Improving outcomes for Older Adults with Heart Failure: A randomized Trial Using a Theory-Guided nursing Intervention

Contributor: Margaret Dexheimer Pharris
September 18, 2018

Quality Improvement/Theory Exemplar

Duffy, J. R. (2005). Implementing the Quality-Caring Model© in Acute Care. The Journal of nursing administration, 35(1), 4. Journal of Nursing Care Quality, 2010 Jan-Mar;25(1):56-64. doi: 10.1097/NCQ.0b013e3181ad0fbd

Key Nurses involved

Joanne R. Duffy, PhD, RN, FAAN
Lois M. Hoskins, PhD, RN, FAAN
Sharon Dudley-Brown, PhD, FNP-BC

Theoretical framework

The Quality-Caring Model is the foundation for care; it prioritizes relationships at two levels–between patients and nurses and with the entire care team. Joanne Duffy explains that the Quality-Caring Model “exposes the hidden value of nursing (caring), guides practice, and provides a foundation for outcomes evaluation and research. In this model, the evidence-based practice environment of present-day healthcare is simultaneously merged with the caring processes of nursing. Caring values, attitudes, and behaviors dominate the process of care.”  (Duffy, 2005)

Project Description

This work aimed at improving quality of life for older adults with heart failure, Duffy, Hoskins and Dudley-Brown sought to evaluate the impact of a Quality-Caring Model home health nursing intervention on intended patient outcomes and resource requirements, as well as to identify unanticipated problems or operational difficulties in delivery of the intervention. They recruited 32 patients into a randomized control trial with one group receiving the intervention (15) and a control group (17) receiving usual home visits.

Evaluation Methods

Prior to delivery of the Quality-Care Model, study participants completed the Living with Heart Failure Questionnaire and the Home Care Client Satisfaction Instrument-Revised. Additionally nurses completed a telephone log to document intervention utilization and content along with nurse opinions of effectiveness and efficiency of visits. The researchers analyzed the Nursing Discharge Summary/Last Clinical Visit Note in the patients’ medical records to gather information about achievement of pathway-defined goals. Resource consumption was measured by the number and length of home visits and telephone interactions. Researchers reported patient recruitment to be challenging and a need to attend to health system referral patterns and admission criteria in future projects.

Outcomes

Although the small sample size inhibited the ability to draw statistically significant conclusions, analyses revealed improvements in patient satisfaction, hospital readmission, and quality of life for the intervention group. The researchers determined that including a relationship-centered caring approach when recruiting patients directly and emphasizing the benefits of having increased time with a known nurse could aide future work.

Theoretical Implications

There is widespread appreciation of the extent to which nursing theory-guided relational care improves patient experiences and outcomes. Duffy and Hoskins demonstrate a method for measuring the outcomes of care rooted in the Quality-Care Model. To further explore the relationship between human caring nursing theory and the evidence based practice milieu of healthcare practice, see “The Quality Care Model: Blending Dual Paradigms” by Joanne Duffy and Lois Hoskins in Advances in Nursing Science, 2003, 26(1), 77-88.

Publications

Duffy, J. R. (2005). Implementing the Quality-Caring Model© in Acute Care. The Journal of nursing administration, 35(1), 4. Journal of Nursing Care Quality, 2010 Jan-Mar;25(1):56-64. doi: 10.1097/NCQ.0b013e3181ad0fbd

Duffy, J. R., & Hoskins, L. M. (2003). The Quality-Caring Model: blending dual paradigms. ANS. Advances in nursing science, 26(1), 77–88. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12611432