1. Brandon, Amy BSN, RN, CCRN
  2. Ellison, Kathy Jo DSN, RN
  3. Schuessler, Jenny DSN, RN
  4. Lazenby, Ramona PhD, CRNP

Article Content


Based upon Orem's self-care deficit nursing theory, this study sought to determine the effect of a clinical nurse specialist (CNS)-led, telephone-based intervention on hospital admissions, quality of life (QOL), and self-care behaviors of heart failure (HF) patients.



Heart failure is a chronic condition that has become a major public health problem. The effects of HF pose daily challenges for those living with this debilitating illness. Frequent hospitalization related to HF exacerbation and a lack of knowledge concerning self-care requisites are barriers that individuals face when diagnosed with HF. Consequently, a poor QOL is often reported by HF patients.



A pretest and posttest experimental design was used for this study.



Participants were randomly assigned to either an experimental group that received the CNS-led, telephone-based intervention or to a control group that received usual care. Instruments used in the study included a demographic data form, the Minnesota Living with Heart Failure Questionnaire, and the 29-Item Revised HF Self-care Behavior Scale. Data were analyzed using a mixed-model analysis of variance with a pretest, posttest repeated-measures factor on readmissions, QOL, or self-care behaviors and an independent group's factor with the CNS intervention versus standard care. In addition, 1-way analyses of variance and t tests were analyzed to determine if selected demographic variables were related to readmissions, QOL, or self-care behaviors.



The results revealed a significant interaction in HF-related hospital readmissions over time for participants in the CNS-led, telephone-based intervention versus standard care (F = 7.63, P = .013) and a significant interaction in self-care behaviors over time in the experimental group versus the control group (P < .001). In addition, there was a significant relationship (P = .016) between New York Heart Association HF classification and QOL indicating that QOL worsened with increasing severity of HF.



The results of this study support the idea that CNSs positively impact HF patient outcomes, particularly by decreasing HF-related hospital readmissions and by improving self-care behaviors.


Implications for Practice:

Therefore, implementation of a CNS-led, telephone-based intervention warrants consideration in the care of patients living with HF.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.