ppt for capstone

A Capstone Presented to the Faculty ofWestern Governors University

February 24, 2015Capstone Mentor: Traci Starkey PhD, RN

Assessment of RN Case Managers Knowledge of Current Evidence-Based Nutritional Guideline Recommendations for Heart Failure Patients

Personal Background7.5 years as staff nurse including on a

medical floor and on a PCU with primary population of cardiac patients

Last 7 years working as telephonic Case Manager for large health insurance company with the last two years working with heart failure population

Working with heart failure patients and contacting fellow RN’s patients realized lack of evidence-based education was being provided to patients

Introduction to Capstone

Literature ReviewLiterature review techniques utilized

Breadth of topicSources utilized

Best practice Effective non-pharmacologic interventionsEducating nursesEffective self-management education

Literature ReviewNonpharmacological Interventions

SodiumFluid

Barriers Affecting ImplementationMethodologies utilized to present educationHow patients process education

Behavioral and cognitive factorsPsychosocial factors

Literature Review Educating Nurses

Influencing factors determining the need for nurse educationSelf-efficacy of nurses in relation to perceived

barriersNurses confidence in ability to educate on heart

failure non-pharmacologic interventions

Barriers to continuing nurse educationTime constraints Support from leadership

Statement of the ProblemRN Case Managers are not properly

educated on updated nonpharmacological information in regards to heart failure (HF).

Affects of not being properly educatedObstacles to obtaining the information

Time available at workWork load of nursesLeadership’s attitude

Methodology Assessment created by the researcher to

assess RN Case Managers Knowledge of Current Evidence-Based Nutritional GuidelinesQualtrics program used to distribute surveyInformed consent and directions on

completionSurvey distributionLength of time to complete surveyExcel used to analyze data and create tables

and figures illustrating findings

Analysis and Quantitative Data

Table 1. Participant Demographic Data: Age

Age n= 20-40 11 41-60 18 61-70 4 >70 0 Total 33 Note. Participants’ responses to the question, “What is your age range?” from the assessment found in Appendix A. Table 2. Participant Demographic Data: Sex Sex n= Female 31 Male 2 Total 33 Note. Participants’ responses to the question, “Please indicate if you are male or female.” from the assessment found in Appendix A.

Age

Sex

Role in Organization


Table 4. Participant’s Level of Education in Nursing

Level of Education in Nursing n= % Associates Degree in Nursing 22 67% Nursing Diploma 2 6%

Bachelors of Science in Nursing 7 21%

Masters of Science in Nursing 1 3% Doctorate of Nursing Practice 0 0% Nurse Practitioner of any specialty area 1 3%

Total 33 100% Note. Participants’ responses to the question, “What is your highest level of education associated directly with the nursing profession?” from the assessment found in Appendix A

Table 5. Participants Years of Experience Working in the Nursing Profession Years in Nursing Profession n= % 0-10 years 8 24% 11-20 years 11 33% 21-30 years 7 21% 31-40 years 4 12% 40 years 3 9% Total 33 100% Note. Participants’ responses to the question, “How long have you been licensed and practicing in the nursing profession?” from the assessment found in Appendix A.

Level of Education

Years Working as a Nurse


Table 6. Participant Years of Experience Working as a Telephonic Case Management Nurse

Years of Experience as Telephonic Case Manager n= %

0-3 years 9 27% 3-6 years 9 27% 6-9 years 8 24% 10 + years 7 21% Total 33 100% Note. Participants’ responses to the question, “How many total years have you worked as a telephonic Case Manager?” from the assessment found in Appendix A. Table 7. Certified as Case Manager Certified Case Manager n= %

Yes 19 58% No 14 42% Total 33 100% Note. Participants’ responses to the question “Are you certified as a Case Manager by any certification organization recognized by the host institution?” from the assessment found in Appendix A.

Years of Experience as Case Manager

Certification as Case Manager


Figure 1. Participant Confidence Level in Heart Failure Nutrition

Figure 1- Percentage distribution associated with the question in the assessment located in Appendix A asking nurses to assess their level of confidence in knowledge of evidence-based nutritional guideline recommendations for heart failure.

Inexperienced, 0.00%

Beginner, 24.00%

Confident, 70.00%

Expert, 6.00%

Participant Responses

Inexperienced

Beginner

Confident

Expert


Figure 2

Sodium Intake for Stage A and B Heart Failure Answer

Response % 1500 mg/day

8 24% 2000 mg/day

16 48% 3000-4000 mg/day

0 0% No recommendations, ask physician for clarification

3 9%

Unsure

6 18% Total 33 100%

Figure 2. This figure illustrates frequency and percentage distribution for the question, “What does the ACCF/AHA use as a guideline for mg of sodium per day for patients with stage A and B HF patients.”

Figure 3. Sodium Intake for Stage C or D Heart Failure

Answer

n= % 1500mg/day

19 58% 2000mg/day

2 6% 2500mg/day

0 0% Insufficient data to support a specific mg/day recommendation

2 6%

3000-4000mg/day

0 0% Unsure

10 30% Total 33 100%

Figure 3. This figure illustrates frequency and percentage distribution for the question asking what stage C and D HF patients should limit sodium to per the ACCF/AHA guidelines.

Sodium intake for stage A & B HF per

ACCF/AHA is 1500mg/day

Sodium intake for stage C & D HF is

insufficient data to support a specific

mg/day recommendation.


Figure 4

Average Sodium Intake by the General Population

Answer

n= % 1500-2000mg

3 9% 2000-2500mg

2 6% 2500-3000mg

2 6% 3000-3500mg

10 30% >4000mg

7 21% Unsure

9 27% Total 33 100% Figure 4. The responses are to the question asking participants to indicate how many milligrams of sodium per day the general population averages.

Figure 5

High Sodium Foods

Answer

n= % A chicken breast

1 3% Beets

0 0% Baking Power

1 3% Ham

27 82% All of the above

4 12% None of the above

0 0% Unsure

0 0% Total 33 100% Figure 5. Frequency and percentage distribution of all answers to the question: “Which of these foods is considered high sodium?” from the assessment in Appendix A.

Average intake of sodium by the general population is more than 4000mg/day.

All are examples of high sodium foods.


Figure 6

Sodium Guidelines for Hypertension Patients

Answer

n= % Consume no more than 1500 mg/day

9 27% Consume no more than 2000mg/day



4 12% Consume no more than 3000-4000mg/day

0 0%

Unsure

4 12% Total 33 100% Figure 6. Responses illustrate frequency and percentage distribution for the question asking what the sodium guideline, according to the ACCF/AHA, for patients with hypertension.

The ACCF/AHA 2014 guidelines for patients with

hypertension is consume no more than 2400mg/day.

Figure 7

Fluid Restriction for Heart Failure Patients

Answer

n= % 1.5-2 gallons/day

2 6% 1-1.5 liters/day

14 42% 1.5-2 liters/day

3 9% Tailored per doctor recommendation only

9 27%

2.5 liters/day

0 0% Unsure

5 15% Total 33 100% Figure 7. Responses from participants expressed in frequency and percentage distribution for the question asking how much fluid is reasonable for an advanced HF patient to consume in a 24-hour period.

Fluid intake recommendation for patients with

stage C or D HF is 1.5-2L/day per

ACCF/AHA 2013 guidelines.

ResultsDemographic data resultsHost organization policy and procedure

resultsClinical guideline based question outcomes

Answer to research question

DiscussionCorrecting knowledge deficitsIndication for leadership intervention after

review of resultsType of interventionsNeed for assessment of leadership

knowledgeInvolve leadership more into future

projects/research

Conclusions and Suggested Changes

Needs of RN CMs for educationChallenges for nurses to gain necessary

knowledge and host organizations role in overcoming

Nurses educating nurses conceptMonthly requirementsTime allottments

Strengths and WeaknessesStrengths

Researchers familiarity with host organization’s education provided and participant obstacles to education

Identified deficitsEvaluation of nurses confidence level

Weaknesses Response rateAssessment of leadership knowledge

ConclusionsIdentified knowledge deficits in need of

urgent resolution Lack of researchFrequently changing guidelines and not just

heart failure

References

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