Heart failure, particularly congestive heart failure, is considered by numerous researchers to be one of the most prevalent problems in the current healthcare system (Black et al., 2014). One of the most prominent issues in this area of concern is that a considerably high level of readmission rates among the patients with congestive heart failure poses a significant problem for clinical institutions since it is associated with more significant hospital expenses and mortality among the patients (Black et al., 2014). Therefore, this paper aims to develop a research proposal on the topic of congestive heart failure and to reduce the readmission rates by providing background and overview of the problem along with formulating research questions, hypotheses, and study variables.
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Background and Significance of the Problem
Black et al. (2014) state that “heart failure is a prevalent and costly condition, affecting some 5.1 million people in the U.S.,” which translates into more than 1 million hospitalizations each year along with the approximate $32 billion expenses for servicing an estimated number of 2.8 million patient visits (p. 125). Therefore, a considerable necessity for the reduction of readmission rates arises. Carthon, Lasater, Sloane, and Kutney-Lee (2015) mention that one of the most prominent risk factors for high readmission rates is the omission of required nursing care.
However, the article by Kripalani, Theobald, Anctil, and Vasilevskis (2014) states that new financial penalties for clinical institutions with high readmission rates have reinforced the hospitals’ efforts to minimize rehospitalization. Therefore, one can hardly deny that this problem is highly significant for the current healthcare system.
Statement of the Problem and Purpose of the Study
The problem for this research proposal should be elaborated on in order to identify the purpose of the research. Employing the evidence from the academic literature on the topic, three primary aspects of the problem could be mentioned. First, the relationship between insufficient nursing care and hospital readmission rates is to be investigated (Carthon et al., 2015). Secondly, there is a considerable necessity for the development of integrated, complex, and effective interventions for rehospitalizations (Kripalani et al., 2014). The third aspect of the problem is the insufficient employment of transitional care programs, which include pre-discharge education along with follow-up calls and telemonitoring (Black et al., 2014).
Thus, the purpose of the research is to study the efficiency of meaningful interactions between nurses and patients during the pre-discharge period, along with the provision of further caregiving. The implementation of this research will translate into the development of an effective qualitative study, which would retrieve meaningful insights in the identified area of concern.
Several research questions have been identified to investigate for this study. The first question is: how can nurses improve their level of caregiving and presence for the patients? The second question is: how can discharge nurses improve the efficiency of their performance during the pre-discharge period? Thirdly, what are specific educational tools that can increase the effectiveness of the pre-discharge patient education? The fourth question is: how efficient will be the implementation of transitional care programs to clinical institutions? The final question is: how will meaningful interactions between nurses and patients during the pre-discharge period influence readmission rates?
Hypothesis: Research and Null
Based on the final research question, the research hypothesis and null hypothesis could be formulated. Research hypothesis states that meaningful patient-nurse interactions, which include pre-discharge patient education along with the implementation of follow-up interventions (telephone calls and telemonitoring), have a considerably positive effect on the decrease of readmission rates. Accordingly, the null hypothesis states there is no considerable difference between the implementation of current clinical practices and proposed practices for the reduction of rehospitalization rates.
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Identifying and Defining Study Variables
The next step of developing this research proposal is the identification of study variables. The primary dependent variable is the number of readmissions among the patients discharged after hospitalization with congestive heart failure. The first independent variable is the amount of time that was spent by a particular discharge nurse to educate a particular patient about his or her health practices after the discharge. The second independent variable is the use of specific educational tools, which would improve the patients’ knowledge about the appropriate post-discharge health practices. The third independent variable is the employment of follow-up interventions after the discharge.
Concerning the study’s dependent variable, the term “readmission” should be operationalized. For this research, readmission is operationally defined as the repeated seeking for congestive heart failure treatment during the 30-day period after the discharge. The first independent variable does not require operationalization. Regarding the second independent variable, “specific educational tools” are operationally defined as the efficient employment of various nursing models, developing and communicating care plans to patients as well as including family members into the educational process. “Follow-up interventions” could be operationalized by referencing Black et al. (2014), who suggest that discharge nurses should perform such interventions as phone calls and telemonitoring to guide their patients during the 30-day post-discharge period, which is highly risky for the majority of patients.
Black, J. T., Romano, P. S., Sadeghi, B., Auerbach, A. D., Ganiats, T. G., Greenfield, S., Ong, M. K. (2014). A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: Study protocol for the Better Effectiveness After Transition-Heart Failure (BEAT-HF) randomized controlled trial. Trials, 15, 124-135.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: A cross-sectional study of US hospitals. BMJ Quality & Safety, 24(4), 255-263.
Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65, 471-485.