s. brian widmar phd, rn, acnp-bc ann f. minnick phd, rn, faan mary s. dietrich phd
DESCRIPTION
Hospital Care Structure and Self-Care Education Processes of Ventricular Assist Device Programs: A National Study. S. Brian Widmar PhD, RN, ACNP-BC Ann F. Minnick PhD, RN, FAAN Mary S. Dietrich PhD 2012 State of the Science Congress on Nursing Research. Acknowledgements. - PowerPoint PPT PresentationTRANSCRIPT
Hospital Care Structure and Self-Care Education Processes of
Ventricular Assist Device Programs: A National Study
S. Brian Widmar PhD, RN, ACNP-BCAnn F. Minnick PhD, RN, FAAN
Mary S. Dietrich PhD
2012 State of the Science Congress on Nursing Research1
Acknowledgements
• Use of the VU REDCap Survey service• Grant support: UL1 TR000445 from NCATS/NIH
2
Significance: Why VAD Self-Care Processes?
• ↑prevalence and incidence of CHF• 2007: 5.2 million, 550,000 annually• 2011: 6 million; 670,000 annually
• Increasing indications for VAD therapy• VAD has emerged as HF therapy– 2007: 208 patients 2011: 1,450 patients
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Why Self-Care Processes• VAD care is complicated, continually
demanding and intimidating to patients
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Why Self-Care Processes
• VAD is an exemplar of new technology requiring self-care processes – what is learned about VAD may help with other technologies.
• Professional experience with different methods of VAD education
5
Gaps and Unknowns
• How VAD patients learn self-care• How self-care education is provided; resource
utilization• Extent to which type, method, and/or
provider of self-care education influences outcomes
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Aim
• To describe care structures and self-care education processes used in VAD hospitals
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Methods and Analyses• AIM: To describe care structures and self-care
education processes used in VAD hospitals– Concepts: Definitions and measurement– Questionnaire development and testing– AHA Data– Human Subjects Protection
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Administration• Sources of VAD Hospital Addresses• Inclusion criteria• 111 eligible• 3 cycles, 3 weeks apart• Paper or internet option
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Methods
• AIM: To describe care structures and self-care education processes used in VAD hospitals– Response rate: 64%– Generalizability tests
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Results:Organizational Framework
• More than half of VAD programs reported to > 2 departments
• > 75% of VAD Coordinators reported to >2 administrators
• Patient-to-Coordinator census– Median = 15; IQR (10, 20); range 2-40 pts/VC
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Results: Healthcare Structure – Organizational Framework
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Healthcare Provider Assignments in VAD Hospitals (N =71)
Healthcare ProviderAssignment Type*
% of row1 2 3 4
Cardiac Surgeon 4 96 0 0Heart Failure Cardiologist
6 90 3 1
Clinical Nurse Specialist 4 31 17 48
Nurse Practitioner 23 54 11 13Discharge Planner 3 69 13 16Biomedical Engineer 14 45 24 17Pharmacist 7 61 27 6Social Worker 9 86 6 0Physical Therapist 1 70 27 1Clinical Psychiatry 3 47 32 17Clinical Perfusionist 4 61 24 11Home Health Nurse 3 27 47 24Respiratory Therapist 3 41 45 11Dietician 4 76 20 0Chaplain 1 45 44 101 = Works with VAD Program Only2 = Same provider regularly assigned but also works with other kinds of patients3 = Not regularly assigned to VAD program, but is available as needed4 = Provider not currently available to VAD program
Note. Items may not add to 100% due to rounding. *Values in cells are row %s.
Results: Health Care Structures – Caregiver Role Delineation
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Results: Health Care Structures – VAD Coordinator Role Delineation
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Role Components (N = 71)Role Component % Role Component %
Development of VAD nursing education
96 Database entry of clinical data 79
On-call patient care responsibilities
95 Direct care nursing (outpatient) 75
Train staff at Subacute/Rehabilitation Facility
93 Maintain inventory of VAD equipment
74
Emergency Response Personnel (EMS) Education
93 Advanced practice nursing (inpatient) 59
Provide nursing staff education 90 Case Management 58Evaluate nursing staff education 85 Direct care nursing (inpatient) 56Research (Outcomes or Clinical) 85 Advanced practice nursing
(outpatient)55
Train housestaff 82 Other 17
Self-Care Education Processes: LVAD Self-Care Validation (N = 71)
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Skill Return Physical Demonstration
%
Skill Return Physical Demonstration
%Battery Changes 99 Emergency Management 52
Dressing Changes 99 Patient Showering 51
Self-Testing System Controller
94 Recognizing Infection 42
Care of the LVAD Percutaneous Driveline 90
Hemodynamic Monitoring 27
Sterile Technique 89 Medication Management 27
Alarm Troubleshooting 59 CHF Symptom Management
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Power Source Changes 54
Self-Care Education Processes:% of Programs Using Only 1 LVAD Self-Care
Evaluation Method (N = 71)
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Skill % Using 1 Method
Skill % Using 1 Method
Medication Management 54 Battery Changes 32CHF Symptom Management 52
Hemodynamic Monitoring 31
Dressing Changes 44Care of the LVAD Percutaneous Driveline 30
Sterile Technique 44 Power Source Changes 28Self-Testing System Controller 42 Emergency Management 21
Patient Showering 39 Alarm Troubleshooting 17Recognizing Infection 37
ResultsCapital Inputs
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Materials Used by Hospitals for VAD Patient Self-Care Education (N = 71)Resource Frequency Used
%Written material developed by device manufacturer/others
96
Verbal Instruction 96Written material developed by hospital or unit 90DVD 89Internet Website(s) 66CD-ROM 21Videotape 18Audio CD 11Podcasts 6Other 17
Self-Care Education Processes: Patient Support
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Organizational Resources for VAD Patients and Family/Caregivers (N= 71)
Resource% of Hospitals with Resources
Available to: Patient Family/Caregiver
Patient Counseling 73 65VAD Support Group Meetings 56 56Hospital Website 45 45Patient-Provider E-mail Correspondence 45 44
Patient Picnics 24 24Facebook/Social Networking 14 14Internet listserv/ Discussion forum 9 9Internet Chat Rooms 6 6
Results: Cluster Analysis (N = 66)
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Cluster A (N = 29) Cluster B (N = 37)
CapitalInputs
Additional Materials Used for Education
Videotape 45% reported use 0% reported useAudio CD 21% reported use 5% reported useInternet Websites 76% reported use 65% reported usePodcasts 14% reported use 0% reported useCD-ROM 14% reported use 30% reported use
Support Processes
Additional Resources Used for Patient and
Family/Caregiver
Patient Picnics 48% reported use 3% reported useInternet Listserv/Discussion Forums
21% reported use 0% reported use
Internet Chat rooms 14% reported use 0% reported useSocial Networking Sites 35% reported use 0% reported use
LaborSum of Healthcare Providers
on VAD Team83% Same providers work regularly with VAD program, others are available as needed
81% Same providers work regularly with VAD program, others are available as needed
DemandActual Number of VAD
Implants in Last Fiscal YearMedian = 16, IQR = 10-36 Median =21, IQR = 9-38
Limitations
• Additional VAD hospitals may exist but not likely
• Lack of financial/budget information
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Implications: Clinical
• VAD programs should evaluate their existing care processes and supportive resources• Use > 1 method for validation• Use of simulation?
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Implications: Future Research• Measurement of patient centered care
satisfaction with SCE within VAD hospitals*• Explore relationship of patient satisfaction
with patient service usage and health outcomes
• Explore relationships of VAD program SCE elements and other patient outcomes– Mortality, quality of life, complications
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Implications• Evaluate VAD coordinator preparation to teach
• Evaluation of current staff RN and VAD Coordinator orientation programs– Are current methods of orientation and training
adequate?
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Next Steps
• Describe reports of patient preference for– Methods used for self-care training– Methods used for evaluation of self-care
• Exploration of patient and family/caregiver perceptions of difficulty of VAD care skills
• Exploration of Staff RN and VAD Coordinator orientation programs
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Next Steps
• Apply a similar approach to the cardiac transplant patient population
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Questions?
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