Implementation of a nurse-led education programme for chronic heart failure patients during hospitalisation, and strategies supporting their self-management at home: a practice development project in the context of the Swiss healthcare system

This study focuses on nursing practice for patients with chronic heart failure (CHF). The aim is to reflect on a practice development project to improve patient care in a person-centred way and to implement evidence into practice. The project consists of two phases with individual aims and evaluation processes. Part one describes the development, implementation and evaluation of an education programme for CHF patients. The goal is to change nursing culture by involving the healthcare team and to build up skills and expertise. Part two describes the further development of the programme through integration of the patients’ perspective. Methods: A person-centred approach formed the basis for changing nursing practice. The development and implementation of the CHF programme was carried out via action research, to expand the healthcare team’s knowledge and improve patient outcomes. A mixed methods design was chosen for the evaluation of the pilot programme. Grounded theory was used to examine the perspective of the patients. Findings: In the first project phase, an educational programme for CHF patients was developed using action research. Key elements were multiple training sessions for nurses and skills training for hospitalised CHF patients. The educational topics were based on the patients’ needs. The programme evaluation showed that the patients were well prepared for hospital discharge but that their needs concerning their living situation were not sufficiently considered. Patients were not adequately prepared for the problems that occurred once they were at home. The second phase of the project focused on patients’ perspectives. Using the grounded theory method, a model explaining factors that benefit or hinder self-management was developed. The key phenomenon in this method was intrinsic motivation for self-management, meaning the ability to achieve the feeling of being ‘at ease with oneself’. Conclusion: Initiating change in practice that considered the healthcare team and the patient’s perspective was challenging and complex. A combination of different methodological approaches was required. The healthcare team needed to broaden its expertise to sustain the developments in practice. The change process required intensive support and supervision of the team over time. A thorough examination of the patient’s perspective indicated ways to optimise the education programme. Using the person-centred approach and integrating the healthcare team and patients into the programme, as well as working over several years, were all fundamental elements for successful practice development.