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Impact of a Nurse Practitioner Led Heart Failure Clinic, Coursework Example

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Coursework

Key Words: chronic; health promotion; self care; disease management; CHF HF- heart failure; PICO- Patient, Intervention, Comparison, Outcome

Clinical Scenario

Heart failure (HF) poses significant danger to millions of people with chronic incapacitating effects. This paper posits to address the impact of a nurse practitioner led heart failure clinic on hospitalizations, functional status, quality of life, and medical cost. The importance of the research is based on the fact that victims of heart failure experience physical symptoms that are chronic, socioeconomic burden as well as emotional strain. The nurse practitioner led heart failure clinic should aim at managing heart failure in the direction of slowing the progression of the disease, decreasing the acuity of the symptoms and prevention of exacerbations that cause readmission to hospital (Strömberg & Mårtensson, et al. 2003).

For the purpose of this study, 106 patients were assigned in unsystematic manner to some trial involving a follow-up procedures to heart failure clinic that were designed in a nurse-led manner or alternatively to usual care. During the staffing process in the clinic, specially trained as well as skilled cardiac nurses were given consideration. They were thereafter given the duties of designing medication changes that were based on protocol. They were also charged with evaluating the status of heart failure when they made their visits. The follow-up procedure was scheduled at 2 to 3 weeks after the patient was discharged. They were also supposed to educate the patients on heart failure in addition to the requirement for social support for the victim and the family (Honess & Gallant, et al. 2009).

Background and Significance

Due to the continued increase in heart failure incidences on annual basis, an effective strategy for the management of the disease is a requirement. In an appropriate program for disease management, the guidelines that are outlined in the practices that are based on evidence should be strictly adhered to. The systematic review thus conducted was intended at evaluating the current practices that are based on evidence leading to the determination of the existing benefits of the need for advanced practices of a nurse practitioner led heart failure clinic on hospitalizations, functional status, quality of life, and medical cost.

The progress so far achieved in heart failure interventions is likely to slow down the rate of progression of the disease and consequently improving on survival. It is also important to put in place some programs for counseling as well as education of the patients which would promote the level of compliance. The planning of discharge may increase the chances of clinical stability and improve the outcomes of the patient.

Although there has been great strides achieved in identifying potential options for the victims of heart failure, the rates of morbidity along with mortality have ever escalated. Patients are in most cases exposed to distressful scenarios involving readmission which comes with erroneously high costs to the victim and the entire community. A need has arisen to improve the extent of care to the patients of heart failure which is aimed at reducing cases of morbidity coupled readmission to the hospitals. The emergence of specialized clinics for heart failures in the last decade has made significant contribution in this regard.

The clinics that depend on the trained nurses in the field of heart failure have become popular. It is imperative in this review to visit the various designs and intervention strategies that are applied in these institutions. The review has involved 18 trials that were conducted in a randomized design to compare the clinics of heart failure with the use of nurses’ intervention to conventional care. Results have been positive with an indication of reduced rates of readmission to the hospital and a shorter span of hospitalization in the case of the intervention group. Other non-randomized investigations designed as control trial have complimented the findings. This has proven the need for heart failure clinics that makes use of nurse intervention which are supposed to be integrated in the patients care process for heart failure victims. Ongoing attention is also a requirement to the care that the clinics offer for the sake of persistence of intervention strategy. It is therefore to keep a continuous record of data that gives a description of the care process with the use of indicators like the ACE-inhibitor along with β-blocker use and doses. The use of electronic record of the medical data has been identified as one of the most efficient strategy in that regard (Gustafsson & Arnold, 2004).

PICO Templates

In this review, it was imperative that PICO template is applied which facilitated for the processing of clinical question. The procedure entailed patient identification (P), strategies of intervention (I), comparing the interventions (I) and the outcomes which gave the most appropriate information (O).

P- Patient: How can I give a description of a patients’ group that has similarity to mine

I – Intervention: Which is the most important intervention that is wroth considering?

C – Comparison: What is the most important alternative that should be to compared to intervention?

O – Outcome intended to be measured or achieved- what do I intend to improve, affect, accomplish or evaluate

P – Less patients having death or admission events after 12 months in groups of intervention in comparison to control group (29 vs. 40, p=0.03) along with less deaths after one year (7 vs. 20, p=0.005).

  • I – fewer admissions in the intervention group (33 vs. 56, p=0.047) along with length of hospital stay (350 vs. 592, p=0.045) during initial 3 months. After one year the intervention became linked to a 55% decline in admissions/patient for each month (0.18 vs. 0.40, p=0.06) along with a lesser duration in hospital/patient each month (1.4 vs. 3.9, p=0.02).
  • C – The intervention group garnered considerably higher scores of self-care at 3 &12 months relative to control group (p=0.02 & p=0.01).
  • Survival in addition to self-care behavior may significantly improve as a result Follow up from hospitalization at the clinic in the case of patients of heart failure together with a reduction of  the events, readmissions as well as days in hospital.

References

Gustafsson, F. & Arnold, J. M. O., 2004). “Heart failure clinics and outpatient management: review of the evidence and call for quality assurance.” European Heart Journal 25(18): 1596-1604.

Honess, C., P. & Gallant, et al. (2009). “The Clinical Scholar Model: Evidence-Based Practice at the Bedside.” The Nursing clinics of North America44 (1): 117-130.

Strömberg, A., J. & Mårtensson, et al. (2003). “Nurse-led heart failure clinics improve survival and self-care behavior in patients with heart failure.” European Heart Journal 24 (11): 1014-1023.

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