Heart failure management

The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure

PURPOSE

The primary purpose of this literature review is to examine advanced practice nurse (APN)-directed versus registered nurse (RN)-directed telemanagement programs for heart failure patients.

DATA SOURCES

Research articles identified through CINAHL and OVID databases.

CONCLUSIONS

Implementing a telemanagement program directed by an APN after hospital discharge decreases the costs and frequent rehospitalizations associated with heart failure and improves the patient's quality of life. While APNs are more costly than RNs, it is important to understand that this level of provider has a more significant impact on the outcomes of patients who use the services provided in the comprehensive discharge programs.

IMPLICATIONS FOR PRACTICE

An APN-directed heart failure telemanagement program can reduce the rising healthcare costs that result from frequent readmissions. These programs can improve the quality of care given to heart failure patients while reducing the cost to the institution, the patient, and the healthcare system. When considering the number of older adults hospitalized each year with heart failure, the potential patient benefits and savings to the healthcare system resulting from APN-directed telemanagement are substantial.

Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.

Outcomes management: from concepts to application

This article provides an introduction to the definition of and rationale for outcomes management and includes a brief review of the outcomes management literature. A model for outcomes management, which links processes that can be changed in care delivery to outcomes that can be measured in a patient population, is reviewed. Guidelines for application of the outcomes management model and practical examples of application to two surgical patient populations are presented. Finally, issues important to outcomes management as a tool for performance improvement are discussed.