Change of Practice in Addressing Heart Failure Capstone Project

Excerpt from Capstone Project :

Heart failure is a serious medical condition that is brought by the failure of the heart to pump sufficient blood throughout the body at the right pressure. Generally, this condition is a progressive and chronic disease in which the heart muscle is incapable to pump adequate blood for all blood and oxygen needs of the body. Since the heart cannot keep up with its workload under this condition, it attempts to make up for the failure through enlarging, developing more muscle mass, and pumping faster. Enlarging involves stretching the heart chamber more in order to pump more blood while developing more muscle mass occurs because of increase in size of the contracting cells and pumping faster helps to enhance the heart's output ("About Heart Failure," n.d.). As a major health problem, potential solutions for heart failure is a nursing focused plan that incorporates identifying nursing goals, monitoring the patient, and specific nursing interventions.

Change Model Overview:

One of the major approaches that can be used to address the problem of heart failure is the change model introduced by Larrabee and Rosswurm. This model guides nurse practitioners through a systematic procedure for the change to evidence-based practice. This is realized through the model's recognition that converting research into practice needs a solid foundation in change theory, principles of use of research, and utilizing standardized arrangement.

Assessment of the Need for Change:

According to Rosswurm and Larrabee, the first step of the change model is evaluating the need for change in order to guide nurses into clinical decision making in the health care setting. Heart failure patients are usually divided into three major groups i.e. those with an ejection fraction of less than 40%, patients with ejection fraction between 40 and 50%, and patients with an ejection fraction of over 50%. Patients with an ejection fraction of below 40% are considered to have heart failure with reduced ejection fraction or systolic heart failure. These patients tend to have high rates of readmission for the disease and increased in-hospital complications. This is primarily because the ejection fraction measurement reveals that blood pumping is below the normal level and at high risks of severe irregular heartbeats. Due to the likely life-threatening effect of irregular heartbeats, addressing this issue requires development and use of effective evidence-based practices.

Linking the Problem, Interventions, and Outcomes:

Generally, an ejection fraction of below 40% may confirm that an individual has heart failure. This problem could result in the progression of heart failure into life-threatening situations, particularly irregular heartbeats. Some of the potential interventions include consideration of life style changes such as proper nutrition and exercising and educating patient or creating awareness regarding the disease. The current practices in addressing this problem include taking medication, ACE inhibitor and ARBS, and unhealthy lifestyles. The current practices do not contribute to reduced cases of heart failure but enhances the cases. Lifestyle changes and patient education can help deal with the disease and contribute to various outcomes like reduced risks of hospitalization and risk of death.

Synthesize the Best Evidence:

The proposed interventions can be carried out through nursing assessment and management with various goals like enhanced patient comfort, maintain peripheral perfusion, address self-care deficits, and ease and prevent signs of fluid overload. Lifestyle changes and patient education can be implemented through advanced monitoring after admission in order to identify the root cause and reaction to treatment (O'Donovan, 2010, p.33). The significance of the proposed interventions is evident in the fact that current practice such as the use of echocardiography does not change hospital admission and discharge regardless of the significant changes in the patient's medical status (Aurigemma, 2006, p.309). According to Hsich & Wilkoff (2013), patient education to address the problem should focus on various aspects like maintaining fluid balance, decreasing sodium in daily diet, and learning about ideal body weight.

The need for change in the measures used to address the condition is demonstrated by the seeming ineffectiveness of current practices. Intervention measures should not only focus on treatment initiatives but also prevention, which would help in reducing these cases. Satpathy et. al. (2006) state that the primary prevention or management of the disease requires lifestyle changes like smoking cessation, reduced alcohol consumption, exercising, and dietary changes (p.843). These changes are necessary because one of the major contributing…

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