In a 1995 research study, experienced nurses and physicians from the Geriatric Cardiology and Behavioral Medicine sections of the Jewish Hospital and Department of Economics at Washington University explore the topic of congestive heart failure as it pertains to current and future patient care (Beckham et al). The title of the study, A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure, is clear and precise, reflective of the research topic.
The researchers state that many older adults access hospitals for congestive heart failure, and this disease is the leading cause of hospital admissions. The issue studied is that due to problematic behaviors, such as poor compliance with treatment, heart disease is exacerbated in the lives of many adults, suggesting that many hospital admissions could be prevented.
The research problem is well described and supported by past literature. In this research design, the health care providers conducted a prospective, randomized trial of the effect of a nurse-directed, multidisciplinary intervention on rates of readmission within 90 days of hospital discharge, quality of life, and costs of care for high-risk patients 70 years of age or older who were hospitalized with congestive heart failure.
The hypothesis is that the intervention with the experimental group, consisting of comprehensive education of the patient and family, a prescribed diet, social-service consultation and planning for an early discharge, a review of medications, and intensive follow-up, will yield a better prognosis for people with congestive heart failure. In looking to the results of this scientific research design, the survival of the patient for 90 days without readmission was used as the principal outcome measure.
In 91 of the 142 patients in the treatment group, there was no readmission, as compared with 75 of the 140 patients in the control group, who received conventional care. Of the patients who did not receive the intervention, there were 94 readmissions, and only 53 readmissions in the treatment group. Overall, the number of patient readmissions for heart failure was reduced by 56. 2 percent in the treatment group in comparison to 28.
5 percent in the control group, and because of the reduction in hospital admissions, the overall cost of care was $460 less per patient in the treatment group. The effects of this experiment demonstrate that patients can be truly aided in the bettering of their heart health through nurse led interventions in comprehensive education of the patient and family, a prescribed diet, social-service consultation and planning for an early discharge, a review of medications, and intensive follow-up.
The strengths of this study, rated at 94 points, are that it is well orchestrated in regard to purpose and the scientific observation of clear dependent and independent variables and overall administration of the interventions, however there are some ways in which the study could have been improved in design and implications for nursing. It is great that the researchers were able to study nearly 300 patients over the course of several months, however a larger, more randomized group of participants studied over a longer period of time would have yielded more conclusive results.
There is no better way to make clear objective observations than to utilize many participants over the course of a long period of time (Conger et al, 2007). In regard to the administration of interventions in the research design, the choice of interventions for these patients with congestive heart failure are wonderful, however, an even more proactive approach would be to work with participants who have a family history of congestive heart failure, providing these types of educational interventions to people before they are actually very sick (Bengoa et al, 2004).
Although nurses are targeted as the best individuals to lead the intervention approach, it is wise to consider how and why physicians or other health care providers such as counselors are not named as being the ones in the appropriate leadership position, explaining the rationale within the study (Clutterbuck et al, 2007). The implications for nurse led interventions are not explained clearly or reasonably.
Looking to the implementation of these interventions from a cost analysis perspective is an economic objective, however, it is also imperative to be able to logically explain to readers the rationale in choosing cheaper methods of health care service, being sure that quality of care is not lost. To optimize patient participation, it is also necessary for health care providers to adopt nonhierarchical and inclusive tones, encouraging patient centered involvement (Leape, 2009).
The need for modern person centered coaching/counseling was not addressed sufficiently within the study, and only when health care can open their minds to the importance of centering on unique patients needs and perspectives will research be able to provide truly humanized care. In providing the most expert opinions in health care through studies such as these, researchers must be clear, thorough, and compassionate in their perceptions and methods.
References Beckham, V. , Carney, R. , Leven, C. , Freedland, K. , Rich, M. , & Wittenberg, C. (1995). A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure. The New England Journal of Medicine 333(18), 1190-95. Bengoa, R. , Epping-Jordan, J. , Pruitt, S. , & Wagner, E. (2004). Improving the quality of health care for chronic conditions. Quality and Safety in Health Care 13, 299-305. Clutterbuck, D.
, Miles, K. , Riley, A. , Sebego, M. , & Seitio, O. (2007). Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana. Bulletin of the World Health Organization 85(7). Conger, R. & Donnellan, M. (2007). Designing and Implementing Longitudinal Studies. Handbook of research methods in personality psychology. Guilford Press. Leape, L. (2009). Errors in medicine. Clinica Chimica Acta 404(1), 2-5.