It's been well established that there is a high prevalence of chronic heart disease among Hispanics and blacks, yet many may lack the education or skills to manage their illness. A randomized trial conducted in Harlem, a mostly nonwhite neighborhood in New York City, has shown that nurses can improve outcomes in these populations.
Patients with heart failure (46% were black, 33% Hispanic, 15% white, 6% "other"; 54% didn't have a high school education) at four hospitals were randomized into either a "usual care" group (n = 203) or a nurse management group (n = 203). In the latter group, nurses taught patients about the physiology of heart failure, the relationship of sodium intake to fluid buildup and shortness of breath, and how to follow a low-sodium diet. Nurses also discussed adherence to medication regimens, physical activity, smoking cessation, and avoiding alcohol. They gave patients a scale and taught them to weigh themselves daily, record their weight, and call their clinician if symptoms got worse. An initial meeting was followed by regular phone calls from the nurse over 12 months for further counseling and reinforcement. Nurses coordinated care with the treating physician and made medication recommendations according to an evidence-based protocol.
At the end of 12 months, there were fewer hospitalizations in the intervention group (143 versus 180), and patients in that group maintained physical functioning at the "slightly impaired" level, compared with the usual care group, whose physical function declined to "markedly impaired." At the end of the year, patients who had received the intervention began to lose function at the same rate as patients in the usual care group. The authors concluded that a nurse-led, evidence-based protocol "can improve functioning and modestly reduce hospitalizations" in predominately minority ambulatory care patients who have systolic dysfunction and a low level of education. They also noted that "[c]ontinued contact with a nurse seemed to be needed to maintain the intervention's effect."
Fran Mennick, BSN, RN