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Incorporating Theory
Agboola, Jethwani, Khateeb, Moore, and Kvedar (2015) found that the Congestive Heart Failure (CHF) could be controlled effectively through outpatient follow-up and patient education. The proposed treatment is in line with the Orem’s theory, which was developed by Dorothea Orem in 1950s (Manzini & Simonetti, 2009). The theory emphasizes patient independence and self-care achieved through quality patient education. According to the theory, nurses may improve the patients’ health outcome through proper education regarding self-care. The patient education programs should be designed in such a way that it allows patients to control their health independently at their homes.
Gellis et al. (2012) observed that the lack of follow-up among the patients with chronic illnesses increased the risk of readmission to hospital. Follow up coupled with self-care may be effective tools for improving the patients’ health against the backdrop of the increasing cases of chronic illnesses such as CHF. One way to contain CHF and prevent readmissions is by empowering the patients to take care of their health and embracing outpatient follow-up. Therefore, the Orem’s theory best fits this analysis since it suggests the empowerment of patients to take care of their health. The selection of the theory to remedy the problem of CHF is informed by the view that the illness may be easily controlled through outpatient follow-up and self-care.
This project seeks to solve the problem of readmissions and poor health outcome for CHF patients. The project is guided by the assumption that knowledge deficiency and lack of follow up are the key causal factors for the recurrent readmissions of patients. The Orem’s theory shall be useful for this project since it promotes patients self-care through education and follow-up.
Review of the Literature
The role of continuous care in reducing readmission for patients with heart failure
Adib-Hajbaghery, Maghaminejad, and Abbasi (2013) adopted a systematic review approach to examine the effectiveness of continuous outpatient services in reducing hospitalizations among CHF patients. The authors obtained 21 articles from reputable databases, such as, Science direct, Pubmed, Iranmedex, SID and Google search engines using the following keywords: readmission, heart failure, continuous care, and follow-up. All the 21 articles were randomized control trials. The results showed that continuous patient monitoring improved the quality of life for the HF patients and prevented readmissions. The results may be applied in the contemporary nursing practice to mitigate emergency hospitalizations and to reduce the cost of health.
Heart failure remote monitoring
Agboola et al. (2015) quantitatively explored the efficacy of outpatient monitoring in reducing hospitalizations and mortality rates. The authors recruited the participants registered in the Connected Cardiac Care Program (CCCP) sponsored by the Massachusetts General Hospital. Besides, the authors recruited a control group from the patients undergoing regular treatment in the same hospital. The hospitalization and mortality rates for the two groups were studied and recorded over a period of 1 year. The authors found that continuous outpatient monitoring improved patient outcome and reduced hospitalization in the short run. The results illuminated the findings from other scholars who had previously found that outpatient monitoring services reduced hospitalization and mortality rates.
Effects of person‐centered and integrated chronic heart failure and palliative home care
Brännström and Boman (2014) used a randomized control trial approach to investigate the effectiveness of the person-centered and integrated palliative advanced home care and heart failure care (PREFER) in improving the patient outcome and reducing hospitalization. The study used a sample population of 72 participants, 36 patients for the treatment group and 36 for the control group. The participants, both from the treatment group and the control group, were assessed at the onset of the study, at 3 months and 6 months. The authors found that patients who received PREFER care had better health outcome than the control group. Therefore, outpatient care services may be a useful tool for improving the patients’ health to mitigate periodical hospitalizations.
Telehealth in adult patients with congestive heart failure in long-term home health care
Cherofsky, Onua, Sawo, Slavin, and Levin (2011) conducted a systematic literature review to investigate the effectiveness of the telehealth interventions on the health outcome for CHF patients. Data validity was guaranteed by exclusively obtaining the articles from reliable medical databases such as CINAHL, MEDLINE, EMBASE and COCHRANE. The listed databases only publish studies, which are reliable and valid. The research team used three randomized controlled trials and two quasi‐experimental studies. The authors found that home-based telehealth reduced chances of emergency hospitalization since it promoted self-care. The findings are important for the nursing practice as nurses are under pressure to cut healthcare cost and improve the health outcomes.
The importance of interactions between patients and healthcare professionals for heart failure self-care
Currie et al. (2014) conducted a systematic review of the literature to investigate the role of frequent interactions between the physician and the HF patients in treatment. The results from the study were valid since the authors systematically selected reliable qualitative based articles from valid health databases. The study reviewed 24 articles that met the inclusion criteria. The authors found that periodic interaction between the physician and the patient improved patient outcome. Additionally, the authors found that such interactions enabled the passage of self-care information from the nurse to the patient hence eliminating hospitalizations. The study is important to the nursing practice since it adds to the existing knowledge regarding minimizing hospitalizations against the backdrop of the heightening campaigns for on-going outpatient services.
Transitional care interventions to prevent readmissions for people with heart failure
Feltner et al. (2014) conducted a systematic literature review to determine the effectiveness of home-based care in reducing readmissions for patients diagnosed with HF. The authors reviewed a total of 41 articles, all of which covered the topic of HF. Data sources for the study included MEDLINE, Cochrane Library, CINAHL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. The researchers found that frequently home visits reduced readmissions and mortality rates. The findings are significant to the nursing practice since they provide an evidence-based solution to the issue of hospitalization of patients suffering from chronic illnesses.
Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure
Gellis et al. (2012) used a randomized control approach to probe the efficacy of telehealth programs in the reduction of hospitalization among patients with cardiac issues. The study recruited a study population of 102 participants, of which 51 were randomly assigned to the treatment group while the rest were assigned to the control group. The treatment group received the relevant care through a home based telehealth program at 3 months of follow-up. The treatment for the control group and was delayed was availed at 12 months of follow-up. The results indicated that the patients in the treatment group recorded less hospitalization compared to the control group whose members were frequently hospitalized.
Cognitive impairment and self-care in heart failure.
Hajduk et al. (2013) used a mixed method approach (both quantitative and qualitative) to explore the effect of cognitive disorder on self-care practices. The researchers used a sample size of 577 participants, who were all patients hospitalized for HF in five hospitals located in the United States. The study involved both interviews and observations to solicit the relevant data from the participants. The results indicate that HF results in cognitive disorder, which affects the ability of the elderly HF patients to practice self-care leading to recurrent hospitalizations. Patients’ follow-up and regular memory screening, according to the authors, may help improve the patient outcome and prevent intermittent hospitalization.
Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland
Inasmuch as many scholars have found a close connection between outpatient care and reduction of hospitalizations, Vuorinen et al. (2014) hold a differing view as they investigated the effectiveness of telemonitoring in reducing hospitalizations for patients with cardiac conditions. The authors recruited 94 participants, and randomly assigned 47 patients to the treatment group and the other 47 to the control group. The treatment group received home-based care and training through a phone while the control group received standard care from the relevant healthcare facilities. The researchers found that telemonitoring of HF patients neither reduced the number of hospital visits nor improved their health outcomes.
Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews
Kitsiou, Paré, and Jaana (2015) invoked a systematic review approach to examine the effectiveness of home telemonitoring of patients with chronic HF. The relevant articles were obtained using different databases such as MEDLINE, EMBASE, CINAHL, and the Cochrane. The validity of the individual articles was assessed using AMSTAR (assessing the methodological quality of systematic reviews) tool to avoid including invalid results in the current research. The researchers found that telemonitoring of HF patients from home reduced the rate of hospitalization and improved their healthcare outcome. Therefore, nurses need to embrace telemonitoring for patients with chronic illnesses to prevent high hospitalizations and reduce the healthcare costs. The results are congruent with that of previous researchers who found outpatient monitoring to be an effective tool for minimizing hospitalization.
Integrating telecare for chronic disease management in the community
May et al. (2011) conducted a qualitative research to investigate the opportunities and challenges of telecare in the treatment of chronic illnesses. Data collection was done through semi-structured interviews with 60 participants drawn from a cross-section of physicians employing the strategy with their patients. The results showed that telecare minimized hospitalization and improved healthcare for the patients suffering from chronic illnesses. However, the authors identified a few challenges to the use of telecare including the lack of coordination across social and primary care boundaries and the lack of financial or other incentives to include telecare within primary care services coupled with the lack of a sense of continuity with previous service provision and self-care work undertaken by patients.
The impact of self-monitoring in chronic illness on healthcare utilization
McBain, Shipley, and Newman (2015) used a systematic review approach to examine the effectiveness of self-care in improving the quality of life and minimizing hospitalization among patients suffering from chronic illnesses. The literature was searched with the help of the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE, AMED, EBM and HMIC. To guarantee the validity of the data obtained, an article had to be covering a single chronic illness to qualify for inclusion. The researchers found that self-care highly reduced hospitalizations and readmissions. Reduced hospitalization had the effect of reducing the cost of healthcare. The findings match that of the previous researchers who hypothesized a close connection between self-care and improved quality of life.
Discharge planning in chronic conditions: an evidence-based analysis
McMartin (2013) used a randomized control trials approach to investigate the efficacy of post-discharge support in reducing readmissions among the HF patients. Eleven (11) studies were selected based on the inclusion criteria set for the study. The 11 articles compared both normal discharge and individual discharge. The results indicate that patients who received post-discharge support recorded few readmissions compared to the patients who were discharged normally. The results cement the findings by other scholars investigating the topic. Therefore, nurses should ensure that the patients suffering from major chronic illnesses receive the necessary support to avert readmissions.
Utilization of trained volunteers decreases 30-day readmissions for heart failure
Sales et al. (2013) quantitatively investigated the effectiveness of outpatient monitoring in reducing the number of readmissions of the discharged CHF patients over a period of 30 days. Seventy-three (73) participants were recruited for the study and they were divided into two groups namely the treatment and the control group. The treatment group received specialized education for self-care from trained volunteers while the control group received standard care. The researchers found that the outpatient monitoring of CHF patients after discharge reduced the number of readmissions. The findings are consistent with that of other researchers in the field who equally observed better patient outcome and reduced hospitalization for patients undergoing outpatient care after discharge. The results are a wake-up call for nurses to embrace principles of the Orem’s theory and ensure that patients receive the necessary training for self-care.
A supportive-educational intervention for heart failure patients in Iran
Zamanzadeh et al. (2013) qualitatively examined the effectiveness of patient education in mitigating readmissions among HF patients. The authors used a population of 80 participants diagnosed with HF drawn from a cross-section of Iranian hospitals. Data was collected using interviews, which were recorded by the researchers. The results showed that patient education improved the health outcome and mitigated readmissions. The results of the study are significant to nurses and other healthcare providers since it increases their understandings of the outpatient based treatment methods for HFs. The results are consistent with that of other scholars who found patient education and outpatient follow-up as effective tools for enhancing self-care.
References
Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The role of continuous care in reducing readmission for patients with heart failure. Journal of Caring Sciences, 2(4), 255-67.
Agboola, S., Jethwani, K., Khateeb, K., Moore, S., & Kvedar, J. (2015). Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program. Journal of Medical Internet Research, 17(4), 101-09.
Brännström, M., & Boman, K. (2014). Effects of person‐centered and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study. European Journal of Heart Failure, 16(10), 1142-1151.
Cherofsky, N., Onua, E., Sawo, D., Slavin, E., & Levin, R. (2011). Telehealth in adult patients with congestive heart failure in long-term home health care: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 6(12), 1271-1296.
Currie, K., Strachan, P. H., Spaling, M., Harkness, K., Barber, D., & Clark, A. M. (2014). The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives. European Journal of Cardiovascular Nursing, 14(7), 451-511.
Feltner, C., Jones, D., Cené, W., Zheng, J., Sueta, A., Coker-Schwimmer, J.,…Jonas, E. (2014). Transitional care interventions to prevent readmissions for people with heart failure. Annals of Internal Medicine, 2(5), 7-11.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012). Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. The Gerontologist, 52(4), 541-552.
Hajduk, M., Lemon, C., McManus, D., Lessard, M., Gurwitz, H., Spencer, A.,…Saczynski, J. (2013). Cognitive impairment and self-care in heart failure. Clinical Epidemiology, 3(2), 407-416
Kitsiou, S., Paré, G., & Jaana, M. (2015). Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal of Medical Internet Research, 17(3), 63-67.
Manzini, C., & Simonetti, J. (2009). Nursing consultation applied to hypertensive clients: application of Orem’s self-care theory. Latin American Journal of Nursing, 17(1), 113-119.
May, R., Finch, L., Cornford, J., Exley, C., Gately, C., Kirk, S.,…Wilson, R. (2011). Integrating telecare for chronic disease management in the community: what needs to be done? BMC Health Services Research, 11(1), 131-36.
McBain, H., Shipley, M., & Newman, S. (2015). The impact of self-monitoring in chronic illness on healthcare utilization: a systematic review of reviews. BMC health Services Research, 15(1), 1-12.
McMartin, K. (2013). Discharge planning in chronic conditions: an evidence-based analysis. Ontario Health Technology Assessment Series, 13(4), 1-11.
Sales, L., Ashraf, S., Lella, K., Huang, J., Bhumireddy, G., Lefkowitz, L.,…Norenberg, J. (2013). Utilization of trained volunteers decreases 30-day readmissions for heart failure. Journal of Cardiac Failure, 19(12), 842-850.
Vuorinen, L., Leppänen, J., Kaijanranta, H., Kulju, M., Heliö, T., van Gils, M., & Lähteenmäki, J. (2014). Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. Journal of Medical Internet Research, 16(12), 282.
Zamanzadeh, V., Valizadeh, L., Howard, A., & Jamshidi, F. (2013). A supportive-educational intervention for heart failure patients in Iran: the effect on self-care behaviors. Nursing Research and Practice, 7(6), 52-67.
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