Dissertation Creation - The UK's original provider of custom dissertations and dissertation help...

Free Dissertations - Nursing Dissertations

'which Community Based Nurse Led Interventions For Heart Failure Patients ...

'Which community based nurse led interventions for heart failure patients are the most effective in reducing hospital readmissions

Undergraduate Degree Level Dissertation


7,500 words

Essay

Implication for practice based on the quality of the research evidence reviewed.

Introduction
Background information
Heart failure is one of the major causes of hospital admission amongst patients who are over the age of 65 yrs. (Chin M H et al. 1997). Congestive heart failure is associated with a high rate of both mortality and also morbidity and therefore has significant implications in terms of cost not only to the individual but to the community as a whole. It has a worse prognosis than most cancers. (McMurray J J et al. 2000).

In specific consideration of cost, Strömberg (Strömberg A et al. 2003) points out that when considering the total burden of cost to the community, 50-75% of the cost is due to hospital admissions whereas only 2-8% is attributable to the drug treatment. There is therefore considerable merit in trying to successfully and accurately identify those patients at greatest risk of readmission and trying to keep them out of hospital and in the community. A brief overview of the literature in the area shows that a logical extension of this argument would be to target the population considered to be most at risk of recurrent (or uncontrolled) heart failure, and to examine the mechanisms by which their management could be improved together with the degree of improvement each facet of management could be responsible for. Many studies have already been done in this area but have been hampered in their analysis by virtue of the fact that they were limited either by small sample size (viz. Ghali J K et al. 1988) or were single centre investigations (and therefore had a large potential for bias). Many of the older studies in the literature have tended to focus on all-cause readmission rates (viz. Vinson J M et al. 1990). The most useful studies have been those that have had both large entry cohorts and have focussed on multifaceted interventions which have been analysed independently for therapeutic effect. As we shall discuss later, this latter point tends to prove the most difficult to assess as, by virtue of the nature of the condition of heart failure, it requires a multifactorial approach for treatment and therefore to try to independently assess one particular strand of treatment in isolation from the others is extremely difficult (if not bordering on the unethical) (Sugarman J et al. 2001)

We can point to the fact that one episode of hospitalisation for heart failure is and independent risk factor for further admissions for the same condition. (Philbin E F et al. 1998). It follows therefore that the starting point in many of the studies that we shall consider is the first episode of heart failure.

Please note: The above dissertation snippet was written by a student and then submitted to us to display and help others. Thanks to all the students who have submitted their work to us.