Introduction
Heart failure affects a large population of adults; approximately 25% of heart failure patients are readmitted within thirty days of discharge. This could warrant the lack of patient education on disease processes and self-care management. Improving patient education could reduce hospital readmissions and the cost associated with caring for this specific patient population. Family Nurse Practitioners and Acute Care Nurse practitioners serve in a vital capacity in ensuring patients understand the disease process and management of heart failure (Morley & Levin, 2021). Patients spend a considerable amount of time with advanced practice nurses in the clinical setting, so it’s paramount that patients are equipped with the correct strategies in self-care management to reduce hospital readmissions. Therefore, this study evaluates the rate of hospital readmission among patients with heart failure and measures that can be enforced to reduce hospital readmission.
The phenomenon of Interest (POI)
Various studies have been relevant in improving patient education to reduce hospital readmissions in patients with heart failure. As researched by Khan et al. (2021), one out of four patients with heart failure are readmitted to the hospital within 30 days of discharge, and nearly half of this population are readmitted to the hospital after six months. The phenomenon of interest for this study is to reduce the heart failure readmission rate through patient education and self-care management. The population of interest are the old aged people above 75 years as they record the highest readmission rate for heart failure due to low immune system.
Offering patient education on self-care management has great significance to the acute care nurse practitioner as it reduces hospital workload caused by an increased rate of readmissions (Ordonez-Piedra et al., 2021). Perhaps, when the hospital records a high rate of readmissions, the workload to attend to the patient increases, resulting from nursing burnout and low productivity. Consequently, offering education to the patient helps reduce the readmission rate for heart failure, improve their health outcome and enhance patient satisfaction.
The increased readmission rate for heart failure results in increased in-hospital mortality and length of stay and expenditure, which put more strain on hospital resources in the United States. For instance, from 2018-2020, the U.S healthcare system recorded 4.2 million adult readmission, with 1.2 million patients suffering from heart failure. The estimated cost for each patient amounted to $15,732 per patient and hence putting much economic strain on the U.S healthcare system (Jeenal, 2020).
Philosophic Viewpoint
One difference between analytical philosophy and continental philosophy about heart failure readmission is that analytical philosophy focuses on science to describe the cause of readmission. In contrast, continental philosophy uses a humanistic perspective to provide an intuition about hospital readmissions. For instance, analytical philosophy provides a statistical cause of heart failure readmission, which includes underlying comorbidity (42%), non-adherence to medical treatment (35%) and non-optimal medication, which accounts for 32% of total hospital readmissions (Lawson et al., 2021). On the other hand, continental philosophy provides clinical risk factors that cause heart failure readmissions, including distressing symptoms, unavoidable progression of illness, health system failure and influence of psychological factors, among others. My preferred philosophical view is analytical philosophy, as it establishes the leading causes of heart failure readmissions and their statistical percentage of the occurrence. This can help acute care nurse practitioners rank and focus on the most pressing issue when offering heart failure treatment and educational programs to reduce the rate of readmissions.
Analytical philosophy significantly reduces heart failure readmissions as it’s based on the objectivity and reproducibility of results, which is most helpful in real-time. Analytical evaluation provides nurses with trends and data that can produce a positive outcome of reducing the rate of readmissions. For instance, analytical philosophy provides statistical information regarding the percentage of occurrence of readmissions over the years (the trend) and provides the expected readmission rate in the near future after educational programs (White-Williams et al., 2021). By identifying these trends and data, Acute Care Nurse practitioners can adjust the healthcare system and tailor educational programs to reflect the rate of readmissions positively. Analytical philosophy also provides statistical data that can help Acute Care Nurse practitioners provide a more tailored healthcare experience for patients, unlike the continental philosophy.
While continental philosophy information is less significant than analytical philosophy data, it provides clinical risk factors and data that cause heart failure readmissions, such as distressing symptoms, unavoidable progression of illness, health system failure and influence of psychological factors. This data is valuable to develop a tailored healthcare experience and personalized educational program and self-care management to maintain their health systems and reduce the readmission rate.
One of the benefits of combining both analytical and continental philosophical views is that it provides statistical and real-time figures as well as the theoretical approach to hospital readmission. For instance, a study by Regmi et al. (2020) showed that underlying health comorbidities contribute to about 45% of heart failure readmissions. The study also shows that health system failure contributes to the unrecognition of these underlying comorbidities, resulting in a high readmission rate. This study provides analytical philosophy as the leading cause of readmission and continental philosophy as the clinical risk factor that should be addressed to reduce the readmission rate.
Ways of Knowing
The four fundamental patterns of knowing identified by Carper (1978) are (1) empirics, the science of learning, (2) esthetics, the art of nursing, (3) personal knowledge and (4) ethics, the moral knowledge. Empirical knowing involves using facts and descriptive and theoretical explanations to offer medical intervention. As an Acute Care Nurse practitioner, I would use practical knowing to reduce heart failure readmission through the competent performance of activities supported by theories. I would use a repertoire of paradigm cases to provide patients with access to educational services to develop self-care management to help them manage their conditions properly and prevent illness and readmission to the hospital. Aesthetic knowing involves using empathy, dynamic adaptation and recognition of specific cases. In this case, I would identify the patient’s personality and underlying health comorbidities to determine how to improve treatment procedures, prevent health constraints based on the specific health care and provide actual treatment to the patient to cure heart failure.
On the other hand, ethical knowing focuses on ethical components of nursing practice of doing the right thing to improve patient health outcomes. As such, I would provide training to the patient to avoid common illnesses that can lead to readmission after heart failure treatment. Personal knowing helps nurses identify their responses and strengths when giving medical treatment. Based on my nursing competency, I would help the patient by managing their medication and educating them on the proper medication scheduling while also enhancing communication with patients to identify further care to avoid heart failure readmission.
Conclusion
This study has noted that improving patient education and correct self-care management strategies can help reduce hospital readmissions in patients with heart failure. The study has also noted that an increased rate of readmission for heart failure results in increased in-hospital mortality and length of stay and expenditure, putting more strain on hospital resources in the United States. However, this can be prevented by offering education to the patient to reduce the readmission rate for heart failure, improve their health outcome and enhance patient satisfaction.
References
Carper, B. A. (1998). Fundamental patterns of knowing in nursing. Perspectives on the philosophy of science in nursing: a historical and contemporary anthology. Philadelphia: Lippincott, 12-20.
Jeenal, P (2020). Heart Failure Population Health Considerations. https://www.ajmc.com/view/heart-failure-population-health-considerations
Khan, M., Sreenivasan, J., Lateef, N., Abougargi, M., Greene, S., Ahmad, T., Anker, S., Fonarow, G. & Butler, J. (2021). Trends in 30- and 90- day readmission rates for heart failure. Circulation: Heart Failure, 14(4). https://doi.org/10.1161/CIRCHEARTFAILURE.121.008335 (Links to an external site.)
Lawson, C., Crothers, H., Remsing, S., Squire, I., Zaccardi, F., Md, D., & Khunti, K. (2021). Trends in 30-day readmissions following hospitalization for heart failure by sex, socioeconomic status and ethnicity. EClinicalMedicine, 38, 101008.
Morley, C. M., & Levin, S. A. (2021). Health literacy, health confidence, and simulation: A novel approach to patient education to reduce readmissions. Professional Case Management, 26(3), 138-149.
Ordonez-Piedra, J., Ponce-Blandon, J., Robles-Romero, J., Gomez-Salgado, J., Jimenez-Picon, N. & Romero-Martin, M. (2021). Effectiveness of the advanced practice nursing interventions in the patient with heart failure: A systemic review. NursingOpen, 8(4), 1879-1891.
Regmi, M. R., Bhattarai, M., Parajuli, P., Garcia, O. E. L., Tandan, N., Ferry, N., & Robinson, R. (2020). Heart Failure with Preserved Ejection Fraction and 30-Day Readmission. Clinical Medicine & Research, 18(4), 126-132.
White-Williams, C., Shirey, M., Eagleson, R., Clarkson, S., & Bittner, V. (2021). An Interprofessional Collaborative Practice Can Reduce Heart Failure Hospital Readmissions and Costs in an Underserved Population. Journal of Cardiac Failure, 27(11), 1185-1194.
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