Theoretical Basis of Practice: Patient Education Strategies

Heart Failure (HF) is the most frequent discharge diagnosis among the majority of Medicare beneficiaries. Furthermore, it is the most common factor causing hospital readmission. Also, it is the most costly condition to treat and costs about $40 billion annually in healthcare expenditures. The condition is often characterized by episodic exacerbations that may need hospitalization with alternating periods of medical stability. The objective of HF care is to treat or manage the symptoms within outpatient settings to prevent readmission because the process is costly and is mainly associated with increased mortality and morbidity. The recent changes in Medicare reimbursements impose a fine if the patients with HF are readmitted within 30 days because they assume that most of the readmissions are avoidable ( Amarasingham et al., 2010) . However, patient education is necessary to avoid readmission. The term paper will evaluate patient education strategies that will reduce readmissions of patients with HF. 

Phenomenon of Interest 

The rate of readmission of patients with HF can be reduced through quality patient education strategies. A large number of the readmissions may be resolved, not with additional tests and medical procedures, but with simple and quality communication. Studies reveal that HF patients who understood hospital care instructions including the appropriate time for follow up appointments and how to take medicine are about 30% less likely to visit the emergency department or get readmitted than patients who did not understand or get adequate after hospital instructions ( Amarasingham et al., 2010) . Most hospitals have many priorities. Unfortunately, patient education strategies have become one of the lower priorities. All healthcare institutions should have efficient post-hospital care plans that will assist patients with HF to understand their post-hospital care plans. If properly implemented, the level of readmission of patients with HF may reduce significantly by more than 30% ( Amarasingham et al., 2010) . 

Nursing Metaparadigm 

The four nursing metaparadigm include nursing, person, environment, and health. The metaparadigm of person describes the patient who acts as the care recipient. It may also involve things such as the patient’s socioeconomic status, spirituality, friends, culture, and family ( Hernandez et al., 2010) . The metaparadigm environment describes the external and internal factors affecting the patients such as their surroundings or interactions with visitors. The metaparadigm health includes the wellness and quality of the patient and refers to the accessibility of quality care. On the other hand, the metaparadigm nurse describes the nurse and the efficiency of their skills and knowledge when caring for their patients. 

The metaparadigm, person , encourages addressing human needs via quality human care. All HF patients have their unpredictable and unique set of human needs, and it is essential to honor and accept the patient's needs regardless of their beliefs, wishes, and customs. In most cases, the HF patients may feel vulnerable and powerless. Nurses should spend adequate time with the patents to prevent such feelings. The metaparadigm, health, emphasizes that treatment should focus on more than curing the condition or just the physiological response ( Anderson & Funnell, 2010) . To reduce readmission of patients with HF, nurses should have a holistic approach to the situation. There should be a balance of the patient’s spiritual, physical, and cognitive self. The patient should believe that HF is manageable so that they can be treated. 

The metaparadigm, nursing, focuses on the need for nurses to develop good relationships with patients. Although science and medicine are essential curative factors, they may not be the dominant factors. By establishing a good relationship, the patients are more likely to understand post-hospital care. Furthermore, the patients will feel more comfortable and safe, and it may encourage better healing ( Anderson & Funnell, 2010) . The environment is an essential factor in healing. The environment affects not only the caregivers but also the patients. The environment of patients with HF should have minimal noise so that it can promote serenity. Other factors that may affect the patient include lighting and access to nature. Adequate lighting and access to nature have therapeutic effects and may reduce readmission. 

Grand Nursing Theory 

The section will focus on Dorothea Orem’s Self Care Deficit Theory. Her theory was based on three main concepts: self-care requisites, self-care, and self-care agency. Self-care describes a section of human life that is affected by systematic activities that people initiate and perform to maintain human integrity, life, well-being, and growth. Self-care agency refers to a human ability to engage in particular actions that achieve the self-care requirements as well as the care needs of dependents in the family ( Butts & Rich, 2013) . On the other hand, self-care requisites include activities carried out for or on behalf of patients with HF to regulate factors affecting human development and functioning. 

The self-care deficit theory was a major focus of Orem’s grand theory of nursing. The theory explains the importance of nursing because it defined the relationship between therapeutic self-care demand and self-care agency. When patients with HF are limited or incapable of meeting their self-care demands, the therapeutic assistance of nurses is necessary for helping patients to take care of themselves to avoid readmission ( Hernandez et al., 2010) . The therapeutic assistance of nurses takes place through five methods: Modifying the patient's environment, doing/acting for patients, supporting patients, guiding patients, and educating patients. When patients with HF are well educated about post-hospital care such as taking medicine and how to live healthy lives, the level of readmission will ultimately reduce. 

The theory emphasizes the significance of self-care through patient education strategies. All healthcare institutions should ensure they have efficient patient education strategies that will focus on how the patients will perform activities on their behalf to maintain well-being, life, and health. However, if the patient is unable to meet their self-care needs, nurses and other family members may perform the self-care activities on behalf of the patient until the time when the patient is capable of meeting the self-care needs ( McCormack & McCance, 2010) . Some of the self-care actions include learning to live with the condition, seeking appropriate medical help, and complying with medically prescribed measures such as a balanced diet and adequate rest. 

Middle Range Nursing Theory 

The section will evaluate factors affecting self-care of HF patients regarding the Middle Range Theory of Self Care of Chronic Illness. Self-care is important in managing chronic conditions such as heart failure. However, a patient cannot achieve proper self-care without patient education through the healthcare institutions. Self-care is described as a way of maintaining and improving the health and well-being of a patient through health-promoting activities ( Krumholz et al., 2013) . Self-care can be carried out in both ill and healthy states. Nurses should educate patients with HF that they should not reduce their self-care practices. 

Self-care is an overarching concept that is based on three main concepts of self-care management such as changing diuretic dose according to symptoms, self-care maintenance such as taking medication according to prescription, and self-care monitoring such as regular weighing. For HF patients, it is necessary to adapt and regulate self-care throughout the condition for instance during advanced specific advanced treatment, in times of deterioration, or when co-morbidities occur ( Commodore-Mensah & Himmelfarb, 2012) . Nurses should assist the patient through patient education strategies that will assist them during the entire process. Self-care has proven to be an essential factor in both person and medicine centered outcomes of HF patients. HF patients who had effective self-care strategies had lower readmission rates, had a better quality of life, and had lower mortality rates than HF patients with poor self-care strategies. 

Despite the obvious relationship positive health outcomes and good self-care, most HF patients find it quite challenging to comply with self-care advice. The lack of compliance may be related to lack of motivation, the complexity of self-care, the needed behavioral changes, or lack of urgency among other factors. Health care institutions should have patient education strategies that should focus on boosting confidence, improving skills and experiences, improving cognitive and functional abilities, motivating the HF patients, understanding the patients’ values and cultural beliefs, and monitoring their habits ( Gruman et al., 2010) . All these factors are essential in improving and developing interventions and patient education strategies for HF patients and their families. However, nurses should explore and include other contextual and personal factors that affect self-care needs. 

Complexity Science 

Complexity science theory describes a natural concept for nurse leaders and nursing educators for use when solving and leading unpredictable and complex issues in the evolving healthcare systems and highly complex healthcare organizations. The concept of complexity science has received increased attention, especially when formulating patient education strategies that will reduce readmission of HF patients. The concept focuses on the study of human healing and health through caring and person-environment relationships that will improve the health of patients with heart failure ( Bradley et al., 2013) . Relationships are one of the primary factors in the epistemology and ontology of nursing. The basic tenet of the concept has relationships that will facilitate patient education strategies. 

For decades, health professionals have focused on advancing their careers by promoting specialization while ignoring some factors and norms that promote systems thinking. Healthcare professionals such as nurses should rediscover their role in leading initiatives that will improve the health care system at the management level. Individual patient care level is important but formulating policies that will enhance patient education strategies for HF patients is also significant in reducing readmission. If all healthcare institutions adhere to the principles of complexity science, they will have a patient-centered and high-quality healthcare system with favorable outcomes ( Ditewig et al., 2010) . The society has evolved from an industrial model that was Newtonian, mechanistic, and predictable to a model that is complex and knowledge driven. Data and information in the modern society have become the new currencies of power. 

Nurses have the role of knowledge workers, and their responsibilities require capacity and broad-based thinking to effectively formulate patient education strategies that will provide patient-centered care. They should use the available information and data to have patient education programs that are modified to address the needs of patients with heart failure ( Krumholz et al., 2013) . Furthermore, having good relationships with HF patients will allow them to feel comfortable and safe. Also, it will encourage patients to comply with self-care strategies that will minimize cases of readmission. All in all, all healthcare professionals should rise to the challenges posed by a complex healthcare system and improve patient education regarding post-hospital care and health literacy. 

Conclusion 

The term paper evaluates patient education strategies that will reduce readmissions of patients with HF. Heart Failure (HF) is the most frequent discharge diagnosis among the majority of Medicare beneficiaries. Furthermore, it is the most common factor causing hospital readmission. The rate of readmission of patients with HF can be reduced through quality patient education strategies. The four nursing metaparadigm include nursing, person, environment, and health and they explain how self-care can improve the favorable outcome of patients with heart failure. Self-care is described as a way of maintaining and improving the health and well-being of a patient through health-promoting activities. Despite the obvious relationship positive health outcomes and good self-care, most HF patients find it quite challenging to comply with self-care advice ( Commodore-Mensah & Himmelfarb, 2012) . Ultimately, implementing self-care through patient education strategies with improving the health and wellbeing of HF patients. 

References 

Amarasingham, R., Moore, B. J., Tabak, Y. P., Drazner, M. H., Clark, C. A., Zhang, S., & Halm, E. A. (2010). An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical record data: Medical care , 48 (11), 981-988. 

Anderson, R. M., & Funnell, M. M. (2010). Patient empowerment: myths and misconceptions: Patient education and counseling , 79 (3), 277-282. 

Bradley, E. H., Curry, L., Horwitz, L. I., Sipsma, H., Wang, Y., Walsh, M. N., & 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. 

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice . Jones & Bartlett Publishers. 

Commodore-Mensah, Y., & Himmelfarb, C. R. D. (2012). Patient education strategies for hospitalized cardiovascular patients: a systematic review. Journal of Cardiovascular Nursing , 27 (2), 154-174. 

Ditewig, J. B., Blok, H., Havers, J., & van Veenendaal, H. (2010). The effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: a systematic review: Patient education and counseling , 78 (3), 297-315. 

Gruman, J., Rovner, M. H., French, M. E., Jeffress, D., Sofaer, S., Shaller, D., & Prager, D. J. (2010). From patient education to patient engagement: implications for the field of patient education: Patient education and counseling , 78 (3), 350-356. 

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., & Curtis, L. H. (2010). The relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. Jama , 303 (17), 1716-1722. 

Krumholz, H. M., Lin, Z., Keenan, P. S., Chen, J., Ross, J. S., Drye, E. E., & Normand, S. L. T. (2013). The relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. Jama , 309 (6), 587-593. 

McCormack, B., & McCance, T. (2010). Person-centred nursing: theory, models, and methods.