Sample Nursing Research Paper on Healthcare Outcomes for Congestive Heart Failure

Healthcare Outcomes for Congestive Heart Failure

Problem

Congestive heart failure affects many people across the world every year, with more than 5 million Americans suffering from the heart condition every year. For every individual suffering from CHF, there are others who are affected either directly or indirectly. Huge losses are incurred socially as well as financially in taking care of patients with congestive heart failure either through loss of time with other family members or through loss of financial resources in terms of hospital and/ or home care costs. For this reason, getting greater positive outcomes for patients with CHF in hospital as well as home healthcare settings is an important factor that should be the consideration of every well meaning practitioners and caregivers who work with patients of CHF. The financial burden, which is approximated at nearly $ 30 billion annually can be reduced significantly through improved outcomes and reduced re-hospitalization rates (Institute for Healthcare Improvement, 2017).

Statement of Purpose

            The need for efficient ways for improving healthcare outcomes among CHF patients in hospital and home settings is undeniable. Through various studies in the past, practices such as encouragement of self management education have been established to result in better health outcomes for CHF patients. The present study attempts to highlight the importance of practices that enhance the healthcare outcomes for CHF patients at home and in the hospital settings. The study is founded on past studies conducted in the area and will be instrumental in advancing the healthcare outcomes of CHF patients. Besides contributing to healthcare and heart failure information, the study will also form a point of reference for other scholars who are interested in expanding healthcare with respect to heart diseases.

Theoretical Framework

            Gardetto (2011) discusses the concept of self- management in heart failure and other chronic conditions. According to Gardetto, self management as a theory has been applied in a variety of chronic conditions from which survival is deemed almost impossible. In most cases, self managed people are more capable of achieving personal and communal healthcare outcome objectives. In the contemporary times, self- management is applied in a variety of chronic healthcare settings where the objective is to enhance the treatment outcomes. As a cornerstone of many chronic care models, the concept of self- management in healthcare is widely applied. For instance, self- management, if practiced effectively, results in the improvement of outcomes associated with most chronic healthcare conditions. Individuals who adhere to the self- managed care regimes are more likely to accomplish better healthcare outcomes especially if the condition of the patient originates from chronic heart failure. According to Gardetto (2011), adherence to self management principles is considered a vital step towards the improvement of patient outcomes in chronic conditions, and patients are trained to practice self management as much as possible. Where patients are intended to stay at home following hospitalization, self- management becomes all the more important. In the contemporary times, the concept of self management is taught as involving the progression beyond the patient education to making patients capable of identifying specific markers and challenges related to chronic conditions and subsequently taking actions geared towards problem solving (Grady & Gough, 2014).

Literature review and Summary of Evidence

            The Institute for Healthcare improvement defines congestive heart failure (CHF) as a health condition that manifests through the inability of the heart to pump sufficient blood through to the rest of the patients’ body. Such a condition significantly reduces the quality of life of patients by limiting their participation in various social activities, especially those which involve high energy consumption rates. According to Butler (2012), the prevalence of heart failure across the world is increasing. In America for instance, the present prevalence rate for congestive heart failure stands at about 5.5 million people. The high prevalence rates are occasioned by the growth in the percentage of the population which is elderly. Moreover, the prevalence rates of life style diseases such as diabetes and hypertension has also increase, expanding the risk factors for CHF (Butler, 2012). The institute for Healthcare Improvement (2017) opine that while it may be very challenging to deal with the financial and non- financial outcomes associated with CHF, many healthcare providers are making efforts to improve the quality of outcomes in such ways that result in reduction of the re-hospitalization rates as well as reduce the social costs of looking after CHF patients. Hospitals such as Saint Luke’s have put in place practices that enable practitioners to discharge only those whose outcomes have been confirmed effective. The components of such practices include: enhancement of post- admission assessment practices; enhanced learning for patients and their caregivers; patient and family- centered communications on how to manage CHF and following up on patients after acute care (institute for Healthcare Improvement, 2017).

Butler (2012) reviews some of the causes of CHF. Some of the risk factors for heart failure include co-morbidities, age, the male gender and medications. Such risks are compounded by factors such as lower physical activity rates, diabetes, hypertension and other diseases. Management of risk factors is encouraged among the aged as well as among those who are more vulnerable to the risk factors. In particular, Butler (2012) asserts that in order to reduce the risk of CHF and other chronic heart failures, those at risk should engage in practices such as increased physical activity, lifestyle changes, modification of dietary habits such as through elimination of alcohol consumption, developing target goals when in therapy and focusing on strategies for general risk reduction. While many studies from the past emphasize on lifestyle changes, especially the movement from sedentary towards more active lifestyles, there are clear indications that better self- management practices can improve outcomes in relation to healthcare provision for CHF patients.

Gardetto (2011) opines that whether patients are engaging in risk reduction activities such as physical activity or practicing day – to- day self- care, they are involved in self management. Self- management is thus considered an essential component of chronic disease management practice and a major theme in the management of chronic heart failure. One of the practices common in self- management is to be capable of identifying the symptoms and impacts of chronic diseases and subsequently understanding the need to act in certain chronic disease conditions. According to Grady and Gough (2014), many chronic conditions share common challenges including symptom identification, dealing with complex medication regimens and adjusting to social and psychological demands among others. The objective of self management education therefore would be to enhance the capacity of the patient to address these challenges in the presence of others as well as individually. The role of the self- management on disease treatment outcome in this regard is inevitable. Other authors have also shown that various outcomes associated with self- management in various other chronic conditions. For instance, Grady and Gough (2014) have established that chronic illnesses including various forms of heart failure have continued to present a social and clinical challenge to the society at large. The development of a set of skills, which can be implemented at an individual level allow patients to self- manage their illnesses at various levels, realizing better health outcomes. When such care is community based, the health outcomes in the society are improved collectively.

For individuals living with heart failure conditions such as CHF, it is advisable that self- management practices should include frequent medication; symptom management; lifestyle behaviors including smoking cessation, physical activity and dietary adherence among others (Inamdar & Inamdar, 2016). In spite of efforts by patients to practice self management, managing heart failure still remains a challenge and hospital readmission rates are still significantly high. The reasons behind this as mentioned by Gardetto (2011) include: most of the patients are aged, have more than one chronic condition to deal with, lack financial and social support and are symptomatic. Such factors make it difficult for them to put in place strategies for self management or to effectively manage their conditions without help.

While most of the studies on CHF focus on the risk factors and the self- management practices to improve health outcomes, some of the studies do not highlight the progress that has been made in the academia. The combination of multiple risk factors and co-morbidity among CHF patients still remain to be the greatest challenge to self- management among CHF patients. Healthcare facilities still have to continue supporting CHF patients while preparing them for home transition. At the same time, there can never be sufficient assurance that the hospital readmission rates will be low.

Translation to Practice

            The evidence obtained from various pieces of literature indicates that congestive heart failure, just like other forms of heart failure can be linked to various conditions. The information obtained from the literature review also indicates that while many health practitioners focus on the need for self management as a strategy for reducing the impacts of chronic illnesses, it may be challenging to apply where the risk factors are many and/ or various co-morbidities exist to prevent the patients from sufficiently taking care of their needs. Nonetheless, the application of self care strategies still remains one of the ways through which effectiveness can be realized in terms of health outcomes for CHF patients. To ensure that self management succeeds as a strategy for improving outcomes, the first step would be to initiate a communication strategy between the patients and the primary healthcare providers. The patients need to know the risk factors for their conditions as well as the symptoms associated with the condition. Informing patients without mentioning the causes of their conditions might not be the best way to go as this has the potential of resulting in self- stigmatization among the patients.

Once the patients understand their conditions and the risk factors associated with it, they can then be informed of how they can improve their lives through changing their lifestyle practices, resting or engaging in various social activities. Ignoring patient needs on the premise that their sickness is a result of old- age could be one of the ways of discouraging them from self management. The patients and their care givers ought to be aware that while self- management may not be easy to hack due to the challenges posed by the patient condition, efforts made are automatically rewarded through increased activity, better capacity to understand their position in regards to the CHF and being able to recognize that the outer environment also contributes to the disease progression. The patient and their people should all understand that willingness to take a positive step is a crucial step towards the healing process.

Improving healthcare outcomes among patients with CHF can be an effective way towards eliminating the costs of social and financial care to patients. In the social environment, the care accorded to patients with CHF due to their inability to manage their conditions eliminates the time that has to be spent with the patient and allows the care givers time to focus on other aspects of life other than care-giving.  One of the ways through which CHF contributes to economic costs is by reducing productivity among the healthy due to time spent taking care of the sick. Through better self management practices, not only do the sick realize that they can take better care of themselves but also that they have even greater opportunities for taking care of themselves. Additionally, economic costs incurred through re-hospitalization practices are reduced significantly by elimination or reduction of hospital readmission rates. As patients learn about self- management in chronic disease conditions, they are likely to understand their symptoms and thus catch the CHF before escalation to uncontrollable levels. In this way, patients have to go through effective self- management as a key principle of improving health outcomes among CHF patients.

Integration

            As a healthcare practitioner, integration of the self care – management training into the individual healthcare plan comes in handy, especially where CHF has to be managed through a transitioning system from hospital based to home based care. The concept of self- management should find applicability both within and without the hospital setting and should thus be aimed at providing a wide perspective to the patient. Within the hospital setting, the best approach towards integration of self- management for better health outcomes can be through assisting patients to recognize vital symptoms associated with the condition. The ability of patients to anticipate certain disease factors can help to identify risks and act accordingly in line with the requirements of medical practice. The objective of integrating self management within the hospital setting would be to encourage patients to learn and adopt practices that would improve their lives and disease management capabilities even once dismissed from the hospitals. The healthcare providers within the hospital setting can play the role of advisors as well as care givers, in giving instructions to patients and giving them the opportunity to monitor their conditions. Once this is accomplished and the patients have learnt to sufficiently monitor and report on their conditions, they would then advance towards preparing their medication regimens, as such is expected even outside the hospital setting.

            Once the patients have understood how to manage basic aspect of CHF within the hospital setting, transition towards the home setting can then be initiated. In the second stage however, the self- management practice should include the care givers who would attend to the patients at home. While the main objective is to see patients taking care of themselves independently, the medical practitioners have to understand that this can only be achieved through the assistance of others in the home setting. To some extent, this plan recognizes the difficulties that are linked to managing CHF independently and the fact that most of those affected are elderly and may need assistance even without suffering from CHF.  Provision of learning materials is one of the ways in which the hospital setting can help develop patients in readiness for home based self- management. Charts and other diagrams act as reminders for the patients to adhere to their medication. Learning about physical activity and lifestyle diseases can also foster self management as a way of improving the health outcomes of CHF treatment in the hospital as well as in the home setting.

 Evaluation

Upon implementation of the practices aimed at improving self management among patients, there will be imperative need to evaluate the methods used against set standards for the same. It is expected that once patients have been taught how to self- manage, the health outcomes for those patients who practice it diligently should improve in a short while. As such, the evaluation practices implemented in the exercise would target two aspects. The first is the comprehension and implementation of the practices by the patients while the second is actual improvement in health outcomes. One indicator of better self- management is awareness of the symptoms associated with the condition and the ability to anticipate these symptoms. To evaluate whether this has been accomplished, the most rational measure would be to request patients to feed back information into the healthcare system. Through quantitative questionnaires, patients can rate their level of understanding and practice of various concepts in relation to self-management practices.

On the second measure, the patients’ records from the past would be compared to the records made after passing the information regarding the practice of self management. For each of the patients then, the objective would be to determine the frequency of hospitalization during the period when the patient did not possess knowledge about self-management. This frequency would then be compared to what was realized after training the patients on self- management.  A reduction in the frequency of readmissions indicates adherence to self- management practices and subsequently to better health outcomes.

Summary

Any healthcare condition that requires that the patient be taken care of consistently, results in the loss of a lot of social and financial resources. Congestive Heart Failure (CHF) is one of such conditions. With the high prevalence of CHF occasioned by various risk factors such as old age and lifestyle diseases like hypertension and obesity, there is growing need to find ways of improving the health outcomes of hospital as well as home treatment of the condition. There is evidence that self- management is one of the strategies that can be used to improve the healthcare outcomes of CHF and many other chronic conditions. Through encouraging, integrating and evaluating the effectiveness of self management in the hospital setting for CHF patients, it is expected that better healthcare outcomes will be realized. The objective of the study in providing an approach towards improving healthcare outcomes of CHF patients is therefore realized.

References

Butler, J. (2012). Primary prevention of heart failure. International Scholarly Research Notices, Cardiology. Retrieved from www.hindawi.com/journals/isrn/2012/982417/

Gardetto, N.J. (2011). Self- management in heart failure: Where have we been and where should we go. Journal of Multidisciplinary Healthcare, 4: 39- 51. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC3084307/

Grady, P.A. and Gough, L.L. (2014). Self- management: a comprehensive approach to management of chronic conditions. American Journal of Public Health, 104(8): e25-e31. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4103232/

Inamdar, A.A. and Inamdar, A.C. (2016). Heart failure: Diagnosis, management and utilization. Journal of Clinical medicine, 5(7): 62. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961993/

Institute for Healthcare Improvement. (2017). Good heart failure care follows patients home. Institute for Healthcare Improvement. Retrieved from www.ihi.org/resources/Pages/ImprovementStories/GoodHeartFailureCareFollowsPatientsHome.aspx