With 5.7 million Americans suffering from heart failure, the likelihood of a nurse caring for a patient with such diagnosis is inevitable. Therefore, it becomes important for nurses to not only skillfully care for and treat this patient population, but also identify patients who may be at risk for developing heart failure.
As nurses continue to be trusted healthcare professionals with close interactions with their patients, they are ideal patient advocates and can make substantial impacts on their patients' lives and well-being.
In a recent cast study discussion in Critical CareNurse, authors Vlad Gheorghiu and Thomas W. Barkley, Jr., identified the unique and powerful role nurses have in identifying and preventing complications from heart failure. As the authors point out, although a patient may come into the hospital for other issues, they may still be at risk for acute decompensated heart failure.
Although heart failure is not a curable disease, the symptoms can certainly be managed in an attempt to improve a patient's quality of life and hopefully prevent readmissions. Heart failure is one of the leading causes of hospital admissions and readmissions, especially in the elderly population, and the Hospital Readmission Reduction Program aims to improve patient outcomes for this population.
Under the program, hospitals are financially penalized for higher-than-expected 30-day readmission rates for acute myocardial infarction, heart failure and pneumonia. So not only do nurses have an impact on their patients' quality of life, but also potentially on the viability of their institution.
Four ways nurses can impact care for their heart failure patients:
1. Recognize risk factors
Although a patient may not have a diagnosis of heart failure, there are certain risk factors that place a patient at risk for developing the disease. These risk factors include a previous myocardial infarction, hypertension, diabetes, smoking and obesity to name a few.
As the case study points out, although patients may come to the hospital for other complaints, they certainly could be at risk for suffering acute decompensated heart failure based on their history and current medical situation. So, knowing the risk factors certainly puts the nurse on notice to be aware and observant to any unexpected changes.
2. Know the signs and symptoms
Although nurses may not be working in a "cardiac" area, they need to be aware of possible signs and symptoms their patients may demonstrate — such as shortness of breath, fluid in the lungs and unexplained weight gain with swelling in the extremities. The nurse would most likely be the first to identify the signs and symptoms.
3. Nurse education
The authors recommended that "a comprehensive education intervention with continued reinforcement may prove useful in increasing knowledge of HF management principles, even among experienced acute care nurses."
As the nursing staff remains educated and confident in their knowledge, they become more efficient and effective in their delivery of patient education. This patient education become important in providing necessary self-care knowledge to the patients as they return to their homes where they do not have the oversight of the healthcare team.
4. Realistic goals
Despite the many care modalities that assist in symptom management, heart failure is not curable. Therefore, it becomes necessary to have the important conversations regarding advanced care planning with patients and their families.
The authors noted that only a fraction of high-mortality-risk heart failure patients receive palliative care services, and they suggest these options should be discussed early in the diagnosis when the plan of care is developed. Again, all in an attempt to maintain the highest level of quality of life.
While heart failure continues to be a complex, debilitating disease, nurses have a unique opportunity to make huge impacts on the lives of the patients they care for each and every day.
