Study: Caregiver Confidence Plays a Major Role in Heart Failure Patient Outcomes

One of the largest health conditions affecting Americans is heart failure.

About 6.2 million Americans experience it every year, with home care workers often called upon to help.

Just as is with many other conditions, however, home care workers are often ill-prepared to deal with these patients and lack specific training. That’s problematic because “preparedness, mutuality and self-efficacy” in caregivers are all incredibly important aspects for outcomes and worker satisfaction, a recently published study in Journal of Cardiovascular Nursing found


In other words, if caregivers have been properly trained, they are more likely to perform well at their jobs.

“It’s about workers’ confidence and preparedness, and how that contributes to their ability to care for patients,” Dr. Madeline Sterling, a health services researcher in the Division of General Internal Medicine at Weill Cornell Medicine, told Home Health Care News. “How confident workers feel is almost like the mediator between how prepared they are and how much they’re contributing to care.

The Journal of Cardiovascular Nursing study involved a total of 317 home care workers employed by 22 different agencies across New York. The group’s median age was 50; 94% of participants were women.


“So theoretically, in an intervention down the road, you could think that training is one factor, but then also measuring confidence with those skills in heart failure could also be a really important factor,” Sterling said. “Interventions need to hit on those factors — confidence and training — to ultimately improve worker outcomes, but also patient outcomes as well, down the road.”

Self-care and self-management are major parts of dealing with heart failure, but those patients often have comorbidities that affect their ability to care for themselves appropriately. Having cognitive, functional and sensory impairments makes self-care harder on the patient, which is often why a home care worker is enlisted. 

The conclusion of the study, which Sterling led, finds that simple improvements to the intervention process could go a long way.

“Home care workers’ preparedness, mutuality and self-efficacy have important roles in influencing their contribution to heart failure self-care,” the study reads. “As a workforce increasingly involved in the care of patients with heart failure, knowing the mechanisms underpinning home care workers’ contribution to self-care may illuminate future interventions aimed at improving their contributions and heart failure patient outcomes.”

For the home care industry, this is one way to improve staffing.

If caregivers don’t feel confident or prepared to do their jobs, they’re more likely to leave that job, or leave the industry entirely.

“Any type of quality training and instruction is great for caregivers and it’s needed more than ever,” Brandi Kurtyka, the CEO of myCNAjobs, told HHCN in an email. “Training is inconsistent across employers and oftentimes only done for compliance. A caregiver is more likely to leave a job if they don’t have the knowledge to do the job well, which means managing clients with specific disease states.”

Chicago-based myCNAjobs is a professional caregiver network that works with home care and home health workers, as well as providers in both fields.

The home care industry’s turnover rate hit an all-time high of 82% in 2018, but rebounded to about 64% in 2019, according to the Idaho-based market research and education firm Home Care Pulse.

As demand rises for home care, competition in staffing could become an even larger trend in 2021 and beyond.

“Training is an investment in your team,” Kurtyka said. “When you strategically invest in your people, you’ll attract and retain the best talent. You’ll also build an army of caregivers that truly know how to deliver the best care, aren’t afraid to ask questions, and feel like they’re growing.”

The concept seems simple, but is often overlooked in home care.

“We’re starting to see greater bifurcation in the industry,” Kurtyka said. “Some companies are accelerating and others are struggling. The companies that are leapfrogging value their people. I think it starts there.”

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