This paper presents a review of a research study conducted by Brandon, Schuessler, Ellison, and Lazenby (2009), which explores the effect of advanced practice nurse (APN) telephone intervention and enhanced disease management on patients living with heart failure (HF). Specifically, the research study investigates the impact of such an intervention on patient outcomes, including readmission rates, quality of life and self-care behaviors. The study was obtained from the Applied Nursing Research journal. According to Knapp’s (1998) definition of research, this study clearly describes an investigative activity with a purpose, and an end goal of knowledge advancement. The article does not merely search for already available information or offer strong opinions; rather, it advances the nursing discipline by studying phenomena to promote health. Through telephone communication, education and indicated intervention, patients living with HF are found to have healthier outcomes versus the control group without intervention.
Basic Research and Questions
Brandon et al. (2009) utilizes Orem’s self-care deficit theory as a theoretical basis for the study. Identified patient self-care deficits are addressed by the APN, and, with support, patients are empowered to practice healthy behaviors leading to improved measured outcomes. This study accurately fits with the description of basic research in that it gathers information and builds on existing knowledge. The study does not attempt to arrive at a solution to solve a problem (applied research).
In review of the study, Brandon et al. (2009) proposes three research questions. The first research question seeks to understand the demographic characteristics of the HF patients in the...
... middle of paper ...
... significantly outweigh the potential risks.
In conclusion, Brandon et al. (2009) report APN intervention resulted in fewer hospital readmissions, and improvements in overall quality of life and self-care behaviors. In a perfect world, regular access and evaluation by an APN or provider would certainly improve patient outcomes and decrease medical costs. Continual research is warranted to help us move in the right direction to improve and advance patient health.
References
Brandon, A. F., Schuessler, J. B., Ellison, K. J., & Lazenby, R. B. (2009). The effects of an advanced practice nurse led telephone intervention on outcomes of patients with heart failure. Applied Nursing Research, 22, e1-e7. doi:10.1016/j.apnr.2009.02.003
Knapp, T. R. (1998). Quantitative nursing research. Thousand Oaks, CA: Sage Publications, Inc.
Nurses and physicians need to become partners in health care reform. We have a responsibility to provide competent care to our patients. National standards need to be put in place to decrease the inconsistencies in APN practice. Overwhelming data supports the APN over the physician in cost effectiveness, quality and access to care and many other aspects.
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
Patients often have complex care needs, and often present with multiple co-morbidities or problems. The process of conducting a comprehensive nursing assessment, and the coordination of care based on these findings is central to the role of the Registered Nurse (NMBA 2006). Evidence-based interventions must then be planned and implemented in a patient-centred approach in order to achieve agreed treatment goals and optimise health (Brown & Edwards 2012).
Implications for nursing practice are as follows. First, the study indicated that additional medical intervention is not always supportive of positive patient outcomes. Instead, it
...y hired nurses on the heart failure floor since discharge education remains one of the responsibilities. I believe knowledge is an important factor to empower the patients about heart failure care and nurses spend nearly 24 hours a day with hospitalized patients; therefore, nurses can be patient advocates by reinforcing teaching. Most importantly, I believe that catering to the patient’s individual needs and establishing a good nurse-patient relationship enhances trust and learning which in the long run, is very beneficial to both nursing practice and the quality of life of the patient. Overall, what I discovered about heart failure is that there is no simple solution in preventing heart failure hospital readmission. Even with the recommended evidence-based practice suggestions, hospital readmission rates for HF still seem to remain high throughout the country.
The aim of this essay is to critically analyse and appraise Local and National policies surrounding Long-Term health conditions (LTC) and complex care needs, which inform community practice. It is intended to critically appraise the complex care requirements of people with Heart Failure as the chosen LTC, outlining areas of care that need to be addressed by professionals utilising contemporary research and evidence based practice. As per the Nursing and Midwifery Council (NMC) (2010) all identities of people and local trusts will be kept confidential.
Scottish Intercollegiate Guideline Network (SIGN) 95 (2007): Management of Chronic Heart Failure (Online). Available at: http://www.sign.ac.uk/pdf/sign95.pdf (Accessed 8th June 2010)
...ions model, Parrinello (2012) described the process of implementing new guidelines to screen for metabolic syndrome in a suburban psychiatric day treatment hospital. Guided by Rogers' diffusion of innovations model, Schaumberg, Narayan, & Wright (2013), developed, implemented, and evaluated a new evidence based practice project, Advanced Practice Nurse (APN) Psychiatric Bridging Intervention. By successful implementation of APN, clients required only 30-minute for initial psychiatric evaluation appointments compared to the typical 60-minute appointment. Moreover, Peeters, de Veer, van der Hoek & Francke (2012) examined the applicability of four perceived attributes in Rogers' diffusion of innovations model, which may influence the adoption of home telecare by elderly or chronically ill people, relative advantage, compatibility, complexity and observability.
...mechanisms linking self-esteem to physiological and/or psychological components in diseases may elucidate causal relationships and enlighten on theoretical models of self-care, well-being, and disease management.
Heart failure is a major clinical, social and economic problem in the United Kingdom according to the Department of Health [DH] (2013).The National Institute for Health and Clinical Excellence [NICE] (2010) reported that about 900,000 people suffer from heart failure in the United Kingdom. The National Institute for Cardiovascular Outcomes Research [NICOR] (2011) conducted a national audit which found that one in every 20 people over the age of 65 is diagnosed with heart failure which demonstrates that it mainly affects the elderly. As a leading cause of mortality, heart failure contributes to more than 6,000 deaths each year (NICOR, 2011). Newly diagnosed cases of heart failure have a 40% risk of dying within a year (NICOR, 2011). Despite advances in therapy, mortality is still high and only half of patients are alive five years after being diagnosed with heart failure (NICE, 2010).
Just like any novice APN I would tend to be more focused on the clinical domain. Coaching and educating patients and family will be important to effect change in their lifestyle to be more compliant with the treatment plan. As we all know a patient’s care is not confined to nursing care but involves the other disciplines; doctors, therapist, social worker, nursing assistant, dietician, pharmacist, etc. and thus the importance of collaboration. Advocating for patient also requires expert communications skills and collaboration. As I continue with my journey to become an Advanced Practice Nurse, I hope to develop all attributes starting with the expert communication to the level where I can advocate for my patient’s needs in the health policy arena. I would also like to work on self-confidence. I know self-confidence comes in time with knowledge and experience. I believe that patients develop trust and confidence when they see confidence of their healthcare
“Heart failure is among the most common diagnoses in hospitalized adults in the United States” (Cole
Katzenstein, Larry, and Ileana L. Pinã. Living with Heart Disease: Everything You Need to Know to Safeguard Your Health and Take Control of Your Life. New York: AARP/Sterling Pub. Co, 2007. Print.
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
For nursing, research has played a major role in the way clinical practice is done. Research has allowed nurses to provide appropriate care to patients. It allows them to perform their job by providing them the tools and information they need in order to make the decisions on the concerns for caring the patient (Polit & Beck, 2006). Moreover, research can also take focus on the workers themselves in order to improve the practice both on a professional and personal level. An example of a study conducted by King, Vidourek, and Schweibert of University of Cincinnati created a study to determine if there is a correlation between ...