Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2024


Doctor of Nursing Practice (DNP)

Primary Advisor

Cara Padovano, DNP, APRN


Heart failure (HF) principles; Chronic disease management; Nurse Navigator competencies; Self-care management


Background: Heart Failure (HF) is a complex, chronic cardiovascular disease effecting more than 6.5 million Americans over the age of 20 years old. The care provided by specialty nurses has been shown to improve disease outcomes and self-care management, significantly reducing unplanned hospitalizations, healthcare costs and patient mortality. Nurse knowledge in disease principles proven critical in caring for patients and in promoting an understanding of self-care management and symptom exacerbation. Current literature implies many nurses are deficient in disease knowledge and lacking understanding of self-care principles, impacting their ability to care for, or adequately teach proper disease management.

Purpose Statement: The purpose of this project was to develop, implement and evaluate the effectiveness of an evidence-based training program to 1) improve nurse navigator (NN) knowledge of heart failure (HF) patient management and clinical practice guidelines and 2) improve documentation of HF patient education and distribution of HF self- care instructional toolkits.

Methods: This project followed a quality improvement, evidence-based practice framework using a pre- posttest design to compare changes in NN knowledge of HF management and documentation of HF patient education before and after implementation of an evidence-based training program.

Results: Six HFNN’s completed the training program and pre-post assessment survey. A paired sample t-test demonstrated statistically significant differences when comparing mean pre-post knowledge scores per participant (mean, [SD], 0.41, [0.17]; t(6)=2.41, p=0.03) dictating improved competence in disease management. A two-sample z-test comparing the proportion of pre-post success scores demonstrated a significant difference, 0.19 (SD= 0.04); (z(6)= 4.87, p< 0.00). A two-way table displayed a 3% increase in patient compliance to HF education when supplemented with a CardioSmart toolkit.

Conclusion: Nurses and Specialty nurses must be properly educated in HF self-management principles to recognize symptoms of deterioration in complex heart failure patients, and practice knowledge and ability to assist during decompensation. Formalized and standardized trainings to improve clinical knowledge, quality of care and nurse directed patient education, imperative to promote health outcomes. As a means of increasing the rigor, transparency, and potential translation of HF research to practice, several gaps and key future directions should be considered. Research in HF should entail balance by sex, as lifetime risk of developing is equivalent. Also, research should entail the involvement of racial and ethnic minorities and marginalized populations, including those with language, economic, and/or health literacy disadvantages. There are also several clinical phenotypes of HF based on etiology (e.g. ischemic and non-ischemic), heart function (e.g. preserved vs. reduced ejection fraction) and/or severity that should be fully considered in the sampling frame of HF research. To move HF science forward, we must view HF as being much more complex than as it manifests in older Caucasian men with ischemic disease and participants that are from the whole social spectrum instead of only highly motivated patients who are interested in making behavioral changes.

Open Access




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