Heart Failure PICO Research, Research Paper Example

PICO question

Will patients with heart failure benefit more from appropriate education compared to rigid medication management in preventing a 60 day readmission to hospital?

P – (Patient) Patients with heart failure

I – (Intervention) appropriate education

C – (Comparison) rigid medication management

O – (Outcome) prevent 60 day readmission

Studies show where there is a very high readmission rate for patients suffering with heart failure. This is very costly and the mortality rate is increasing. However, research evaluating the extent of this irregularity provided alternate measures for reducing readmissions. The researchers identified partnering with other hospitals in providing care was one effect strategy. Nurses providing adequate medication reconciliation upon discharge were a key factor. Also, follow up appointments reduced incidences of readmission. Currently, $38 billion US is spent on readmission of heart failure patients. An estimated 1 million heart failure readmissions occur annually in United States of America. Heart failure rates continue to rise at a rate of 30% annually (Gheorghiade, Vaduganathan & Fonarow, 2013).

Summary paragraph for nursing quantitative article

This article examines the ‘Discharge Clinical Characteristics and 60-Day Readmission in Patients Hospitalized With Heart Failure.’ Three facts that are projected in this research pertain first to heart failure being a clinical syndrome creating very high incidences of economic burden, morbidity and mortality, morbidity in our society.  Second fact relates to patients themselves. Heart failure is a medical condition that produces frequent hospitalizations this is due to acute exacerbations, which are incurred with the condition.  These recurrent hospitalizations, especially, soon after discharge is detrimental to the specific patient population thirdly, rehospitalizations within 60 days suggest inappropriate management during hospitalization. Precisely the authors advance that the causes for readmission reflects markers of clinical instability. Clinical characteristics at time of discharge are believed to promote incidences of frequent readmissions and measures ought to be taken in re-evaluating discharge readiness for this category of patients (Anderson. 2014).

 Reliability paragraph for nursing quantitative article

 Reliability refers to the extent results presented in a study are consistent over time. It also determines accuracy at which the total population was represented. Precisely, this examines sampling criteria and whether the techniques used for selecting the sample resulted in accurately representing the population under review. Reliability pertains also, to whether the results received at the end of a study could be obtained again or replicated if the same methodologies were employed in another research project. Once this is achieved the instrument applied in collecting data is considered reliable. In the quantitative research article selected for this project researchers selected a descriptive correlational design in conducting a research on heart failure patients. The instrument utilized in this study was records because the actual study was a review of data pertaining to the subject researched (Cohen,  Manion  & Morrison, 2013). The records of a sample of 134 patients diagnosed with heart failure upon discharge were reviewed. The reliability question here is how accurate are the records being used as an instrument in this research. While the sample could be considered representative is the instrument. According to research scientists if the instrument is not reliable then the results would be inaccurate and the entire research unreliable. In their results the researcher mentioned reasons for readmission. The objective guiding in this study pertained to finding out the clinical and diagnostic features of patient hospitalized with heart failure. However, the results reports seem not to coincide with the original objective of the study.

Validity paragraph for nursing quantitative article

Validity evaluates if the research accurately measures and reflects the intentions of the researcher. For example, in the selected quantitative article written by Anderson (2014) it was observed that the objective did not coincide accurately with results presented. The objective for this study was presented as seeking to investigate the clinical and diagnostic features of patients hospitalized with heart failure. The results reports seem not to coincide with the original objective of the study. Variables such as dyspnea, crakles, assistance with activities of daily living; along with independent of age, gender and multiple other factors were offered as results/answers to the objective of investigating the diagnostic and clinical features of patients hospitalized with heart disease (Anderson, 2014). How truthful these results are based on the methodology undertaken is another validity issue. Validity has its internal, external as well as content validity criteria issue. This discrepancy of inaccurately representing the original intention in the findings presented could reflect both internal and external validity issues due to the instrument adopted in the study. The technique of establishing validity within a study is selecting an instrument that is capable of most accurately measuring the intentions of the research. The author reviewed data from a sampled 134. Data was collected from patients electronic medical records, which may not be the best instrument for an intricate study of this nature. Perhaps, a more scientific approach such as an experiment with the sample might have more accurately measured the intention. Often when a researcher is not an expert in validity measurements, especially, when quantitative designs are adopted the rule is to evaluate the instrument, results and methodology with similar studies in making comparisons (Cohen et.al, 2013).

Two additional strengths and weaknesses from nursing article

Two major strengths in this research pertain to the design. The researcher chose to apply a descriptive, correlational, comparative, quantitative design. Quantitative designs add value to a research project because the statistical interpretation of data is considered more accurate than theoretical explorations as utilized in qualitative studies. Subsequently, a retrospective review was incorporated as the instrument for collecting data. While other instruments could be as applicable the purpose of this study created the necessity for a retrospective account of the phenomenon. Another strength that can be identified is the data analysis process. The latest SPSS version 16 or SPSS/ PASW version 17 (SPSS Inc) were the main measurement tools. These statistical packages for the social sciences (SPSS) are considered accurate in facilitating data analysis procedures in quantitative research studies. Features included in thsi package found valuable for this research project were descriptive statistics, frequencies, cross tabulations, linear regress, factor analysis and prediction for identifying groups. Two major weakness, however, lie in the lack of presenting a theoretical framework for the study. Even though this is quantitative study there is no theoretical framework guiding the research it could be interpreted that this may be related to heart failure. What heart failure theories guide the 60 day readmission process? None was presented. The second weakness is related to the first. While an extensive/impressive display of data was presented the research lacked balance in a missing literature review. The strength of a comprehensive literature review is to let the reading audience know that the results of the study could be replicated through supporting literature. The research mentioned that she did consult literature, but none was presented in the research.

 Clinical practice guideline summary

The clinical practice guideline for heart failure could be found on the American College of Cardiology Foundation (ACCF)/ American Heart Association (AHA) websites. They have been developed after according to a task force investigation into heart failure management in the United States of America. Agency for health care research and quality website also carries clinical guideline for heart failure interventions. Three facts found on this website related to the question, will patients with heart failure benefit more from appropriate education compared to rigid medication management in preventing a 60 day readmission to hospital are first the specific diagnostic evaluations. Diagnostic evaluations will facilitate accuracy in management on the first admission with a heart failure related condition. Here is where the readmission syndrome is arrested with a correct diagnosis and relevant treatment. The second fact relates to the treatment protocol itself. Behavioral medication was the first line of treatment. This is consistent with the PICO question which considers education in relation to pharmacological interventions. Pharmacology is listed after behavioral change education has been presented. The third fact presents models of care encompassing comprehensive discharge planning; follow up by trained heart failure nurses and a multidisciplinary follow up, including pharmacy input (Agency for health care research and quality, 2013). These models directly impact the PICO question as well as my personal clinical practice interacting with patients suffering from heart failure. Comprehensive discharge planning is essential towards limiting the 60 readmission rate of patients with heart failure.

Fourth source summary

This fourth resource was taken from the Circulation: Cardiovascular quality and outcomes journal. The precise article is entitled, ‘Hospital Strategies Associated With 30-Day Readmission Rates for Patients with Heart Failure.’ This is a quantitative study and the researchers’ objective was to identify techniques hospitals applied in their efforts to lower readmission rates for heart failure patients. A total of 599 hospitals were sampled using a web-based search to select a purposive sample. These researchers realized that reducing readmission rates for heart failure patients was a national priority, especially, due to the economic burden. These selected hospitals were participating in a national program aimed at reducing readmission rates for patients suffering from heart failure. At the time evidence regarding appropriate strategies adopted by these hospitals which successfully reduced readmission rates was limited. From the survey researchers successfully identified six techniques, which were associated with reduction in readmission rates for patients with heart failure. They included establishing partnerships with community physicians and physician groups; engaging local hospitals in the program; making nurses responsible for medication reconciliation; creating a schedule for follow-up visits before discharge. It was also found that by enhancing the process of patient records transfer through the electronic record system was an important factor.  Essentially, all discharge or electronic summaries must be sent directly to the patient’s primary care physician. Finally, making it mandatory that all follow up test results are taken and transferred to the follow up physician. A special nurse must be assigned to executing this process (Bradley, Curry & Horwitz, 2013).              While patient education was not highlighted in these results they are significant in answering the question, Will patients with heart failure benefit more from appropriate education compared to rigid medication management in preventing a 60 day readmission to hospital? Three facts identified from this source are first readmission of heart failure patients is a national concern. Secondly, there are limited data on how to reduce readmission rates. Thirdly, studies conducted offered six distinct strategies which can be applied.

Closing paragraph 1

PICO question:

Will patients with heart failure benefit more from appropriate education compared to rigid medication management in preventing a 60 day readmission to hospital?

P – (Patient) Patients with heart failure

I – (Intervention) appropriate education

C – (Comparison) rigid medication management

O – (Outcome) prevent 60 day readmission

The learning experience from this project for me related to acknowledging that the situation of readmissions for patients with heart failure is really not a patient issue. Rather it relates to management of cases during hospitalization and the follow up care interventions. Consequently while the PICO question is suggesting patient education without adequate management during hospitalization and improved follow up techniques education would be of little value. If education is executed it must coincide with establishment of hospital partnerships ensuring that the education has been effective.

Closing paragraph 2             

The recommendations for practice are quite clearly exampled in research literature and guidelines. More responsibility for nurses administering medications is mandatory to ensure that patients’ response to treatment coincide with expectations of the cardiologist. Transfer of records to primary care physician is mandatory in reducing readmission. Also, follow up diagnostic testing and results evaluation is mandatory.

References

Anderson. K. (2014). Discharge Clinical Characteristics and 60-Day Readmission in Patients Hospitalized With Heart Failure. Journal of Cardio Vascular Nursing, 29(3), 232Y241

Agency for healthcare research and quality (2013).Guideline Summary. Management of chronic heart failure. A national clinical guideline. Retrieved on March 15^th,2015 from http://www.guideline.gov/content.aspx?id=10587

Bradley, E. Curry, L., & Horwitz, L. (2013). Hospital Strategies Associated With 30-Day Readmission Rates for Patients with Heart Failure. Circulation: Cardiovascular Quality and Outcomes, 6; 444-450

Cohen, L. Manion, L., & Morrison, K. (2013). Research Methods in Education. Routledge.

Gheorghiade, M. Vaduganathan, M., & Fonarow, C. (2013). Rehospitalization for Heart Failure: 61(4):391-403