This review focuses on how discharge planning information can impact patient of CHF Congestive Heart Failure follow-up. This is due to observed non-adherence of the patients to instruction as well as discharge plan that is inadequate and is given after discharge has shown to be potential re-hospitalization factors. This paper is to review different studies to analyze and categorize into ‘Health Education’, and ‘Nursing Care’. Basing on several studies the findings show that discharge plan invented by nurses relies on two major categories. The nurses’ role to enhance health education can permit CHF patients to improve on self-care.
Introduction
The process of nursing is a method of work that is systematic which is employed by nurses in care delivery. It entails five stages that are inter-related: diagnosis, planning, investigation, evaluation and implementation which involve a dynamic and systematic approach to deliver nursing care. Planning entails desired outcomes determination and interventions identification to meet such results. Implementation on the other hand refers to plan establishment of action as well as initial responses observation (Alfaro et al, 2005).
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Investigation performed should be a determinant to a discharge plan during collection of data as well as collected data during hospitalization that includes the patient limitations, the caregiver, the family or environment, in addition to resources that is existence. These data includes the coordination and implementation of the plan care. This is a process that is essential on information exchange with patients, caregivers as well as those responsible for care (Taylor et al, 2007).
Discharge plan that is Inadequate from hospital and non-adherence to instructions by the patients have shown to be factors that result to patients re-hospitalization with heart failure, which indicates the relevance of discharge plan to enhance patients life quality (Bacal et al, 2009).By definition Heart Failure (HF) is a clinical condition that involves failing of the heart to pump the required blood volume to achieve the demands of metabolism in tissues. It can be acute, due to rapid onset or change of clinical symptoms and signs and, leading to urgent therapy need. Congestive Heart Failure (CHF) or Acute HF may be a condition that is new or as a result of a intensive pre-existing HF (Decompensate Chronic Heart Failure)( Almeida et al,2005).
Acute decompensated HF that is linked to hospitalization causes particular problems that are specific. It has been noted that acute HF indicates a critical alteration in the disease natural history. The year mortality rates of HF cases after hospitalization are higher as compared to those not hospitalized. Hospitalization due to HF stands to be one of the most crucial mortality risk factors. Furthermore, hospitalization due to acute HF by itself generates more hospitalizations; (Montera et al, 2009).
The diagnosis HF is majorly based on anamnesis and physical assessment that is detailed whereby symptoms and signs are as a result of low cardiac output and verification of systemic and pulmonary congestive phenomena (Almeida et al, 2005). Due to the high complexity of CHF syndrome, the patient needs to be prepared for hospital discharge that is critical role played by the nurses. Professionals should involve scientific evidence when making such critical resolutions, (Ciliska et al, 2010).
Purpose
To identify literature on how discharge plan can influence patients with CHF follow-up.
Method
Several review method that is integrative in nature has been used in many studies to raise published studies and make conclusions about the topic of interest(Silveira et al,2006), such as scientific evidence knowledge incorporation to the topic, with the aim of improving the hospital discharge of CHF patients.There are a set of studies represented by integrative review that is already published and enables one to draw conclusions about the topic. Integrative review that is correctly done needs the same rigor standards, clarity as well as the likelihood of results replication used in studies that are primary (Beya et al,1998).
This review type is crucial due to the positive influence it has on the implementation of changes that enhances the nursing conduct quality through models of research (Ganong et al, 1987)
Health Education
Knowledge improvement on self-care is so relevant in the successive reduction of mortality and morbidity as well as other health costs linked to HF (Aliti et al,2007). Health education is necessary to enhance self-care to enable daily weight monitoring, limit sodium and fluids intake, practice individually programmed exercises, regular medication use maintenance, signs and symptoms showing disease worsening monitoring and contact with the team Should be maintained(Costa et al,2004).The major contributing factors to self-care ignorance are linked to limited knowledge about the disease together with its treatment; treatment non-adherence and the clinical manifestation of the disease’s; disease non-acceptance; lack of support from the family; slight symptoms improvement ; drug therapy that is complex; medication side effects; and prolonged treatment with no cure expectations (Albert et al,2008).For example interventions of Educational nursing in the context of Brazilian implemented during hospitalization enhance knowledge about HF, self-care and the patient’s life quality as well as their family members.
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Health education is based on a team of various multi-disciplinary which offers knowledge and patients sensitization about diseases to enable them adhere to treatment, sodium and fluids intake restriction, and able to recognize symptoms and signs that indicate the progression of disease (19). In addition, to educate patients about their own disease, the link between the disease and pharmacological therapy and also between disease and healthy behavior can impact rates of re-hospitalization
Nursing Care
Nursing care about instruction given to patients that endorsed this practice enhance treatment adherence that is greater and consequently enhances clinical outcomes. Patient-Nurse relationship trust encourages treatment and promotes adherence to it. In addition, there should be reliable and open communication between both parties to facilitate education, care and discharge plan organization. Home visits and phone calls can enable the achievement of knowledge reinforce about disease and patient follow-up, adherence to treatment and behavioral changes by Nursing practice. These strategy enables the patients to stick to treatment due to they enhance the instructions memorization and doubts clarification that may come up during treatment, additionally, signs and symptoms identification that shows HF is worsening and encourages patients to go for intervention early prior hospitalization is required. It has been observed that Home visits by public health network nurses after discharge from hospital has had a positive effect in the re-hospitalization prevention of patients with HF.
Conclusion
Data explored here indicates various aspects the discharge plan of CHF patient’s hospital is composed of, how it’s planned by nurses, and the outcomes of the plans, such as re- hospitalization rates reduction as well as health system costs.
The contribution of the study was on knowledge deepening of the theme investigated hence resulted to the conclusive remarks that the plan discharge is extremely critical for patients with HF and that essential role is played by nurses in terms of planning. The plan should be individualized and integral even after discharge from hospital with actions from nursing that enhances self-care and health education, it includes aspects like weight regulation, fluids and salt restrictions, medication guidance, exercise, diet and on symptoms coaching which shows worsening of disease status. In the study we have some gaps associated to lack of knowledge about the disease and treatment by the patient; if there is time by nurses to plan hospital discharges that is individualized and if these are sufficient enough to educate the patients; whether family members and the patients can endorse the plan discharge, this is because they receive a lot of information at the hospital discharge time; educational written material accessibility and instruction about the plan discharge; and whether there is adherence of patients to treatment for efficacy confidence of hospital discharge.
T increase the degree of confidence of this study result, further studies are needed to address the implementation and development of plans of discharge and also the effect of such plans on patients with CHF, patients’ knowledge validation, support from family of discharge plan, and educational material development to educate patients. Furthermore we have other scientifically addressed aspects that can lead in incorporation of evidence into nursing practice directed to patients with CHF. The major contributing factors to self-care ignorance are linked to limited knowledge about the disease together with its treatment; treatment non-adherence and the clinical manifestation of the disease’s; disease non-acceptance; lack of support from the family; slight symptoms improvement ; drug therapy that is complex; medication side effects; and prolonged treatment.
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