I agree with your statement that “self-care and outpatient treatment will reduce hospitalization for patients” with heart failure. When I worked as a manager at Sub-acute rehab, I encountered many patients with a diagnosis of heart failure that were lacking self-care and outpatient treatment. In that circumstance, they were re-admitted to the hospital multiple times when they went into heart failure exacerbation. At home they had difficulty breathing, their lower extremities were so swollen that they couldn’t put their shoes on and they were scared. After acute care they were referred to my unit for a rehab and in that case, I placed a referral to a Palliative Care team for a chronic disease management and comfort care. According to “Palliative
Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body 's needs for blood and oxygen. Basically, the heart can 't keep up with its workload. American Heart Association Statistics (2016) reveals that heart failure accounts for 36% of cardiovascular disease deaths. Projections report a 46% increase in the prevalence of Heart Failure (HF) by 2030 by affecting over 8 million people above 18 years with the disease. Healthy People 2020 goals are focused on attaining high quality longer lives free of preventable diseases, promotion of quality of life, healthy development and healthy behaviors across all stages of life (Healthy People 2020, 2015).
Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of
When nursing any patient with heart failure it is important to have an understanding of how the heart should work to understand how it stops working correctly. This knowledge is important as writtler (2006) (cited in Jones) feels that district nurses have little knowledge when it comes to heart failure. Patient, Writler (2006) feels that by understanding how the heart works and how it is damaged we, as district nurses will be able to recognise the signs of heart failure earlier7a?.
The heart is an organ that pumps oxygenated blood to the body and deoxygenated blood to the lungs. Heart failure is when the heart can’t pump blood very well. If the heart fails to work properly, a major system called the circulatory system won’t work properly and therefore the whole human body will fail to work properly because the cells won’t be able get oxygenated blood and use the oxygen to undergo cellular respiration and make energy.
Evaluation is the final and often the most critical step in evidence based research and practice. Evaluation of evidence based practice follows a pathway beginning with the selection of the area for improvement, synthesizing the research into a process improvement activity and evaluating both the implementation of the process improvement as well and the outcomes of the intervention (Titler, 2008). To measure the results of process change in the management of heart failure patients a retrospective analysis will be conducted comparing the readmission rates of a pilot and control population over a 6-month period. The pilot population will be evaluated with the LACE index readmission risk assessment upon admission and subsequently receive the recommended interventions based on the risk stratification. In comparison, the control group will receive the current process of telephonic contact only. The pilot group will include patients over the age of 18 residing in zip-codes 45402 and 45403,
According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having
Heart failure (HF) is a debilitating condition that has become a public health problem. There are many debilitating effects of HF for many people that have to live with this disease. According to Hardin and Hussey (2003), recognize inadequate patient education, poor symptom control, and insufficient social support as factors that contribute to preventable HF related hospitalizations (p.p.74). Many people are frequently hospitalized because of HF exacerbation related to lack of knowledge, poor quality of life and medication non adherence. This research proposal determines the effect of Advance Practice Nurse led telephone intervention in the community and how their phone calls would improve the outcomes of patients with Heart Failure. This proposal identifies variables and measurement levels, research methodology and conclusion. The results of the research studies will support the idea that Advanced practice nurses has a positive impact on patients with HF, decreasing HF related hospital admissions and improving their quality of life.
established the clinical problem that heart failure is associated with high morbidity and poor prognosis (Hobbs, et al., 2007). She further added that it decreases patients’ quality of life as it places a heavy burden on them, as well as their families, as well as the huge negative impact on health care resources (Iqbal, et al, 2010), contributing to lost productivity from unplanned hospital admissions. The authors presented the research problem strongly, stating that there is a limited study of the role of specialized heart failure nurses in the multidisciplinary team in managing heart failure patients, thus warranting a further investigation to be conducted. Special nurses, as defined by Glogowska et al, are experienced senior nurses who are involved in providing medical, psychological and emotional support that begins at the initial diagnosis of heart failure and continues onward. They provide transitional care in assisting patients manage their heart failure. The research article focus on the experiences and perceptions of clinicians in managing heart failure patients, and it aims to understand the special role of specialized heart failure nurses in the interdisciplinary team. The authors designed to answer the following questions when conducting this study:
Congestive Heart Failure (CHF) and Heart Failure (HF) are serious problems in regards to hospital re-admissions especially regarding the sixty-five year old population. Data demonstrates approximately over 670,000 individuals each year are diagnosed with CHF, along with that there are 6 (six) million Americans affected with CHF. Hersh, Masoudi, and Allen (2013) described readmissions of patients with CHF is increasing by 25% within thirty days of discharge from the hospital. This creates a huge impact on the taxpayers and patients due to the increasing percentages being re-admitted into the hospitals (Post discharge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Re-admission, 2013). The problem is to identify a plan to decrease the CHF/HF hospital re-admissions into the especially regarding the 65 (sixty-five) year olds and older, in spite of efforts from the hospital staff providing guidelines and nursing education regarding CHF/HF signs and symptoms.
Congestive Heart Failure (CHF) is a foremost health problem worldwide, touching 4.8 million U.S. patients and accounts for 978,000 or 5-10% of all hospitalizations. Some estimates show 550,000 new cases of CHF diagnosed each year in the United States alone. Currently, CHF accounts for 20% of all discharges in the over age 65 categories; with the aging demographic, this statistic is expected to increase significantly. Overall, the cost of treating CHF is very high -$38 billion annually in the U.S., representing 5.4% of total health care costs and involves many physician visits - at least 11 million ambulatory visits per year. The mortality rate for CHF is high, with one in five persons dying within 1 year, more than half of the CHF patients
During exacerbations of Congestive Heart Failure (CHF), older patients may receive care in multiple settings; often resulting in fragmented care and poorly-executed care transitions. The negative consequences of fragmented care lead to duplication of services; inappropriate or conflicting discharge instructions, medication errors, patient/caregiver anxiety, and increased costs of care. In light of changes in Medicare reimbursement penalizing hospitals with above set limits for heart failure (HF) readmissions, models of care are being evaluated for their effectiveness in satisfying this change as well as reducing fragmented care in this population. This paper reviews the Transitional Care Model created by Dr. Mary Naylor at the
This literature review has been conducted with ten primary research articles and or/systematic literature reviews to draw a conclusion to the clinical question: what is the best evidence based nursing practice in relation to reducing hospital readmissions in patients with chronic heart failure. Heart failure patients have multiple hospital illness, due to their condition being undermanaged; majority of reasoning for readmissions can be prevented (Lambrinou, Kalogirou, Lamnisos & Sourtzi 2011). Kalogirou et al. (2011) states the patient’s lack of knowledge regarding their disease and non-adherence to their medications, and inability to detect signs and symptoms of decomposition of diseases. Along with gaps in health care result in frequent, very preventable hospital re-admissions. In relation to what is the best evidence based nursing practice in relation to reducing hospital readmissions in heart failure patients the literature studied draw on three common themes a multidisciplinary approach, nurse-led patient education and nurse-led telecommunication.
According to the Heart Foundation (2010), “Best-practice management of chronic heart failure (CHF) involves multidisciplinary care” (p. 3). A care coordinated with his different physicians including cardiologist, pulmonologist, and referring physicians, as well as clinical nurses, and dieticians will be an important step in Mr. P’s CHF care. As they are concerned about the mobility outside of their home, a telephonic follow-up after discharge from the hospital, and door delivery of medicines could be beneficial. It is also very important to help him to overcome his polypharmacy. Since Mrs. & Mr. P seem emotionally weak, they need emotional support to cope up with the situation. They are worried about the heaping medical bills. Provide information about the possibility of getting qualified for Medicaid/Medicare as well as grants from organizations like Patient Access Network
Background: Heart failure is a serious progressive disease. It is also a common illness requiring multiple medications and significant self-care behaviors. Self-care behavior is important for patients with heart failure to prevent worsening of the disease. Self-care is an important aspect of non-pharmacological management of heart failure as it comprises key behaviors that have been shown to improve clinical outcomes for patients.
Extraneous variables are undesirable variables that influence the outcome of an experiment, though they are not the variables that are of actual interest (Grove, Burns, & Gray, 2013). Family influence could be an extraneous variable that would need to be addressed. Establishing a family intervention would control this extraneous variable. There are few family intervention studies for heart failure. Many patient education guidelines promote inclusion of family in teaching heart failure patients. The structure and nature of family relationships are important to mortality and morbidity. It is clear that those patients living alone are a vulnerable group to target. Isolation leads to depression, which could relate to poor self-care behaviors. Family interventions have shown to improve outcomes and lower patient hospital readmission (Dunbar, Clark, Quinn, Gary, & Kaslow, 2008).