Thesis NUR290; CHAPTER 1: INTRODUCTION TO THE PROBLEM

Chapter1: Introduction to the Problem

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Chapter 1: Introduction to the Problem 

Introduction 

After five days of open-heart surgery, a patient may be allowed to go home. At this stage, the patient is often considered stable, and the doctor may recommend that the patient be discharged for the surgical incision to heal at home. However, after discharge from the hospital, such patients often experience adverse health issues such as hospital readmissions accompanied by healthcare complications such as infection at the site of surgery, arrhythmia, and volume overload above 25 percent. The hospital rating system indicates a low health service quality when there is a high hospital rate of readmission (McIlvennan, Eapen, Allen, & Colleen, 2015). This paper aims at bringing awareness of how proper discharge planning, coupled with quality of care and the comprehensive self-care discharge education, could potentially lead to a decline in the 30-days readmission rate after open-heart surgery.

Problem Statement

Currently, the increase in the rate of hospital readmissions, coupled with complications after cardiac surgery, leads to serious health issues to patients, families, and health care institutions. Hospital readmissions to not only linked to the rise in the financial burden for patients and families but also results in delays for the patient and his or her family to return to a healthy life. Besides, unanticipated hospital readmission after discharge could result in a poor quality of life for the patient and his or her family because of the delay in returning to the previous healthy lifestyle.

Notably, the idea of discharge planning can potentially lead to desirable patient outcomes because it can possibly minimize the barriers to quality patient care and promote the financial revenue of the healthcare institution through decreasing undesirable healthcare practices like the 30-days readmission. The rate of hospital readmission defines the quality of care in the healthcare system. For instance, a higher percentage of hospital readmission indicates a low-quality of health care services by the Center for Medicare Services (CMS). Consequently, healthcare institutions face reimbursement consequences, which end up giving them a bad reputation, all due to the increase in hospital readmission rates.

Purpose Statement

The purpose of this study is to investigate the various strategies of preventing hospital readmission after patients undergo cardiac surgery.

Research Question

What interventions for discharge planning can be utilized to reduce hospital readmissions after patients undergo cardiac surgery?

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Hypothesis

Proper discharge planning, coupled with supportive resources of self-care for patients who have undergone cardiac surgery, would reduce the 30-days readmission with health care complications.

Theoretical Framework

This study uses Orem’s Self-care Deficit Theory to determine the best interventions to prevent hospital readmissions. The theory emphasizes the responsibility of the patient to self-manage their health to their best. Orem goes ahead to state that individuals need to care for themselves and their basic needs through the promotion of life, health, development, and well-being (Masters, 2015). Notably, Orem’s theory has a significant impact on the current health care trend. The self-care theory can be used to solve the current health care problem. For instance, after the implementation of the Affordable Care Act, the government enforced some restrictions on the health care facilities’ financial reimbursement. As a result, contemporary healthcare has been forced to encourage patients as well as their families to cooperate during care. The government has come up with policies to have hospitals to lower the 30-days readmission rates, reduced lengths of hospital stay, promoting disease prevention, and the policy of enhancing the quality of healthcare. The demands from the government to hospitals make Orem’s theory of self-care most applicable in the discharge planning ideology to reduce the rates of hospital readmissions.

Rationale and Significance of the Study

Currently, the majority of health care institutions require the solution to close the gap between public demands and actual practices to minimize financial risks and enhance the quality of care. However, there are gaps in achieving this objective of closing the gaps. Notably, there is evidence that effective discharge planning minimizes the readmission penalties, which results in undesirable health care costs for health care institutions and reducing the emotional and financial burdens to patients and their families. Besides, it is essential to note that the burdens are associated with delays in getting back the usual healthy lifestyle. 

Further, recurrent hospital readmissions lead patients to financial constraints with health care institutions co-paying and the added lack of income source that is attributed to the illness. Besides, effective discharge planning and education enhance patients’ and families’ success in the self-care at home, resulting in higher levels of care satisfaction (Mabire, Dwyer, Garnier, & Pellet, 2018).

Summary

For better patient outcomes, the combination of physicians’ assessment, the case managers’ coordination of care, and the bedside nurses’ teaching to the patients and families are vital. As a result, nurses require proper education on appropriate ways of delivering discharge instructions to patients and their families by the usage of the teach-back technique. Besides, hospitals need to become responsible and provide proper training to their nursing staff. The training should incorporate staff competency checklists containing discharge instructions. The training concept entails discharge planning, coordination, and discharge education.  Further, it is essential to keep in mind that each individual in the multidisciplinary team members has a significant contribution to the care of the patient and ensure the safety and effective patient discharge planning. Lastly, when patients and their families are prepared for discharge planning teaching from the point of hospital admission to the end of the admission course, patient outcomes are enhanced, and hospital rates of readmission are reduced.  

References

Mabire, C., Dwyer, A., Garnier, A., & Pellet, J. (2018). Meta‐analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home. Journal of advanced nursing, 74(4), 788-799.

Masters, K. (2015). Framework for professional nursing practice. Role Development in Professional Nursing Practice, 450.

McIlvennan, C. K., Eapen, Z. J., & Allen, L. A. (2015). Hospital readmissions reduction program. Circulation, 131(20), 1796-1803.