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Chronic health failure is a leading cause of hospital readmissions and is reaching epidemic proportions in the United States. Explanatory models of illness can provide insight about how people with heart failure perceive their etiology of heart failure. Six themes were found in this descriptive, qualitative study to explore the perceived origin of heart failure in 50 participants. Forty percent of the people were unaware of why they had the diagnosis. Misconceptions and misinformation were common, including confusion about whether the symptoms themselves caused the disease.

Background The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. Objective The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. Methods This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. Results The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). Conclusions An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.

Critical incidents can be defined at sentinel events, critical patient care issues, or any patient event outside the normal parameters of care. Nurses are central to maintaining the standard of care for patients in these situations. Miscommunication, including inadequate communication and illegible or incomplete documentation, forms a basis for many clinical and interpersonal problems in nursing practice. This practical article discusses expectations, both professional and legal, for avoiding and/or managing critical incidents. Suggestions for assessment parameters to report are included in table format, which the nurse can 'clip and use' as a reminder of data to have prepared before calling and/or presenting the problem. Steps are proposed for a logical, organized plan to help the nurse communicate more effectively. Recommendations for essentials of documentation regarding the verbal interaction and orders received are also presented.