Education and Ethics In Nursing ISSN: 2322-5300

Systematic Protocol for Adapting a Clinical Guideline for Education and Home‑Care in Older Adults with Heart-Failure After Hospital Discharge: Mixed‑Methods Study

https://doi.org/10.22034/ethic.2026.2096521.1248
Volume 15, Issue 1
June 2026
Pages 143-154
Education and Ethics In Nursing ISSN: 2322-5300

Document Type : protocol study

Authors

Mahrokh Keshvari 1
Tayebeh Karimi 1
Maryam Sadat Hashemi 2
Ali Norouzi 3
Negar Farajzadeh-Dehkordi 1

1 Nursing and Midwifery Care Research Center, Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Nursing and Midwifery Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

3 School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract
Introduction:
Heart failure is associated with frequent hospital readmissions and high mortality. In Iran, there is a gap between international guidelines and local practice, particularly in home care and self care education, which emphasizes the need to adapt clinical practice guidelines. This study aimed to design an integrated framework to adapt a clinical guideline for heart failure management, with a focus on structured self care education in home care for older adults and on strengthening the role of nurses in post discharge education.
Methods:
This mixed methods study was developed based on a ten step framework for guideline adaptation. The steps included forming an expert team, defining the scope and key questions using the PIPOH framework, conducting a systematic search for relevant guidelines, and assessing their quality with the AGREE II tool. Selected recommendations were reviewed using the GRADE ADOLOPMENT approach and Evidence to Decision tables to decide whether to adopt, adapt, or develop new recommendations. Expert consensus was achieved using the RAND/UCLA Appropriateness Method, and barriers and facilitators to implementation were analyzed with the Theoretical Domains Framework.
Results:
A clear, step-by-step protocol for selection, evaluation, and adaptation of heart failure guidelines in the Iranian health system is presented. This includes a custom implementation package, structured educational programs for nurses, patients, and caregivers, and standardized home monitoring tools. This approach is expected to enhance knowledge, skills, and self-care among older adults with heart failure.
Conclusions:
By combining guideline adaptation, expert consensus, and implementation science frameworks, this protocol offers a practical tool to reduce the gap between evidence and practice and improve the quality of care. Standardizing self care education, designing nurse led educational programs, and integrating education into the home care pathway after discharge may help reduce rehospitalizations and increase health system efficiency. Applying this protocol in future studies and real clinical settings will allow evaluation of its impact on patient outcomes and health system performance.

Keywords

Heart failure
Aged
Home Care Services
Adaptation
Practice Guideline
Education
Subjects
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