In the United States, congestive heart failure (CHF) is a cardiac condition with increasing hospitalization and rehospitalization burden to patients, families, and the healthcare system. This chronic condition is expected to affect more than 8 million people by 2030; however, not much is known about the relationship between risk factors and hospital readmissions once CHF patients are discharged to a skilled nursing facility (SNF). Applying a systems theory unbounded systems thinking, coupled with a systems-thinking approach the purpose of this quantitative, retrospective cohort study was to examine CHF hospital readmissions from SNFs within a 90-day period using a secondary data set of gender, age, race, SNF geographic location, length of SNF stay, and home health use risk factors. A binary logistic regression analysis revealed that out of 238 episodes, 99 patients were readmitted; however, no statistically significant relationship between the risk factors and readmission was found. Findings suggest that CHF readmissions from the SNF are not attributed to only quantifiable risk factors. Based on these findings, further research can support social change through multifaceted quantitative and qualitative systemic analyses to identify and inform how healthcare organizations can better assist the elderly population with CHF and improve future post-acute community-based health education and prevention programs.

With more than 700,000 new diagnoses annually, congestive heart failure (CHF) is a chronic condition that affects the chambers of the heart. When not managed correctly, the disease rapidly progresses to substantial fluid volume overload that impacts activities of daily living and the overall quality of life. The financial implications for poor CHF management cost a mean annual medical expenditure of $33,427 per patient per year. The need for a diagnostic and prognostic at-home protocol is needed in the medical community, as there is currently no such tool on the market. Donabedian's framework was used to guide the formulation and interpretation of this research. The purpose of this project was to design a CHF protocol using evidence-based research for clinicians making home visits to homebound patients with a primary diagnosis of CHF with an individualized protocol focusing on disease management, in home support system, knowledge base and financial factors for homebound patients. The protocol was released through a snowballing campaign to clinicians who work with CHF, transitional care, or homecare who then evaluated the protocol on its perceived efficacy if integrated into practice. Findings were analyzed using simple descriptive statistics by 32 nurses and other health care professionals who responded work in home care, cardiology, medical surgical nursing hospitalists, or skilled nursing facilities. Thirty-one of the 32 respondents deemed the protocol useful and stated a clinical need of protocol as evidenced by completed the AGREE II Questionnaire. The findings demonstrate that the CHF Practice Protocol provides clinicians with an evidence-based guidance to manage homebound patients with CHF on a small scale.

Abstract African Americans are disproportionately affected by heart failure, with prevention and treatment of heart failure being a public health concern in the United States. The purpose of this retrospective quantitative study was to examine the primary variable race, specifically African Americans, and how this variable relates to 30-day readmission post discharge when controlled with geographic location (urban vs. rural), gender, and insurance status. The expanded chronic care model was used as a framework to shape health promotion, prevention efforts, and social determinants of health and to enhance community involvement related to chronic disease issues. The research questions were focused on determining a relationship among African Americans being at a higher risk for 30-day readmission than others using selected control variables. Secondary data were collected for 565 patients diagnosed with congestive heart failure from the 2015 Hospital Inpatient Discharges data set and analyzed using simple and multivariate logistic regression methods to answer research questions and test hypotheses. Key results of the simple logistic regression revealed that African Americans were 1.7 times more likely to be readmitted than other races and 1.3 times more likely to be readmitted than Caucasians. The multiple logistic regression revealed race, gender and geographic location (urban) as significant predictors of readmission among African Americans. Insurance status revealed no significance for readmission among African Americans. Implications for social change from this study may include policy implementation at the family, organizational, and societal levels, such as policy related to education on establishing a surveillance system that identifies those in the population who are at risk and more vulnerable to social and health care disparities.

African Americans suffer disproportionately higher incidence of congestive heart failure (CHF) at an earlier age of onset and with more rapid progression compared to other races. Due to this escalating prevalence of CHF within the African American population and the lack of culturally responsive support for the caregiving role, African American family caregivers of adult CHF patients face greater challenges and suffer increased caregiver burden, stress, depression, and financial strain compared to European American caregivers. The purpose of this project was to conduct a systematic literature review to find the recommendations that target African American family caregivers of adult CHF patients. The Joanna Briggs Institute model for systematic review (JBIM-SR), and the caregiver stress theory proposed by Tsai, guided this project. A review of multiple databases yielded 118,078 articles. After removal of duplicates and exclusion of articles not consistent with the purpose of the review, 1 article was selected. A second reviewer completed an independent search of the databases using the same exclusion/inclusion criteria and identified the same review. The selected article was analyzed and graded using the JBIM-SR grading tools. Family Heart Failure Home Care, a telephone coaching intervention adapted to the cultural preferences of the African American family caregivers of adult CHF patients, was suggested as an effective culturally sensitive intervention. Results of this project can promote positive social change by improving the care and well-being of the African American community. Nurses at the project site can use the findings to provide evidence-based care to the African American family caregivers of adult CHF patients.

Abstract not available

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--The University of North Carolina at Greensboro, 2008. / Directed by Paul Davis; submitted to the Dept. of Kinesiology. Title from PDF t.p. (viewed Jul. 20, 2010). Includes bibliographical references (p. 104-112).

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1435896. ProQuest document ID: 1136092801. Includes bibliographical references (p. 28-29)