Research proves that health care is the leading cause of patient hospitalization with high costs of medical care costs and high chances of patient readmission. Statistics show that an average 25% of patients mostly over 70 years of age suffering from heart failure are often readmitted after 30 days. The readmissions were a direct cause of the heart failure plus other complications such as pneumonia, renal disorders and arrhythmias. This therefore necessitated the urgency to reduce these readmission and morbidity rates of patients by assessing comparative competitiveness, efficacy and transitional care interventions. Nursing is basically a profession that is grounded on the frameworks of ethics and morality, requiring practitioners to think about the right and responsible ways of handling situations, as detailed in the American Nurses Association (ANA) ( Bradley, Curry, Horwitz, Sipsma, Wang,Walsh & Krumholz, 2013).
On discovery of these statistics, nurses enrolled the home-visiting program, which proved effective in not only reducing the readmission rates but also the composite end point of heart failure which is death. This was coupled with the Multidisciplinary heart failure clinic intervention. The Structured Telephone Support program was also rolled out and it helped in reducing specific causes of readmissions. As such, these interventions should be considered in the clinical practice to provide transitional care to patients with heart failure.
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In attempts to remedy the situation of readmissions, the Patient Protection Affordable Care Act of 2010 created incentive policies that would minimize the reimbursements to hospitals that displayed high and excessive risk readmission rates. This strategy was effective as state and local bodies engaged in campaigns that aimed at helping hospitals reduce readmissions (Cline, Israelsson, Willenheimer, Broms & Erhardt, 1998) . The probability of patient readmissions can be minimized by improving the quality of care transitions such as by improving patient discharges.
A number of strategies can thus be employed to reduce risk-standardized readmission rates which require the partnering with physicians and local hospitals that engage resources in this practice. Nurses should also be held accountable for medication reconciliation and should plan follow up appointments before discharging them. Coordination should also exist between the nurses and the patient’s primary physician by communicating patient details.
The ethical principle of Autonomy in the case of patients with heart failure necessities the nurse to fully disclose the medical condition to the patient and relatives and to allow them the freedom to make choices in regards to health procedures. Transitional Care Intervention programs therefore focus on caregiver and patient education given either before or after patient admission, offer medication reconciliation information and engage the professional bodies coordinating the transition. Hospital-to-Home care strategies also proved effective as quality healthcare could be provided to patients who preferred the comfort of their homes to hospital room. Such patients and caregivers receive education on heart failure and other opportunistic conditions and proper self management, with the assurance of easy access to routine follow-up ( Bradley, Curry, Horwitz, Sipsma, Wang,Walsh & Krumholz, 2013).
The nursing principle of Non-maleficence requires the clinicians and care givers to engage strategies that avoid translating harm to the patient. Beneficence is the principle that essentially translates into medical interventions that seek the full benefit of the patient. Every intervention that nurses undertake should focus on the health and well being of patients. These two principles are interrelated and require nurses to avoid instances of conflicting priorities by engaging patients and family in teach-back interventions that enable patients to take proper care of themselves, minimizing readmission rates. Teach-back intervention has proved to be an effective tool in patient education and should be engaged in daily to ensure that patients fully comprehend their conditions and factors that may risk their readmissions, which are costly and potentially avoidable. The nursing clinician should also take accountability for any misunderstanding by the patient, and as such should engage in open discussion and question-answer sessions with patients (Peter, Robinson, Jordan, Lawrence, Casey & Lopez, 2015) .
The ethical framework of principlism is an overview of the principles of autonomy and beneficence as discussed above. This framework embraces the ethics of the nursing profession rules and duties as pertaining to documents such as the Patients’ Bill of Rights. It covers the identification and alignment of patient and caregiver goals to those of the nurses, continuity and coordination of medical care and engaging them educational and behavioral strategies.
However, limitations exist in that there are knowledge gaps on the effective means of interventions for the care of patients with heart failure conditions. Despite medical advancement, most heart failures are fatal are fully incapacitate the patient with no hope of full recovery. Patient and family education is the way to go in achieving patient and family satisfaction, enhancing communication and reducing readmission of patients with heart failure and their length of stay in hospitals. Patient education would help the patients in understanding their needs and following-up on their needs, enabling them to seek prompt medical attention from their physicians. This would include education on the importance and method of medication and drug consumption and when to have their follow-up appointments. The embracing of these communication and education processes enhances the relationship and understanding of family caregivers, patients and healthcare providers (Feltner, Jones, Cené, Zheng, Sueta, Schwimmer & Jonas, 2014) .
References
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Krumholz, H. M. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes , 6 (4), 444-450.
Cline, C. M. J., Israelsson, B. Y. A., Willenheimer, R. B., Broms, K., & Erhardt, L. R.
(1998). Cost effective management programme for heart failure reduces hospitalisation. Heart , 80 (5), 442-446.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., ...
& Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Annals of internal medicine , 160 (11), 774-784.
Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015).
Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration , 45 (1), 35-42.
