Adaptation of a Clinical Practice Guideline for Home Care Nursing in Heart Failure Patients: A Multi-Method Study Publisher

Summary: How can home heart-failure care be guided? An Iranian expert adaptation produced 117 nursing recommendations across six domains; effects need evaluation. #HeartFailure #HomeCare

Hashemlu L ; Esmaeili R ; Bahramnezhad F ; Rohani C
Source: BMC Nursing Published:2026

Abstract

Background: The demand for home healthcare services for chronic conditions has increased due to the transition of care from hospitals to the home. This study aimed to adapt a Clinical Practice Guideline (CPG) for home-based nursing care of adult patients with heart failure in the healthcare system of Iran. Methods: This study was conducted using a multi-method design within the 10-step framework of the Practice Guidelines Evaluation and Adaptation Cycle (PGEAC). A systematic review was conducted in PubMed, Scopus, Web of Science, and nine publicly accessible CPG databases to find relevant guidelines. Subsequently, a robust CPG was selected based on the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) checklist. After translating the guideline, a search for supporting evidence was conducted in databases for each guideline recommendation, and the results were classified based on the level of evidence. Next, a qualitative study was conducted to strengthen recommendations with a weak evidence level and uncover additional recommendations and domains. The preliminary draft of the CPG was then evaluated in an expert panel meeting. In the final phase, the adapted CPG was validated through three Delphi rounds. Results: “Adapting Heart Failure Guidelines for Nursing Care in Home Health Settings,” was selected as an appropriate CPG with 145 recommendations within five domains. Following translation and evaluation of the evidence level, 26 recommendations were categorized in the weak level of evidence. In the qualitative phase, these recommendations were further examined, and also 26 new recommendations were developed; 12 under the domain of the “Generic care in heart failure” and 14 within two newly identified domains. Twenty-one recommendations were removed during the expert panel meeting, as well as 33 ones in the first Delphi round, due to duplication or not being applicable the Iranian healthcare system. The final adapted CPG included 117 recommendations within six domains. Conclusions: This adapted CPG provides a robust framework for nurses and other healthcare professionals to deliver home healthcare services for Iranian heart failure patients and their families. It can enhance the quality of home-based care, reduce hospital readmissions, improve patients’ outcomes, and the cost-effectiveness of home-based care programs. © The Author(s) 2026.