Patients with chronic conditions are heavy users of the health care system.

There are
opportunities for significant savings and improvements to patient care if patients can be
maintained in their homes. A randomized control trial tested the impact of 3 months of
telehome monitoring on hospital readmission, quality of life, and functional status in
patients with heart failure or angina. The intervention consisted of video conferencing and
phone line transmission of weight, blood pressure, and electrocardiograms. Telehome
monitoring significantly reduced the number of hospital readmissions and days spent in the
hospital for patients with angina and improved quality of life and functional status in
patients with heart failure or angina. Patients found the technology easy to use and
expressed high levels of satisfaction. Telehealth technologies are a viable means of
providing home monitoring to patients with heart disease at high risk of hospital
readmission to improve their self-care abilities.

This study was funded by The Richard Ivey Foundation, The Change Foundation
and an unrestricted educational grant from Merck-Frosst Canada.

Reprint requests: A. Kirsten Woodend, RN, MSc, PhD, Associate Professor,

University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth
Road, Room 3052, Ottawa, ON, K1H 8M5.

Copyright © 2008 Mosby, Inc. All rights reserved.

Heart & Lung: The Journal of Acute and Critical Care

Volume 37, Issue 1, January 2008, Pages 36–45

International Journal of Nursing Studies

Volume 49, Issue 10, October 2012, Pages 1230–1242

The effectiveness of telehealth care on

caregiver burden, mastery of stress, and
family function among family caregivers
of heart failure patients: A quasi-
experimental study
 Li-Chi Chianga,
 Wan-Chou Chenb, ,
 Yu-Tzu Daib, c, ,
 Yi-Lwun Hod, ,

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doi:10.1016/j.ijnurstu.2012.04.013
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Abstract
Background

Telehealth care was developed to provide home-based monitoring and support for patients
with chronic disease. The positive effects on physical outcome have been reported;
however, more evidence is required concerning the effects on family caregivers and family
function for heart failure patients transitioning from the hospital to home.

Objective

To evaluate the effectiveness of nursing-led transitional care combining discharge plans

and telehealth care on family caregiver burden, stress mastery and family function in
family caregivers of heart failure patients compared to those receiving traditional discharge
planning only.

Design

This is a quasi-experimental study design.

Methods

Sixty-three patients with heart failure were assessed for eligibility and invited to participate
in either telehealth care or standard care in a medical centre from May to October 2010.
Three families refused to participate in data collection. Thirty families who chose
telehealth care after discharge from the hospital to home comprised the experimental
group; the others families receiving discharge planning only comprised the comparison
group. Telenursing specialist provided the necessary family nursing interventions by 24-h
remote monitoring of patients’ health condition and counselling by telephone, helping the
family caregivers successfully transition from hospital to home. Data on caregiver burden,
stress mastery and family function were collected before discharge from the hospital and
one month later at home. Effects of group, time, and group × time interaction were
analysed using Mixed Model in SPSS (17.0).

Results

Family caregivers in both groups had significantly lower burden, higher stress mastery,
and better family function at one-month follow-up compared to before discharge. The total
score of caregiver burden, stress mastery and family function was significantly improved
for the family caregivers in the experimental group compared to the comparison group at
posttest. Two subscales of family function—Relationships between family and subsystems
and Relationships between family and society were improved in the experimental group
compared to the comparison group, but Relationships between family and family members
was not different.

Conclusions

The results provide evidence that telehealth care combined with discharge planning could
reduce family caregiver burden, improve stress mastery, and improve family function
during the first 30 days at home after heart failure patients are discharged from the
hospital. Telenursing specialists cared caregivers with the concepts of providing
transitional care to help them successful cross the critical transition stage.

Keywords
 Telehealth;
 Telenursing;
 Discharge planning;
 Family caregiver;
 Heart failure

Corresponding author at: NTU Telehealth Center, NTUH East Wing B Block, 3rd
Floor, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Tel.: +886 2 2356
2872; fax: +886 2 2356 2885.

Copyright © 2012 Elsevier Ltd. All rights reserved.