CHF as One of the Fatal Diseases - Research Proposal Example

?Review of Research Affiliation with more information about affiliation, research grants, conflict ofinterest and how to contact Theory CHF, one of the fatal diseases, has become a health hazard of almost 1 out of 100 people all around the world. Therefore, it is a source of rallying point for the medical community, to find better ways of administering treatment to facilitate faster relief as well as rehabilitation on a long term basis for patients. On an evaluation of the present scenario relating to combating the problem, it transpire that the improper appreciation of the components of Population, Intervention, Comparison, Outcome and Time (PICOT) has remained contributory factor in impending the progress in this regards. However, a more dominant reason that poses the real problem in containing CHF is the non compliance by patients of the physician’s instructions. This it leads to recurrent hospitalization of the patient and the path to recovery becomes cumbersome and, more often than not, fatal result ensure. Thus, the theory gains importance as on the prospect of evolving the proper means to identify the problems and come up with appropriate solutions to eradicate the same. The major findings to this theory of non compliance to physicians’ instructions stems mainly due to certain factors mentioned below: 1. Inability of patients to recognize correctly signs and symptoms of CHF. 2. Strategic failure to encourage patients to adhere to medication and create awareness and also physicians’ tendency to underestimate the values of preventive treatment. 3. Lack of expertise as well as focused study by physicians and other healthcare professionals in the subject and the areas where scope exists for improvement, to remove bottlenecks, besides curtailing any notion of prejudiced barriers. Therefore, to bring more CHF patients under the ambit of compliance, the task of basic training and education and incorporating many of the solutions and recommendations brought forth in the review of the research work discussed below are expected to help in overcoming the misconceptions of non-compliance. Review of Research In the modern day, with its problematic lifestyles, CHF has become a major threat to human lives. The challenges for healthcare professionals, in controlling this fatal issue in terms of finding solutions of long term nature, are a critical factor. This makes it necessary to identify the hurdles they confront in the process of recovery and rehabilitation of the patients assigned to their care, and how they can overcome the major constraints. Keeping in view this vital aspect, the broader concern that emerges is whether noncompliance plays a key role in recurrent hospitalization of CHF patients because of the physician’s underestimation in preventive treatment for improved outcomes. This major hurdle in efficient management of Population, Intervention, Comparison, Outcome and Time (PICOT) occurs mainly due to noncompliance by patients of the physician’s instructions due to lack of lack of awareness. In agreement of this hypothesis there exists overwhelming evidence and the reasons for the same, as gleaned from a literature review on the topic, are narrated below: 4. Ignorance and lack of understanding regarding signs and symptoms of CHF. 5. Strategic failure to encourage patients to adhere to medication and creating awareness in them on the need to overcome such problems through strict compliance. 6. The physicians and other healthcare professionals lack expertise in the subject and the areas where scope exists for improvement as well as to remove bottlenecks. Besides, they need to eschew any notion of prejudiced barriers. Hence, a formula has to be evolved, where more patients of CHF are brought under the perspective of compliance to preventive treatment and how basic training and education will help identifying the causes as well as signs and symptoms. Besides, it will also facilitate deciding and administrating the medication and treatment that have to be followed. Thus, a physician will be able to appropriately use this expertise to analyze the situation and determine best treatment to be administered to his patient. Such a strategy of diagnosis and treatment, if properly adhered to, will go a long way to control the crucial aspects associated with CHF. Some interesting facts which can throw light on the impediments due to non-compliance by the patients and how it can be incorporated in seeking a proper course of action with regard to treatment and medication, is dealt in brief in the succeeding paragraphs. The most significant consideration when seeking ways to make patients comply with treatment positively is to identify the signs and symptoms that they experience rather than just relying on those they think have some relation with heart failures. Thus, facilitating a checklist, clearly specifying the symptoms will prompt the patients to report relevant manifestations. In this context the article titled, “Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?” written by Albert et al is relevant. The authors refer to a survey conducted in a sample population of “276 patient’s (164 ambulatory, 12 hospitalized)” to determine the demographics and medical histories (Albert et al. 2010, p. 1). The survey has found that patients feel more confident if they are better informed for recognizing the signs and symptoms. Thus, such a checklist used to report symptoms of heart failure, will assist the patients in correctly identifying the symptoms and it will also encourage them to shed their reluctance besides enabling care providers to take appropriate decisions about the treatment to be given. The most significant finding in this case is that since dysphea prevails as a manifestation in the case of hospitalized as well as functional patients, this symptom in isolation cannot be used to determine whether a patient’s condition is improving or deteriorating. Thus, dysphea cannot be considered as an indicator of the status of heart failure. Thus, the report suggests that building the trust of the patients by accurate diagnosis will make them more compliant. The purpose of a research is the collection and analysis of information to increase the understanding of a topic under study by following certain systematic procedures and to arrive at a result, which will give additional inputs to already existing knowledge. In order to achieve these objectives, the researcher will have to use appropriate methodologies to elicit information and to glean evidence within the parameters of scientific methods. The emphasis here is on the patients’ understanding of the treatment and their adherence to instructions of the physicians. It necessitates effective rapport and communication between the physician and patients, which will facilitate trust in the treatment and make them more complaint to medication and other instructions. Noncompliance occurs due to several factors including demographic indicators such as age, gender and socio-economic status, the regimens of medication like side effects or the complexity associated with them, psychological problems etc. Besides, social and family attitudes as well as their concepts about self esteem also play a major role in this. Thus, in the present day, noncompliance by patients in adhering to physician’s advice is creating a major impediment in effectively combating the disease. In this scenario, there is a high relevance for compliance related interventions ‘Hospital discharge .Education’ ‘Sara Paul Crit Care Nurse 2008’ (Paul, 2008, p.1) in a study, stresses the importance of this vital aspect. Here the findings suggest that educating patients before discharge can lead to lessening of readmission, it promotes self-care and patients can identify problems early. There should be active participation by patients in their health management where they can learn about their conditions and medication and when medical treatments have to be availed. It also discusses the need for nurses to understand the hurdles to self-care and help patients to cross these barriers. HF occurs when the heart is not able to pump adequate blood to meet body needs, leading to an “exacerbation on the effect of blood pressure, lungs and bodily fluid retention” (Chandler, 2010). As per the finding of the Merck Manual, heart failure affects the life of 1 out 100 people, causing sudden death. Treatment and change in lifestyle can help a person overcome this hazard and live longer. The findings conclude that approximately 70% dies within 10 years. Thus, proper compliance to symptoms recognition can have several positive outcomes in the treatment of HF. Lately another strategy adopted to adhere to compliance is through telephonic interventions. Long termed results shown after telephonic intervention in CHF, the purpose being the study to assess the rate of death and hospitalization for HF in a randomized trial of telephonic intervention (DIAL) to improve compliance and knowledge in stable patients (Daniel et al 2010, p.1). It was observed that there was sustained benefit in the intervention period during and 1 to 3 years succeeding the end of intervention This was mainly affected by the educational interventional impact on patients behavior and habit. For successful treatment of CHF it was assessed that self management with proper consultation behavior was essential. The findings into the study of type-D patients with CHF, who are characterized by high social inhibition, may cause delay of medical consultation. Patients with CHF with a type-D personality display inadequate self-management. Failure to consult for increased symptom levels may partially explain the adverse effect of type-D personality on cardiac prognosis (Heart 2007). A notable challenge of non adherence with medical regimen in HF, can become a major cause for non favorable results translated into the real world, associated with several therapies evaluated in clinical trials. This has a complex influence and poor net results are associated with it. “Proposals for improvement of drug taking behavior such as in hospital initiation of therapy, dosing regimens simplified through a combination and long acting formulation being adopted and improvement in provider-patient communication is on the review” (Heart Failure Reviews February 2008,Volume 13, Issue 1, pp 99-106) In yet another study it was noticed that the prospect of hospitalization increased when patients with HF demonstrated non compliance. However, smaller studies limited the scope of any reliable conclusions as they either dealt with individual component of compliance or its related factors. The aim of this research was to study all dimensions of compliance and other relevant aspects in one HF population. Data was collected from 501 HF patients and assessed with clinical and demographic references. They completed questionnaire on compliance, beliefs, knowledge and self-care behavior. The findings showed that to improve compliance “an increase in knowledge and change of patient’s beliefs by education and counseling was needed and more careful attention was to be paid to patients who displayed symptoms of depression. Last but not the least is the importance of having a team of highly trained and efficient health care professionals who can guide and advice the HF patients the emergence symptoms and visible signs indicating the potential threat of heart failure to stage of treatment and rehabilitation, to overcome the fatalistic tendencies. This is especially so because heart failure is a serious disease which affects millions in America and the world around, leading to disability and death in many cases. As such the patients need to take immediate measure to control and treat it as soon as the symptoms appear and the perception sink into the patient. In the present times, the picture is not so dismal as was in the past, with advancement in medicine, infrastructure and expert, knowledge based health care professionals. The demand for well trained healthcare professional makes it more relevant to have a “team of good doctors, specialized nurses, dietician, clinical health educators, pharmacist, dedicated social workers and specialists in behavioral medicines.” The article summarizes the need for healthcare professionals with the active support from family members in the treatment. Besides, patients should get educated and follow a strict medication regimen which will help to the non-compliant attitude of the patients to a large extent. It also indicates that the presents of specialized nurses, equipped with expertise knowledge of handling CHF patient can bring considerable improvement with vast decrease in cases of readmission, giving quality care and minimizing hospitalization, minimizing the rate of mortality and morbidity. An exhaustive analysis of the finding gleaned from the above studies point to the fact that non-compliance to the medical norms and physician’s advice can lead to recurrent hospitalization of CHF patients and the undermine preventive medicine and treatment by physicians and health care professionals. Thus, the management of PICOT can become a challenging and often impossible call. If the conclusion of these studies and recommendations are accorded due priority and utmost importance then the medical fraternity can aspire to evolve better solutions to deal with CHF patients. Reference List Albert et al. (2010). Signs and Symptoms of Heart Failure: Are You Asking the Right Questions? American Journal of Critical Care. Vol. 19. 2010. Retrieved from http://www.aacn.org/WD/CETests/Media/A101905.pdf Carter, S. & Taylor, D. (2003). A Questions of Choice- Compliance in Medicine Taking. Medicines Partnership. Retrieved from http://www.keele.ac.uk/pharmacy/npcplus/medicinespartnershipprogramme/medicinespartnershipprogrammepublications/aquestionofchoicecomplianceinmedicinetakin/research-qoc-compliance.pdf Daniel, F. et al (2010). Long-Term Results After a Telephone Intervention in Chronic Heart Failure: DIAL, CSA ILLUMINA. Retrieved from http://md1.csa.com/partners/viewrecord.php?requester=gs&collection=ENV&recid=13407312&q=&uid=792114450&setcookie=yes Chandler, S. (2010). What are Heart Failure Exacerbation. Live Strong. com. Retrieved from http://www.livestrong.com/article/200385-what-are-heart-failure-exacerbations/ Hulka, B.S. et al. (1976). Communication Compliance and Concordance between Patients and Physicians with Prescribed Medication. American Journal of Public Health. Retrieved from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.66.9.847 Paul, Sara. (2008). Hospital Discharge Education for patients with Heart Failure: What really Works and What is the Evidence? Critical Care Nurse. Retrieved from http://ccn.aacnjournals.org/content/28/2/66.full.pdf+html Intext: (Veldhuisen et al. 2004, p.). Veldhuisen, D. J. et al. (2004). Compliance in Heart Failure Patients: The Importance of Knowledge and Belief. European Heart Journal. Retrieved from http://eurheartj.oxfordjournals.org/content/27/4/434.short Intext: (X-Plain Congestive Heart failure, 1995, p.). X-Plain Congestive Heart failure. (1995). The Patient Education Institute. Retrieved from http://www.nlm.nih.gov/medlineplus/tutorials/congestiveheartfailure/ct129105.pdf Read More