Discharge Education for a Patient with Congestive Cardiac Failure - Term Paper Example

Discharge education for a patient with CCF Congestive cardiac failure (CCF) is a significant health problem. 50% of the patients die within the 5 years of the first start of symptoms (Zamanzadeh et al, 2013, p.2). Congestive cardiac failure is among the common causes of hospitalization in the elderly population and leads to high morbidity and disability rate and hence generates very high healthcare costs (Shan et al, 2014, p.23). According to Zamanzadeh et al (2013, p.1) about 54 percent of patients are readmitted within six months post-discharge.. Studies show that behavioral aspects like failure to adhere to medications, diet, as well as delay in seeking preventative care are attributed to readmissions as well as premature deaths as a result of congestive cardiac failure. Discharge education has been shown to increase adherence to diet, exercises, and treatment regimen as well as empowers patient in management of a condition that would otherwise considerably decrease readmission rate and death for patients with congestive cardiac failure (Shan et al, 2014, p.28). As Zamanzadeh et al (2013, p.1) further explain that the nature and severity of congestive cardiac failure symptoms significantly depends on the knowledge, collaboration, as well as active participation of the patient in their health management. Therefore, discharge education for patients with CCF can help patients to improve health and prevent progression of CCF because the patient is educated on how to adopt self-care skills, adhere to the treatment regiment, as well as change lifestyle behaviors. CCF patients who receive post-discharge education gain skills on different features of therapeutic self-care behaviors and skills failure (Shan et al, 2014, p.28). Nurses have the ability to identify any present and potential health issue and provide the suitable educational intervention. Evidence shows that post-discharge education is among the most effective interventions for improving self-care capabilities and behaviors, among patients with CCF: this eventually improves prognosis and at the same time decreases readmission rates (Zamanzadeh et al, 2013, p.2). The key aim of education for CCF patients is to improve the patient’s management of the condition, and hence reduce the onset of complications as well as morbidity. Key messages from the research i. Significance of discharge education for CCF patients CCF patients require effective discharge education after their hospitalisation in order to promote self-care and prevent re-admission as well. This is because according to Andrietta et al (2011, p.2) improvement of knowledge for self-care is fundamental to effectively decrease readmission rates, complications, as well as reduce mortality and health costs allied to CCF. Prior to discharge, patients should be educated on self-care aspects such as weight monitoring, limiting fluids and sodium intake, suitable exercises and physical activities, adhere to the treatment regiment and medications, as well as monitor the signs and symptoms that manifest disease deterioration (Andrietta et al 2011, p.2). This therefore indicates the significance of discharge education interventions in order to improve the knowledge of patients regarding CCF, management, self-care as well as improve the quality of life for the CCF patients. During discharge education, the nurse providing the discharge education should have the required skills and knowledge to sensitize the patient about the CCF disease to ensure the patient is able to adhere to the treatment regiment, limit sodium and fluid intake, as well as recognize and identify symptoms and signs that point to disease progression (Gardetto, 2011, p.48). In addition, the discharging nurse should educate the patient about the disease, the correlation between the disease and the pharmacological treatments, as well as the relationship between healthy behavior and the disease. i. Educational content Specifically, in regard to weight CCF patients should be educated on how to check their weight in the morning following urination, and before taking breakfast, wear light clothes and use the same measurement scale. An increase of 1.3 kilograms in body weight within 2 days or 1.3 kgs-2.2 kilograms within a week might be an indication of fluid retention. Patients should also be educated on symptoms of deteriorating condition like oedema, weight gain, continuous fatigue, and dyspnea. Accordingly, the discharge education should focus on educating the patients and their carers on early recognition of these signs in order to avoid decompensation incidents (Tovar 2016, p.3). For the medications, during discharge it would be appropriate to review the medication regiment with the patient and cover all aspects regarding the medication. Frequent educational scheme can be used by when educating the patient about medication regimen. For example, Andrietta et al (2011, p.4) suggests that the discharging nurse can draw tables listing the patient’s name, the time, dosage, indication and side effects of each medication. The patient should be instructed to always take medications even when feeling well, because that is the outcome of effective treatment. The nurse should also advise the patient to come with the table/prescriptions during each clinic appointment in order to easily identify likely omissions, dosage increase or confusion. In regard to the diet, the patient should be educated on sodium restriction and fluid restriction (Gardetto, 2011, p.48). Lastly, the patient should be educated on alcohol and smoking because alcohol and tobacco have been shown to adversely affect the cardiovascular system (Rabelo et al 2007, p.2). Evidence indicates that poor adherence to treatment regimen, such as low salt diet and medications is a major risk factor to CCF patients. i. Educational strategies/methods Effective teaching and educating methods should thus be used to increase and ensure patient understanding. Evidence shows that combination of various teaching modalities while taking into account the patient’s learning preference is effective in reducing readmission rate in patients with CCF. CCF booklet, videos, web pages, explanation, teach-back session, computer programs as well as set-up with specialist clinical nurse practitioner on discharge are some of the educational health strategies that have been demonstrated to be effective in increasing patient’s understanding of their condition and management. Liou et al (2015, p.650) provide that the discharge nurse should conduct comprehensive face-to-face educational sessions using teaching booklets and other education materials such as videos. The patient should then be provided with the educational materials for reference after discharge. Rabelo et al (2007, p.3) opines that during discharge CCF patients should be provided with follow-up telecommunication or support group due to the vast information provided to the patients during the discharge. Recommendations Hospitals should implement a discharge education program for all patients with CCF because the readmission rate among CCF patients is very high. In addition, non-compliance to self-care measures essential in the management of CCF is allied to exacerbation and readmission (Tovar 2016, p.6). The discharge content in the implemented education program should include: CCF knowledge, daily weight, low sodium diet, medication knowledge, recommended fluid daily intake, physical activities, social interaction and support, and symptoms/signs that necessitate medical attention. This is because evidence shows that ineffective self-management skills of weight monitoring, physical activities, medication adherence, diet management, sodium and fluid intake in patients with CCF adversely affects the prognosis and progression of the disease condition (Regalbuto et al, 2015, p.641). The methods used to educate the CCF patients should include the teach-back session method and a booklet that should be availed to the patient after the teaching session. The rationale of using teach-back method is that the nurse can validate if the patient has understood the information by having the patient explain the taught information to the educator (Raborn 2017, p.2). The patient can use the booklets as the reference materials while at home. Home tele-monitoring should be implemented for the CCF patients after discharge especially to the patients who are not stable and at high risk of readmission or death. Cleland et al (2011, p.416) explains that home tele-monitoring enables healthcare providers to monitor the weight, blood pressure as well as pulse rate and also the personal management aspects such as diet, exercises, fluid intake for the patient. A policy should be formulated to have all hospitals implement a standardized multidisciplinary approach in discharge planning to be used during the discharge of all patient with congestive cardiac failure ((Raborn 2017, p.6). Implementation of results to improve clinical practice, and/or education The Plan-Do-Study-Act (PDSA) tool will be used in the implementation of results. All tasks involved in the implementation of results include; plan, do, study and act (Curran E & Bunyan D, 2012, p. 108). The planning phase will include providing all stakeholders with the results and the plan to conduct an audit 30 days after the implementation and compare if the readmission rate of patient with CCF has reduced. The do phase include budgeting for the project and assigning of responsibilities. This phase will also include training nurses on discharge educate and more importantly practically conducting the recommended discharge education to all patients with CCF (Curran E & Bunyan D, 2012, p. 108). The third phase is study where records should be reviewed to establish if the recommended discharge education is performed to all CCF patients being discharged. For instance, a simple table and feedback form can be used to document the number of patients who receive discharge education. The rate of readmission and mortality for the CCF patients can also be used to study the efficiency of discharge education in reducing readmission rate and death. Follow up appointments for the patients should also be made after the discharge to monitor and evaluate patient’s adherence to treatment regiment and self-care management in order to study the efficacy of discharge education (Kripalani et al, 2014, p.475). The last phase will consist of the actual performance of the proposed recommendations. Reference list Andrietta M, Moreira R & Barros A, 2011, Hospital discharge plan for patients with congestive heart failure, Rev. Latino-Am. Enfermagem, 19(6). < http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692011000600023> Cleland G, Trotman-beasty, Atkin P, Crundall A & Anthony R, 2011, Education for patients with heart failure: rationale, evidence, and practical implementation, Medicographia, 1(33), pp:409-418. < http://www.medicographia.com/2012/02/education-for-patients-with-heart-failure-rationale-evidence-and-practical-implementation/> Curran E & Bunyan D, 2012, Using a PDSA cycle of improvement to increase preparedness for, and management of, norovirus in NHS Scotland, JHospInfect, vol. 82, no. 2, pp: 108-113. Gardetto N, 2011, Self-management in heart failure: where have we been and where should we go? J Multidiscip Healthc, 1(4), pp: 39–51. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084307/> Kripalani S, Theobald C, Anctil B & Eduard V, 2014, Reducing Hospital Readmission: Current Strategies and Future Directions, Annu Rev Med, 65(1): 471–485. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104507/> Liou H, Chen H, Hsu C, Lee S, Wu M, & Chang J, 2015, The effects of a self-care program on patients with heart failure, Journal of the Chinese Medical Association, 78(11), pp: 648-656. http://www.sciencedirect.com/science/article/pii/S1726490115001495 Raborn N, 2017, Preventing Avoidable Heart Failure Readmissions: The University Hospital Experience, Journal of Clinical Outcome Management, 1(1), pp: 1-6. < http://www.jcomjournal.com/preventing-avoidable-heart-failure-readmissions-the-university-hospital-experience/> Rabelo E, Aliti G, Brun A, Karen R, 2007, What to teach to patients with heart failure and why: the role of nurses in heart failure clinics, Rev. Latino-Am. Enfermagem, 15(1). Regalbuto R, Maurer M, Chapel D, Mendez J & Shaffer J, 2015, Joint Commission Requirements for Discharge Instructions in Patients with Heart Failure: Is Understanding Important for Preventing Readmissions? J Card Fail. 20(9): 641–649. Shan D, Finder J,Daryl D, & Lewis P, 2014, Interventions to prevent heart failure readmissions: The rationale for nurse-led heart failure programs, Journal of Nursing Education and Practice, 4(11), pp:23-32. Tovar, N, 2016, The Effects of Patient Education and Knowledge of CHF Patients As Evaluated by the PakSAC Survey, The Eleanor Mann School of Nursing Undergraduate Honors Theses. 49. < http://scholarworks.uark.edu/cgi/viewcontent.cgi?article=1047&context=nursuht> Zamanzadeh V,Leila V, Howard F & Jamshidi F, 2013, A Supportive-Educational Intervention for Heart Failure Patients in Iran: The Effect on Self-Care Behaviours. Nurs Res Pract. 1(1), pp: 1-8. < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794621/>   Read More