Louise LaFramboise

Comparison of Health Buddy with traditional approaches to heart failure management.

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy®) and (b) compare the effectiveness of the Health Buddy® with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy® issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.

Predictors of modifications in instrumental activities of daily living in persons with heart failure.

Objectives: The objective of this study was to identify factors related to disability in heart failure (HF) patients using a modified version of the model of disability proposed by Nagi. The hypothesized relationships among pathology (severity of HF and comorbidity), impairment (dyspnea, fatigue, muscle strength), functional limitation (functional capacity), and disability (modification in instrumental activities of daily living [IADLs]) were assessed as well as the influence of age and sex on pathways to disability. Methods and Results: Using a cross-sectional design, a convenience sample of 48 men and 53 women (mean age, 59.5 years) with New York Heart Association class II-IV was recruited at a HF clinic. Path analyses via Amos revealed that 71% of the variance in modifications in IADLs was explained by the significant predictors of dyspnea (B = .67), functional capacity (B = −.25), and age (B = .19). Dyspnea and comorbidity also had indirect effects on modification in IADLs through functional capacity. Age also had an indirect effect on modification in activities of daily living through functional capacity, and sex had an indirect effect through dyspnea and functional capacity. Conclusion: Patients with HF may benefit from interventions targeted at reducing dyspnea with daily activities and improving functional capacity to prevent disability.

Predictors of Cognitive/Affective and Somatic Depression in Heart Failure Patients:

The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.

A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure

Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η2) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η2 = .015) and functional status (η2 = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η2 = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention’s underlying physiological effect is needed.

Collaborative Student Leadership Conference.

In April 2008, the New Careers in Nursing (NCIN) Program launched a collaborative initiative between the American Association of Colleges of Nursing and the Robert Wood Johnson Foundation. One of the main goals of this initiative was to provide leadership development through structured activities for NCIN scholars. In order to meet this goal, 3 participating NCIN schools came together to plan and conduct a collaborative student-focused, scholar-led leadership conference for accelerated nursing students. Admittedly, collaboration among institutions of higher education is sometimes not a standard practice. Although sharing the common goal of preparing future nurses to provide high-quality care, many schools of nursing often compete for scarce resources including recruitment of faculty and students, securing clinical placements, and new graduates and alumni compete for jobs. However, there are advantages to sharing financial and intellectual resources in order to ensure a richer educational experience for NCIN scholars and for all accelerated nursing students. Using the Robert Wood Johnson Foundation monies awarded for our Legacy Project, 3 NCIN program liaisons overseeing accelerated nursing programs in Nebraska met to discuss the advantages and disadvantages related to planning and conducting a collaborative student leadership activity for NCIN scholars and their peer-accelerated nursing students. The program liaisons wanted to establish common goals for the endeavor and ensure the use of approaches that would foster leadership development of the NCIN scholars and establish mechanisms by which the group would create a collaborative environment. Although the 3 collaborating colleges were and continue to be competitors for prospective accelerated students, the benefit of collaborating on a joint leadership development project for the NCIN scholars and their peers was clear. Program liaisons recognized that this opportunity would strengthen leadership development and provide relevant experience for the NCIN scholars and result in a conference for other accelerated nursing students.