Congestive Heart Failure Paper

Details:
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.Congestive Heart Failure Paper

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Background
Problem statement
Purpose of the change proposal
PICOT
Literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Rubric:
1
Unsatisfactory 0-71%
0.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%
60.0 %
Content

5.0 %
Background
Background section is not present.
Background section is present, but incomplete or otherwise lacking in required detail.
Background section is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Background section is present and complete. The submission provides the basic information required.
Background section is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Problem Statement
Problem statement is not present.
Problem statement is present, but incomplete or otherwise lacking in required detail.Congestive Heart Failure Paper
Problem statement is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Problem statement is present and complete. The submission provides the basic information required.
Problem statement is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Change Proposal Purpose
Purpose of change proposal is not present.
Purpose of change proposal is present, but incomplete or otherwise lacking in required detail.
Purpose of change proposal is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Purpose of change proposal is present and complete. The submission provides the basic information required.
Purpose of change proposal is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
PICOT
PICOT is not present.
PICOT is present, but incomplete or otherwise lacking in required detail.
PICOT is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
PICOT is present and complete. The submission provides the basic information required.
PICOT is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Literature Search Strategy
Literature search strategy is not present.
Literature search strategy is present, but incomplete or otherwise lacking in required detail.
Literature search strategy is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Literature search strategy is present and complete. The submission provides the basic information required.
Literature search strategy is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Literature Evaluation
Literature evaluation is not present.
Literature evaluation is present, but incomplete or otherwise lacking in required detail.
Literature evaluation is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Literature evaluation is present and complete. The submission provides the basic information required.
Literature evaluation is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Utilization of Change or Nursing Theory (2.2)
Theory utilization is not present.
Theory utilization content is present, but incomplete or otherwise lacking in required detail.
Theory utilization content is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Theory utilization content is present and complete. The submission provides the basic information required.
Theory utilization content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Proposed Implementation Plan with Outcome Measures (3.2)
Implementation plan is not present.
Implementation plan is present, but incomplete or otherwise lacking in required detail.Congestive Heart Failure Paper
Implementation plan is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Implementation plan is present and complete. The submission provides the basic information required.
Implementation plan is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (2.3)
Identification of potential barriers to plan implementation and /or discussion component is not present.
Identification of potential barriers to plan implementation with a discussion component is present, but is incomplete or otherwise lacking in required detail.
Identification of potential barriers to plan implementation with a discussion component is present. Some minor details or elements are missing but the omission(s) do not impede understanding.
Identification of potential barriers to plan implementation with a discussion component is present and complete. The submission provides the basic information required.
Identification of potential barriers to plan implementation with a discussion component is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 %
Appendices Inclusive of Practice Immersion Clinical Documentation (1.2)
Appendices are not present.
Appendices are present, but incomplete or otherwise lacking in required detail.
Appendices are present with minor elements missing that do not impede understanding.
Appendices are present and complete. The submission provides the basic information required.
Appendices are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
10.0 %
Evidence of Revision
Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques.
Incorporation of research critique feedback or evidence of revision is incomplete.
Incorporation of research critique feedback and evidence of revision are present.
Evidence of incorporation of research critique feedback and revision is clearly provided.
Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.Congestive Heart Failure Paper
30.0 %
Organization and Effectiveness

10.0 %
Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis is insufficiently developed or vague. Purpose is not clear.
Thesis is apparent and appropriate to purpose.
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
10.0 %
Argument Logic and Construction
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
10.0 %
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
Writer is clearly in command of standard, written, academic English.
10.0 %
Format

5.0 %
Paper Format (use of appropriate style for the major and assignment)
Template is not used appropriately, or documentation format is rarely followed correctly.
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.
Appropriate template is used. Formatting is correct, although some minor errors may be present.
Appropriate template is fully used. There are virtually no errors in formatting style.
All format elements are correct.
5.0 %
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Congestive Heart Failure Paper
100 %
Total Weightage

Across the United States as well as in my current healthcare setting, congestive heart failure has gradually emerged to be a condition of public health significance that results to frequent admissions, readmissions, additional medical costs, and poor health outcomes. This is one of the reasons that, following the implementation of the Affordable Care Act, the Centers for Medicare and Medicaid Services through the National Quality Forum implemented a readmissions reduction program to reduce the reimbursements paid to hospitals which reported excess readmissions as a performance measure (Goldgrab et al., 2019).  The purpose of this program was to influence high-quality care that would see a reduction in the rates of readmissions in hospitals leading to good health outcomes. However, the rates of readmission of heart failure patients are reportedly still high. Heart failure is a chronic condition which is primarily characterized by recurrent exacerbations which alternate with periods of stability (Goldgrab et al., 2019).

According to the National Institute of Health, despite improved living conditions and therapy for people with cardiovascular disorders, those with heart failure have an approximated daily risk of readmission which tends to be the highest on the 3^rd day following discharge. Frequent readmissions are linked to poor quality of care and are a source of excessive medical spending (Goldgrab et al., 2019).  It is for this reason that it is important for policymakers, researchers, and clinicians to actively engage in evidence-based research and develop evidence-based strategies that can be used in clinical care to prevent readmissions in patients with heart failure.

Problem Statement

            According to the statistics provided by the World Health Organization, approximately 6 million adults in the United States live with heart failure and by the year 2020, these projections are expected to increase. Based on a report that was published by the National Institute of Health, heart failure hospitalizations incur the largest expenses and amounts estimated at $30.7 billion (Goldgrab et al., 2019).  Due to these reasons, the federal government of the United States has prioritized prevention and reduction of heart failure readmissions through the Department of Health, stakeholders in the health sector, researchers and clinicians.

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            Research reveals that compliance with medications and appropriate dietary guidelines among patients with heart failure is an issue that needs to be addressed. Similarly, according to data obtained from the American Heart Association, up to 90% of CHF readmissions are linked to poor compliance to nutritional guidelines and medications and this increases the rates of complications, mortalities and morbidities which can otherwise be prevented (Shan et al., 2014).   Scientific research evidence suggests that discharge planning is an effective approach that can be used to reduce readmissions 30 days post discharge in patients with heart failure. In this context, discharge planning involves: educating patients on nutrition, adhering to prescribed medications and advocating for lifestyle behavior change.Congestive Heart Failure Paper

Purpose of the Change Proposal

            Nurses have a critical role to play in the management and evaluation of patients with heart failure who present in acute care settings. After stabilization, nurses are still responsible for discharge preparation and educating patients and caregivers on long-term strategies that can be employed for good long-term outcomes. As supported by Goldgrab et al.,(2019), it is undeniable that readmissions progressively contribute to the deterioration of individual health status of patients and endanger clinical outcomes and patient safety. Discharge planning through policy implementation aims at ensuring that: nurses plan for the discharge of heart failure patients, optimizes the support given to patients during discharge and facilitates effective communication during and after discharge (Goldgrab et al., 2019). Therefore, the proposed change purposes to ensure that patients are provided with high-quality care with improved health outcomes during and after hospitalizations to reduce the likelihood of readmissions.

PICOT

Among Medicare patients discharged with a diagnosis of CHF (P), how does discharge planning (I) compared to follow-up via telephone calls(C) prevent readmission within 30days (O) post discharge?
Literature Search Strategy Employed

 Initial research was done by the use of the search engine EBSCOHost in the scientific databases of Cochrane, CINAHL, PubMed and Medline. Full-text articles whose topic was on preventing readmissions in patients with congestive heart failure were searched for using the following keywords: heart failure, readmission prevention, discharge planning, follow-up, and telephone calls. The literature search was specific to articles in English which had been published in the last 10 years. The entire search yielded 20 articles which were relevant to the study topic. A more comprehensive review narrowed the findings to 10 relevant articles.

            After the following exclusion criteria were applied: articles which were in other languages apart from English, articles which had been published before the year 2010 and articles which used a small sample population. A total of 5 articles which met the inclusion criteria were obtained. Therefore, in the comprehensive literature review, all the articles included ranged from the year 2010-2019 and discussed how discharge planning is an effective intervention to prevent readmissions in patients with heart failure within 30 days after being discharged from hospital

Evaluation of the Literature

            Research evidence suggests that readmissions of heart failure have the largest economic burden with approximately $20billion as direct costs incurred the year 2015, an amount which is expected to increase by 2030 to an estimated $50 billion. It is for this reason that heart failure is a priority and an area of focus for healthcare reforms with an aim of improving patient’s quality of life and health outcomes through nurse-led interventions in primary care settings and community settings. According to an integrated literature review by Shan et al., (2014), patient education, self-care instructions during discharge and continuous follow-up ensures that the medical needs of patients are well addressed.

In a systematic review by Ziaeian &Fonarow (2016), during discharge time, 98% of patients are often not aware of any changes made on prescribed medications and this often results in medication errors. However, with discharge planning, nurses are provided with adequate time to improve the support provided to patients, hold open discussions with patients on the prescribed drugs with their dosages and nutritional modifications to adhere to. Wan et al., (2017) in their systematic review found that through discharge planning, nurses are provided with the chance to write discharge summaries which are comprehensive and of high quality. Such summaries have been associated with low readmission risks for heart failure patients. In other words, discharge planning through comprehensive discharge summaries promote care coordination between healthcare providers and patients and also prevent premature discharges by improving clinical decision making.Congestive Heart Failure Paper

Applicable Change and Nursing Theory Utilized

The self-care of chronic illnesses nursing theory will be used to implement the proposed change. This theory acknowledges self-care as an approach where disease management and health promotion are purposely used to involve a patient in his/her care. Self-care will enable the patient to learn how best to cope with his illness and make care decisions based on nursing education (Eller et al., 2018).  It also includes modification in behavior and actions that an individual engages in to improve health status. The goals of nurses in discharge planning are to educate and inform the patient on what is expected of him/her and to motivate him/her in becoming an active participant in individual care and to be compliant to treatment (Eller et al., 2018). In this case, potential examples of self-care activities include: taking medications as prescribed, observing dietary guidelines as instructed, promptly attending to follow-up schedules and minimizing alcohol consumption and tobacco smoking as recommended.  When the client truly takes part in these processes, they are likely to recognize refined changes in their health status and even prevent complications which lead to readmissions (Eller et al., 2018).

Proposed Implementation Plan with Outcome Measures

The proposed plan of discharge planning aims at: scheduling follow-up appointments between 48hours-7 days following discharge, embracing a multidisciplinary approach in the management of heart failure patients before, during and after discharge from hospital, patient and family education on the diet to be observed and compliance to medications, emphasis on behavior change in relation to alcohol consumption and tobacco smoking, developing schedule appointments for patients with local clinics in community settings, developing processes where patients without primary healthcare providers are assigned to one,  carefully identifying and addressing barriers  which are the major contributors to canceled healthcare appointments and proving  families and patients  the phone number of a discharge unit to call in case of any concerns or questions (Wan et al., 2017).

By implementing these measures, it is expected that: the readiness of patients for discharge will be determined appropriately by nurses before discharge, nurses will also be able to  compile a  discharge summary that is accurate and comprehensive, patients and their respective families will be involved  in the plan of care, appropriate post-discharge care settings will easily be determined based on a patient’s preference and patient care post-discharge with multiple providers and settings will be well coordinated.Congestive Heart Failure Paper

Identification of Potential Barriers to Plan Implementation and How These Could Be Overcome

            The most potential barrier which is likely to hinder the implementation of the proposed plan is reluctance from nursing staff citing how intensive the proposed plan is time-consuming as compared to the currently available nursing manpower. This can however be well addressed through transforming the hospital setting into a learning organization where nurse are continuously educated on how significant it is for patients, the healthcare organization and staff to implement the proposed plan.

References

Goldgrab, D., Balakumaran, K., Kim, M. J., & Tabtabai, S. R. (2019). Updates in heart failure 30-day readmission prevention. Heart failure reviews, 24(2), 177-187.

Shan D, Finder J, Dichoso D & Lewis P. (2014). Interventions to prevent heart failure readmissions: The rationale for nurse-led heart failure programs. Journal of Nursing Education and Practice. 4(11).

Wan T, Terry A, Conn E, McKee B, Tregerman R & Barbaro S. (2017). Strategies to Modify the Risk of Heart Failure Readmission. Health Serv Res Manag Epidemiol. 2017(4).

Ziaeian B & Fonarow G. (2016). The Prevention of Hospital Readmissions in Heart Failure. Prog Cardiovasc Dis. 58(4), 379–385.

Eller, L. S., Lev, E. L., Yuan, C., & Watkins, A. V. (2018). Describing self‐care self‐efficacy: Definition, measurement, outcomes, and implications. International journal of nursing knowledge, 29(1), 38-48.Congestive Heart Failure Paper