The Effect of a Nurse-led Daily Weight Monitoring Intervention (Wake and Weigh) on Heart Failure Quality of Life and Self-care

Research question: Are the methods used in a pilot study that is designed to implement a nurse-led daily weight monitoring intervention, appropriate for a larger study to be conducted later, which will test the intervention's effect on self-care and quality of life among older adults with heart failure, compared to those who receive routine care? It may be unrealistic to expect patients to have the agency to perform adequate self-care when they are living with activity-limiting symptoms, and perceive that heart failure (HF) self-care instructions are complicated. Given that HF symptoms interfere with the ability to perform self-care, it is vital to concurrently address symptoms and self-care, while also attempting to reduce information overload. Therefore, the purpose of this pilot study is to implement a simple weight tracking tool to affect HF self-care and HF quality of life (using a measure that focuses on symptoms and quality of life) in a population of adults age 55 years and older who have HF, and test the methods to be used in a larger study.

1. The primary (exploratory) aims of this pilot study are to test methods to be used in a future randomized controlled trial:

2. Determine intervention fidelity by 1) examining unintended variations in intervention implementation by nurse investigators, and 2) evaluating use (versus no use) of the Wake and Weigh tool by participants.

3. Determine the feasibility of recruitment by assessing how long it takes to recruit 10% of the anticipated larger study sample size.

4. Determine the feasibility of randomization and retention for each group.

5. Test the use and appropriateness of the SCHFI and KCCQ in a population of recently discharged adults aged 55 years and older who have HF who had been admitted to a small regional hospital.

a. Test the appropriateness of the chosen measures by i. Determining percentage of completed SCHFI and KCCQ 2. The secondary aim for this study is to test participants' HF self-care and quality of life i. Reporting test scores for the SCHFI and KCCQ (descriptive) ii. Reporting results of additional questions on confidence, belief, and likelihood of use for Wake and Weigh tool (see variable list) iii. Reporting change in test scores if sample size allows. The setting for this study is a 126-bed regional hospital (Cleveland Clinic, Avon Hospital) in Northeast, Ohio. The hospital inpatient areas include adult medical-surgical units and a 12-bed medical intensive care unit. All inpatient areas in the hospital care for patients with HF. Participants for this study will be selected from a population of adult inpatients at the study site who have a new or existing diagnosis of HF.

The intervention for this study will be the introduction and implementation of the Wake and Weigh tool, which will be provided on hospital admission to patients with HF who are randomized to the intervention group. Currently, usual care education for weight and fluid management is delivered utilizing a HF handbook. Although the handbook is available, patient use of the weight record in the handbook is inconsistent. The handbook is given only on initial HF admission, whereas the Wake and Weigh tool is designed as an additional visual management tool, to remind patients to weigh upon waking and to monitor for weight changes. It is designed for any and all admissions for patients with HF. Further, the Wake and Weigh tool is designed to help patients learn to recognize weight changes through daily weighing, using nurse-led role modeling while they are hospitalized and for easy use at home after discharge.