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Running Head: EBP
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Jenna Winters
Ferris State University
Evidence Based Practice
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Evidence Based Practice
Introduction
This paper is an evaluation of a study that was completed with heart failure patients in
mind as well as the effects nursing management, education and interventions could have in the
outcome of patients. It will discuss the population of the study, how the data was gathered,
results of the study, limitations and how nursing care may differ between population groups. A
care plan will also be developed for a patient with heart failure.
Improving Patient Care
Evidence Based Study
Sisk et al. (2006) prepared a randomized trial was done to determine the effect of nurse
management and the quality of heart failure care in minority communities. There were 406
ethnically diverse adults aged 18 or older from Harlem, New York in this study. Eligibility
requirements included: systolic dysfunction, English or Spanish-speaking, and current patient in
a general medicine, geriatrics, or cardiology clinic or office. Bilingual nurses, in a 12 month
study, provided education to patients on sodium intake, fluid buildup, medication adherence, and
self-management of symptoms through an initial visit and follow up telephone calls. Systolic
dysfunction was defined as “defined impaired systolic dysfunction as a left ventricular ejection
fraction less than 0.40 or moderately or severely reduced systolic dysfunction on
echocardiography, radionuclide ventriculography, myocardial stress sestamibi or thallium stress
testing, or left-heart catheterization” (Sisk et al., 2006).
Results
In the study completed by Sisk et al. (2006), the control group was given federal
consumer guidelines for managing systolic dysfunction while the intervention group received the
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education stated above. At a three month interview, intervention patients reported better
functioning. At the end of the 12-month trial, the intervention group had fewer hospitalizations
per person per year than the control group. Overall, the control group reported worse functioning
and marked limitations in physical activity versus maintaining functioning with slight limitation
to physical activity in the intervention group. This study shows the importance of nursing
management in patients who are being treated for systolic dysfunction. Non-Hispanic black and
Hispanic patients have a higher rate of systolic dysfunction than other communities. It is
important for nurses to educate on the importance of sodium intake, fluid buildup, medication
adherence, and self-management of symptoms in minority communities because of the
disproportionate burden from heart failure.
Limitations
This study was conducted in only one area with primarily non-Hispanic black and
Hispanic patients (Sisk et al., 2006). There were also only three nurses who provided the
education/intervention to the participants in the study. This study also did not identify which
patient and intervention characteristic accounted for improved outcomes. In further studies it
would be beneficial to determine if certain patients were more likely to benefit from the
intervention and to also analyze which components of the intervention improved patient
outcomes.
Other Populations
In other populations nursing interventions and education would have to be altered.
Education has to be based upon the patients’ readiness to learn as well as their diagnosis. The age
and education level of the patient also has a big impact on the education nurses give. This study
focused low educated minority patients. This particular disease process specifically targets non-
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Hispanic black and Hispanic communities which would make the intervention toward other
communities not as relevant. The information that is given to patients with heart failure is very
similar, however, it depends on the patient for the nurse to determine the best way present that
information and educate them about their disease process and potential complications which may
be able to be avoided or slowed down.
Care Plan
Activity intolerance related to weakness and fatigue as evidenced by exertional dyspnea
and verbalized report of weakness (Ladwig & Ackley, 2008). Excess fluid volume related to
impaired excretion of sodium and water as evidenced by adventitious breath sounds, change in
mental status, and edema. Ineffective health maintenance related to deficient knowledge
regarding care of disease as evidenced by lack of adaptive behaviors and demonstrated lack of
knowledge regarding basic health practices.
Patient outcomes are to maintain normal skin color, warm and dry, and free from edema;
follow mutually agreed upon healthcare maintenance plan; demonstrate an increased tolerance to
activity with no evidence of dspnea or orthopnea (Ladwig & Ackley, 2008). For this patient,
nursing interventions would include allowing for periods of rest before and after planned
exertion periods; monitor vital signs; monitor location and extent of edema, monitor lung sounds
and daily weight; assess patient feelings; and discuss symptoms of daily living as well as the
major disease.
Conclusion
This article clearly proves the importance of nursing care in patients with heart failure.
The nurse is responsible for determining the patients’ level of understanding and level of
education and is then able to educate the patient on the disease process and the important factors
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that will influence their quality of life. In this article the nurses educated patients on the
importance of sodium intake, fluid buildup, medication adherence, and self-management of
symptoms. Overall, there were fewer hospitalizations when patients were given this information
and had regular contact with a nurse which demonstrates the importance of nursing practice.
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References
Ladwig, G. B., & Ackley, B. J. (2008). Mosby’s Guide to Nursing Diagnosis (2nd ed.). St Louis,
MO: Mosby, Inc.
Sisk, J. E., Hebert, P. L., Horowitz, C. R., et al. (2006). Effects of nursing management on the
quality of heart failure care in minority communities. Annals of Internal Medicine,
145(4), 273-283. Retrieved from annals.org