Can an evidence based coaching intervention improve outcomes for older people with congestive heart failure (CHF) and their informal caregivers within their own homes? Cécile (Belgium) Carmen (Sweden) Andrew (UK) Hannele (Finland) Anne (Germany) Elisabet (Spain )

The European Academy of Nursing Science 2 DEVELOPMENT 1. BACKGROUND (LITERATURE REVIEW)  Congestive heart failure (CHF) is a significant predictor of repeated hospitalization  Research has shown that older people with CHF prefer to remain at home  Caring for elderly people with CHF is a significant burden on informal caregivers  Informal caregivers play a crucial role in supporting people with CHF within their homes  There is a need for strategies for supporting caregivers to manage people with CHF in their home environments 2. IDENTIFY THEORY  Social cognitive theory (Bandura)  Increase in knowledge and skills result in changed behaviour and improved self efficacy  Achieved through goal setting, active learning, guided practice and reinforcement

Modelling Process and Outcomes Based on Multiphase Optimization Strategy (MOST (Collins et al, 2007) Screening phase (identify active components of CHF coaching ) Systematically review the literature Review of evidence based clinical practice guidelines Qualitative phenomenological explorations of patients, health professionals and caregivers perspectives Consultation with stakeholders Refining Phase Piloting the proposed intervention and evaluation of the pilot study Confirming Phase Definitive effectiveness study modelled on the pilot study (RCT) The European Academy of Nursing Science 3

PICOD P = Older people (+ 65) with CHF I = Coaching of informal caregivers by community nurses C = Care as usual O = Caregiver burden/periods of time at home between hospital admissions D = Cluster RCT (Sweden) The European Academy of Nursing Science 4 OutcomeCaregiverOlder people CHF Primary outcomes Lower levels of caregivers burden (caregiving burden scale) Greater periods of time at home between hospital admissions (hospital records) Secondary outcomes Increased knowledge on heart failure (questionnaire) Decreased frequency of hospitalization Home care preparedness (questionnaire) Improved QoL Increased heart failure home management skills

Feasibility/Piloting Interviews and survey (caregiver/older people) Development of an evidence based nurse coaching training course Program consists of:  Initial nurse assessment of the environmental and individual factors  Initial nurse led coaching based on the initial assessment of needs  Follow up support and guidance via telephone  Based on American heart failure home skills checklist Pilot Study  Two cluster sides (urban and rural)  Identifying barriers and facilitators (training, delivery of the intervention)  Acceptability  Recruitment of individuals in the study The European Academy of Nursing Science 5

Thank you for your attention The European Academy of Nursing Science 6