Nursing is a profession with a multifaceted skill and role provision, development, and integration. The broad spectrum of the nursing profession dictates that nurses specialize in specific areas where they can discharge their duties more professionally, dutifully, and concisely (Lee & Fawcett, 2013). One of the key areas where the nursing profession should focus and develop their service provision is in the reduction of hospital readmissions for patients with heart failure. The severity and reoccurrence of this condition presents a multiplicity of problems that require constant attention by both physicians and nurses. However, literature dictates that it is possible for readmissions of heart failure patients into hospitals to be reduced significantly, and nurses can play a pivotal role in achieving this endeavor.
Significance of the Problem
In the United States, there are 1 million hospital admissions annually, for patients with heart failure complications, under different classes. However, during the 6 months after the patient has been discharged, the readmission rates are approximately 50%, with the mortality rates are also pegged at 50% over a five-year period (Bradley, 2013). Therefore, it is paramount that measures be adapted to reduce these rates not only to ease hospital congestion and readmission, but also to improve the mortality rates for patients suffering from this condition.
Relation of the Issue to a Nursing Metaparadigm
Among the four concepts of the nursing metaparadigm, the focus for this analysis will be on nursing, since it provides a multiplicity of functions, perceptions, and constituents that are paramount for resolving the issue. The perspicacity for solving the issue requires the participation of the nurses in several parameters such as social, personal, environmental, and professional attendance of the patients (Anderson & Mangino, 2006). This will develop a concise picture of the role of the nurses. Aside from their role as the caregivers, the nurses are mandated to take the medical histories of the heart failure patients, educate them on personal care, assess the level of development of the condition, offer appropriate medication, counsel the patients, and personally interact with them to provide better care, understand them, and advice them (Bradley, 2013). All this multiplicity of functions falls under the nursing metaparadigm that relates to health care and nursing as a profession.
Resolution of the Problem
Myriads of strategies have been advanced that have been applied to the decline of heart failure readmissions of patients into hospitals. The successes and failures of these strategies have been based on a variety of factors such as age, gender, hospital polices, level of care, nurse-patient and doctor-patient relationships, patient commitment, among others. However, one the most successful strategies that have been implemented are the engagement of patients through community policing and outreach.
According to the goal attainment theory, nurses are mandated to interact with the patients on a social and professional level to enhance their level of care (Gonzalo, 2011). This interaction should be on a repetitive and regular manner to act as checkups of patients, as well as education and counseling of the patients and their families. Therefore, the community policing and outreach allows the nurses to engage with patients outside the hospital setting and offer the necessary care. The practicality of the theory dictates that it is improbable for nurses to continually engage with patients since it would invade on their time, personal space, social life, and scope of duties (Peterson & Bredow, 2013). Therefore, this strategy of outpatient services enhances the goals and objectives of the goal attainment theory.
One of the metaparadigms of the nursing profession is the provision of skill and education when dealing with patients (Lee & Fawcett, 2013). Nurses dealing with patients with heart failure need to ensure that undertake and adhere to certain roles, rules, and methodologies when dealing with such patients (Kim, 2013). For instance, the nurse should take the patient’s medical history and ask if their dietary restrictions or allergies have changed. Additionally, the nurse should check or ask the patient if they have experienced anxiety, lethargy, fatigue, nocturnal dyspnea, nocturia, shortness of breath, nausea, cough with frothy sputum, anorexia, weight gain, or orthopnea that occurs when one needs at least two pillows to sleep. This is a short duty allocation and responsibility that is listed under the nursing competency practice when dealing with patients with a heart failure condition.
Accordingly, if the nurse fulfills her roles, rules, responsibilities, and professional mandate, she has ensured that the health of patient has been successfully and wholly analyzed. Knowledge of all these parameters is crucial for providing the best care and medication. Consequently, this directly translates to better patient health and a significant reduction in patient readmission into the hospital due to a misdiagnosis occasioned by poor information retrieval from the patient. Since nurses are the primary caregivers, King’s goal attainment theory dictates that they should engage the patients socially and on interpersonal levels to retrieve information, as well as offer advice to them (Gonzalo, 2011).
One of the competency standards providing the code of conduct and standard of practice for nurses dictates that they should be cooperative and interactive with their superiors and work colleagues. This competency clause is representative of the nursing metaparadigm that advocates for coordination between nurses and other medical practitioners serving both within the hospital, and outside. Therefore, as a prerequisite for enhancing their professional acumen, nurses have to perform their roles as envisioned in their skill and knowledge levels and pass on other pertinent issues, information, and roles to other qualified individuals in different fields both within the medical field and outside it (Peterson & Bredow, 2013).
Implementation of such a strategy for reducing readmissions into hospitals for patients suffering from heart failures would require an intricate process, mechanisms, and strategies to accomplish (Hines, Yu and Randall, 2010). For instance, nurses can educate patients on dietary provisions, and pass on the exact contents of the diet to a nutritionist. This would allow them to focus on their core job responsibility, and ensure that better nutrition acts as one of the preventative measures control complications associated with heart failure from recurring. Therefore, this is only one of the strategies that can be used to provide an avenue for changing a current readmissions trend that is afflicting the heart failure patients.
The changing health environment dictates the integration of systems, policies, and professional conduct that advocates for lower mortality rates, better health care, and effective diseases management. Readmission of heart failure patients is one of the pertinent areas under consideration where strategies have been effected to promote its reductions. Based on King’s goal attainment theory, coupled with the nursing metaparadigms, a concise and articulate code of practice and patient interaction can be formulated to enhance patient care, and consequently reduce patient readmissions into hospitals. However, the strategies outlined in this report cannot be considered as wholly conclusive, since others have to be created based on changing demographical factors of patients, and changing code of practice and competency for nurses.
Anderson, C. D. & Mangino, R. R. (2006). Nurse shift report: Who says you can’t talk in front of the patient? Nursing Administration Quarterly, 30(2), 112-122.
Bradley, H. E. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes. 6:444-450
Gonzalo, A. (2011). King’s conceptual system and theory of goal attainment and transactional process.
Hines, P. A., Yu, K. And Randall, M. (2010). Preventing Heart Failure Readmissions: Is Your Organization Prepared? Nursing Economics. 28 (2): 74-86.
Kim, M. S. (2013). Evidence-based Strategies to Reduce Readmission in Patients with Heart Failure. Journal for nurse practitioners. 9 (4): 224-232.
Lee, R. C. & Fawcett, J. (2013). The influence of the metaparadigm of nursing on professional identity development among RN-BSN students. Nursing Science Quarterly. 26 (1), 96-98.
Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: Application to nursing research (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.