Improving Self-Efficacy in Heart Failure Patients Through Motivational Interviewing

Abstract

Problem & Purpose: Heart failure (HF) patients account for a large percentage of 30-day readmissions to the hospital which can produce grim consequences for both the institution as well as the patient. On the Progressive Care unit (PCU) at an academic medical center the HF readmission rate was close to 29% for fiscal year 2018. Literature supports the use of motivational interviewing (MI) for the improvement of self-efficacy and confidence in completing self-care in patients with HF. By improving self-efficacy patients can more successfully manage their HF at home, thus keeping them out of the hospital and promoting positive outcomes long-term. Methods: In July/August of 2019, 30 patients with HF on the PCU were surveyed using the SelfCare Index of Heart Failure (SCHFI) tool twice during their admission. Once toward the beginning and then again prior to discharge. This was done to evaluate the growth in their confidence level over their inpatient stay. Upon completion, nursing staff participated in hybrid format MI training including both in-person and online components. Participants were surveyed pre- and post-training to measure their MI communication skills. Following the trainings, nursing competency was assessed in MI. In November/December post-surveys were completed for 30 new HF patients on the PCU completed in the same way as the pre-surveys, with the confidence section of the SCHFI tool at two points in their admission. A paired t-test was used to test the significance of improvement. Results: Statistically significant improvement was seen in MI communication skills from pretraining (6.6/10) to post-training (8.6/10) using paired t test (p=0.0035). There was also a statistically significant improvement in likelihood to use effective communication skills pretraining (1.8/5) to post-training (2.4/5) (p=0.0216). There was statistically insignificant improvement in confidence growth in patients cared for by MI-trained nursing staff (M=3.77, SD=3.65) (t=2.99, p=0.02) than pre-MI-trained nursing staff (M=4, SD=2.60). Conclusion: Reducing readmissions by improving the confidence in HF patients will promote more positive patient outcomes overall. Reducing hospital length of stay and improving the current readmission rate of 29% on the PCU, contributes to a culture of patient safety and high quality patient care overall.