M-MANUSCRIPT SECTION 6

MSN Project Manuscript Section I-III

Heart Failure Management

Heart Failure Management

Executive Summary

The main goal of this project was to investigate the implementation of a comprehensive

nursing-led disease management program for heart failure patients in the elderly population in

Miami, Florida. The project was designed to find out if this intervention, as opposed to standard

care, would result in better clinical outcomes, fewer hospital readmissions, and a better quality of

life within the 8-week period. The amalgamation of literature and evidence helped to the

understanding of the current practices and interventions in the management of heart failure. The

suggested intervention, its implementation strategies, and dissemination plans were designed to

deal with the identified problem in a proper way.

Section 1: Introduction and Problem Identification

Problem Statement

Heart failure is a chronic condition that occurs when the heart does not pump enough

blood to meet the body!s needs (Groenewegen et al., 2020). This condition is the main healthcare

challenge that is mostly seen among the elderly population in Miami, Florida, involving many

hospitalizations and reduced quality of life (Zacke, 2019). Despite substantial strides in heart

failure management, it is still necessary to create specific interventions to improve results and

reduce healthcare spending. Therefore, the purpose of this project is to evaluate the efficacy of a

nursing-led disease management program targeted towards elderly heart failure patients in

Miami.

Problem Background

The heart failure management is a multidisciplinary task, taking into account the

complicated nature of the disease and its effect on the lives of the patients. The present practices

are mainly on the symptom management and the acute care interventions, thus hospital

readmissions and suboptimal outcomes are frequent. Through the introduction of a nursing-led

comprehensive disease management program for the elderly population in Miami, it is possible

to improve patient care, decrease the healthcare usage, and increase the overall quality of life.

Stakeholders

The stakeholders who are affected by this project are the elderly patients with heart

failure, their families, healthcare providers, hospitals, insurance providers, and community

organizations that are part of the healthcare delivery system. Every stakeholder group is very

important in making the proposed intervention successful and sustainable.

PICOT Question

"In elderly heart failure patients (population), does the implementation of a nursing-led

comprehensive disease management program (intervention) compared to standard care

(comparison) lead to improved clinical outcomes, reduced hospital readmissions, and enhanced

quality of life (outcome) within an 8-week timeframe (timing)?”

Section 2: Literature Support

Review of Literature

There is strong evidence from the literature that calls for initiation of comprehensive

disease management programs for elderly heart failure patients under the guidance of qualified

nurses. Disease management programs include a set of integrated health care services and

information handling with patients suffering from chronic illnesses (Seferovic et al., 2019;

Bragazzi et al., 2021). These programs are aimed at achieving a healthier and better life by

offering medical, psychosocial, and lifestyle interventions. Research shows that such initiatives

help to improve patient outcomes (Tomasoni et al., 2019). For example, a study conducted by

Jackevicius et al. (2018) reveals that such programs have a positive impact of decreasing

morbidity and mortality in patients diagnosed with heart failure. Additionally, these interventions

have been repeatedly associated with a reduced rate of readmissions to the hospital, thereby

relieving the burden on the healthcare systems and enhancing the efficiency of resource

utilization (Gingele et al., 2019; Bozkurt et al., 2021). The inclusion of dietary counseling,

exercise prescription, symptom assessment, and patient information to these programs yields for

improved patient management of heart failure symptoms with improved quality of life (Bragazzi

et al., 2021). The literature also points out that nurses play a significant role in these programs

(Arrigo et al., 2020). Nursing-led interventions employ the skills of nurses in patient teaching,

coordination, and chronic conditions, thereby emphasizing patient engagement (Arrigo et al.,

2020). This approach is also in line with the evidence which suggests that comprehensive disease

management programmes do not only improve clinical status but also increase quality of life of

elderly patients with heart failure by meeting their physical, emotional and social requirements.

Section 3: Intervention Description

Proposed Intervention

The goal is creating a nursing-led comprehensive disease management program that is

targeting the needs of the elderly heart failure patients in Miami. This program will cover

medication management, dietary counseling, exercise regimens, symptom monitoring and patient

education with nurses stepping into the lead role in its implementation and supervision.

Setting

The project will be conducted in health facilities that serve the elderly population in

Miami, with the goal of creating an organizational culture that supports the change of evidence-

based practice. The readiness to change in these environments will be checked to make sure the

intervention is implemented successfully. Assessing the readiness for change in these settings

will ensure the successful implementation of the intervention.

Barriers

The obstacles to the project are the resistance to change among healthcare providers, the

scarcity of resources, and the difficulties in patient adherence to the program. The ways of

coping with these problems are staff education, stakeholder engagement, and the use of the

community resources to help patients' needs. Addressing these obstacles will involve

comprehensive staff education, active stakeholder engagement, and leveraging community

resources to meet patient needs.

Outcomes

The expected results of the intervention are a reduction of hospital readmissions, the

enhancement of the symptom management, the increased patient satisfaction, and the better

adherence to the treatment regimens. The results will be measured by observing the clinical

indicators, patient-reported outcomes, and healthcare utilization metrics.

Action Plan

The action plan defines the nursing-led disease management program to be phase

implemented with nurses as the core actors of the program whose role is to teach patients,

monitor their symptoms and coordinate their care. The first step is conducting a thorough needs

assessment to identify specific gaps in the current heart failure management practices. This will

be followed by developing detailed protocols and guidelines tailored to the needs of the elderly

heart failure patients. Staff education will play a crucial role, involving comprehensive training

sessions to familiarize the healthcare providers with the new protocols and ensure they have the

necessary skills to implement the program. Collaborating with multidisciplinary teams, including

cardiologists, dietitians, and physical therapists, will be essential to provide holistic care. The

program will be introduced as a specific protocol within the health facilities, with clear

documentation and monitoring processes to track progress and outcomes. Engagement with

community resources and organizations will also be crucial to support patient adherence and

provide additional resources.

References

Arrigo, M., Jessup, M., Mullens, W., Reza, N., Shah, A. M., Sliwa, K., & Mebazaa, A. (2020).

Acute heart failure. Nature Reviews Disease Primers, 6(1), 16.

Bragazzi, N. L., Zhong, W., Shu, J., Abu Much, A., Lotan, D., Grupper, A., ... & Dai, H. (2021).

Burden of heart failure and underlying causes in 195 countries and territories from 1990

to 2017. European Journal of Preventive Cardiology, 28(15), 1682-1690. https://doi.org/

10.1093/eurjpc/zwaa147

Bozkurt, B., Fonarow, G. C., Goldberg, L. R., Guglin, M., Josephson, R. A., Forman, D. E., ... &

ACC!s Heart Failure and Transplant Section and Leadership Council. (2021). Cardiac

rehabilitation for patients with heart failure: JACC expert panel. Journal of the American

College of Cardiology, 77(11), 1454-1469.

Dang, D., & Dearholt, S. L. (2018). [Excerpt and supplemental materials for] Johns Hopkins

nursing evidence-based practice: Model and guidelines. Sigma Theta Tau International.

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins

evidence-based practice for nurses and healthcare professionals: Model and guidelines.

Sigma Theta Tau.

Gingele, A. J., Ramaekers, B., Brunner-La Rocca, H. P., De Weerd, G., Kragten, J., Van Empel,

V., ... & Knackstedt, C. (2019). Effects of tailored telemonitoring on functional status and

health-related quality of life in patients with heart failure. Netherlands Heart Journal, 27,

565-574. https://doi.org/10.1007/s12471-019-01323-x

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart

failure. European journal of heart failure, 22(8), 1342-1356. https://doi.org/10.1002/

ejhf.1858

Jackevicius, C. A., Page, R. L., Buckley, L. F., Jennings, D. L., Nappi, J. M., & Smith, A. J.

(2019). Key articles and guidelines in the management of heart failure: 2018

update . Journal of Pharmacy Pract ice , 32(1) , 77-92. ht tps: / /doi .org/

10.1177/0897190018819413

Seferovic, P. M., Ponikowski, P., Anker, S. D., Bauersachs, J., Chioncel, O., Cleland, J. G., ... &

Coats, A. J. (2019). Clinical practice update on heart failure 2019: pharmacotherapy,

procedures, devices and patient management. An expert consensus meeting report of the

Heart Failure Association of the European Society of Cardiology. European journal of

heart failure, 21(10), 1169-1186. https://doi.org/10.1002/ejhf.1531

Tomasoni, D., Adamo, M., Lombardi, C. M., & Metra, M. (2019). Highlights in heart

failure. ESC heart failure, 6(6), 1105-1127.

Zacke, C. (2019). The Implementation of a Faith-Based Heart Healthy Education Program for

Latinos in Miami, Florida.