Health Condition 3

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Assessing the Problem: Leadership, Collaboration, Communications, Change Management, and Policy Considerations

Assessing the Problem

August 3, 2024

Introduction

Heart disease is a broad term that includes coronary artery disease, heart failure, and hypertension. It is still a major public health concern, especially for underprivileged communities, where the effects are frequently more severe than for more affluent ones. Cardiovascular disease (CVD) remains as the leading cause of death in the United States, accounted for 928,741 deaths in the year 2020 (AHA, 2024). This startling statistic emphasizes how critical it is to address heart disease's epidemic as well as its inequities in outcomes.

Cardiovascular disease, a disorder where plaque builds up in the arteries, narrowing them and limiting blood flow. According to Almustafa (2020), high blood pressure, diabetes, fluctuating cholesterol, and stress are all variables that contribute to heart disease. A person's age, genetic makeup, and family history of heart disease are examples of non-modifiable risk factors. Moreover, by aggravating other risk factors, long-term stress and binge drinking can also lead to heart disease. Regardless of being among the most widespread chronic conditions leading to a large percentage of disability and mortality across the globe, heart disease is recognized to be among the most avoidable and controllable diseases (Ansarullah, 2022).

Patient Identification

Heart disease has been a struggle for my 64-year-old neighbor, whom I interviewed for this practicum, for several years. Even though he is married, he has a history of unhealthy eating habits, regularly consuming convenience meals that are heavy in sugar and saturated fat. His continuous struggles serve as a reminder of how tough it can be to manage chronic diseases, particularly when they are exacerbated by rooted lifestyle patterns and the challenges associated with adjusting to new medical procedures. My neighbor has been recommended a prescription of meds to control blood pressure, decrease cholesterol, and avoid further cardiovascular events to manage his heart disease. It has been difficult for him to stick to this regimen despite his best efforts because of his ingrained habits and sporadic moments of indifference.

As a registered nurse, I frequently find myself offering encouragement to assist him in making progress toward leading a healthy lifestyle. I can provide helpful guidance based on my experience. However, it also offers me a unique insight into the difficulties when attempting to break old behaviors and take care of their health outside of medical settings.

Heart Disease Intervention

Major studies demonstrating the impact of cardiac disease emphasize its significance, especially in patients like my neighbor. Studies show that patients with unmanaged risk factors—such as high blood pressure and elevated cholesterol—face a higher likelihood of adverse outcomes, including heart attacks and worsening heart failure (CDC, 2024). For individuals already diagnosed with CVDs, lifestyle modifications serve as essential components of disease management, improving outcomes and quality of life (Ghodeshwar, 2023). Despite quick diagnostic and treatment progress, one-third of patients who suffer from a heart attack are still dying; also, two-thirds of those who survive will never fully recover and return to normal life (Tavakoli, 2019).

Relevance to Nursing Practice

Given its widespread influence on public health and the vital role nurses play in managing chronic diseases, heart disease is an issue that baccalaureate-prepared nurses must address. The most common cause of death worldwide is heart disease, and managing it calls for a multimodal strategy that combines professional expertise with patient education. Along with giving prescriptions and keeping track of patients' progress, a nurse’s job also includes educating and supporting patients to support them in changing their lifestyles.

Regarding the care of patients with heart failure, another essential nursing intervention is related to provide all the necessary information about social and personal consequences of the disease, either in terms of the appropriate lifestyles that must be carried out or in terms of aspects as varied as sexual activity, self-help groups, immunization, or driving and travel advice (Ordóñez‐Piedra, 2021). This information is essential for creating strategies and interventions that enhance patient outcomes and lower the overall burden of heart disease. Furthermore, the issue of heart disease emphasizes how critical a holistic approach is to nursing practice.

Health Action Process Approach Theory (HAPA)

A psychological framework known as the Health Action Process Approach (HAPA) theory focuses on identifying and encouraging changes in health-related behavior. Multiple studies have shown that the Health Action Process Approach (HAPA) theory, which combines motivation, intention, and action into a dynamic behavioral process theory, can promote patients' transition from awareness to action and enable them to implement their awareness of lifestyle habits and medication adherence into actions (Lu, 2023). In a recent study, researchers examined how patients with heart failure and coronary heart disease (CHD) responded to multi-dimensional nursing based on the Health Action Process Approach (HAPA) the theory in terms of their abilities to take care of themselves and their hearts.

From January 2021 to October 2022, 94 patients with coronary heart disease participated in the research study. The participants were divided into two groups at random: 47 patients in the control group received normal nursing care related to cardiology, and 47 patients in the observation group received multidimensional nursing interventions based on the HAPA framework. As opposed to the control group, the observation group benefited more from the multidimensional approach. Under the direction of HAPA theory, multidimensional nursing interventions improved the psychological and behavioral components of patient care in addition to addressing the medical aspects. This personalized nursing intervention can help improve patients' self-efficacy, knowledge and skills, overcome obstacles, improve the persistence of self-care behavior, and then promote the recovery of patients with coronary heart disease and heart failure (Lu, 2023).

Barriers

The Health Action Process Approach (HAPA) theory-based multidimensional nursing treatments are beneficial in controlling cardiac disease; nevertheless, several barriers prevent the widespread application of these evidence-based approaches. The integration of these sophisticated treatments into standard clinical practice, which frequently depends on conventional models that prioritize medication and disease treatment, is one of the major challenges. Nurses may encounter challenges in regularly implementing comprehensive, theory-based approaches because of many restrictions, including limited time, insufficient training, and insufficient resources. Furthermore, poor health literacy, financial limitations, and psychological barriers can all have an impact on patients' adherence to self-care activities.

Effectiveness of Nurse Standards

A nurse-led 7-step transitional program is successful in improving heart failure treatment, according to a study carried out in hospitals located around South Barcelona. This study demonstrated how structured, evidence-based care delivered by established nursing standards can greatly improve patient outcomes. These evaluation and associated interventions seek to establish an individualized follow-up plan in the most suiting healthcare environment for each patient profile (Alcoberro, 2023). Within 30-, 90-, and 180 days following discharge, the treatment pathway for high-risk patients attending outpatient visits dramatically decreased the chances of death and hospitalization. In the short and midterm, this strategy successfully reduced the combined risk of hospitalization and mortality.

Role of Nurse in Policy Making

With their clinical knowledge and patient insights, nurses may advocate for evidence-based solutions and play a transformative role in improving the management of cardiac disease through policymaking. Their participation in healthcare reform projects, identification of care needs, and creative solution-making can all have an impact on policy. To improve patient outcomes and lower the number of readmissions to hospitals, nurses can also take the lead in implementing comprehensive care models that address heart disease therapy and prevention.

Let us examine the Emergency Nurses Association (ENA) and how it has enhanced the care of heart disease patients. The ENA is committed to collaborating with other health care partners; promoting compassion in emergency nursing; embracing diversity and inclusivity; promoting excellent, high-quality patient and nursing standards; and fostering a culture of inquiry and lifelong learning among its thousands of members worldwide (ENA, 2021). The ENA's programs can have a big impact on people like my 64-year-old neighbor, who has heart disease and is having trouble with symptoms and medication adherence. Their evidence-based procedures aid in ensuring that emergency care is efficient and successful, attending to patients' urgent needs while concentrating on long-term management techniques. Healthcare providers may deliver better-coordinated care that supports the management of chronic diseases, lowers hospital readmission rates, and improves overall quality of life by putting ENA's guidelines and recommendations into practice.

State and Organizational Policies

Policies from organizations or the government, along with state board nursing practice standards, are essential in guaranteeing that patients with long-term conditions like cardiovascular disease receive consistent and efficient care—even in the face of disruptions like the COVID-19 pandemic. For clinicians and public health officials, this represents the challenge in balancing the recommendation to stay at home against the need to seek medical care when appropriate (Khera, 2020).

During the pandemic, policies that supported telehealth and remote monitoring became essential in maintaining patient care continuity. My 64-year-old neighbor was greatly helped by the Coronavirus Preparedness and Response Supplemental Appropriations Act 2020, which provided vital funding to support remote monitoring and expand telehealth services. In response to the pandemic, the Centers for Medicare & Medicaid Services (CMS) significantly relaxed a number of previous telehealth regulations in order to reduce the spread of the virus and make it easier for patients to receive needed medical care (Dowling, 2020). By encouraging the adoption of flexible care models and supporting healthcare infrastructure, these policies help ensure that patients like my neighbor can continue to receive quality care and avoid the negative consequences of delayed or interrupted treatment.

Effectiveness of Leadership Strategies

Studies have shown that leaders who promote evidence-based practices and foster a culture of continuous improvement achieve better results in chronic disease management. Effective leadership is critical for healthcare organizations to illustrate continuous reforms for efficient and effective service delivery at regional and global levels (Teame, 2022). For example, research on multidimensional nursing interventions, such as those based on the Health Action Process Approach (HAPA) theory, demonstrates that leadership driving the implementation of these practices can lead to improved symptom management and reduced hospital readmissions for patients with heart disease.

To address the challenges of managing chronic illnesses, leaders must advocate for the adoption of comprehensive care models and evidence-based approaches. This entails encouraging the use of cutting-edge care techniques, like telemedicine and transitional care initiatives, and making certain that medical staff members have the necessary tools and training to successfully apply these techniques. This involves acknowledging and involving patients and healthcare providers as important stakeholders in the development and implementation of improvements.

Giving healthcare teams the tools and training they need guarantees that they are ready to successfully implement new procedures and technologies. Implementing regular touch-points that engage multiple stakeholders, such as communities of practice, can help to create positive feedback loops that enable systems change (Spanos, 2024). These change management techniques aid in making sure that patient requirements are successfully met and that advancements in the treatment of heart disease are long-lasting.

Conclusion

Heart disease continues to be a major public health concern, impacting millions of people due to its numerous risk factors and severe outcomes. By thoroughly examining the effects of heart disease, especially for people like my 64-year-old neighbor, we have brought attention to the pressing need for efficient interventions and comprehensive care plans. A holistic strategy is necessary to improve patient outcomes and manage heart disease more effectively, from the integration of the Health Action Process Approach (HAPA) theory to the function of nurse-led transitional programs and the influence of organizational policies.

Research also indicates that supportive and creative leadership can result in notable changes in patient care, making leadership in healthcare essential to the advancement of these initiatives. Healthcare executives may improve the management of chronic diseases and guarantee improved patient quality of life by embracing evidence-based methods, encouraging teamwork, and putting strong change management techniques into place.

References

Alcoberro, L., Moliner, P., Vime, J., Jiménez-Marrero, S., Garay, A., Yun, S., Pons-Riverola, A., Ramos-Polo, R., Ras-Jiménez, M., Tajes, M., Hidalgo, E., Calero, E., Ruiz, M., José-Bazán, N., Ferre, C., Delso, C., Alcober, L., Enjuanes, C., & Comin-Colet, J. (2023). Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure. PLoS One, 18(2)https://doi.org/10.1371/journal.pone.0279815

Ansarullah, S. I., Saif, S. M., Kumar, P., & Kirmani, M. M. (2022). Significance of Visible Non-Invasive Risk Attributes for the Initial Prediction of Heart Disease Using Different Machine Learning Techniques. Computational intelligence and neuroscience, 2022, 9580896. https://doi.org/10.1155/2022/9580896

Centers for Disease Control and Prevention. (2024, May).  Heart disease facts. Centers for Disease Control and Prevention. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html 

Dowling, M. K., Terry, A. T., Kirilichin, N. L., Lee, J. S., & Blanchard, J. C. (2020). United States Congressional COVID-19 Legislation: Recent Laws and Future Topics. The western journal of emergency medicine, 21(5), 1037–1041. https://doi.org/10.5811/westjem.2020.7.48891

Ghodeshwar, G. K., Dube, A., & Khobragade, D. (2023). Impact of Lifestyle Modifications on Cardiovascular Health: A Narrative Review. Cureus, 15(7), e42616. https://doi.org/10.7759/cureus.42616

Heart disease and stroke statistics - 2023 update. Professional.Heart.Org. (2024). https://professional.heart.org/en/science-news/heart-disease-and-stroke-statistics-2023-update

Javier Ordóñez‐Piedra, Jose Antonio Ponce‐Blandón, Jose Miguel Robles‐Romero, Juan Gómez‐Salgado, Nerea Jiménez‐Picón, & Macarena Romero‐Martín. (2021). Effectiveness of the Advanced Practice Nursing interventions in the patient with heart failure: A systematic review. Nursing Open, 8(4), 1879-1891. https://doi.org/10.1002/nop2.847

Khaled, M. A. (2020). Prediction of heart disease and classifiers’ sensitivity analysis. BMC Bioinformatics, 21, 1-18. https://doi.org/10.1186/s12859-020-03626-y

Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., Navar, A. M., Taub, P. R., Toth, P. P., Virani, S. S., Wong, N. D., & Shapiro, M. D. (2020). Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. American journal of preventive cardiology, 1, 100009. https://doi.org/10.1016/j.ajpc.2020.100009

Spanos, S., Leask, E., Patel, R., Datyner, M., Loh, E., & Braithwaite, J. (2024). Healthcare leaders navigating complexity: a scoping review of key trends in future roles and competencies. BMC Medical Education, 24, 1-13. https://doi.org/10.1186/s12909-024-05689-4

Tavakoli, F., Kazemi-Zahrani, H., & Sadeqhi, M. (2019). The effectiveness of dialectical behavior therapy on adherence to treatment and self-caring behavior in patients with coronary heart disease. ARYA Atherosclerosis, 15(6), 281-287. https://doi.org/10.22122/arya.v15i6.1733

Teame, K., Debie, A., & Tullu, M. (2022). Healthcare leadership effectiveness among managers in Public Health institutions of Addis Ababa, Central Ethiopia: a mixed methods study. BMC Health Services Research, 22, 1-11. https://doi.org/10.1186/s12913-022-07879-6

The Emergency Nurses Association: 50 Years of Advocacy and Advancement: JEN. (2021). Journal of Emergency Nursing, 47(2), 224-238.e1. https://doi.org/10.1016/j.jen.2020.11.007