Date of Conferral



Doctor of Nursing Practice (DNP)




Andrea Jennings-Sanders


Heart failure is a chronic disease and a common cause of hospitalizations and readmissions within 30-days of discharge. To decrease the cost of care for patients with heart failure, the Centers for Medicare and Medicaid Services initiated the Readmissions Reduction Program that reduces payment to hospitals with preventable readmissions. Among the causes for readmissions of patients with heart failure are concurrent behavioral health issues that can lead to decreased medication compliance and increased risk for disease progression. The prevalence of comorbid depression is as high as 77% among patients with heart failure and may be an important factor in readmissions. Although cardiac nurses in the emergency room, intensive care unit, and the progressive care units at a community hospital were perceived by managers to be in optimal settings to assess for behavioral health issues and make referrals as appropriate, assessments were not being conducted. The purpose of the project was to determine the barriers nurses faced in completing the assessments. Four audiotaped focus groups with a total of 18 cardiac nurses were held and the data were transcribed for analysis. Using Kalcaba's comfort contexts (physical, psychospiritual, social, and environmental), the barriers identified by the nurses were categorized into a fishbone diagram and a Pareto chart. The nurses identified lack of a standardized screening tool, lack of priority given to behavioral health assessments, lack of time to conduct the assessments, and lack of a clear facility policy related to the assessments as barriers. A positive social change resulting from the project is an initiative to address the barriers and ensure that patients with heart failure are cared for in a holistic manner that addresses physical and behavioral health issues.