Practice Tip of the Week | Targeting Heart Failure: A Clinician-Focused Project

By Ebony S. Gebrehawariat, BSN, RN and Laura Kincheloe, Ed.D., MSN, RN, NE-BC 

Cardiovascular disease (CVD) and heart failure (HF) are chronic conditions impacting hundreds of thousands of people every year. In 2023 alone, an estimated 920,000 people died from cardiovascular disease, which equates to approximately 1 in every 3 deaths (CDC, 2025). The most common type of heart disease is coronary artery disease, which kills more than 370,000 each year (CDC, 2022). In Texas, heart disease and stroke remain in the top three causes of death. 

Problem and Purpose

Gaps in home health clinician knowledge, skills, confidence, and care coordination practicesmay limit timely recognition of worsening heartfailure and appropriate intervention. The purpose of this project is to assesshow a comprehensive heart failure (HF) education program, compared with no program, can affect clinician knowledge, skills, attitudes, and practice behaviors in HF carea mong home health Licensed Vocational Nurses (LVN ) and Registered Nurse (RN) clinicians.

The goal  of the project is to improve patient outcomes by reducing potentially preventable hospitalizations (PPH) and unplanned emergency room visits. The educational resources emphasize d include:

While there was a targeted purpose and aim to the overall project, educational  objectives included: 

The Johns Hopkins Evidence-Based Practice (JHNEBP) Model guided this project through the Practice Question, Evidence, and Translation (PET) process. This framework  facilitated the systematic identification of the practice problem, appraisal of the best available evidence, and  translation of evidence into a clinically meaningful educational intervention for home health clinicians.

Literature Search & Appraisal

A comprehensive literature search was conducted using databases including CINAHL, PubMed, and Google Scholar. Search terms included heart failure, home health , early recognition , fluid overload , care coordination , SBAR, and preventable hospitalizations. Evidence was limited to peer-reviewed articles, clinical guidelines, and systematic reviews published within the last 5–10 years. The 2022 AHA/ACC/HFSA Guideline for the Management of  Heart Failu re served as the primary clinical reference. Articles were appraised for quality and relevance using the Johns Hopkins Evidence Appraisal Tool

The literature consistently  demonstrated that early recognition of worsening heart f ailure  symptoms, structured communication, patient education, and timely intervention are key strategies for reducing hospital readmissions. Evidence supported  the use of standardized assessments, daily weight monitoring, SBAR communication, and multidisciplinary care coordination as effective components of heart failure management in post-acute and community-based settings. Educational interventions targeting clinician knowledge and confidence were shown to improve adherence to evidence-based practices and clinical decision-making.

Implementation

This project was implemented in a home health setting, where LVN/RN clinicians provide skilled nursing care to patients with chronic  heart failu re. Home health clinicians are uniquely positioned to detect early clinical changes; however, variability in experience, assessment practices, and access to structured HF education may  impacttimely  escalation of care. This setting was selected due to its critical role in preventing potentially preventable hospitalizations.

The intervention consisted of a novel, interactivesuperhero-themed educational experience (“Heart Heroes: Saving Mr. Heartwell”), delivered over a three-month period. The program emphasized:

Education was delivered using a gamified escape-room format, incorporating case-based scenarios, riddles, and decision-making challenges. Clinician outcomes were evaluated using paired pre- and post-surveys measuring knowledge, skills, attitudes, and self-reported practice behaviors.

Results

Participation in a comprehensive superhero- themed, escape-room educational intervention resulted in statistically significant improvements across clinicianconfidence, knowledge, skills, and attitudes related to heart f ailure  management. Post-intervention survey results demonstrated a consistent shift toward higher confidence and agreement scores (4–5) across all measured domains:

The greatest mean improvements were  observed in early recognition of worsening heart f ailure and baseline determination, indicating enhanced clinical vigilance and assessment accuracy. Improvements across all domains suggest strengthened readiness for timely intervention and escalation, which may reduce delays in care associated with potentially preventable hospitalizations (PPH).

Key Findings (Paired Pre–Post Analysis)

Participation in a superhero-themed, escape-room educational intervention resulted in statistically significant improvements across clinician confidence, knowledge, skills, and attitudes related to  heart failu re management. Confidence in determining a patient’s heart fai lure baseline improved significantly (mean increase +1.2, p < .01), reflecting enhanced ability to identify stability and deviations from baseline. Focused cardiac assessment skills demonstrated a significant increase (+1.1, p < .01), supporting improved bedside assessment in the home health setting. The largest improvement was observed in early recognition of worsening  heart failu re (+1.3, p < .01), indicating strengthened clinical vigilance and timely identification of decompensation. Clinician advocacy for escalation and intervention improved (+1.0, p < .05), suggesting increased confidence in SBAR communication and recommending evidence-based actions. Knowledge and skills related to heart fai lure pathophysiology, self-management education, and guideline-based care improved overall (+1.1, p < .01). Attitudes related to professional responsibility and motivation showed moderate-to-large improvement (+0.7, p < .05), reinforcing clinician ownership in preventing potentially preventable hospitalizations. Large effect sizes (Cohen’s d ≥ 0.8) across most domains indicate meaningful and practical educational impact beyond statistical significance.

Implications for practice

The use of an interactive, gamified educational format suggests that innovative delivery methods may be effective in improving clinician engagement, knowledge retention, and translation of evidence into practice. These findings support the scalability of this educational intervention as a low-cost, adaptable strategy for improving  heart failu re management practices in home health settings. Future implications include integrating structured chart audits and outcome tracking to evaluate the sustained impact of improved clinician behaviors on PPH and emergency department utilization.

References

Brockway, Kaelee (2024) . Leveraging Gamification and Social Media to Teach Heart Failure Clinical Practice Guidelines in Entry-Level Physical Therapist Education. Journal of Innovation in Health Sciences Education : Vol. 1: Iss. 3, Article 2.

Centers for Disease Control and Prevention. (2024, October 24).  Heart disease facts. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.htm

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A.,  Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E.,  Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of  Heart Failu re. Journal of the American College of  Cardiology , 79 (17). https://doi.org/10.1016/j.jacc.2021.12.012

Lukey, A., Mackay, M., Hasan, K., & Rush, K. L. (2023). Clinical Perspectives on the Development of a Gamified  Heart Failu re Patient Education Web Site. Computers, informatics,  nursing : CIN, 41 (8), 615–620. https://doi.org/10.1097/CIN.0000000000000983

Malicki, A., Vergara, F. H., Van de Castle, B., Goyeneche, P., Mann, S., Preston Scott, M., Seiler, J., Meneses, M. Z., & Whalen, M. (2020). Gamification in Nursing Education: An Integrative Literature Review.  Journal of continuing education in nursing,  51(11), 509–515. https://doi.org/10.3928/00220124-20201014-07

Verma, A., Heidenreich, P. A., &  Ziaeian, B. (2023). Opportunities for change in home health care in heart failure. JACC:  Heart Failu re , 11(10), 1449–1453. https://doi.org/10.1016/j.jchf.2023.02.018