The Effect of Simulation on Heart Failure Self-care Maintenance, Symptom Recognition, and Self-care Management

Author: ORCID icon
Wypych, Paula, Nursing Practice - School of Nursing, University of Virginia
Wiencek, Clareen, NR-Nursing: Faculty, University of Virginia


Background Heart failure is associated with high morbidity and mortality, as patients undergo treatment and frequent hospitalizations. Heart failure patients and their support person are charged with implementing self-care behaviors to prevent heart failure exacerbations and hospitalizations. Patients often fail to implement these measures, recognize worsening symptoms or act on them when they arise. Gamification, though newer to heart failure, is an innovative avenue that may develop these self-care goals.

Purpose To study the effect of heart failure gamification on heart failure self-care maintenance, symptom recognition and self-care management in patients recently discharged with a heart failure diagnosis.

Methods This study utilized a quantitative quasi-experimental design. The study included patients who were admitted to an inpatient advanced heart failure unit. After traditional heart failure education, patients completed the Heart Failure Coach simulation game. The Self-Care in Heart Failure Index (SCHFI) v. 6.2 was completed by patients immediately after the simulation game while in the hospital, and seven days after discharge. After the game, patient knowledge gaps identified by the Heart Failure Coach game were reviewed, additional education provided, and a satisfaction questionnaire filled out.

Results 107 patients were screened while admitted for heart failure diagnosis on an acute care unit. Twenty patients were enrolled and 17 patients completed the study. One patient died prior to follow up and two were lost to follow up. The mean age was 61.15 years and the sample was mostly Caucasian (75%), male (65%), NYHA class III or IV (95%) and educated at or above the college level (75%). There was a significant increase in self-care maintenance and self-care confidence on the SCHFI (t = -3.769 [CI -24.58 - -6.88] p < .002 and t =-4.570 [CI -25.49 – -13.67] p < .001 respectively). Due to lack of symptoms, follow up SCHFI self-care management scores could not be assessed. Greater than 90% of the patients were satisfied with the Heart Failure Coach in areas self-care maintenance and symptom recognition and more patients (45%) requested additional heart failure education with the Heart Failure Coach versus traditional education methods (15%).

Conclusion Participation by patients admitted with a heart failure diagnosis in gamification with the Heart Failure Coach, showed a positive impact on heart failure self-care maintenance and confidence. Patients reported that the game was easy to use and well liked regardless of age. The Heart Failure Coach game provided a simulated and active learning environment to enact heart failure scenarios independently or with a support person. Further exploration of the use of heart failure gamification to effect self-care behaviors, particularly in symptom recognition and management, should be pursued.

DNP (Doctor of Nursing Practice)
Heart failure, Simulation game, Self-care, Gamification
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