Satisfaction with Patient-Centered Care and Self-Care Education in Left Ventricular Assist Device Patients

Abstract

NURSING SCIENCE

SATISFACTION WITH PATIENT-CENTERED CARE AND SELF-CARE EDUCATION IN LEFT VENTRICULAR ASSIST DEVICE PATIENTS

STEVE BRIAN WIDMAR

Dissertation under the direction of Professor Ann F. Minnick The study’s purposes were to: a) describe care structure and ventricular assist device (VAD) patient self-care education processes used in hospitals, and b) describe VAD patient reports of patient-centered care and satisfaction with care. The study used a prospective cross-sectional design. AIM 1: A mailed 26-item survey, based on the Minnick and Roberts framework, was sent to all VAD centers in the United States (N = 111) in 2011. Two subsequent mailings with computer or paper completion options resulted in a return rate of 63% (n = 71). AIM 2: A 59-item survey, adapted from the Health Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey and from Young & Minnick (1996), was completed via telephone with five patients receiving VAD therapy from one high-volume VAD hospital. Programs varied in their use of Advanced Practice Nurses and VAD coordinator advanced practice inpatient nursing (p < .05). There was no standard method of providing postoperative VAD patient self-care education or evaluating self-care across hospitals. Most VAD programs (75%) used more than two resources in providing self-care education in addition to education materials provided by the VAD device manufacturer. Almost half of VAD programs (46%) used more than two methods of self-care evaluation for each skill set. Patients were satisfied with patient-centered care and self-care education, and were grateful for regained independence and reduced heart failure symptoms. Patients reported uncertainty regarding their performance in emergencies. Preparation of local non-VAD hospitals to care for VAD patient health emergencies was identified as a need. Further research is needed to explore relationships between VAD care processes and other outcomes such as survival and readmissions. Understanding the processes of self-care education and patient reports of patient-centered care after VAD implantation is necessary to improve VAD education and outcomes.