Challenges in Heart Failure Disease Management in Skilled Nursing Facilities: A Qualitative Study

Abstract

Clinical guidelines recommend clinicians in skilled nursing facilities (SNFs) monitor body weight and signs and symptoms related to heart failure (HF) and encourage a sodium restricted diet to improve HF outcomes; however, SNFs face considerable challenges in HF disease management (HF-DM). In the current study, we characterized the challenges of HF-DM with data from semi-structured, in-depth interviews with patients, caregivers, staff, and physicians from nine SNFs. Patients receiving skilled nursing care were interviewed together as a dyad with their caregiver. A data-driven, qualitative descriptive approach was used to understand the process and challenges of HF-DM. Coded text was categorized into descriptive themes. Interviews with five dyads ( n = 10 individuals), SNF nurses and certified nursing assistants ( n = 13), and physicians ( n = 2) revealed that, among the sample, HF care was not prioritized above other competing health concerns. Staff operated in the challenging SNF environment largely without protocols or educational materials to prompt HF-DM. [ Journal of Gerontological Nursing, 48 (5), 13–17.]

Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility

“…Due to the limited controls in place during the present investigation, further research is needed to confirm the HFMP's effectiveness. Multiple barriers to the consistent application of evidence-based recommendations for HF patients in the SNF setting exist (Morrow et al, 2022). A limited number of previous interventions have decreased HF-related hospital readmission through a coordinated approach to care delivery, particularly outside of the U.S. (Boxer et al, 2013;Daamen et al, 2015;Friedman et al, 2021;Manemann et al, 2017).…”