Assignment Purpose :To connect students with on-line resourc

Assignment Purpose :To connect students with on-line resources for… Assignment Purpose: To connect students with on-line resources for evidence-based practice and to use this information to support nursing interventions for an identified nursing problem. Guidelines: You will use on-line resources to find evidence summaries, recommended practices, best practice information sheets or systematic reviews to support the use of specific nursing interventions for an identified nursing problem you have seen in clinical. Please address each of the following five items: NOTE: Writing mechanics and grammar should reflect professional nursing. The tone of the paper should be written for healthcare professionals.Organization and flow of writing should reflect college level work.Lay terms should be avoided.  2.  Briefly describe the clinical nursing problem or nursing intervention identified and describe why it is important to determine best practice. For example, what is the concern with not determining best practice for this particular problem? What consequences or complications may occur if the problem continued or the intervention was not successful? Think in terms of consequences for the patient physically, financially, length of hospital stay, etc.BELOW IS THE ARTICLE:  CHRONIC HEART FAILURE: TRANSITIONAL CARE FROM HOSPITAL TO HOME Search date 28/12/2021 Author Sandeep Moola PhD Publication date 18/03/2022What is the best available evidence regarding transitional care from hospital to home for people with chronic heart failure? Clinical Bottom Line Transitional care is a broad term used to describe interventions provided to patients transitioning between and within care settings. Transitional care interventions aim to ensure safe and timely movement between the settings and can delay or prevent early re-hospitalization. People with chronic heart failure (HF) often require recurrent hospitalizations. Transitional care from hospital to home may assist in promoting improved self-management, with follow-up care able to be delivered in community or outpatient settings.  An overview of systematic reviews assessed the effect of transitional care interventions on hospital readmissions. Reviews with mixed patient populations demonstrated consistent evidence that readmissions were reduced with structured, individualized discharge planning and hospital-at-home interventions. Specifc evidence for patients with HF included:1 (Level 1)  One systematic review that focused on post-discharge remote monitoring via structured telephone support (STS) or telemonitoring, found that STS interventions were associated with reduced longterm ( > 6 months) HF readmissions and mortality.  Another systematic review assessed a range of transitional care interventions, categorized as homevisiting programs, STS, telemonitoring, outpatient clinic-based, primarily educational and other. Multidisciplinary HF clinic visits or home visits reduced all-cause readmissions and mortality. STS reduced HF-specifc readmission and mortality, but not all-cause readmissions. Telemonitoring or primarily educational interventions did not reduce readmission or mortality rates.  A systematic review evaluated transitional care models for patients with HF and identifed eight common themes that can be applied to improve long-term outcomes. The themes included: planning for discharge; multi-professional teamwork, communication and coordination; timely, clear and organized information; medication reconciliation and adherence; engaging social and community support groups; monitoring and managing signs and symptoms after discharge and delivering patient education; outpatient follow-up; and advanced-care planning and palliative and end-of-life care.2 (Level 1)  A systematic review assessed hospital to home transitional care led by clinical nurse specialists (CNSs). In three studies including patients with HF, CNSs visited patients while in hospital and had regular postdischarge contact via telephone, home visits and a HF clinic. Transitional care was superior to usual care for a number of outcomes, including death, re-hospitalization, adherence to treatment recommendations, patient satisfaction, costs and length of re-hospitalization stay. These fndings, however, should be interpreted with caution as they are based primarily on low-quality evidence.3 (Level 1)  A systematic review investigated the impact of transitional care for patients with HF on acute health service use. Transitional care reduced the risk of readmission by 8% (relative risk [RR] = 0.92, 95% confdence interval [CI] 0.87 to 0.98, p = 0.006) and emergency department visits by 29% (RR 0.71, 95% CI 0.51 to 0.98, p = 0.04). Home visits combined with telephone follow-up, clinic visits or both was associated with reduced readmissions. Clinic visits or telephone follow-up alone, without home visits, were not effective.4 (Level 1)  A systematic review investigated the effect of transitional care interventions on readmission rates for adults with chronic illnesses, including HF. Transitional care was effective in reducing all-cause intermediate and long-term readmissions. Short-term (within 30 days) readmissions were only reduced with high-intensity transitional care interventions, including care coordination by a nurse, communication between the primary care provider and the hospital, and a home visit within three days after discharge.5 (Level 1)  A scientifc statement from the American Heart Association reported recommendations for transitional care for patients with HF. These included:6 (Level 5)  Systematically implementing transitional care principles, such as very early post-discharge contact and communication with patients and post-discharge care providers, patient education on selfmanagement (initiated in hospital and continued during community-based care), and integrated collaboration and coordination between disciplines and settings of care.  Assessing patients for high-risk characteristics, such as cognitive diffculties, impaired learning capabilities, language diffculties or limited access to healthcare, which may be associated with poor post-discharge outcomes.  Ensuring that transitional care services are provided by qualifed and trained HF nurses or other healthcare providers.  Allotting adequate time in hospital and post-discharge settings to deliver complex interventions, such as self-management education.  Implement discharge planning and ensure that discharge documents, including patient health records, are provided to post-discharge care providers in a timely manner.  A systematic review of RCTs and a pseudo-RCT found that patient-centered education for adults with chronic HF may play a role in reducing readmission to hospital, increasing patient knowledge, improving patient selfcare and in turn improving quality of life. Signifcant contributing factors include multidisciplinary team involvement and individualized advice during transitions of care between hospital and home.7 (Level 1)  A systematic review and network meta-analysis of transitional care services for patients discharged from in-hospital care for HF found that nurse home visits were the most effective method of decreasing allcause mortality and signifcantly decreased all-cause readmission. Both disease management clinics and nurse case management were also effective in decreasing all-cause mortality and readmission. Of note, telecommunication, pharmacist and education interventions did not signifcantly improve clinical outcomes.8 (Level 1)  A systematic review evaluated the effectiveness of transitional care interventions on health care utilization after hospitalization for HF. Meta-analysis results from 29 trials showed that there was a statistically signifcant reduction (11%) in all-cause admissions when compared with usual care. Additionally, there was a signifcant 22% reduction in the risk of HF-specifc readmissions. Evidence from six trials did not show a signifcant reduction in emergency department (ED) utilization. The evidence was inconclusive for the outcome related to length of stay. Overall, the evidence was reported to be of low quality.9 (Level 1)  A systematic review evaluated the effectiveness of transitional care interventions on patient-centered health outcomes. Meta-analysis results from 42 trials showed that there was a statistically signifcant reduction in mortality when compared with usual care. Results from another meta-analysis of 13 trials indicated that there was a signifcant improvement in quality of life of those who received the interventions. Multidisciplinary interventions were found to have signifcantly better effects in improving quality of life in patients with HF. No signifcant effects were reported on anxiety and depression. However, the evidence related to various outcomes was reported to be of low quality.10 (Level 1)  An economic evaluation study assessed the cost-effectiveness of three types of post-discharge transitional care services and standard care among elderly patients with HF. The interventions evaluated included disease management clinics, nurse home visits and nurse case management. The results showed that the implementation of a transitional care service was cost-effective in signifcantly reducing mortality and readmission risks. Nurse home visits were found to be more effective and less costly compared to other transition care interventions. No signifcant differences were reported among the three interventions in terms of improvements in health outcomes.11 (Level 1) Characteristics Of The Evidence This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: An overview of systematic reviews including 10 reviews of different intervention types and seven reviews of different patient populations.1 A systematic review including 24 studies, primarily randomized controlled trials (RCTs) and quasiexperimental studies.2 A systematic review including 13 RCTs (n = 2,643 participants), with three RCTs that evaluated interventions for patients with HF (n = 632).3 A systematic review including 41 RCTs.4 A systematic review including 26 RCTs.5 A scientifc statement from the American Heart Association based on relevant literature.6 A systematic review including fve RCTs and one pseudo-RCT .7 A systematic review and meta-analysis including 53 RCTs involving 12,356 participants.8 A systematic review and meta-analysis of 38 RCTs that included a total of 10,871 patients.9 A systematic review and meta-analysis of 42 RCTs that included a total of 10,784 patients.10 An economic evaluation study that utilized decision analytic microsimulation modelling.11 Best Practice Recommendations Transitional care interventions are recommended for people with HF transitioning from hospital to home, especially those at high-risk of poor post-discharge outcomes. (Grade A) Transitional care interventions should include home visits, combined with telephone follow-up and/or clinic follow-up. (Grade A) Structured, individualized discharge planning is recommended. (Grade A) Care coordination and communication between multi-disciplinary health professionals and patients/ caregivers is recommended. (Grade A) Transitional care services should be provided by qualifed and trained HF nurses or other healthcare providers. (Grade B) Patients/caregivers should receive self-management education that is initiated in hospital and continued in community-based care. (Grade B)  References 1. Kansagara D, Chiovaro JC, Kagen D, Jencks S, Rhyne K, O’Neil M, et al. So many options, where do we start? An overview of the care transitions literature. J Hosp Med. 2016;11(3):221-30. 2. Albert NM. A systematic review of transitional-care strategies to reduce rehospitalization in patients with heart failure. Heart Lung. 2016;45(2):100-13. 3. Bryant-Lukosius D, Carter N, Reid K, Donald F, Martin-Misener R, Kilpatrick K, et al. The clinical effectiveness and costeffectiveness of clinical nurse specialist-led hospital to home transitional care: a systematic review. J Eval Clin Pract. 2015;21(5):763-81. 4. Vedel I, Khanassov V. Transitional care for patients with congestive heart failure: a systematic review and meta-analysis. Ann Fam Med. 2015;13(6):562-71. 5. Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, Geerlings SE, de Rooij SE, Buurman BM. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff (Millwood). 2014;33(9):1531-9. 6. Albert NM, Barnason S, Deswal A, Hernandez A, Kociol R, Lee E, et al. Transitions of care in heart failure: a scientifc statement from the American Heart Association. Circ Heart Fail. 2015;8(2):384-409. 7. Casimir Y, Williams M, Liang M, Pitakmongkolkul S, Slyer J. The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review. JBI Database System Rev Implement Rep. 2014; 12(2):188-262. 8. Van Spall H, Rahman T, Mytton O, Ramasundarahettige C, Ibrahim Q, Kabali C, et al. Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure: a systematic review and network meta-analysis. Eur J Heart Fail. 2017; 19(11):1427-1443. 9. Li Y, Fu MR, Luo B, Li M, Zheng H, Fang J. The effectiveness of transitional care interventions on health care utilization in patients discharged from the hospital with heart failure: A systematic review and meta-analysis. J Am Med Dir Assoc. 2021; 22(3):621-629. 10. Li Y, Fu MR, Fang J, Zheng H, Luo B. The effectiveness of transitional care interventions for adult people with heart failure on patient-centered health outcomes: A systematic review and meta-analysis including dose-response relationship. Int J Nurs Stud. 2021; 117:103902. 11. Blum MR, Øien H, Carmichael HL, Heidenreich P, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of transitional care services after hospitalization with heart failure. Ann Intern Med. 2020; 172(4):248-257Health Science Science Nursing NUR 356

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