BACKGROUND Heart,failure nurse specialists strive to optimize patients' outcomes in home-based settings. OBJECTIVE To document the activities of home-based heartfailure nurse specialists. METHOD A modified narrative analysis of clinical notes of home-based heartfailure nurse specialists during a 12-month period was used. RESULTS Data analysis revealed 7 key activities of home-based heart failure nurse specialists: (1) monitoring signs and symptoms and reinforcing patients' self-management: identifying trends and appropriate action; (2) organization, liaison, and consultation with other health professionals to deal with changes in clinical status; (3) clarifying and reinforcing patients' sek-care strategies; (4) assisting patients in their desire to avoid institutionalized care; (5) identifying patients' psychosocial issues: dealing with social isolation; (6) providing support: journeying with patients and patients' families; and (7) helping patients and patients' families deal with death and dying. CONCLUSIONS A major proportion of the activities of home-based heart ail re nurse specialists are related to facilitating communication between health professionals and providing information and support to patients and patients' families.
American Journal of Critical Care Vol. 14, no. 5, p. 426-433