Name
Chamberlain University
NR-585: Research Methods and Evidence-Based Practice for Advanced Nursing Practice
Prof. Name
Date
As a home health nurse, I frequently encounter patients diagnosed with Congestive Heart Failure (CHF). Many of these patients demonstrate limited knowledge regarding effective disease management, which creates barriers to improved outcomes. To optimize patient care, it is essential to evaluate their current understanding of CHF and design individualized interventions. These interventions include educational strategies related to medications, dietary adjustments, and the importance of monitoring symptoms.
CHF is a chronic and progressive condition that occurs when the heart fails to pump blood efficiently, leading to fluid buildup in the lungs and extremities (Cleveland Clinic, 2024). It is one of the most common reasons for hospitalization among adults aged 65 and older, with over 6 million Americans affected (Cleveland Clinic, 2024). If not managed appropriately, CHF can shorten life expectancy by nearly 10 years. Several factors contribute to the development of CHF, including myocardial infarction, coronary artery disease (CAD), diabetes, hypertension, and obesity.
The clinical concern revolves around the impact of daily weight monitoring versus the absence of such monitoring, combined with medication adherence versus non-compliance, in reducing rehospitalization rates for CHF patients. Weight monitoring serves as an early indicator of fluid retention, while adherence to prescribed medications ensures that patients effectively manage their condition. Together, these interventions empower patients to recognize early warning signs and seek timely medical attention, thereby preventing unnecessary hospital readmissions.
In CHF patients (P), how do daily weights and medication adherence (I), compared to no daily weights and medication noncompliance (C), affect rehospitalizations (O) within 60 days (T)?
| Element | Description |
|---|---|
| P (Population) | Patients diagnosed with unmanaged CHF |
| I (Intervention) | Daily weight monitoring and adherence to prescribed medications |
| C (Comparison) | No daily weight monitoring and medication noncompliance |
| O (Outcome) | Reduced hospital readmissions due to CHF exacerbation |
| T (Timeframe) | 60 days |
A review of multiple studies provided evidence-based insights into effective CHF management:
| Study | Design | Key Findings | Citation |
|---|---|---|---|
| Study 1 | Qualitative | Identified psychosocial and comorbidity factors (e.g., diabetes, atrial fibrillation, renal disease) influencing CHF readmission. | Ryan et al., 2019 |
| Study 2 | Meta-analysis | Demonstrated that nurse-led interventions reduced readmission and mortality compared to standard care. | Qiu et al., 2021 |
| Study 3 | Clinical Practice Guidelines | Showed that medication-guided therapies (MRAs, ARBs) improved long-term CHF outcomes. | Heidenreich et al., 2022 |
| Study 4 | Quantitative | Found that many patients had poor knowledge and inadequate self-care strategies for CHF. | Sedlar et al., 2021 |
| Study 5 | Systematic Review | Highlighted the role of compliance, nursing interventions, and self-care in reducing CHF complications and rehospitalizations. | Istianah et al., 2024 |
Across the reviewed literature, several common themes and gaps emerged.
Effective CHF management requires nurse-led interventions.
Patient compliance with medications and daily monitoring reduces rehospitalizations.
Significant knowledge deficits exist regarding CHF symptoms and long-term management.
| Identified Gap | Explanation | Source |
|---|---|---|
| Unreliable outcomes | Influence of uncontrollable variables (e.g., comorbidities) | Ryan et al., 2019 |
| Inconsistent findings | Variation in outcomes across different patient populations | Qiu et al., 2021 |
| Limited resources | Lack of standardized education and community support | Multiple studies |
| Risk of systematic errors | Potential publication bias | Qiu et al., 2021 |
Overall, the evidence supports the integration of daily weight monitoring and medication adherence within patient care plans. These interventions, combined with education and self-care strategies, lead to fewer CHF-related hospitalizations.
Based on the literature review, the following recommendations are proposed:
Frequent assessments using questionnaires to identify patient knowledge gaps.
Implementation of patient-specific care plans including medication management and interdisciplinary collaboration.
Education on daily self-management practices such as the significance of daily weights, sodium-restricted diets, and early symptom recognition.
Support group involvement for patients and families to improve long-term adherence and provide emotional support.
Patients with CHF
Healthcare providers (nurses, physicians, social workers)
Community and support systems
| Resource | Purpose |
|---|---|
| Online support groups | Provide patient/family emotional and educational support |
| AHA educational tools | Enhance disease-specific understanding |
| Patient-friendly resources (videos, infographics) | Improve health literacy |
| Ongoing CHF education | Strengthen long-term disease self-management |
American Heart Association. (2024). Heart Failure Tools and Resources. https://www.heart.org/en/health-topics/heart-failure/heart-failure-tools-resources
Cleveland Clinic. (2024). Congestive Heart Failure. https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heartfailure#management-and-treatment
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., … Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012
Istianah, I., Said, F. B. M., Nambiar, N., Tohri, T., Ramadhan, M. D., Purwanti, T. F., & Juwita, N. A. (2024). Nursing knowledge and practice in self-care compliance in heart failure patients: A systematic review. International Journal of Nursing, 3(1), 7–15. https://doi.org/10.58418/ijni.v3i1.59
Qiu, X., Lan, C., Li, J., Xiao, X., & Li, J. (2021). The effect of nurse-led interventions on re-admission and mortality for congestive heart failure: A meta-analysis. Medicine, 100(7), e24599. https://doi.org/10.1097/MD.0000000000024599
Ryan, C. J., Bierle, R. S., & Vuckovic, K. M. (2019). The three Rs for preventing heart failure readmission: Review, reassess, and reeducate. Critical Care Nurse, 39(2), 85–93. https://doi.org/10.4037/ccn2019345
Sedlar, N., Lainscak, M., & Farkas, J. (2021). Self-care perception and behaviour in patients with heart failure: A qualitative and quantitative study. ESC Heart Failure, 8(3), 2079–2088. https://doi.org/10.1002/ehf2.13287
