Project 6

Managing Congestive Heart Failure through Motivational Education

Rosaline Hicks

Chamberlain University

Dr. Sheryl Cator

March 26, 2020

The purpose of this paper is to discuss how motivation can improve outcomes in congestive heart failure (CHF). CHF is a chronic progressive condition that affects the pumping ability of the heart muscles. This paper will cover CHF as a practice problem, the role of evidence to in regard to CHF, and the role of the DNP practice scholar in the translation of evidence.

Addressing issues related to CHF management through education program is important in the improvement of self-management. Most of the reported readmission cases, morbidity, and mortality are associated with poor self-care and self-management of the diseases. The focus of most healthcare facilities when it comes to the management of the CHF is focused on an identified medication regimen, and little to no attention is given to the importance of patient education to improve self-management of CHF.

A study by Bader et al (2018) revealed that an advanced heart failure program helped in the improvement of disease awareness and self-care behaviors when the patients were led by well-trained heart failure nurses. Another study by Howie-Esquivel et al (2015) used the approach of TEACH-HF intervention to manage CHF patients. The study outcome revealed a significantly lower hospital re-admission rate and decrease in the length of stay.

DNP practice scholar play a key role in the translation of evidence. The DNP practice scholar is instrumental in the initiation of projects that focus on the standardized educational process for CHF patients. The initiation is done through the development of new education tools and clinician documentation of evidence-based heart failure care (Myslenski, 2018).

Practice Problem and Question

Patient education is becoming an effective process of managing CHF at home. Patient education aids in the improvement of knowledge and self-care behaviors, thereby, reducing the incidence of readmissions cases (Bader, et al., 2018).

Heart failure is a common, high-risk condition that is characterized with high reports hospitalization and sometimes death. This disease affects more than 6.5 million Americans and in 2012 the CDC reported that it cost approximately 30.7 billion dollars to care for CHF patients and wages lost due to hospitalization. Unlike other cardiovascular illnesses, CHF appears to be the most common one and nearly 1 million new cases are being reported annually internationally. This, therefore, makes it the fastest growing cardiovascular disorder (Savarese & Lund, 2017).

This study is guided by the following Picot question: Does the multidisciplinary educational approach work effectively towards the prevention of hospital re-admission for patients diagnosed with congestive heart failure as compared to no education?

Population: Patients diagnosed with congestive heart failure

Intervention: Multidisciplinary educational intervention

Comparison: No Education

Outcome: reduction in the rate of readmission of the CHF patients

Evidence Synthesis of Literature

A study by Bader et al., (2018) was based on the nurse-led education for CHF patients in developing nations. According to this study, CHF readmission leads to an increase in morbidity and mortality. Adequate education on adherence and self-care behaviors help in the reduction of readmission rate with nurses being at the frontline in delivering patient education (Bader, et al., 2018). In another study by Walsh (2017), the aim was to examine the outcomes of a nurse led patient education program that educated on self-care to improve quality of life for patients with CHF. According to this article, patient education on self-care skills and knowledge is important in controlling symptoms and in the prevention of hospitalizations. Education was tailored to the patients’ needs and goals, which in turn, showed improvement in self-care and quality of life (Walsh, 2017).

According to Howie-Esquivel et al, (2015), the primary goal of caring for the CHF patient was to help with the management of symptoms which play a huge role in re-hospitalization. Due to the increase in reported cases of mortality and the cost of CHF readmission, the focus has been switched to management programs which include coaching, tutoring, rapid follow-up, and the discussion for support services i.e. TEACH-HF intervention (Howie-Esquivel et al, 2015).

Srisuk et al (2017) states that CHF is a major health concern whose management is complicated. The authors of this study aimed at assessing CHF education program created for patients and caregivers in Thailand. The outcome of this study revealed that a family-based CHF program is important in improving patient adherence, individual management behaviors, and quality of life (Srisuk, Cameron, Ski, & Thompson, 2017).

Based on the evidence presented in the case studies above, it is clear that education specific to the patients shows better outcomes. Motivational education assists in reducing healthcare cost, meaning that it is an important strategy that can be implemented in healthcare facilities , even more, after discharge from the hospital.

Appraisal of the Evidence

The study by Howie-Esquivel et al (2015) would be considered level II and quality of evidence A since it is consistent, generalized, generalized outcomes, sufficient sample size (1033), and has an adequate control. The study by Srisuk et al (2018) is level I since it is a randomized controlled it too would be considered quality evidence A since it is consistent with generalizing study outcome. The study by Walsh (2017) I rated as level II and quality B since it is a systematic review, or a combination of studies. The study by Bader et al is an experimental study that involved the use of 131 cardiac center-based nurses, and is considered level I evidence and quality evidence A since the outcome can be generalized.

The articles presented are showing that there is a gap in ensuring that patients are knowledgeable about the concepts of self-care pertaining to CHF. The articles support the intervention of educating patients to improve quality of life and decrease readmission

Translation Path into Practice

One of the internal factors to be considered is the willingness and the ability of the healthcare providers to teach the patients diagnosed with the CHF concerning the approaches of managing CHF. This is important in the improvement of self-care in that it helps in the prevention of complications associated with the disease. The external factors, in this case, are the readiness of the CHF patients to learn what they are being taught. External factor can include language barriers or cultural differences which might affect the communication process during the learning process.

The change Model employed for this case is the Chronic Care Model and it shows evidence-based interventions to help in the improvement of healthcare services to patients. This model is used to help design a healthcare delivery system, decision support, information systems, community connection, self-care, and the proper arrangement of health systems. The model also provides patients with individual management support of their condition (Howie-Esquivel, Carroll, Brinker, Kao, Rago, & De Marco, 2015).

The outcome of the intervention program can only be considered successful if the goals of patient education are achieved. Therefore, the evaluation plan is based on looking at whether the patients have acquired knowledge about self-care when it comes to the individual management of CHF. The success of the program is also shown by the reduction in the rate of reported readmission associated with poor management of CHF.

Conclusion

The overall expected outcome is a reduction in patients' readmission associated with poor management, reduction in the morbidity or other complications from the disease, and a decrease in mortality rates. Therefore, to ensure that there is sustainability of multidisciplinary education, it is important that healthcare providers remain committed. This is ensuring that patients are taught about self-management of CHF. Patients and healthcare providers alike must also adhere to the teaching plan. The organization can also create policies and guidelines that ensure that healthcare providers fully follow these guidelines.

Poor implementation or lack of CHF multidisciplinary education leads to the increase in the admission rates. It increases morbidity and mortality rates of the patients. Studies have shown that patient education interventions assist in addressing the issue of readmission and re-hospitalization of patients as a result of poor management of CHF. DNP practice scholar help in the initiation of the CHF educational process by ensuring that the use of evidence-based educational materials and improvement in managing of CHF symptoms.

References

Bader, F., Atallah, B., Sadik, Z. G., Tbishat, L., Soliman, M., Khalil, M., et al. (2018). Nurse-led education for heart failure patients in developing countries. British Journal of Nursing, 27 (12), 690-696. Howie-Esquivel, J., Carroll, M., Brinker, E., Kao, H., Rago, K., & De Marco, T. (2015). A strategy to reduce heart failure readmissions and inpatient costs. Cardiology research, 6 (1), 201. Lesyuk, W., Kriza, C., & Kolominsky-Rabas, P. (2018). Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC cardiovascular disorders, 18 (1), 74. Luo, E. K. (2018, August 8). What is congestive heart failure? Retrieved March 23, 2020, from Healrthline: https://www.healthline.com/health/congestive-heart-failure Myslenski, M. (2018). Implementation of Standardized Heart Failure Educational and Documentation Processes within an Outpatient Heart and Vascular Clinic. Savarese, G., & Lund, L. (2017). Global public health burden of heart failure. Cardiac failure review, 3 (1), 7-11. Srisuk, N., Cameron, J., Ski, C., & Thompson, D. (2017). Randomized controlled trial of family‐based education for patients with heart failure and their carers. Journal of advanced nursing, 73 (4), 857-870. Walsh, J. (2017). Nurse Led Clinic’s contribution to Patient Education and Promoting Self-care in Heart Failure Patients: A Systematic Review. International Journal of Integrated Care, 17 (5).

Appendix

Summary of Evidence Table