Date of Award
Doctor of Philosophy (PhD)
Heart Failure (HF) patients are at increased risk for higher rates of hospital readmission within 30 days. Previous studies have demonstrated educational interventions delivered by nurses reduce readmission but the relationship of the dose of teaching to HF readmission or ED utilization remains unclear. A retrospective correlational design framed by the General Outcomes Effectiveness Model was utilized to (1) establish a relationship between the dose of discharge teaching documented by acute care nurses and the outcomes of hospital readmission and ED utilization within 30 days of a previous hospital discharge and (2) identify the teaching components included in an evidence-based education plan essential to discharge preparation. The sample consisted of 1383 unique HF patients from 4 hospitals and 29 units of a large Midwestern healthcare system. Electronic Health Record (EHR) and billing data were extracted and linear regression and direct entry logistic regression procedures were performed to answer the research questions. Patients were more likely to be readmitted for every unit increase in the aggregate teaching component dose or for every unit increase in the activity level teaching component dose. Patients were less likely to be readmitted with each additional exposure to sodium restriction teaching. Patients were more likely to experience an ED visit within 30 days with each additional unit of fluid restriction teaching provided and less likely to have an ED visit with each additional unit of diuretic teaching provided. No association was found between the number of discharge teaching components received and hospital readmission or ED utilization within 30 days of discharge. Patient characteristic and clinical conditions did not moderate the relationship between discharge teaching and outcomes. Although there were conflicting findings, this research adds to the study of nurse dose by utilizing nursing documentation from the EHR to link the nursing care process of discharge teaching to the outcomes of hospital readmission and ED utilization within 30 days of discharge. Further research is needed to clarify the relationship between the type and dose of HF teaching and patient outcomes.
Available for download on Sunday, May 12, 2019