Reducing Readmission Rates for Patients with Heart Failure Complications
Contemporary healthcare environment is plagued with myriads of issues arising out of a need for better patient care and medical reach and accessibility for people regardless of their demographical backgrounds or psychodynamics. In this context, medical professionals involved in policy creation, direct care, and health care management are integrating a vast array of methodologies and tactics to resolve these multiplicities of issues in a concise and efficient manner. However, in spite of these efforts, gains in reducing mortality rates are still considered as below par and measures that are more intricate have to be employed to give the health care environment credence for quality work (Hines, Yu & Randall, 2010). In the US, measures being taken are on a multi-governmental level affecting not only the national, regional, state, and county governments, but also the patients, health institutions, insurance companies, and medical professionals.
Strategies such as the Obama Health Care Act have been formulated to ensure ease of accessibility to health through provision of insurance. Further, it has improved access to medical care through provision of more health facilities and equipment, better trained medical professionals, increased provision of medicine, and improved information management using electronic health records. However, in spite of all these measures being undertaken, one commonality being reviewed is the pertinent changes are not being felt immediately and wholesomely. Is this due to the ineffectiveness of the policies, systems, and structures, does it have other underlying factors. What is the role of the health care institutions and their medical professionals in mitigating the effects of poor health provision?
One case scenario is the cases of hospital readmission of patients suffering from heart failure complications. These cases documented across the United States have shown a significant rise in patients suffering from heart failure complications being brought in owing to a variety of reasons. Some researchers have blamed environmental carcinogens as one of the core causality for these issues (Johns, 2007). However, is this really the core causality or is the problem manageable from a patient and medical practitioner viewpoint? Can measures be implemented to mitigate the effects of increased heart failure complications in people?
The nurse can be an integral person in answering and forming resolutions to these problems since they are involved in direct care of these patients. However, there are multiple nursing roles, responsibilities, and ranks such as nurse leader, nurse informatics, nurse practitioner, registered nurse, CNRA nurse, nurse educator, among others. Assessing this issue from a general nursing profession would be intricate owing to the large pool of information that could be generated. This is because each nurse has a different role to play in patient care, which would result in the research outcome becoming too saturated. Therefore, this paper will assess the role of the nurse leader in reducing hospital readmission rates for patients suffering from heart failure complications.
Background Significance of the Problem
Heart failure complications occur or are diagnosed at different levels based on their severity of the problem to the patient’s health. These are levels I to IV, with higher levels indicating that the disease has progressed infinitely and could have adverse reactions to the patient such as death or stroke due to a heart attack. Lower levels can be controlled using medication and changes to one’s lifestyle, while higher levels require constant medical attention and readmissions into hospitals. However, what are the main causalities for increased hospital readmissions for patients suffering from low-level heart failure complications. Can the causalities be mitigated by the nurse leader, and methodologies can she employ to achieve this objective?
In the US, patients diagnosed as suffering from heart failure complications increase by an average of 1 million people annually. Further statistics indicate that approximately 50% of these patients are readmitted back into hospitals within a year after being diagnosed with the condition. The mortality rate for these patients suffering from heart failure complications is pegged at 50% over a five-year period (Hines, Yu & Randall, 2010). These figures are large and represent a problem in dealing with patients suffering from heart failure complications. Is the health care system at fault, or is it the poor level of care being given to these patients? Can nurses be able to influence a change in these readmissions and hence reduce these high mortality rates?
According to research, several mitigation measures have been undertaken by nurses in countering the effects of heart failure complications. However, prior to analyzing, it is paramount to analyze and understand some of the causality of readmissions of patients with heart failure complications. Research indicates that majority of the patients being readmitted suffering from heart failure complications do not have enough information on self-care and hence have poor lifestyle choices such as poor nutrition, alcohol and drug abuse, lack of exercise, heavy work schedules, among others. These are all-detrimental to worsening the effect of heart complication and may cause the heart to fail, hence causing a readmission back into hospital.
According to the self-care theory, nurses are mandated to ensure that they educate patients and their families on self-care within and outside the hospital. This is in accordance with their competency standards that mandate them to not only provide health care, but also ensure that in their absence, the patient can undertake several measures for their health benefit. Therefore, what is the role of the nurse leader to ensure that her junior nurses are adhering to self-care methodologies when dealing with such patients? Further, is it plausible to conclude that the misinformation by patients on self-care can be one of the major causalities for increased hospital readmissions for patients suffering from heart failure complications? If so, what raft of measures, strategies, and techniques can the nurse leader take in addressing this issue?
Resolving the Problem
According to research, involvement of nurses in information disbursement to patients on self-care has been considered as one of the primary means of reducing readmissions for patients suffering from heart failure complications. One research indicated that its success has the ability to reduce hospital readmission for these patients by at least 12%, which is a very significant stride (Hines, Yu & Randall, 2010). As a nurse leader, generating policies and systems to ensure that junior nurses achieve these information disbursement strategies is paramount in reducing these readmissions. Therefore, to achieve this, the nurse leader can rely on the goal attainment theory that advocates for achieving certain goals and objectives using personal, interpersonal, and social interaction with the patients and other workers. This forms a useful analogy to base any policies or strategies that can be generated to enhance the outcome of a successful information disbursement solution.
Foremost, since the nurses are mandated under their competency standards to provide education on self-care to the patients and their families, the nurse leader can integrate a system that mandates all nurses to provide this service. This could involve reminding the nurses of their contract clause that mandates them to adhere to the nurse professional code of conduct and perform their duties and responsibilities in a professional manner. The goal of this strategy is to develop systems where the nurse can use the goal attainment theory to interact with the patients on a personal and professional level.
Interaction between a patient and a nurse can help in the development of trust between the two and can result in the patient being more receptive to the suggestions and advice being offered by the nurse. In this context, the nurse is trained on the quality and type of information that should be shared with the patient to enhance their health. This information can be such as better lifestyle choices, exercise, medication, diet, and avoidance of drugs and alcohol use or abuse. A strict adherence to these can reduce once chances of development of a heart failure complication by at least 45%, which is a significant stride. In retrospect, an adherence to this information and advice can also serve to significantly the patient’s immune system and ability to fight off other diseases (Burns et al., 2001). This can be beneficial to their reductions in hospital readmissions since in some instances other underlying health issues such as diabetes and stress can cause heart failure complications. This form of patient self-care methodology is a form of health management that exercises lesser intervention by medical practitioners, and more involvement of the patient in maintaining their health.
In some instances, the nurses may know the pertinent methodology for giving or disbursing the information, but may be unaware of the pertinent advice to give to the patients that would serve to improve their health (Porrit, 2007). This is a gap that the nurse leader should identify and provide methodologies and strategies for enhancing knowledge acquisition and disbursement by the nurses. Therefore, the nurse leader is mandated under her competency standards to provide a framework for ensuring that her junior staffs are well trained and educated to perform their duties and responsibilities in a professional, productive, and effectual manner. In this context, the nurse is mandated to find viable programs for education and training of the junior nurses (Johns, 2007). Further, she is mandated to manage the provision of the education and training including assessing the ability of the nurses to understand and apply the content of the program through frequent assessments and evaluations of the nurses’ work output.
This is important to ensure that the nurses are able to apply the content of the education and training to their jobs and enhance their ability to have a positive influence on the patients that is geared towards reducing their readmissions rates. Aside from education and training programs that nurses can give information to patients on self-care methodologies, the nurse leader also has to train and educate her nurse on interpersonal skills and communication. This is esteem in ensuring that her nurses have the ability to communicate with their patients in an effectual and responsive manner (Burns et al., 2001). For instance, an education and training program on interpersonal communication can involve role-playing where nurses can practice communicating with each other and assessors trying to determine and correct areas that they deem as weak for this professional and social communication process.
According to the nurse competency standards for the nurse leader, she is mandated to conduct research on viable and useful tools, equipments, treatments, and general medical strategies being employed or discovered to improve patient care (Bradley, 2013). This nurse leader is the mandated to apply some of the researches that she perceives as useful to enhancing patient care based on her roles, duties, and responsibilities within the hospital. For instance, in the past two decades, advancements in equipments and medication for managing, controlling, detecting, and treating heart failure complications have been invented and are being used in different hospitals. As a nurse leader, one should learn and conduct research on which of these are viable, funds required for their application or use within the hospital, and the education and training required for her junior nurses. According to research the use and application of these research over the past five decades has resulted in the reduction of hospital readmissions for patients suffering from heart failure complications by more than 80%.
According to the role modeling theory of nursing, the nurse is supposed to act as pillar of responsibility that others can emulate. In this context, the nurse leader is responsible for creating and enforcing policies that she believes would be useful in reducing patient readmission through better care (Winter & Munn‑Giddings, 2001). However, some of these polices can be met with disquiet and rebellion from her junior staff. Therefore, as a role model, she can interact with the nurses and patients and engage them in the application of these policies through direct care. This presents an avenue for the junior nurses to learn and mimic her skills, knowledge, and patient care strategies (Peterson & Bredow, 2013). This builds a sense of skills development and hard work in the other nurses as they consider the actions of the nurse leader as useful not only the actions of the nurse leader as useful not only for patient care, but also the development of crucial skills that would be vital for their career development plans. Through application of some strategies, the nurse leader can improve patient care delivery in areas such as prognosis, diagnosis, and treatment of patients suffering from heart failure complications and consequently be instrumental in the reduction of readmission rates.
Feedback, either positive or negative, can have overwhelming effects in decision-making, planning, and operational management. In a hospital setting, creation of polices, systems and structures is insufficient in provision of quality patient care. Other underlying issues on service delivery serve as impediments to the provision of quality care or patient health improvement. Therefore, one of the methodologies of understanding the operational issues that could be occurring during service would be the use of feedback from patients and employees on the quality of health care being provided. The nurse leader can interact frequently with the patients and enquire as to the level of service being provided and its viability in improving their health. Further, the nurse leader can be responsible for creating and disbursing questionnaire forms, which both patients and employees can fill regarding service, and areas they deem as requiring improvements (Winter & Munn‑Giddings, 2001). For instance, during collection of medical histories, some patients may feel that their privacy is being infringed when the nurse asks questions regarding their social lifestyles. The nurse leader can counter this negative perception by authorizing the nurses to assure those patients of the confidentiality of the information given, and its viability in provision of quality health care.
According to research, this primary stage is crucial in the development of trust and close ties between the patient and the nurse and it is vital that the nurse leader generate strategies for enhancing the communication process by using feedback as one of the primary means for assessing the viability of the processes being employed. Improving the health care service delivery strategies can be instrumental in enhancing better medical care at an early stage and reducing readmission rates. For instance, better information collection can assist the nurse in determining the level of heart failure complication for the patient and provide better medical care that would serve to reduce their readmissions rates. Information collected that is relevant in giving a prognosis is such as dietary restrictions and allergies (Bradley, 2013). The nurse should also monitor and request for information of occurrences of such health issues as anxiety disorders, anorexia, lethargy, fatigue, nocturnal dyspnea, shortness of breath, nausea, cough with frothy sputum, weight gain, nocturia, or orthopnea that occurs when one needs at least two pillows to sleep.
Community outreaches are another successful methodology that is being employed to reduce patient readmissions into hospitals. As earlier stated a nurse’s competency standards mandate her to proffer education and training to patients and their families on self-care tactics. Instead of waiting for the patients to visit hospitals seeking medical advice or care, the nurse can opt for outpatient care to the community to issue medical care and advice to communities on predetermined days (Peterson & Bredow, 2013). As a nurse, one is responsible for organizing this community outreach programs, determining the number of number of nurses needed, the amount of medicine, type of equipments needed, and sourcing for funding to finance the program.
A successful community outreach program can be structured as a corporate social responsibility program meant to give back to the community by proffering free medical services. For patients suffering from heart failure complications, these visitations can act as checkups or avenues to seek advice regarding their condition in an open and enabling environment. Studies conducted in different areas have shown that these community outreach programs have a profound effect in providing the community a chance to seek medical assistance due to the ease of access, affordability, and professionalism (Institute of Medicine, 2011). In this context, majority of the community outreach programs conducted for different types of diseases have on average had a 35% accessibility and outreach rate. For patients suffering from heart failure complications, such numbers are phenomenal owing to the readmission rates they have, since the community outreach medical care proffers a chance to reduce these rates. As a nurse leader, increasing accessibility to this community outreach for patients should be a prime agenda during its implementation and execution. Further, through these programs, early detection of heart failure complication can be detected and appropriate measures undertaken to combat it at its onset before it advances and increases hospital visitation and readmission rates.
Based on the above strategies that can be employed to reduce hospital readmission rates for patients suffering from heart complications, it is plausible to conclude that a nurse leader plays a pivotal role (Patterson & McMurray, 2002). However, it is also inconceivable to note that all these strategies being employed are mainly pegged on better management and leadership by the nurse leader. Each of these strategies is a subset of good leadership and management by the nurse leader, and implementation of this would serve to reduce hospital readmission rates for these types of patients. It is integral to ensure that a nurse leader adheres to her competency standards that advocate for effectual management of her junior staff, as well as creation of effectual polices that would serve to improve employee welfare and better service delivery for patients.
The reduction of hospital readmission rates for patients suffering from heart failure complications needs the application of a multifaceted approach by a nurse. Strategies being employed to reduce them should be planned, executed, and assessed in a professional and ethical manner to ensure their success in achieving the desired goals and objectives. Management of nurses should be one of the key methodologies that need to applied, from which other strategies should stem (Institute of Medicine, 2011). This can be achieved through the integration of such strategies as education and training and role modeling. Policy creation should also be structured in a manner that would promote the needs of not only the patients, but also those of the employees dealing with them.
Caution should be taken when applying any of strategies being suggested since it is paramount that they adhere to not only ethical standards, but also legal provisions. This would avoid cases of legal malpractice suits being applied to the nurse leader, her junior staff, or the hospital. In essence, it is vital that measures be taken to consult legal counsel on a continual basis to avert such issues from occurring (Porrit, 2007). Further, as information is being collected for medical histories that could relate to social welfare of the patients, caution should be taken to ensure that the nurse does not retrieve information that could be a contravention of the patients’ rights. These can be controlled using the nursing metaparadigm as a basis when dealing with patients.
Patient’s readmission rates for heart failure complication are an issue that is of great concern due to its ability o be controlled and curbed. Not only the patients, but also the nurses and other medical personnel dealing with the patient should take measures to control it. The viability of the use of different methodologies to control patient readmission rates by a nurse leader is measured by the need of a particular strategy and its success in other places. The nurse leader can use strategies such as education and training, feedback, and better management of the nurses to enhance their service delivery output. This is essential in promoting a culture of professionalism in the nurses to ensure that they do not waver in the execution of their duties and responsibilities. Changes to lifestyle choices can be another integral measure for reducing patient readmission rates and it is the prerogative of the nurse leader to teach her nurses on better communication processes for the nurses when dealing with patients with heart failure complications.
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