Challenges Home Health Nurses Experience Transitioning Chronically Ill Heart Failure Patients from a Curative to a Palliative Level of Care

Home health nurses provide nursing care to acutely and chronically ill patients with a wide variety of diagnoses and comorbidities. Patients with heart failure present a unique challenge for home health nurses, because these patients transition from a curative to a palliative level of care and eventually to hospice care. Advanced heart failure results in an illness trajectory that often changes and may improve or deteriorate until the time of death. The purpose of this study was to describe the experiences of home health nurses assisting patients with advanced heart failure to transition to palliative or hospice care. Thirty home health nurses were recruited from four home health agencies located in the Southeastern United States. Data were collected through taped interviews and analyzed using qualitative thematic analysis research methods. Three main themes were identified: illness awareness, communication skills, and knowledge. Patterns emerged during the interviews showing factors that triggered the nurse to consider transitioning a patient to hospice or palliative care. Results indicated the nurses’ communication skills with the patient, families, and physician were a key factor in the timing of the transition discussion. Finally, a need for increased knowledge was expressed by nurses regarding disease trajectories, differences between home health, hospice, and palliative care, and ways to successfully transition patients to hospice or palliative care. The major conclusions of this research were that home health nurses would benefit from knowledge of indicators about the timing of conversations with patients and families; and that home care nurses are seeking ways to handle situations related to end-of-life care, including difficult situations when patients and/or families refuse to transition to hospice.