• Background Heart failure nurse specialists strive to optimize patients’ outcomes in home-based settings.
• Objective To document the activities of home-based heart failure nurse specialists.
• Method A modified narrative analysis of clinical notes of home-based heart failure nurse specialists during a 12-month period was used.
• Results Data analysis revealed 7 key activities of home-based heart failure nurse specialists: (1) monitoring signs and symptoms and reinforcing patients’ self-management: identifying trends and appropriate action; (2) organization, liaison, and consultation with other health professionals to deal with changes in clinical status; (3) clarifying and reinforcing patients’ self-care strategies; (4) assisting patients in their desire to avoid institutionalized care; (5) identifying patients’ psychosocial issues: dealing with social isolation; (6) providing support: journeying with patients and patients’ families; and (7) helping patients and patients’ families deal with death and dying.
• Conclusions A major proportion of the activities of home-based heart failure nurse specialists are related to facilitating communication between health professionals and providing information and support to patients and patients’ families.