Factors for Keeping Employees

Readmission of Hispanic Populations for CHF Abstract Background: The specific phenomenon examined within this paper is the readmission of Hispanic patients for congestive heart failure (CHF). Hispanic patients are representative of myriads of underserved populations in this regard and are frequently troubled by readmissions for this ailment due to an assortment of factors revealed from an thorough literature review about this subject. Literature Review: The literature review for this paper involved searching and parsing through scholarly articles specific to this phenomenon.

The author of this document sought out articles focused on this particular population segment and issues contributing instances of readmission for CHF. The literature examined was within the past 15 years. Moreover, this literature was analyzed within the context of middle ground theory as it applies to the nursing profession. History of the Theory: Middle ground theory is innately multidisciplinary when it is utilized within the context of nursing. This theory initially arose as a framework for analyzing sociological phenomena.

However, when it is deployed for healthcare and nursing use cases, it pinpoints ways to alter clinical practice as a means of positively affecting patient care. Three Conceptual or Theoretical or Methodological Issues: These issues are predicated on the dearth of research about the phenomenon explored within this paper. There are too few research studies focused on Hispanics (as opposed to other historic minority groups), CHF (as opposed to other forms of heart disease, and CHF instead of other types of heart failure.

Summary: There are multiple socio-economic issues contributing to this phenomenon, which can be ameliorated with increased education. Introduction The phenomenon studied within the literature review for this assignment is the readmission of Hispanic patients with congestive heart failure. Readmission for this specific condition is significant because it indicates that patients are having difficulty overcoming this condition. The reasons for those difficulties can involve low levels of patient adherence, comprehension issues specific to language difficulties, self esteem, and general motivational problems.

Moreover, there are certain racial disparities pertaining to both the attainment of healthcare treatment objectives and to those associated with CHF which relate to socio-economic factors that also affect readmission rates of Hispanic patients for this specific medical condition. Middle range theory is a prominent mechanism used within the preponderance of the research examined in the literature review for the factors contributing to the readmission of Hispanic patients with CHF.

This theory helps to explicate some of the basic social constructs and their ramifications which can explain the relatively high rate of incidence of readmission for Hispanics afflicted with CHF. Essentially, this theory posits the notion that there is no one (or even limited number of defining social characteristics) or variables contributing to phenomena such as that detailed within this paper. This document also explicates the particular criteria which helped determine the articles analyzed within the literature review which informed this paper.

These include key words, databases, and the years included in the search. Additionally, there are three defining conceptual and methodological issues which were uncovered during the literature review which significantly impacted the conclusions drawn about this particular phenomenon for Hispanic patients.

Nearly all of these problems are demonstrations of the fact that there is a dearth of literature exploring the particularities surrounding the readmission of Hispanic patients with CHF, including a shortage of literature about Hispanic patients with this condition, failure to distinguish such patients who have CHF from those with other varieties of heart disease, and failure to distinguish CHF from other forms of heart failure. Components of the Literature Search The major components of the literature search conducted for the annotated bibliography accompanying this assignment were varied.

The primary focus of the literature search was stratified into a pair of two parts. The first of these concentrated on locating literature pertaining to CHF. However, the second of these components was predicated on finding said literature as it specifically relates to a population of Hispanic patients. These two different dimensions of the literature search significantly informed the key words utilized to find research articles. Initially, those key words include CHF, Hispanics and Hispanic patients.

However, it soon became apparent that Middle Range Theory, as initially popularized by Linda Hall, would also be a critical factor in understanding the correlation between Hispanic populations and the effects of CHF. Therefore, Middle Range Theory and Linda Hall were also included in the key words. Still, there is also value gleaned from research which did not involve this theory advocated by Hall.

Thus, there were some searches issued in which Middle Range Theory and Linda Hall were not included as key words, in order to compare the results of studies both grounded in and not involving Hall’s theory. Since themes pertaining to the phenomenon of CHF within a specific population segment such as Hispanics can vary over time periods, it was essential to obtain relatively recent research. Thus, the years searched for were from 2005 to the present.

The databases used for the search were under the general subject of nursing and health sciences. These included specific databases such as CINAHL, Cochrane Library, Joanna Briggs Institute EBP, Nursing & Allied Health Database, Ovid Nursing Essential Collection, and PubMed. History of Middle Range Theory from Nursing Literature When tracing the history of middle range theory from the nursing literature in which it is found, it is important to begin with a multidisciplinary approach.

Specifically, middle range theory initially advanced from the field of sociology as a means of providing a medium between the limitations of pure theory and hypotheses, and the empirical research required to effectively ground those theories. Middle range theories utilize both of these perspectives to account for social phenomena such as the readmission of patients for conditions like CHF. When applied to fields of health care and nursing in particular, this theory is useful for helping to identify and, ideally, rectify the deficiencies nurses encounter when doing these jobs.

These problems can be readily identified, explained, and addressed with middle range theory as it is applicable to the nursing profession. Therefore, the multidisciplinary facets of middle range theory in nursing are rooted in this theory’s sociological foundation, yet are exceedingly apropos for methods to deal with nursing problems. The major nursing problem examined under this theory is the high rates of readmission of Hispanics for CHF.

Middle range theory, then, can elucidate various facets of this problem by combining both theoretical hypotheses with empirical evidence that evinces potential solutions to this issue. These solutions may revolve around some of the different manifestations of middle range theory, which typically rely on facets of self efficacy, social support, health promotion, and others. These different theories provide both a lens with which to analyze the scope of negative issues contributing to health care problems in the nursing field, and the potential for devising solutions to redress those issues.

Three Conceptual or Theoretical or Methodological Problems Perhaps the primary conceptual or theoretical or methodological issue uncovered during the literature review pertains to the relative paucity of research focused exclusively on Hispanic patients in relation to CHF. This issue was anticipated by the author, and was readily confirmed by the results of the literature review. On the one hand, it was possible to find multiple articles pertaining to Hispanic patients and this particular malady.

However, in order to get the 10 articles desired for this literature review, the author had to incorporate research for other populations which were not exclusively Hispanic. The general premise behind this reality is the bifurcation of patients into stratifications that typically involve either those of white or Eurocentric ethnicities, and the general grouping of all other patients into non-white or non-Europeans. For example, the article by Pu et al (2014) considered the incidence of CHF from the perspective of historic minority groups in general.

The results codified findings pertaining to whites, African Americans, and Hispanics—which is not indicative of a research study explicitly focused on Hispanics. Thus, only a portion of the results actually related to the present literature review, a fact which does not improve its general efficacy. Therefore, this problem is conceptual in nature. Furthermore, this issue was also present in other research considered in this literature review.

For example, the research study written by Qian et al (2015) is concentrated on the presence of racial disparities in general as they correlate to heart failure. This study also bases a fair mount of its findings on results pertaining to African Americans—which is not necessarily useful for a study focused on CHF for Hispanics.

Although the author was able to extrapolate some of the statistical results to determine how they exclusively focused on the latter population segment, doing so still decreased the population sample on the whole and the overall effectiveness of using this study for this literature review. The author was forced to include this study and the other one mentioned in this section of the paper in order to get the full 10 sources used for this literature review.

Nonetheless, it would have been more advantageous to get studies which focused exclusively on the population segment that is the focal point for this document, Hispanics. Another conceptual issue with this literature review pertains to the specific maladies incorporated in it. This writer’s attempt was to find 10 articles which pertained not only to Hispanics, but specifically to those afflicted with CHF. Unfortunately, there was a scarcity of such literature which expressly explored the ramifications of this malady on Hispanics.

Thus, the author of this document had to incorporate research about other conditions that were related to CHF, but which did not necessarily involve this condition. For instance, the study by Rodriguez et al (2011) examines both heart failure and acute myocardial infarction. Essentially, this article is focused on the relationship between heart disease in general and Hispanic populations. Of course, CHF is certainly one of the numerous conditions associated with heart disease.

However, the fact that there are so many different medical conditions affiliated with heart disease is problematic because the literature review is supposed to be exclusively about CHF and Hispanics, and not heart disease in general and Hispanics. However, in order to include a bevy of articles to attempt to get the best literature review possible, the author still had to use this article which was not as targeted as some of the others.

Therefore, there were certain inferences the author had to make about the results from this study and some of the others in order to make them suitable for this literature review. The third issue stemming from this literature review involves the specificity of the types of heart failure examined. As previously indicated, the point of the literature review was to assess scholarly works about congestive heart failure as it relates to Hispanic populations.

However, because of the dearth of articles solely studying this phenomenon within this population, the literature review includes some articles which are centered on heart failure in general. Many of these articles do not necessarily evaluate this condition within the context of CHF. A good example of this fact is illustrated by the foregoing article attributed to Rodriguez et al (2011). Not only does this article explore different aspects of heart disease, but it also does not detail whether the instances of heart failure examined are necessarily those involving CHF.

There are multiple types of heart failures; without researchers specifying the type of heart failure the author is only left to make assumptions about the results of the study and their relevance to CHF. Several of the articles analyzed within this literature review are about heart failure, and do not necessarily consider this phenomenon as it relates to CHF. The article by Stromberg (2005) demonstrates this point handily. The author scrutinizes the role of patient education in heart failure, which could potentially involve heart failure types that are not CHF.

The crux of the matter, however, is that this issue stems from the amount of detail desired in the literature review, and the amount of detail available in the existent literature. The former outstrips the latter. As such, the literature is much more general than the author of this document would have liked it to have been. It still is functional and certainly provides a substantial amount of information about the subject of the readmission of Hispanic patients with CHF.

However, the literature in the literature review requires some dedicated inferencing about the effects of CHF on this patient population because of the lack of available research specifically pertaining to CHF, as opposed to heart failure in general. State of the Science The state of the science in respect to.