DNP- LEADERSHIP FOR ADVANCED NURSING PRACTICE

Introduction

In United States, the prevalence of chronic diseases has presented a major public health challenge. Heart disease tops the list of chronic illnesses that negatively affected the health and well-being of people in the U.S. This calls for cardiologists to use DNP knowledge and skills in providing extensive healthcare to vulnerable population suffering from heart disease. Notably, cardiovascular disease has hit nearly half of the Americans with 121.5 million people suffering from the illness –translating to 48 percent of the total population (American Heart Association, 2019). Moreover, “cardiovascular disease continues to be the leading cause of deaths” in United States –with 840,678 deaths reported in 2016. Additionally, statistics shows that 1 in every 4 deaths reported in United States is as a result of heart disease that is highly linked to high bold pressure or hypertension. These statistics have raised a major concern among key stakeholders in the healthcare sector –majorly the public health nurses.

DNP-prepared practitioners are striving to contain this epidemic that is threatening the health and well-being of the people in the entire United States. Healthcare practitioners are striving to apply skills and expertise in assessing health needs of the vulnerable population –a move that helps in developing, implementing, and evaluating patient-oriented interventions that are meant to provide help to victims of cardiovascular disease. Low-income earning citizens in United States find it hard to access medical care hence putting them at risk of dying from heart disease. Because most people are yet to access medical insurance, it is pretty clear that public health nurses have a huge task in addressing the needs of this vulnerable group whose chances of accessing proper medical care are minimal. The needy population require assurance through assessment and development of policies that puts in place public health workforce and other resources required to cater for their needs.

Literature Review

The prevalence of cardiovascular disease remains high among adults in United States (Saydah et al., 2014). The risk of cardiovascular disease increases (CVD) as people continue to gain more weight. Furthermore, smoking was highlighted as another root cause of CVD among adults in the U.S. 46 percent of the American adults are exposed to the risk of CVD. Moreover, more than 70% of Americans aged 18 years and above are exposed to at least one risk factor that causes cardiovascular disease. Poor feeding styles especially meals containing high levels of cholesterol continues to expose most Americans to the risk of obesity and consequent hypertension. Additionally, most Americans lives with untreated hypertension as a result of lack access to healthcare. Poverty levels and lack of awareness were some factors that contributed to high cases of untreated hypertension that could lead to more adverse health effects (Saydah et al., 2014).

Heart Disease (HD) is among the leading killer illnesses in the U.S. Heart disease was highlighted as a major cause of disability and death among adults in United States. CVD continues to be a burden to most people nationally hence the need to rely on innovation as an essential way of preventing heart disease (Sidney et al., 2016). Though the introduction of Affordable Care Act is set to improve CVD outcomes, constant involvement in risky behaviors may continue to expose people to this chronic disease. Lack of physical exercise and consumption of meals with high cholesterol levels presented a major challenge. Moreover, the number of people who engaged in active smoking between 1999 and 2012 increased –hence exposing them to the risk of CVD. Therefore, the concept of cardiovascular health needs to be given longstanding emphasis by DNP-prepared public health nurses –a move that will prevent deaths resulting from CVD.

According to Rodriguez et al. (2014), “CVD remains the leading cause of death among Hispanics, as it is among the rest of the US population.” Lack of physical activity, obesity, and smoking are highlighted as the major causes of CVD among the Hispanics. One of the key goals of Healthy People 2020 was to “reduce the number of deaths attributed to cardiovascular disease and stroke” among Americans (Rodriguez et al., 2014). Generally, CVD presents a major concern that needs proper planning in order to revert its effects. The access of healthcare in United States is based on whether an individual will get a health insurance or not. However, Hispanics represents 31.1% of the people in United States who lack medical insurance cover. This has forced them to independently cater for their medical expenses –a scenario that has made it hard for CVD patients to access healthcare services due to huge expenses involved. Generally, cardiovascular disease is a problem that has led to high mortality rates –hence the need to come up with interventions meant to address this problem.

Description of the Case and Situation

The public healthcare challenge presented by cardiovascular disease is worrying as the illness continues to claim lives of Americans every year. According to CDC (2017), in every four deaths reported in United States, one of them is associated with cardiovascular disease. On average, over 800,000 people die every year as a result of CVD. These statistics shows that indeed, CVD is a serious public health problem that require proper attention from key stakeholders in the healthcare sector. Fighting this menace requires proper planning that includes both the federal and state governments. Cardiovascular disease has become a huge burden to the country with the cost associated with management and prevention of the disease. Lack of proper and timely medical attention would make the situation even worse resulting into more deaths. Acute and chronic heart failure is a life-threatening condition that require proper management.

Treating CVD is very costly in United States –hence presenting a huge economic burden. More than $400 billion is spent on dealing with CVD-related cases whereby each patient is estimated to have used $118,656 (Patel, Nagar & Dalal, 2014). This cost is alarming meaning that most people without medical insurance covers will find it hard to access the right treatment. With the increased cases of high blood pressure, obesity, smoking, and consumption of food with high cholesterol levels means that people are at a high risk of contracting cardiovascular disease. DNP-prepared practitioners among them cardiologists should be at the forefront in addressing the needs of vulnerable populations that consist of poor people who cannot afford insurance covers or money to cater for their medical expenses.

Discussion

The major arguments presented in the literature review have identified cardiovascular disease as a major healthcare challenge to the American healthcare system. CVD is among the key causes of deaths in United States. Despite the introduction of Affordable Care Act, most people remain uninsured hence making it hard for them to access proper medical care. Research indicates that more than 46% of Americans are exposed to more than two risk factors which cause cardiovascular disease. This shows that the prevalence is still high among the American population.

Notably, engagement in an individual’s risky behavior means that the fight against cardiovascular disease is far from over. Constant smoking, alcohol drinking, lack of physical exercise, and consumption of foods with high cholesterol levels exposes people to high risk of cardiovascular disease. Thus, the fight against CVD requires a more systematic approach in order to create more awareness regarding the importance of living a healthy lifestyle rather than relying on medication while assuming the risk factors linked to cardiovascular disease.

Access to proper and timely healthcare forms the basis of proper fight against the spread of CVD. However, most people are unable to access appropriate medical care due to poverty levels and inability to secure a medical insurance cover (Kaiser Family Foundation, 2016). Now, the statistics shows that almost half of the American population is battling cardiovascular disease. Moreover, a huge percentage of people live with untreated hypertension which is the root cause of cardiovascular disease. Considerably, most people lack awareness regarding CVD while others lace resources required to access proper healthcare help and support. Consequently, people continue being exposed to cardiovascular disease and number of deaths will go up unless appropriate and effective interventions are put in place.

Summary of the Case

In summary, cardiovascular disease has become a major public health issue in United States. Statistics show that almost half of the Americans suffer from cardiovascular disease –translating to 121.5 million people (American Heart Association, 2019). This has presented a more progressive problem to cardiologists and other medical DNP-prepared public health nurses. More than 840,000 Americans died as a result of CVD in 2016 and up to date, this illness remains the major cause of deaths in United States. Lack of awareness and inability to access proper treatment continues to threaten the welfare and well-being of Americans suffering from heart disease. Kaiser Commission Report shows that despite the introduction of Affordable Care Act, over 27.4 million non-elderly people remain uninsured in United States (Kaiser Family Foundation, 2016). This is mostly attributed to high cost of medical insurance, lack of employment, and poverty levels. This has become a major problem in the effort to curb the rising cases of cardiovascular disease in the U.S. Failure to observe healthy living continues to expose more Americans to CVD –meaning that the figure will soon surpass the current 121.5 million. The introduction of ACA has not fully addressed the needs of vulnerable populations since more low-income people remain uninsured hence making it hard for them to access effective healthcare. Thus, the effort to contain cardiovascular disease remains an issue due to lack of insurance coverage, which makes the treatment process not affordable for most low-income earning Americans.

Proposed Solution

Notably, cardiovascular disease remains a major healthcare challenge that require appropriate and effective intervention programs. There is need to create awareness among the people so that they can understand the nature and effects of CVD –including the risks that lead to cardiovascular disease. Moreover, intervention programs will highlight the importance of healthy living and how to avoid various things that might cause CVD. Notably, DNP-prepared public health nurses and cardiologists should utilize their skills and expertise to ensure that they address the needs of the vulnerable populations. Thus, it is important to ensure that various “safe and effective interventions are available for primordial, primary, and secondary prevention and control of CVD” (Mayo Clinic, 2019). This will improve adherence, survival, and overall quality of life. The following process will be followed in order to solve the public health challenge presented cardiovascular disease.

Advocacy

This is essential in creating awareness on the existence of cardiovascular disease and its effects. People from vulnerable groups should be educated on cardiovascular health and the need to go for check-up in order to get tested. This will be done through media (both traditional and digital media), social groups and gatherings, as well as face-to-face communication. This will create awareness among the communities and individuals will be willing to avail themselves for check-up.

Assessment and Diagnosis

First and foremost, there is need to establish whether a patient is suffering from heart disease or not. Cardiologists and other public health nurses will first conduct physical examination by asking a number of questions regarding a person’s medical history –both personal and family (Mayo Clinic, 2019). Then the practitioner will proceed to conduct chest X-ray and blood tests. Moreover, there are a number of tests that can be conducted including:

Holter Monitoring: This is a portable device that can be used to detect any irregularities in heart rhythm.

Electrocardiogram (ECG): Just like Holter monitoring, ECG is also used to detect heart rhythm irregularities.

Cardiac CT scan: This is used to check heart problems

“Cardiac magnetic Resonance Imaging (MRI)”: MRI helps to produce pictures that are used to evaluate the state of the heart.

Echocardiogram: The process involves examination of the heart structure and functioning by taking the ultrasound image.

Cardiac Catheterization: This is aided by x-ray pictures take using ultrasound.

Treatment

Once the issue of cardiovascular disease has been established, there is need to begin treatment right away in order to avoid further adverse effects. The two treatment techniques include:

Medications: Notably, heart diseases differ, and the practitioner will prescribe drugs according to the specific CVD.

Medical Surgery: This will occur when medications are not enough to heal the heart problem.

Clinical Trials and Interventions

Practitioners should be able to come up with interventions meant detect, treat, prevent, and manage cardiovascular disease. This will involve the adoption of a healthy lifestyle whereby a patient is able to:

· Stop alcohol

· Frequent blood pressure testing

· Eating meals with low cholesterol levels

· Managing stress and depression

· Engaging in regular physical exercise

· Stop smoking

· Observing good hygiene (Mayo Clinic, 2019).

Support Interventions

Generally, people suffering from cardiovascular disease may sometimes feel frustrated and overwhelmed by their condition. Hence, there is need to offer them support in order to ensure that they recover from such cases. The support interventions include:

· Support groups including family and friends who will talk to the patient and encourage him or her to remain strong during the recovery process.

· Treatment follow-up and check-ups: This can be done even at home by public health nurses.

· Rehabilitation: This helps to closely monitor the patients and offer them emotional support and counseling (Mayo Clinic, 2019).

Issues and Inefficiencies

The whole process of offering support to patients suffering from cardiovascular disease encounters a number of challenges that include:

· Lack of Medical Insurance Coverage: According to Kaiser Commission Report, over 27 million non-elderly people in the U.S. have no medical cover hence making it hard for them to access healthcare services (Kaiser Family Foundation, 2016). Notably, treating CVD is among the most expensive medical process –making it hard for patients to access some services like medical surgeries. Thus, there is need to develop a policy that will ensure that all Americans have a medical cover.

· Shortage of Nurses: One of the modern-day characteristics of healthcare issues in United States is the aging workforce, which unfortunately is almost 50 percent of the NPs that are set to retire in the next three years. These days, healthcare practitioners especially nurses are forced to work for more than 10 hours a day without offs (Haddad & Toney-Butler, 2019). Lack of enough practitioners will thus make the whole process of fighting cardiovascular disease a hard task.

Evaluation

Notably, it is essential to evaluate the treatment process and interventions used to help patients suffering from cardiovascular disease. This would be essential in establishing the effectiveness and success various interventions and the entire treatment process. The following tools will be used for evaluation:

· Observation: The practitioners can observe the patients and establish whether there is progress in their health.

· Content Analysis: Analyzing medical records of the patient can help to establish whether there are any improvements in the weight of the patient and his or her blood pressure, which can both cause a heart problem.

· Interviews and questionnaires: These can be used to gauge the progress of patients and whether are ready to observe healthy lifestyle.

Conclusion

In conclusion, chronic illnesses like cardiovascular disease presents a major challenge to the American healthcare system. Nearly half of the country’s population is suffering from CVD hence threatening the welfare and livelihood of people in the U.S. Moreover, people continue to engage in risky behaviors like alcohol drinking, smoking, and consumption of foods with high cholesterol contents –hence increasing chances of contracting the disease. Additionally, millions of people in United States are still uninsured despite the introduction of the Affordable Care Act (ACA) –hence making it hard for them to access medical care. Generally, this case report explores the issue of cardiovascular disease, the challenge it presents to the U.S. healthcare system, data regarding the disease, the medical and non-medical interventions, as well as how to evaluate the success of treatment process applied in addressing the needs of patients suffering from CVD.

References