treating patients with Congestive Heart Failure

The primary goal of treating individuals with Congestive Heart Failure is for them to attain clinical stability. Despite recent advancements in Congestive Heart Failure, treatment mortality and morbidity rates among hospitalized patients remain high. Despite the development of novel therapeutic approaches, it is obvious that evidence-based therapies play an important role because they place a heavy emphasis on educating patients and their families. Providing patients with education at discharge appears to be a critical component in improving the outcome of Heart Failure. Institutions with established patient education systems must focus primarily on medication adherence, sodium salts and fluid restriction, and identifying clinical deteriorating signs. Nurses, who are active in Congestive Heart Failure programs are objected to teaching, improve, reinforce and evaluate the ability of the patient’s self-care. These self-care activities include monitoring weight and checking sodium levels (Semigran & Shin, 2012).

Accountability of Nurses

The ability of a clinical nurse to provide high-quality care to patients depends highly on his or her ability to think, reason and provide judgment. Nurses are usually held liable for their actions and decisions. In nursing, critical thinking is a significant component of quality health care and professional accountability. One essential mode for clinical nursing is evaluating evidence and applying nursing practice standards, which are well established. Accountability means that only nurses are responsible for their actions. The NPHPSP (i.e. National Public Health Performance Standards Program) may require a different nurse to explain to the board the reasons for their actions (Burns & Grove, 2010). The accountability tools that can be used to measure effectiveness include the scale for autonomy assessment, which involves confounding the job autonomy and job characteristics also called job independence/interdependence. The autonomy scale is usually has high validity and reliability as per the psychometric analysis.

Evidence Based Plan

The plan uses clinical expertise incorporating patient’s values to provide guidance in patient’s decisions making process. Qualitative and descriptive researches have also been used to evaluate the evidence based nursing practice. Experts opinions hare also utilized in cases where scientific research base is not available. The practice involves reviewing and synthesizing the evidence and evaluation after implementation of the patient’s intervention.

Congestive Heart Failure Patient Discharge Plan

Objectives

Discuss clinical signs and symptoms of Congestive Heart Failure. Patients will learn how to detect changes in their clinical status or body weight early.

Equip patients with skills, strategies, knowledge and problem solving ability for effective self-care.

Patients will learn the importance of self-care follow up plans and the significance of adherence to improving their quality of life.

Tools

Patient Management Tools for reporting and tracking patient’s clinical improvement.

Discharge instruction literature that includes the overall discharge checklist.

Education materials such as books to allow patients to read at their convenience

Heart failure, also referred to as CHF (i.e. Congestive Heart Failure) is a condition that occurs when muscles in the heart are too weak to function effectively or when they unable to relax. The heart pumps fluids around the body. When the heart cannot pump these fluids effectively, they accumulate in legs, lungs and abdomen leading to oedema (Semigran & Shin, 2012).

Apparently, a sudden gain or loss in weight may be a sign of clinical worsening of the heart failure condition. The patients’ needs to understand the significance of monitoring his or her weight every day. Monitoring weight on a daily basis helps patients to determine the amount of extra fluid that has been accumulated in their bodies. One will tell his condition is worsening if there is a sudden gain in weight (Stewart, Inglis, & Hawkes, 2008).

The patient needs a weighing scale to track his weight. The patient needs to weigh himself or herself on the same weighing scale each day at the same hour of the day. It is recommended that CHF patients measure their weight every morning after taking a shower but before they drink or eat any meal. After that, he needs to keep a calendar besides the scale. If there is a sudden gain, it is wise to call your physician (Semigran & Shin, 2012).

Symptoms of heart failure may worsen slowly over the weeks or suddenly. This form of worsening is referred to as decompensating or clinical exacerbation. Understanding these symptoms is important so as to know what to do in case they occur. Shortness of breath is common among Congestive Heart Failure patients. It is recommendable for patients to keep track of all their breathing patterns. In case you experience shortness of breathing while lying down or during the night, it might be an indication for clinical worsening. Discomfort or mild pain might accompany swelling of legs. The neck veins might bulge. Other signs include tiredness, loss of appetite, increase heartbeat. Monitoring these symptoms allows the healthcare provider adequate time to recommend medication for delaying clinical worsening (Stewart, Inglis, & Hawkes, 2008).

Ensuring Patient Compliance

To ensure that patients comply easily with this education program, a health care nurse offers this service before discharge. The session will take at least 60 minutes to ensure that heart failure patients understand the need for self-care to minimize clinical worsening and readmissions. The educative program should aim at equipping not only patients with useful self-care information but also their families and family practitioners. Through this 60 minute program, patients, affected families and family caregivers will understand the preventive actions to take when there is a sign of health deterioration. The program will facilitate by an RN educator before the patient is discharged. The patient will also be given standardized instructions to improve clinical outcomes. The facilitation will also be supplemented by inputs from hospital physicians and dietitians. Depending on the patient’s convenience the program could be broken down into multiple sessions as long as all the topics are covered. Since patients may belong to different cultural backgrounds or languages, the hospital will develop mechanisms to harmonise all the factors. The RN educator will have to ensure that the patient is comfortable with undertaking the program. Understanding the patient’s cultural background is a key since some cultures do not allow disclosing the illness of the members. Language interpreters will also be readily available for non-English speaking patients (Burns & Grove, 2010).

Professional and Legal Standards

The American Heart Association recommends that every hospital must develop a post-discharge education and follow-up plan for patients with congestive heart failure. Additionally, studies conducted by the American College of Cardiology reveal that educating patients of self-care after discharge helps to minimize the rates of readmission by over thirty percent. The New York Heart Association recommends that heart failure patients should be discharged instructions, cessation advice on smoking and drinking and counselling. Additionally, the new heart failure discharge guidelines suggest that hospitals should create a clinical care team to collect follow-up information from patients and review their compliance and clinical improvement (Semigran & Shin, 2012). Ethics is an essential or rather integral part in nursing. The nursing code of Ethics offers a framework for nurses for decision-making and ethical analysis.

Incorporation of Legal Standards

The code of ethics and other legal standards can be incorporated through professionalization to enhance the value placed by the society on nurses. There should be continuous training, education and development among nurses. Nurses need to develop specialized skills through evaluation of their professional practice, research and utilization of resources. A proper leadership and management system should also be in place to ensure supervision, accountability and responsibility among health care workers to achieve the desired level of excellence in nursing standards (Semigran & Shin, 2012).

References

Burns, N., & Grove, S. K. (2010). Understanding Nursing Research: Building and Evidence-Based Practice. Elsevier Health Sciences.

Semigran, M., & Shin, J. T. (2012). Heart Failure. CRC Press.

Stewart, S., Inglis, S., & Hawkes, A. (2008). Chronic Cardiac Management: A Practical Guide to Specialist Nurse Management. John Wiley & Sons.