms. Their educational method, known by its acronym MAWDS, uses “zones” that delineate times when action is needed.

“We created pocket guides with scripted messages about MAWDS as one example of a tool that can be given to nurses to help standardize the message delivered to HF patients,” Rasmusson said. “Institutional support to create or have such tools available will allow for nurses to deliver to patients is meaningful and understandable.” – by Allegra Tiver

References:

AAHFN Patient Education website. Available at: www.aahfnpatienteducation.com.

Rasmusson K, et al. Heart Lung. 2015;doi:10.1016/j.hrtlng.2015.01.001.

Rasmusson K, et al. Presented at: American Association of Heart Failure Nurses Annual Meeting; June 25-27, 2015; New Orleans.

Disclosure: Rasmusson reports no relevant financial disclosures.