The Effect Of Advance Practice Nurses During The Community And How Their Phone Calls Improve Their Quality Of Life

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

In this essay, I am going to consider how evidence-based practice can be used to support, justify, legitimate and/or improve clinical practice. I am also going to explore and discuss primary and secondary research evidences about how nursing interventions can potentially improve the quality of life of patients in the community suffering from heart failure. I will gather these evidences using a literature search which I will include an account of. Using a critiquing framework for support, I will appraise both primary and secondary evidences that I have chosen. I will also look at potential non-evidential factors that can influence evidence utilisation in practice. Finally, a conclusion will be drawn.

Heart Failure affects nearly 5.8 million people in the United States. The American Heart Association reports that the total economic cost of heart disease and stroke in 2011 was $320.1 billion. ("Efforts to Prevent Heart," 2015). More Medicare dollars are spent for the diagnosis and treatment of heart failure than for any other diagnosis (Schneider, O'Donnell, & Dean, 2011). Hospital admissions for heart failure are very common, especially among Medicare aged patients, and heart failure hospital readmissions are a major contributor to rising healthcare costs. Evidence suggests that factors influencing readmission rates for heart failure patients include knowledge deficits in nursing education, standardized patient education, and transitional

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?.

My phenomenon of interest is: The effect of health promotion on the outcome of African- American heart failure patients. Heart failure is fast becoming prevalent among African -Americans due to high incidence of CAD and hypertension. African Americans have the highest mortality rates from chronic diseases. Evidence depicts health promotion as vital to the outcome of heart failure patients. The role of nursing in health promotion has been shown to promote positive outcomes such as adherence, knowledge of illness and improved quality of life. There is a need to decrease readmission and mortality rates in African American heart failure

Hospitals nationwide have been striving to reduce the rate of patient readmissions. Both the federal government and private insurers are tired of picking up the tab. In a 2009 study in the New England Journal of Medicine, researchers estimated that a year's worth of unplanned re-hospitalizations cost Medicare alone $17.4 billion. Congestive heart failure is a particularly big target, as one in four patients end up back in the hospital within 30 days of discharge. Starting in the fall of 2012, the government will cut Medicare reimbursements for hospitals with higher-than-expected 30-day readmission rates for heart failure and two other conditions: heart attack and pneumonia (Avril, 2011).

Congestive Heart Failure (CHF) patients and their consistent trending of hospital re-admissions continue to threaten quality care and patient quality of life. Considered a chronic condition, CHF is diagnosed in approximately 13% of patients 85 or older (Clarke, Shah & Sharma, 2011). Re-admissions have become so prevalent among the CHF populations, that Centers for Medicare has initiated a quality campaign and offers incentives when hospitals implement telemedicine programs and show reduction in CHF hospital admissions. In relation to CHF, Conway, Inglis, and Clark (2014) states that, “Telemedicine involves transmission of physiological data, such as weight, … from the measuring device to a central server via telephonic, satellite,

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

A resident at the time saw that although there is a hearty amount of evidence that illustrates that adhering to heart failure guidelines decreases the rate of mortality and morbidity, nationally there is modest adherence to heart failure practice guidelines. Doctors have voiced a multitude of reasons to this poor participation including but not limited to time constraints in a visit, inertia of patterns in practice, lack of awareness and lack of acceptance are a few. This new web-based tool, the “Smart” Heart failure sheet is designed to help connect previously compartmentalized information. It seeks to link guidelines to their patients’ clinical and laboratory characteristics and systematize adherence to heart failure guidelines. It accomplishes this by uploading pertinent patient-specific data, including laboratory and imaging results, procedure reports and relevant medications. Additionally it also provides tools, such as a flow chart for diuretic dosage and weights. Overall this tool is useful to help physicians identify patients who may benefit from a treatment. From there it provides support tools that alert the physician to a personalized medical treatment. The “Smart” Heart Failure Sheet acts as a registry for scholarly research and also provides educational resources to expand providers’ knowledge, thereby improving patient care (Battaglia,

Policy makers are constantly searching for new innovative ways to increase quality patient care and lower Medicare program spending. One indicator of inadequate quality that results in increased Medicare spending is the rate of readmissions to the hospital. Heart Failure patients are on the top of that list. Readmission refers to a patient’s being hospitalized within 30 days of an initial hosptial stay. This seems to be an indicator of inadequate quality of care in the hospital or a lack of appropriate coordination of postdischarge care.

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

While evaluating the face to face component of this category, two systemic reviews guided from meta-analyses were included. Both provided substantial, adequate feedback on the use of face to face monitoring or evaluation. Despite the evidence to support the frequent use of telehealth in the outpatient community, face to face monitoring with a physician or clinical specialist in the home does report a reduction in admissions a delay in admission if clinically inidicated (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). All aforementioned studies evaluated heart failure patients with awareness of the pressing subject of heart failure readmission and the costly effect of lapses in outpatient care.

This paper proposes a telemedicine model of care provision to monitor congestive heart failure (CHF) patients to reduce the rates of readmissions. The high rates of readmission for CHF cases at a large university-affiliated hospital in a metropolitan setting helped produce the proposed system to actively monitor patients. By identifying critical elements in the communication devices, patient monitoring systems, and connectivity from telecommunication devices, the healthcare organization (HCO) can understand the scope of the proposal. Procuring hardware and establishing networking capabilities along with training will help the HCO and CHF patient communicate data that is updated to the electronic health record (EHR).

In phase of Stetler Model, retrieval of evidence was obtained from CINAHL, Cochrane, and PubMed research databases using search times: CHF, telehealth, tele-monitoring, hospital reimbursement, right-sided heart failure, and re-admissions. Search was conducted by using the terms “congestive heart failure, telemedicine, telephone monitoring, nursing, hospitalization, and readmission.” Search criteria were restricted to articles published in the last ten years, with full text, and in English only. While searching for evidence, 20 articles dating from years 2000 to 2015 were reviewed and five articles were selected for the study. Among the five articles chosen, results yielded both qualitative and quantitative data, for which conclusions were identified.

Congestive heart failure (CHF) is the leading cause of hospitalization among patients older than 65 year of age. Annually, greater than 1 million patients are hospitalized with a primary diagnosis of heart failure, accounting for a total Medicare expenditure exceeding $17 billion (Desai & Stevenson, 2012). Heart failure (HF) occurs when cardiac output is insufficient to provide adequate blood flow to meet metabolic and circulatory demands (Houston, Kalathiya, Kim, & Zakaria, 2015). Despite dramatic improvement in outcomes with medical therapy, admission rates following heart failure hospitalization remain high, with greater than or equal 50% patients readmitted to hospital within 6 months of discharge (Desai & Stevenson, 2012). Mortality in Heart Failure is high, approaching 20% at 1 year and 50% at 4 years (Rickenbacher et al., 2012). The purpose of this paper is to evaluate how the application of Roy’s theory of adaptation model can decrease hospital readmissions and mortality in patients with heart failure. The Roy adaptation model (RAM) is an appropriate guide when providing nursing practice care for patients with chronic diseases such as heart failure (Bakan & Akyol, 2007). The use of Roy’s theory can show interventions of how patients can adapt to their condition and how it can decrease hospital readmission and mortality in patients with heart failure. Therefore, the content of this paper will examine the application of RAM applied to heart failure patients.