Change of Practice in Addressing Heart Failure

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 factors to heart failure is poor lifestyles. Gutierrez & Blanchard (2004), concur that lifestyle changes have been proven to lessen the risk of all kinds of cardiovascular disease (p.2614). In addition, these measures should be adopted at an early stage before structural changes and systolic dysfunctions have taken place (Mandinov, 2000, p.822).

Design Practice Change:

Patient monitoring for lifestyle changes and education will be carried out between three to four months period. This multidisciplinary team approach will involve establishing contact during hospitalization, conducting follow-up after discharge, providing telephone support and remote evaluation, and home-based visits. During this period, patients will receive information regarding adherence and self-care management. Some of the major stakeholders to be involved in the design for change include heart failure nurses, physicians, and patient's families and/or caregivers. Therefore, the desired practice change will incorporate the use of these stakeholders or key players in providing patient education and monitoring through establishment of contact, home-based visits, remote monitoring, and telephone support.

Implementation and Evaluation of the Change in Practice:

One of the major differences in this practice of patient monitoring is the inclusion of measures that would encourage support and evaluation outside the health care setting. As a result, this change in practice will involve a multi-dimensional approach across the various elements in the process. Patients will be assigned to different heart failure nurses and physicians and the other major players who will design the respective schedules for monitoring the patients within the four months period. These players will document various aspects of patients' lifestyle changes and education in light of their impact in dealing with the disease. The evaluation of the change in practice will involve examining the impact of these changes and education in light of nursing goals that were established before the beginning of the intervention.

Integrating and Maintaining of the Change in Practice:

The change in practice will be integrated and maintained into current nursing practice for addressing heart failure depending on the impact of the process in lessening the rate of heart disease cases. In essence, the change in practice will be further evaluated and considered if it helps these patients to significantly lessen the risk of life-threatening conditions like irregular heartbeats. Moreover, the integration and maintenance of the change in practice depends on its effect on the patient's ejection fraction.

Summary:

Heart failure is a major health problem in the modern society because it is largely brought by people's lifestyles. Actually, the existing lifestyles contribute to increased rates of this disease because they enhance the major risk factors. Since this disease is divided into various categories, patients with an ejection fraction of less than 40% face the most risk because they may be confirmed to have heart failure. This condition is likely to degenerate to life-threatening conditions such as irregular heartbeats. Therefore, it is important to take new measures for dealing with the disease such as promoting lifestyle changes and patient education. These interventions should be integrated in patient monitoring initiatives that involve a multidisciplinary team composed of various professionals. The intervention could contribute to reduced risk of hospitalization and death since it addressed one of the major risk factors. However, the effectiveness of the intervention will be determined by its effect on the rate of heart failure incidents and achievement of established nursing goals.