Client satisfaction with a nurse-managed clinic

To survive and thrive in today's competitive health-care market, health-care providers must evaluate outcomes of their services, including client satisfaction, then use this information to set standards. In the past, standards of care for the elderly were based on tradition rather than evaluation of their effect on outcomes (Thorsland, 1986). There are, therefore, few guidelines for evaluating outcomes of care in any setting and almost none for care of the elderly in nurse-managed centers. As a first step in evaluating client satisfaction in a nurse-managed clinic a focus group discussion was conducted with nine clients of the Nurse Education Link to Aged (NELA) Wellness Center. The focus group participants indicated that the Center had done an excellent job of meeting physical and emotional health needs of clients. Participants especially liked the location of the clinic in the apartment building where they live. Additional services requested by participants included programs for coping with depression and stress, alcoholism, and arthritis, and for increasing social interaction between men and women.     

A retrospective pilot study: management of patients with heart failure.

An epidemic disease - a major cause of chronic disability - congestive heart failure adversely affects the health of millions. Congestive heart failure is the most frequent cause of cardiovascular hospital admissions and shares a significant responsibility for the high cost of healthcare. Despite medical and technological advances, studies show that the treatment of heart failure is suboptimal. Physician knowledge and awareness of appropriate treatment may contribute to patient compliance and improve delivery of healthcare. The purpose of this article is to examine how patients with heart failure in a heart failure clinic are managed. Recommendations are proposed and the role of nurses and clinicians in heart failure management is discussed.     

A microcomputer-based information management system for a nurse-managed clinic.

A project team from a nurse-managed health care center designed and used a microcomputer-based information management system to document the activities of their clinic. Commercial software, dBase III Plus, was used to program the system, called Nurse Education Link to Aged Center (NELAC). NELAC reflects the center's philosophy of helping clients attain maximum satisfaction of their health care needs through self care. NELAC's specific purposes include 1) matching student nurses with potential clients for clinical experiences; 2) providing an efficient reminder system to improve follow-up care for clients; 3) maintaining longitudinal client records; 4) producing reports of services and activities of the center; and 5) providing aggregate data for research.     

How to start a nurse-managed foot care clinic

The goals of a nurse-managed clinic are to prevent illness and encourage an active participation in health maintenance by increasing patient knowledge. A nurse-managed clinic that focuses on foot care presents an excellent opportunity to provide quality care to patients who are at risk by monitoring for debilitating foot conditions while teaching proper foot care techniques. It is well documented that foot care can prevent serious complications, such as amputation, making it essential for patients to be educated and receive professional foot care. This article addresses the development of a foot care clinic managed and staffed by nurses.     

Impact of chronic heart failure on elderly persons' daily life: a validation study.

BACKGROUND: Knowledge about how elderly persons perceive the impact of chronic heart failure (CHF) on daily life is important when planning nursing care. For this purpose, disease specific instruments are needed. However, few instruments have been developed or tested specifically on elderly persons. AIM: To validate a Swedish version of the Minnesota Living with Heart Failure Questionnaire (LHFQ) on elderly persons with CHF, and use it to describe the impact of CHF on daily life in the same population. METHODS: The sample comprised of 357 persons, aged between 65 and 99, diagnosed with CHF. A questionnaire including background data, the LHFQ and the SF-12 was used. RESULTS: A factor analysis resulted in four dimensions: physical, emotional, treatment and pleasure. LHFQ showed convergent validity and ability to discriminate between known groups. Cronbach's alpha for the total scale was 0.94. Impairments in the physical dimension were most common, especially fatigue (88%) and shortness of breath (87%). CONCLUSIONS: The LHFQ showed satisfying psychometric properties in an elderly Swedish population with CHF and can, with minor alterations, be recommended for research and clinical use. The impact of chronic heart failure on daily life was mostly physical, but other impairments were also common.     

Health care needs of homeless adults at a nurse-managed clinic

Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the homeless. The purpose of this study was to establish baseline health data on homeless persons prior to attending a nurse-managed clinic.(1) This study was a cross-sectional, retrospective health survey of homeless clients at a nurse-managed clinic. A total of 110 participants completed a baseline health survey. Of these, 61% reported that prior to coming to the clinic, they used the ED as a source of health care. The most frequent medical diagnoses reported were substance use disorders, depression, back pain, hypertension, and asthma. Providing care for chronic conditions at a nurse-managed clinic has the potential to improve health and reduce use of the ED.     

Community development through faculty practice in a rural nurse-managed clinic

This article describes a community-academic partnership that led to the development of a nurse-managed clinic (NMC) in 1996 in a rural Indiana area designated by the state as a medically underserved area (MUA) and a health professional shortage area (HPSA). Application of the community development model in faculty practice is described in relation to the clinic. The project is ongoing; lessons learned to date, which have implications for others involved in faculty practice, are described.     

Development of self-care educational material for patients with heart failure in Japan: a pilot study

This study assessed the need for information regarding heart failure and self-care, developed self-care educational material, and investigated the feasibility of the material. A total of 22 hospitalized heart failure patients (mean age: 63 years) completed a self-administered questionnaire. We found that more than 90% of patients desired information, particularly about heart failure symptoms, time to notify healthcare providers, prognosis, and exercise/physical activity. After examining the eight existing brochures for Japanese heart failure patients, we developed self-care educational material. This was based on heart failure guidelines and on the results of our inquiry regarding information needs. Finally, a pilot study was conducted in nine hospitalized heart failure patients (mean age: 57 years). None of the patients had difficulty reading or understanding the educational material. The self-administrated questionnaire survey revealed that comprehension of the following improved after the educational sessions with the material: heart failure symptoms, medication, weighing, sodium intake, and fluid intake (P < 0.05). In conclusion, heart failure patients have a great need for information about heart failure. Our pilot study suggests that the material was readable and had a beneficial effect on heart failure comprehension.     

Adaptation of guidelines for the treatment of chronic heart failure in a specialized heart failure clinic

BACKGROUND: Chronic heart failure is associated with high mortality and morbidity. In spite of a number of trials showing significant improvement in survival and reduction in hospitalization for patients who received ACE inhibitors/AT1 receptor antagonists (ACEI/ARB), beta-blockers and spironolactone, and notwithstanding the recommendations of national and international guidelines for the management of heart failure, substantial proportions of patients are not receiving this treatment. The aim of our study was to analyse 1. the efficiency of a specialized heart failure clinic in translating guidelines into clinical practice, and 2. the effect of optimized neurohormonal therapy on patient outcome. METHODS AND RESULTS: The data of patients with systolic heart failure and an ejection fraction < or = 35% referred to the Innsbruck Heart Failure and Transplantation Program between February 2000 and October 2001 were analysed. The number of patients treated with ACEI/ARB, beta-blocker and spironolactone increased significantly in the investigation period (p < 0.05). Equivalent dose for captopril and bisoprolol per patient developed from 66.4 +/- 42.8 to 96.5 +/- 41.9 mg (p < 0.001) and from 2.0 +/- 2.9 to 6.3 +/- 4.0 mg (p < 0.001), respectively. Optimization of neurohormonal therapy was associated with a significant improvement in NYHA class (2.5 +/- 0.8 vs. 1.9 +/- 0.8; p < 0.001). No relevant changes were noticed for blood pressure, serum creatinine, serum sodium, and serum potassium, whereas heart rate dropped significantly. Kaplan-Meier curves examining the time to first event of the combined end point of mortality and hospitalisation for worsening heart failure revealed a clear benefit for patients on combined neurohormonal therapy (ACEI/ARB and beta-blocker, n = 86) when compared with patients on neurohormonal monotherapy (ACEI/ARB or beta-blocker, n = 35), (p < or = 0.001). Differences remained significant (p = 0.022) after adjusting for NYHA class at referral, age, gender, etiology of the underlying cardiomyopathy, ejection fraction, and atrial fibrillation in Cox regression analysis. CONCLUSION: Guidelines for the management of chronic heart failure patients can be translated efficiently into clinical practice by a specialized heart failure clinic. Optimization of therapy is associated with an improvement in functional status and a decrease in mortality or hospitalization for worsening heart failure. Therefore the nationwide installation of specialized heart failure clinics is required.     

Low literacy self-care management patient education for a multi-lingual heart failure population: Results of a pilot study

PurposeThe purpose of this pilot study was to test the impact of language-free, low literacy self-care management patient education materials in an ethnically diverse multilingual heart failure (HF) population.MethodsA one group pre-test–post-test design measured changes in self-care, knowledge and health-related quality of life (HRQL) after a 1 month intervention using language-free, low literacy self-care management patient education materials and delivered by a health educator.ResultsThe ethnically diverse sample (n = 21) was predominately male (72%), 48% Black, 42% Hispanic, and 28% marginal/inadequate literacy. There were significant improvements in self-care and knowledge but not HRQL.ConclusionsLanguage-free, low literacy self-care patient education may facilitate improved self-care and knowledge in diverse populations who are at risk for poor HF outcomes.     

A community model of group rehabilitation for older patients with chronic heart failure: a pilot study

Purpose. The aim of this study was to develop and evaluate a community-based programme for heart failure patients, with emphasis on exercise and education.

Method. In a before-and-after trial, subjects with heart failure underwent a 12-week group programme comprising of exercise, education and mutual support. Outcome measures included subjects' compliance and views of the programme, knowledge related to disease management, physical parameters (symptoms, exercise tolerance, muscle strength) and psychosocial well-being (using generic and disease-specific tools). A focus group was held and participants' feedback noted.

Results. Overall patient compliance and satisfaction rate was high. Significant changes were observed in knowledge, physical performance and psychosocial parameters. Subjects' feedback following the programme was generally positive.

Conclusions. This pilot study shows that a group programme for heart failure patients is feasible, acceptable and improved physical status and quality of life. It can be a useful model in the management of chronic disease in the community.     

Impact of comprehensive nurse-managed transitional care

The purpose of this study was to test the effect of nurse-managed transitional care on the quality of care and functional ability of individuals following discharge from subacute units. Registered nurses employed on subacute units in a skilled nursing facility provided the nurse-managed transitional care. Using a quasi-experimental design, data were collected on admission to the subacute unit, at the time of discharge, 1 week following discharge, and 3 months following discharge on 242 treatment and comparison participants. The treatment group participants' overall function and quality of the care environment were significantly higher than the comparison group at 1 week and 3 months following discharge. Participants did not differ significantly on basic activities of daily living or number of readmissions.     

The correlation of standard heart failure assessment and palliative care questionnaires in a multidisciplinary heart failure clinic

Context

Heart failure (HF) is a leading cause of death and disability, and despite optimal care, patients may eventually require palliative care. Little is known about how palliative care questionnaires (the Edmonton Symptom Assessment Scale [ESAS] and the Palliative Performance Scale [PPS]) perform compared with HF assessment using the New York Heart Association (NYHA) functional class and the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Objectives

To assess the utility of a palliative care questionnaire in patients with HF.

Methods

One hundred and five patients (mean age = 65 years, 76% male, mean ejection fraction = 28%) followed in an HF clinic were surveyed with the NYHA, PPS, ESAS, and KCCQ.

Results

The PPS and ESAS were each correlated to the NYHA class (P < 0.0001 for both) and the KCCQ score (PPS: R² = 0.57; ESAS: R² = −0.72; both P < 0.0001). There were 33 patients who either died (10 deaths) or were hospitalized (26 patients) for more than one year. In addition to age and gender, a higher (worse) ESAS score trended toward significance (P = 0.07) and a lower (worse) PPS was a significant (P = 0.04) predictor of all-cause hospitalization or death.

Conclusion

In a cohort of HF patients, we found a modest correlation with NYHA class and KCCQ assessment with the PPS and ESAS, two standard palliative care questionnaires. Given the difficulty in identifying patients with HF eligible for palliative or hospice care, these tools may be of use in clinical practice.