Abstract
Congestive heart failure (CHF) is a severe disease affecting the well-being of a patient in many ways. Typically, medical establishments provide patients with extensive guidelines upon discharge, which should guide their self-management and care at home. However, these educational materials are not used by the patients because they are not easy to understand, include information that requires further clarifications, and therefore do not help educate patients on their condition and prevention measures.
Education, however, is the critical element of care for individuals with CHF. Researches suggest that educational programs targeting the patient’s comprehension of primary symptoms and other aspects of their disease are crucial. Based on Lewin’s change theory and the literature review presented in this paper, a nursing intervention was designed. This capstone project aims to create a leaflet that nurses will distribute to patients with CHF upon discharge, which will contain page numbers and key facts from the hospital’s guide. Readmission rates within 30 days will be examined to determine the success of this project.
Capstone Project
CHF is characterized by a severe impairment of a patient’s heart function and leads to a variety of issues that require individuals to monitor their health daily, adhere to the recommendations of medical personnel, take medication, and adjust their lifestyle. According to Pi and Hu (2018), 5,000,000 patients in the United States are impacted by CHF. The illness is diagnosed in people aged 20 years old and above.
Most importantly, the current prognosis of the number of individuals who have CHF suggests that by 2030 the number of patients diagnosed with CHF will increase by 46% (Pi & Hu, 2018). This indicates a need to adjust the existing clinical care practices to ensure that the current healthcare resources can address this issue. One concept that can be applied here is patient-centered care and self-management, where individuals are educated to make valuable changes in their lifestyle and adhere to recommendations regarding the treatment process to adequately manage CHF.
In Sant Barnaba, a large number of patients are admitted and diagnosed with CHF. The main implication of this condition is that upon discharge, patients have to monitor their well-being closely and ensure that they take their medication as prescribed, follow a diet, and consult their doctor if their symptoms progress (Pi & Hu, 2018). Unfortunately, many people fail to follow these simple steps because they are unaware of behaviors they should adopt upon being discharged. This issue is a significant gap in medical care because healthcare facilities should focus on providing wholesome care, which includes educating individuals on the changes they should make to their daily routines to sustain healthy living.
CHF is dangerous not only because it affects a large number of individuals but also because it is associated with many complications. According to Mohamed et al. (2018), this is “profound disease morbidity and mortality and has an adverse impact on the quality of life” (p. 121). Moreover, the authors state that in their hospital, 96% of patients admitted to the coronary care unit have CHF. These statistics suggest that hospitals have a substantial number of patients with CHF, and adjusting their practice and guidelines to suit the requirements of these patients is a necessity.
Moreover, CHF is often associated with other physiological and psychological comorbidities, such as anxiety or depression, which affect the process of treatment and self-management (Mohamed et al., 2018). These psychological problems make it even more challenging to adhere to treatment plans, requiring appropriate support and information from medical establishments to reduce anxiety associated with this disease.
The education of patients is the single most effective approach to ensuring that they know how to manage their health state properly and when to contact a medical professional. This approach should improve the efficiency of care and impact the quality, as well as satisfaction rates and overall well-being. For a person with CHF, there are some recommendations regarding diet and attention that should be followed upon being discharged from a surgical unit. The main issue is that hospitals provide patients with information materials that are too complex and not easy to understand. Chapter 1 will focus on reviewing the problem at Sant Barnaba’s hospital concerning patients with CHF.
Chapter 2 will present an assessment of the literature on the topic of CHF and patient education, which will be used to design the fact sheets for this project. This project aims to improve the current discharge practice used by Sant Barnaba’s nurses by developing an informational sheet that can be placed on the patient’s refrigerator with information about CHF and references to the hospital’s guide where they can get more information.
Problem Statement
The problem under investigation is the fact that patients with CHF upon discharge need to be educated about their condition and behaviors that will help them manage CHF effectively. However, at Sant Barnaba’s hospital, patients are provided with a bulky guide, which contains a lot of information. CHF affects a substantial number of individuals and often results in complications or frequent readmissions. As Mohamed et al. (2018) explore the issue of high readmission rates and comorbidities of patients with CHF, they state that “patient’s satisfaction is one of the two main components of care quality which includes respect for the patient, understanding his needs and providing services” (p. 121).
The current guidelines that exist at Sant Barnaba do not address the aspect of self-care and at-home management of diseases, which impairs the service aspect of the quality of care. This capstone project argues that patients who are discharged from the hospital should receive a leaflet explaining their condition, symptoms, medication, diet, and lifestyle specifics, as well as who and when to contact if they are having difficulties.
Background
Sant Barnaba’s hospital serves a diverse community of patients, who require help and guidance after discharge. Additionally, the current practice used in the coronary care unit implies that patients who are discharged from the cardiac medical care unit receive a booklet containing a large amount of information regarding CHF and its specifics. Arguably, although the booklet is a valuable source of information for many individuals, it requires background knowledge of medicine to be able to understand the issues discussed in it. Moreover, patients will have to dedicate a significant amount of time to reading the entire booklet, which is why many patients with CHF choose to overlook the recommendations provided in this information source.
While the care continuum within the hospital appears to correspond with the standards, some issues arise when patients are discharged and have to go home to care for themselves. In this case, patients may be confused and unable to care for themselves because they do not have enough information or misunderstood some of the advice given by medical professionals. Patient interpretation of medical advice is a severe issue for the healthcare system, and to address it, many hospitals, including Santa Barnaba, develop guides provided to individuals when they leave. However, the usability of these guides is questionable because it contains 28 pages and requires dedication and commitment to be studied by a patient.
As such, they are unable to read the guide and their health is thus in danger, because these patients do not know when to take their medication, what doses to use, and when to contact a physician. For other individuals, the bulky guide is an issue as well, because they cannot understand the majority of information taken from medical textbooks and professional journals.
As such, this guide creates more confusion for patients. Hence, the purpose of this project is to address the problem of patient education comfortably and comprehensively – by creating an information sheet that contains key facts about CHF and refers to the hospital’s guide with page numbers, which patients can place on their refrigerators.
Additionally, this capstone project argues that the hospital needs a more comprehensive and easy to use tool for patients, such as an information sheet or a leaflet, which will contain critical data about CHF – what is this condition and its symptoms, what medication should be taken by patients and when, what are the dietary requirements and changes to their lifestyle, as well as whom and when the patients should contact in case they have concerns or they feel worse than before. Hence, the problem is a societal concern because although hospitals use evidence-based practices, such as providing patients with additional educational materials, these practices are not always appropriate and address the issue.
The issue of information interpretation and health-related literacy is the central concern of this project. According to Delle Pelle, Orsatti, Cipollone, and Cicolini (2017), “low health literacy has been found in older people with heart failure” (p. 859). This suggests that people, especially older individuals, may experience difficulties in managing CHF because their health literacy is inadequate, which will affect the quality of treatment and their life.
Moreover, Pi and Hu(2018) state that “development of patient education materials based on practice guidelines for old HF patients is a key component to ameliorate patient outcomes” (p. 387). Therefore, this project addresses the key issues that individuals with heart conditions encounter and critical aspects of nurses’ responsibilities. The Appendix presents the information sheet that will be utilized in this project.
Purpose
The purpose of this capstone project is to identify a problem that exists in Santa Barnaba’s hospital and use evidence-based solutions to address it. The main issue is the people with CHF in the coronary care unit because the hospital has a large number of them. Therefore, this project attempts to improve the existing continuum of care at Sant Barnaba’s hospital by providing patients with an easy-to-use reference leaflet in addition to the hospital’s guide.
This project is important for nursing because these medical professionals are responsible for teaching their patients how to take care of themselves at home. The organization will benefit since proper care leads to better patient satisfaction and a reduced level of readmissions. Finally, leadership is enhanced in this project since it allows a nurse to demonstrate and apply professional skills and knowledge in practice.
The Nature of the Project
This project aims to accomplish the goal of improving the patient’s understanding of their condition to improve their self-management upon discharge. The leaflet contains all the information about key aspects of CHF management and the page numbers for reference that the patients can then use to find more information in the guide provided by the hospital.
Following Lewin’s theory of the change process, this project considers the issue of restraining and reinforcing factors that affect nurses when implementing a change, meaning that a nurse leader will guide the implementation of the new discharge process and evaluate the result based on this theory. This project will involve printing out a leaflet with crucial information about CHF management and page numbers from the hospital’s 28-page guide in case patients will need more information, and the readmission rates will be evaluated after 30 days.
At the first stage of this project, it is necessary to prepare the nurses for the change by educating them and discussing the problem, by Lewin’s theory of change. One barrier is that during the unfreezing stage, the group members may be unaware of the fact that some aspects of their work can be improved. Hence, the change agent will educate the nurses using the information from the literature review, highlighting the need to enhance patient education as a key method of decreasing CHF readmission rates. Supporting the nurses is the key to successfully implementing any change project, and here, it can be achieved by pointing out the existing issue – an overly complex guide and presenting a solution in the form of a reference leaflet, which is presented as Figure 1 in the Appendix.
At the second stage, the actual implementation of the project occurs, with the change agent creating the plan for change and supporting the nurses (Hussain, 2018). Here, nurses will implement the distribution of the leaflet concerning pages in the hospital’s 28-page guide, which patients can place on their refrigerator to remember key aspects of self-management. Finally, at the refreezing stage, it is important to ensure that the project is permanently implemented, within 30 days of distributing the leaflets.
Research Question
Will readmission rates (O) decrease in patients with congestive heart failure (P) receiving an additional leaflet (I) compared to those not receiving any (C)?
Summary
In summary, CHF is a serious condition that affects 5 million people across the United States. For adequate management, patients have to be aware of what care practices they should apply outside the hospital. In the examined healthcare establishment, Sant Barnaba’s hospital, patients are provided with a guide that is too complex and can often be overlooked by individuals. This capstone project will implement a more straightforward solution in the form of a leaflet with key information and references to the hospital’s guide that patients can place on their refrigerators for easy access.
Literature Review
Introduction
This chapter intends to provide a literature review that will guide this capstone project. This chapter contains a literature review table, where the main findings from interventions and studies on managing CHF are presented. Mainly, the nursing research directed at improving the health outcomes of CHF patients is directed at nurse-led education. As such, this review explores the varied types and methods, as well as the information that can be applied to help patients manage CHF.
Historical Overview and Current Findings
Table 1 is the assessment of the literature on the topic. In most cases, nursing interventions for patients with CHF focus on enhancing their knowledge through educational sessions. Little research data is available addressing the element of hospital-issued guides or information sheets. Pi and Hu(2018) highlight the main aspects of education that should be addressed by nurses – “patients with HF should be advised to strictly comply with a heart-healthy diet, including sodium control” (p. 387). When synthesizing the data from studies presented in Table 1, one can argue that education significantly improves the knowledge of patients about CHF.
Current Findings
Proper patient education is the key to ensuring that they follow the recommendations of their providers and mitigate the risk of readmission, especially for CHF, where diet, exercise, and medication are vital. Jonkman et al. (2016) analyzed 20 studies to determine if self-management affects the number of readmissions that the patients with CHF experience. Readmissions burden the hospitals and patients, especially in cases when the issue can be addressed by adhering to behavioral and lifestyle recommendations.
Jonkman et al. (2016) state that self-management decreases the number of days when a patient stays in a hospital when compared to a lack of knowledge and awareness of self-management practice. This suggests that the nurses’ efforts should be directed at ensuring that CHF patients, when being discharged, receive necessary information and tools that can help them adjust their lifestyles.
Firstly, the study by Mohamed et al. (2018) titled “Effect of applying a clinical pathway for patients with Congestive Heart Failure on their health status outcomes” was found in ProQuest when searching using keywords “CHF readmissions intervention.” Mohamed et al. (2018) suggest that patients with CHF require additional guidance, and they usually experience anxiety after being discharged from a hospital. This obstructs their ability to fully recover and return to normal life, as well as manage CHF effectively using the recommendations of their provider. The researchers aimed to reduce anxiety by helping patients improve their knowledge of CHF by preparing a colorful guidebook that was distributed to them upon discharge.
As a result of this quasi-experimental study, all participants reported an enhanced understanding of their condition and less anxiety when compared to the same assessment conducted before this experiment. Mathew and Thukha (2018) focus on educational sessions with patients over the age of 65 who were going to be discharged after CHF admissions. This study also highlights the positive impact that additional information patients receive has on their well-being and readmissions.
Next, Rice et al. (2018) conducted a systematic literature review, attempting to determine the role of nurses in educating patients about CHF. The results suggest that efforts from nurses are directed at educating CHF patients to reduce the readmission rates. This suggests that frequent readmissions can be prevented if patients have an understanding of the behaviors they should adopt, such as a healthy diet and regular exercise, and when to contact a medical professional. Additianlly, Sherin et al. (2017) state that nurses’ interventions can affect the patient’s ability to address key aspects of having a proper lifestyle to avoid CHF complications.
The examined studies suggest that nurse-led education of patients can have a positive impact on their understanding of CHF and on how they manage their behavior at home. Since such education sessions are a significant intervention that requires additional resources from the hospital, such as time and personnel who will teach the patients during the educational sessions, a different intervention targeting the improvement of the current education process was developed. The guide that the hospital provides is overly complex, with patients having to read 28 pages, which is why the leaflet developed for this intervention, which contains key aspects of self-management and page numbers from the original guide, should help address the problem.
Conclusion
In conclusion, nurses who discharge patients with CHF have to ensure that their knowledge of self-management, including diet, exercise, and warning signs is sufficient, meaning that patient education is central to decreasing the number of readmissions.
Overall, this literature review will allow developing a capstone project intervention for patients with CHF. This literature review contributes to the Capstone Project because it synthesizes information from five studies, three of which were carried out by nurses. In all cases, the educational programs allowed patients to improve their comprehension of CHF, which are positive findings. The negative findings suggest that nurses have to use one on one sessions to fully examine all specifics of self-management. The need for the Capstone Project is thus reflected in the requirement to develop an easy-to-use guide since the literature indicates a lack of knowledge among the population with CHF.
Summary
The literature review helped explore the studies that examine nurse-led programs for improving the health-related knowledge of patients with CHF. The critical points of the literature review are that patient education can be addressed in varied ways, including one on one sessions or guides. Moreover, the information provided to patients can also include advice regarding anxiety that can be connected to the need for managing this condition. In general, the health outcomes of individuals improve if they are provided with appropriate resources to address self-management.
Table 1. Literature review (created by the author).
References
Della Pelle, C., Orsatti, V., Cipollone, F., & Cicolini, G. (2017). Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey. Journal Of Clinical Nursing, 27(3-4), 859-865. Web.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. Web.
Jonkman, N., Westland, H., Groenwold, R., Ågren, S., Atienza, F., & Blue, L. … Hoes, A. (2016). Do self-management interventions work in patients with heart failure?. Circulation, 133(12), 1189-1198. Web.
Mathew, S., & Thukha, H. (2018). Pilot testing of the effectiveness of nurse-guided, patient-centered heart failure education for older adults. Geriatric Nursing, 39(4), 376-381. Web.
Mohamed, M., Alaa El-Deen, S., Ali, G., & Ibrahim, M. (2019). Effect of applying a clinical pathway for patients with Congestive Heart Failure on their health status outcomes. Nursing and Palliative Care International Journal, 2(1), 12-19. Web.
Pi, H. Y., & Hu, X. (2016). Nursing care in old patients with heart failure: current status and future perspectives. Journal of Geriatric Cardiology : JGC, 13(5), 387–390. Web.
Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Education And Counseling, 101(3), 363-374. Web.
Appendix
Figure 1. Reference guide for patients (created by the author).