In this assessment, the patient problem that will be addressed is a heart attack. Heart attacks are among the most prevalent cardiovascular diseases in the United States. A heart attack, also known as a myocardial infarction, occurs when one of the coronary arteries gets blocked, preventing blood from reaching a portion of the heart (Benjamin et al., 2019). The heart muscle might be injured if the heart’s blood flow is not rapidly restored. A blood clot occurs when a plaque in a coronary artery ruptures, further obstructing blood flow. A heart attack occurs when the blood supply to a portion of the heart muscle is entirely cut off, leading to irreversible cardiac damage. It is crucial to treat a heart attack as soon as possible to restore blood flow to the afflicted area of the heart and minimize damage to the heart muscle. The primary objective of emergency care is to restore blood flow as rapidly as possible to the blocked artery and heart muscle since the quicker blood flow is restored, the less heart muscle will be injured (Benjamin et al., 2019). Therefore, effective leadership, collaboration, change management, and policy considerations are required to meet emergency treatment requirements.
I will work with a 55-year-old African American man with a history of type II insulin-dependent diabetes and hypertension who smokes 20 cigarettes a day and has peripheral atherosclerosis. After seeing his son play basketball, he went to a nearby hospital because he was experiencing shortness of breath and chest pain. According to further questioning, he had been experiencing chest pain more frequently throughout the previous week. He had persistent chest pain not relieved by three nitroglycerin (NTG) pills, diaphoresis, and severe shortness of breath, necessitating intubation. The patient was brought to the coronary care unit to reduce the possibility of myocardial infarction. After discharge, the recommended treatment included a stent through the radial artery, HTN medications, patient education, methods of reducing cholesterol, and smoking cessation. During the two practicum hours, I will be working with the patient on an educational program involving strict medication adherence, smoking cessation support, physical exercise and diet, and diabetic care.
Context, Data, or Information Substantiating the Patient Problem
According to Curtin (2019), a heart attack occurs every forty seconds in the United States. Each year, over 805,000 Americans have a heart attack. Six hundred and fifty-five thousand are first heart attacks, two hundred thousand are second heart attacks, and about one-fifth are quiet; the harm is done, but the individual is unaware. This is evident in the patient’s case, as he continuously felt chest pains but ignored them until they became severe. The data also proves this problem in the United States, and there is a need for patient education to achieve full recovery. Therefore, the plan for the two practicum hours is to improve the patient’s knowledge concerning the required practices and changes that he should adopt to achieve long-term recovery. The importance of leadership, collaboration, change management, communication, and policy considerations for the patient’s case because a heart attack can result in death is not addressed urgently. Therefore, working with the patient and his family is important to achieve long-term recovery and avoid readmissions or, in worst-case scenarios, death.
Relevance of the Patient Problem to a Baccalaureate-Prepared Nurse Practice
The relevance of the patient problem to a baccalaureate-prepared nurse practice is because nurses are the most common first emergency personnel to cardiac arrest and are present at hospital bedsides the most often around the clock. A prompt reaction to cardiac arrest requires nurses to recognize and respond promptly to deteriorating patient circumstances. Prior research has revealed that a lower patient-to-nurse ratio is related to a greater likelihood of survival after cardiac arrest in the hospital (Harrison et al., 2019). An increasing body of evidence indicates that healthcare facilities with a higher proportion of nurses holding a bachelor’s degree in nursing (BSN) have better patient outcomes, including reduced death and failure to rescue rates. Increases in the number of nurses with a BSN within hospitals are connected with decreases in fatality and advancements in care quality and patient safety. In 2010, based on compelling data, the Institute of Medicine recommended that by 2020, at least 80 percent of the nursing workforce should hold a BSN or higher degree (Harrison et al., 2019).
The findings of Harrison et al. (2019) are consistent with what I typically notice in nursing practice settings, namely that heart attack survivors require nurses with knowledge and competence about evidence-based interventions, such as patient education. BSN nurses enable patient education, an essential method of coping with life’s pressures and events, since it promotes independence, self-care, increased healthy habits, self-efficacy, and a decrease in urgent care admissions and impairment (Harrison et al., 2019). Hence, educational interventions can empower heart attack patients to assume responsibility for their treatment while living with the disease, and nurses play a vital role in inpatient rehabilitation and education. They can help patients improve their ability to complete daily tasks by instructing, altering attitudes, and concentrating on the patient’s residual talents.
Barriers to the Adoption of Evidence-Based Practice
One of the problems facing cardiac rehabilitation (CR) is that despite its benefits and the increasing burden of cardiovascular illness, participation and completion of patient education programs by eligible patients remain low (Chindhy et al., 2020). Physician challenges to CR patient education include low referral rates and inadequate physician endorsement. Patient hurdles include gender bias, ethnic, social, and psychological problems, language barriers, and poor physical health. Structural impediments include proximity to CR centers, costs of CR education, and disjointed care between CR patient education programs and referring healthcare professionals (Chindhy et al., 2020).
The Effectiveness of Nursing Standards and Policies in Improving Patient Outcomes
The capability of nurses to provide high-quality healthcare services to patients, families, groups, communities, and populations is contingent upon the probability of achieving desirable outcomes and their consistent understanding of the evidence-based practice. The three critical parts of quality care are nursing treatments, intended outcomes, and adherence to developing evidence-based practice. Aligning nursing interventions with current evidence-based practice is crucial to providing quality care (Dickerson & Durkin, 2022). The American Nurses Association’s Quality of Practice Standard of Professional Performance ensures that nurses provide safe, effective, efficient, equitable, timely, and patient-centered care. In addition, it encourages the incorporation of evidence into nursing practice to improve outcomes, as well as the use of creativity and innovation to improve care quality. It also provides critical examination and evaluation of policies, processes, and standards to improve health care quality. In addition, it encourages the interprofessional team’s participation in formal and informal peer review processes and quality improvement activities (Dickerson & Durkin, 2022).
Another policy that has contributed to the improvement of patient outcomes is the Quality and Safety Education for Nurses (QSEN) project, which advocates for safe, quality patient care by establishing six skills for pre-licensure registered nurses of patient-Centered care, collaboration and teamwork, evidence-based practice, safety, quality improvement, and informatics (Dickerson & Durkin, 2022). The project promotes collaboration between interprofessional teams to apply diverse views in the improvement plans and interventions. It also emphasizes the relevance of professional and specialist qualifications in providing the best care.
Leadership Strategies to Improve Outcomes
Effective leadership is essential to enhance patient outcomes in cardiac rehabilitation. It ensures that teams and organizations have direction, alignment, and commitment (Heinen et al., 2019). According to the healthcare team’s vision, values, and strategy, direction assures agreement and pride among the team members over its goals. Alignment enables effective coordination and integration of the activities. At the same time, commitment ensures everyone in the organization takes responsibility and makes it a personal goal to guarantee the organization’s success as a whole rather than being focused on personal or their immediate team’s performance (Heinen et al., 2019). In care settings for heart attacks, effective leadership strategies to enhance patient outcomes include stressing the significance of safe, high-quality, and compassionate care; providing supportive, available, empathic, fair, respectful, compassionate, and empowering leadership; providing practical support for staff to innovate within safe boundaries; insisting on transparency concerning errors, serious incidents, complaints, and problems; acting effectively to address poor performance; and proactively addressing aggressive, inappropriate behavior (Heinen et al., 2019). These leadership strategies can enhance the quality of care, safety, and health outcome in cardiac rehabilitation.
Communication and Collaboration Strategies to Enhance Outcomes
The situation, background, assessment, and recommendation (SBAR) structured communications, and the STICC (situation, task, intent, concern, calibrate) protocol are examples of available communication strategies (Becker & Hunziker, 2019). SBAR facilitates nurse-to-nurse communication during physician consultations and shifts handovers by providing information about the patient’s status, history, evaluation, and suggestions. The STICC procedure, on the other hand, offers structure to briefings and guarantees that crucial practice-related material has been comprehended.
Providing a platform for engagement, appreciating and acknowledging team members, incorporating collaboration into daily tasks and activities, implementing team building, promoting open communication, imparting knowledge, perspectives, and resources, and utilizing technology to support an interdisciplinary collaboration strategy are all ways to improve the outcomes of CR patient education through collaboration (Becker & Hunziker, 2019). These tactics will allow multidisciplinary team members to share their knowledge, abilities, and resources to provide the highest quality patient-centered care to improve health outcomes and patient satisfaction levels.
Change Management Strategies to Enhance Health Outcomes
When dealing with patients who have suffered a heart attack, change management strategies are required since the intervention involves lifestyle and behavioral changes. Therefore, behavioral and lifestyle change strategies are the most appropriate in this case. Some lifestyle and behavioral change strategies include social support, goal-setting, reduction of negative emotions, self-monitoring of behavior among the patients, self-monitoring of the outcomes of the behaviors, problem-solving, decision-making, and pharmacological support (Thomas et al., 2019). These change management strategies involve encouraging patients to change unhealthy lifestyle decisions and behaviors contributing to poor health. They can assist the patient in changing and engaging in healthy activities, such as a healthy diet and physical exercises.
References
Becker, C., & Hunziker, S. (2019). The importance of communication between physicians and patients. Therapeutische Umschau. Revue Therapeutique, 76(5), 231-238.
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528.
Chindhy, S., Taub, P. R., Lavie, C. J., & Shen, J. (2020). Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Expert Review of Cardiovascular Therapy, 18(11), 777-789.
Curtin, S. C. (2019). Trends in cancer and heart disease death rates among adults aged 45–64: United States, 1999–2017.
Dickerson, P. S., & Durkin, G. J. (2022). Nursing Professional Development Standards of Practice: Standards 1–6. Journal for Nurses in Professional Development, 38(4), 248–250.
Harrison, J. M., Aiken, L. H., Sloane, D. M., Brooks Carthon, J. M., Merchant, R. M., Berg, R. A., … & American Heart Association’s Get With the Guidelines–Resuscitation Investigators. (2019). In hospitals with more nurses who have baccalaureate degrees, better outcomes for patients after cardiac arrest. Health Affairs, 38(7), 1087–1094.
Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378-2392.
Gobis, B., Yu, A., Reardon, J., Nystrom, M., Grindrod, K., & McCarthy, L. (2018). Prioritizing interprofessional collaboration for optimal patient care: a call to action. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 151(3), 170-175.
Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., … & Whooley, M. A. (2019). Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89.
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