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An Analysis of Congestive Heart Failure as a Nursing Issue

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Overview of Selected Evidenced-Based Practice Project

Evidence-based practice defines incorporating clinical proficiency with the preeminent external evidence from systematic study. In evidence-based practice, there is the incorporation of patient morals, clinical know-how, and paramount research evidence. The various clinical practices have to be based on strong evidence in order to improve the patient’s benefits overall. Using the evidence-based practice has been considered to be the basis of formation of clinical recommendations and various practices across the health service sector. Since there is a lot of evidence-based activities being done, the evolution of research can lead to changes in the evidence-based practices and recommendations in the healthcare services are also going to change as a result.

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Most nurses are attracted to qualitative research because it is similar to the art of being a nurse. The nursing practice requires a person to be able to understand the patient and knowing the various patients individually. The qualitative research is also important to nurses because results from the various tests are supposed to be analyzed and results extracted. This is similar to quantitative research and that proves that research in nursing practice can assist in improving evidence-based practices.

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The selected nursing issue to be analyzed is the congestive heart failure. This is a chronic condition that affects the muscles power to pump blood to the other parts of the body (Díez-Villanueva and Alfonso, 2016). The congestive heart failure is normally referred to as heart failure.  Specifically, CHF refers to the stage in which various fluids usually accumulate around the heart and causes malfunctioning of the heart.

The rationale for selection of the major nursing issue is based on the various risks which most people who have such failures face and the care they deserve in order to make them better. As a family nurse in primary care, the concern on the topic is based on the growth of personal experience and knowledge on how to solve the various issues of heart failure and the care required to such people. The various issues of readmission rates of the various people with congestive heart failure are high and therefore the family nurse practitioner is suited for the management of care provided to the people of all ages.

Application to MSN in Family Nurse Practitioner

Gaining more knowledge about the congestive heart failure helps in building up more knowledge on Master of Science in nursing as a family nurse practitioner. Chronic heart failures can be understood better when a person advances their level of education to a higher level. The various readmission conditions of the various patients with Chronic heart failure is high and therefore through advancing in nursing practice can help in reducing the conditions by the provision of quality care to all the patients (Feltner et al., 2014).

The communication existing between various health providers can also be enhanced through reduction of the various hospital’s readmission rates. If a certain patient is admitted to the hospital and then diagnosed with congestive heart failure the various practitioners will be able to communicate on the various ways in which the condition of the patient can be solved easily. Resolving the congested heart failure can increase the rates of post-acute care follow up appointments of the various people (Inamdar and Inamdar, 2016). Most patients who have been past the congested heart failure disease, they are usually offered a post care service which makes them maintain their health conditions.

Most of the patients are usually affiliated to the original area in which they were offered their treatments and therefore increasing the level of care makes the funding of the hospital to be high. All the healthcare teams are affected as a result of increase or decrease of financing of the health facility. Therefore a decrease in funding makes most of the health professionals to unite together to decrease the health readmission rates through increasing the quality of the services they offer.

Congestive Heart Failure and Supporting Evidence

Heart failure is considered to be the inability of the heart to meet the various needs of the different tissues and organs in the body. The decrease in the cardiac output leads to the reduction of the amount of blood pumped away from the heart and back to the heart and that causes a leak of water to the capillary blood vessels of the body (McKelvie et al., 2013). The symptoms of heart failure include weakness of the body, shortness in breath and swelling in most parts of the body. The development of CHF can be attributed to lack of energy in the body to pump sufficient blood to the body. CHF can be considered to be a life-threatening disease because the blood and other fluids in the body are able to be returned back to lungs, abdomen, lower body and the liver (Scott and Winters, 2015). There are several clarifications of heart failure which can affect different people. The congestive heart failure problem can be classified predominantly into three main classes consisting of left ventricular heart failure, the biventricular based congestive heart failure and the right ventricular congested heart failure (Scott and Winters, 2015). All these classes are caused by the failure of the heart muscles in any part of the heart to pump blood to the other parts of the body easily and accessing the blood back.

The congestive heart failure is a major cause of morbidity as well as mortality among the majority of the people in the society and that has led to high costs of readmissions of the people (McKelvie et al., 2013). The condition makes the quality of life of the various patients to be low as well as the body functioning of the various patients. The elderly people who have this condition are more than 80% and this includes the number of incidences and prevalence of the heart condition (McKelvie et al., 2013). In the home care setting, patients with congestive heart failure are considered to be old and increase in age leads to increase in the various risk factors associated with the management of the disease as well as increased mortality. There are high readmission rates of the patients with congestive heart failure and according to research, 24% of the various patients who have the condition are usually readmitted back (McKelvie et al., 2013).

Most of the elderly people are subjected to high rates of hospital readmission as well as high mortality rates in the society and therefore they are the main stakeholders impacted by the issues. The family nursing practitioners and the family of the elderly people are also involved in the provision of care and therefore education on personal maintenance can be appropriate in the management of the condition (Scott and Winters, 2015). The family nurse practitioners are stakeholders because they help in the provision of care of the various patients and therefore the higher the rates of readmission and higher the rates of lack of provision of enough knowledge of personal care leads to increased mortality rates of the patients. This increases the cost of provision of care to the elderly people and the patients and their families.

In order to ensure that there is the improved provision of care to the various people who have the congested heart failure, the quality of the services offered by the healthcare providers has to be high in order decrease the readmission rates of the various people. Provision of knowledge and basic education of management of the condition can also be effective because it assists in making the various patients understand their health condition better. Providing an extensive care and increasing the number of family nurse practitioners to the patients can also help in minimizing the congested heart failure. This is because the extensive care helps the patients and the practitioners to interact often and that assist in monitoring the health progress of the various individuals (Scott and Winters, 2015). A multidisciplinary educational approach has to be adopted in order to increase the quality of services offered. The nurses have to use research in order to assist in solving the various congested heart failure issues in the patients. Researching helps in understanding the conditions better and that helps in building up on the recommendations based on evidence-based practices (Yancy et al., 2016).use of telemonitoring programs and the use of nursing assurance programs can also be effective as appropriate ways in which the patients  can be managed effectively from their homes (Yancy et al., 2016). This makes the health condition to be easily manageable because the patient’s adverse conditions can be treated with specialized referrals when the telemonitoring and follow up care shows worse effects.

Upon implementation of an evidence-based practice, the family nurse practitioner is able to gain a lot of knowledge in solving some health issues. For the congested heart failure, the practitioner will be able to learn more about how to provide advanced care to the patients and also make them be aware of the various challenges faced by the patients (Yancy et al., 2016). The practitioners will also learn more about how to treat the patients better and the expected outcome to be achieved at the end of it all. This helps in making the risks of the provision of care to be minimal for the nursing practitioner. For the family and the patient, the introduction of evidence-based practice will assist in making sure that the patients gain a lot of knowledge and skills necessary to make sure that they manage the health condition effectively (Yancy et al., 2016). The cost incurred in the provision of treatment will be lower because the patients will have known ways in which they can effectively manage themselves while having the congested heart failure.

Evidence-Based PICOT Questions

Since the research adopted a qualitative approach in carrying out the main research, a PICO question has been adopted into the research. The question in regards to the congestive heart failure is how does provision of knowledge and integration of research into evidence-based practice led to decreased rates of mortality and readmission rates of the various patients.

The population under consideration is made up elderly people above 65 years of age who have been affected by the congested heart failure.

The most appropriate intervention to be taken in the management of the condition in this study is the adoption of follow up care and telemonitoring. This is the best intervention to be taken especially for the patients who have received a necessary patient education of managing themselves towards mitigation of the health condition.

The comparison provided is concerned with the patients who do not receive effective care through telemonitoring and follow up care and they are compared with the patients who have received care through telemonitoring and also follow up care.

The outcomes of the study show that there is a reduced rate of congested heart failure mostly to the patients who received follow up care and the ones who used telemonitoring too. This shows that the rates of readmission of the various patients are reduced as a result.

Conclusion

Congested heart failure can be a threat when not properly managed easily. To the old people, the condition has increased the mortality rates and therefore adoption of better follow up care and telemonitoring can help in minimization of congested heart failure problems to the entire population. The number of adults who have been experiencing this problem has been increasing and therefore through the adoption of research in evidence-based practice can assist in minimization of the number of readmissions of the various people. This can lead to the improved outcome of the patients if they follow up all the procedures they are trained on self-management. From the study, there is the provision of more knowledge about the condition of congested heart failure and some of the strategies which can be used in the management of the condition from the safety of the homes of various patients. The various strategies can be effective in the management of the condition effectively when followed especially for the 65-year-old person. The recommendation of the research is to adopt the follow-up programs and also adopt telemonitoring programs in order to improve the outcomes of the various patients.

1. Díez-Villanueva, P., & Alfonso, F. (2016). Heart failure in the elderly. Journal of Geriatric Cardiology : JGC, 13(2), 115–117. http://doi.org/10.11909/j.issn.1671-5411.2016.02.009

2. Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., … & Jonas, D. E. (2014). Transitional Care Interventions to Prevent Readmissions for Persons with Heart Failure a Systematic Review and Meta-analysis Transitional Care for Persons With Heart Failure. Annals of Internal Medicine, 160(11), 774-784.

3. Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine, 5(7), 62. http://doi.org/10.3390/jcm5070062

4. McKelvie, R. S., Moe, G. W., Ezekowitz, J. A., Heckman, G. A., Costigan, J., Ducharme, A., … & Howlett, J. G. (2013). The 2012 Canadian Cardiovascular Society heart failure management guidelines update: focus on acute and chronic heart failure. Canadian Journal of Cardiology, 29(2), 168-181.

5. Scott, M. C., & Winters, M. E. (2015). Congestive heart failure. Emergency Medicine Clinics, 33(3), 553-562.

6. Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., & Hollenberg, S. M. (2016). 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 68(13), 1476-1488.

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