Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Susan Dean-Baar, Ph.D., R.N., CENP, FAAN


Karen Monsen, Ph.D., R.N., FAIMA, FAAN


Anne Fish, Ph.D., R.N., FAHA, FAAN

Kimberly Werner, Ph.D.

Jean Bachman, Ph.D., R.N.


Purpose/Background/Significance: For the past 30 years, heart failure has been in the top 3 readmission diagnoses with patients discharged to community care. This is costly to the healthcare system and negatively impacts the patient’s quality of life. The purpose of this study is to evaluate a community care database to determine if previously under-considered latent variables exist that could provide early detection of heart failure signs and symptoms. Theoretical/Conceptual Framework: The theoretical and conceptual frameworks surrounding this work are the Omaha System and Donabedian’s structure, process, and outcomes theory for healthcare quality improvement supported by Neuman’s Systems Model. The Omaha System was constructed on the combined basis of these theoretical underpinnings by three components: The Problem Classification Scheme, The Intervention Scheme, and The Problem Rating Scale for Outcomes. Methods: This study was a retrospective, descriptive, observational, comparative study using secondary data. Major HF-associated signs and symptoms related to problems of circulation and respiration were queried. Latent Class Analysis (LCA) was used to identify if other significant groupings of signs and symptoms were associated with heart failure signs and symptoms. Findings: Evaluation of the sample for signs and symptoms of HF related to the Omaha System Problems of Respiration and Circulation revealed 4215 individuals. LCA revealed four significant groupings of signs and symptoms related to the problems of Mental health, Cognition, Heart failure and General/Other. Further analysis determined that the HF group had the most interventions and visits yet had the lowest change in Knowledge, Behavior, and Status scores indicating that HF required intensive outpatient care to maintain their status in the community care environment without benefiting from significant final status improvement. Analysis revealed that patients with Cognition group benefited the most from increased visits and interventions.

Conclusion: Patients exhibiting signs and symptoms of heart failure may also experience signs and symptoms of Mental health and Cognition changes, which may either contribute to heart failure exacerbation, or be as a result of the heart failure disease process. Further research is needed to examine possible mechanisms that may help defer HF exacerbations.

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