NRS 445 Topic 3 Assignment Research Critiques and Evidence-Based Practice Change Proposal Guidelines

Research Critiques and Evidence-Based Practice Change Proposal Guidelines Nursing

Chronic Heart Failure (CHF) represents a common and multifactorial condition involving the decreased capacity of the heart to deliver adequate amounts of blood to the tissues resulting from reduced cardiac output, shortness of breath, fatigue, and oedema. It is important to convince a management of CHF to reduce the occurring of complication and hospitalization in the adults (Abassi et al., 2022).

This assessment will consider home-based telemonitoring for further each against usual face-to-face follow-up visits in adults with CHF in terms of its effects on systolic blood pressure. The assessment is based on a set of literature reviews of the available studies that focuses on the integration of the findings and on to the plan of developing evidence-based practice changes (Abassi et al., 2022). With regard to the identified nursing practice problem, it is the aim to promote improvements in patient care and health for clients suffering from CHF.

• Practice Problem: Chronic Heart Failure

Chronic Heart Failure (CHF) is a common global health issue that is defined by the failure of the heart to pump blood normally due to fatigue, breathing difficulties, and edema. It is fairly common among the geriatric population and its management often results in hospitalizations because of the disease’s multifaceted nature (Chukwuka Elendu et al., 2023).

An important part of the CHF management is Blood Pressure (BP) since a proper regulation of it is vital in order not to experience more severe episodes such as stroke or the progression of the disease. Biophysical measurements are usually done physically from time to time in formal management care units for blood pressure check. These visits can lead to care gaps and delay in appropriate access to treatment for a particular disease.

• Purpose of the Paper

Telemonitoring is now considered as a possible solution through which patients with hypertension can manage their blood pressure levels right in their homes any changes to their management plans can be made (Chukwuka Elendu et al., 2023). The effectiveness of home-based telemonitoring compared with conventional face-to-face outpatient visits has not been definitively established to lower systolic blood pressure.

The purpose of this paper is to review research and determine if home telemonitoring reduces systolic blood pressure in heart failure patients. The main purpose is to assess current research evidence and suggest an evidence-based practice transformation based on the PICOT inquiry (Jaarsma et al., 2021).

In adult patient with CHF (P), what effect does home telemonitoring (I) as compared to usual face to face follow up appointments (C) have on the reduction of systolic BP (O) over 6 months (T)? This research will sum up findings from four chosen articles and develop an evidence-based intervention that will enhance patient outcomes in the management of CHF.

• PICO(T) Question

Method of Studies

The studies used different methods of research in order to address the issues related to blood pressure management in heart failure patients, and each study made a significant contribution in answering the research question (Jaarsma et al., 2021).

Oh & Cho. (2020) used data from medical records in a retrospective cohort study with patients through five years. In this method of analysis, the researchers were able to look at a large number of patients in order to assess how well blood pressure was controlled and the resultant effects on heart failure hospitalisations and survival. Due to the comparison of various systolic blood pressure readings with the outcomes in the case of CHF patients. This study contributes a relevant set of observational data capable of revealing a series of trends and correlations that are employer for CHF management.

Fuchs & Whelton. (2020) Applied Randomized Controlled Trial (RCT) to evaluate the outcomes of varied BP medications on hypertensive and CHF patients. This is especially relevant with this kind of methodology because numerous variables can confound results and prevent a clearer understanding of how specific interventions affect systolic blood pressure. Randomized controlled trial design is good for producing high quality, stronger, and less open to interpretation evidence which means that potentially causal ideas about the relative efficacy of different treatments can be generated and that is highly important for practice.

Schwinger. (2021)provided a literature review that aimed at identifying what is already known about the role of the heart failure pathophysiology and blood pressure. This method involves reviewing a wide range of work to understand how, for instance, telemonitoring can address the underlying processes of CHF. The information this review offers is helpful as it contributes to the development of a theoretical framework in order to study new approaches to management.

A prospective cohort study by Selvaraj et al. (2020) analyzed systolic blood pressure data from clinical trials of sacubitril/valsartan treatment. This is instrument for the collection of data that reflects current state and show how medication and follow up affects change of the blood pressure in time. The prospective design increases knowledge of the treatment effectiveness and the patients’ outcomes to meet the call for research-backed treatment of CHF.

Collectively the mentioned methodologies present a snapshot appreciation of blood pressure control in CHF clients. Retrospective and prospective cohort studies provides useful observational data and RCT provides ‘gold standard’ evidence of clinical interventional efficacy. Furthermore, literature reviews assist in placing the findings within the existing clinical information hence coming up with reasonable management procedures.

Results of Studies/Key Findings

The four selected studies provided different management strategies of SBP in CHF patients. 

• The study by Oh and Cho (2020) indicating tighter control of SBP improved the outcome of patients with heart failure. The number of hospitalizations and deaths were also comparatively lower in patients with controlled SBP at or below 140mmHg times than in patients with uncontrolled hypertension (Oh & Cho, 2020). The study concludes that there is a great need for routine surveillance of SBP so that CHF can be well managed.
• Like many other RCTs, Fuchs & Whelton, (2020) found that drugs that act on the Renin-Angiotensin-Aldosterone System (RAAS) system effectively lowered Systolic Blood Pressure (SBP) in hypertensive patients with heart failure. It also compared outcomes of patients who complied with medication as opposed to patients who did not and stressed on the fact that patients required person-specific programs.
• According to Schwinger, (2021) it is crucial to disentangle the processes that constitute heart failure since the interventions will be based on those processes. The paper stated that apart from the medications, constant check of blood pressure and any other vital sign can help the healthcare practitioners identify any adverse effects on time.
• Selvaraj et al. (2020) also found a decrease in systolic blood pressure over time among patients who took sacubitril/valsartan. The study built on the premise that constant follow-up, and modifying treatment according to data obtained in real time (for instance through telemonitoring) could aid in the prevention of complications of CHF.

Each study has confirmed that routine blood pressure checks are important in the management of chronic heart failure. The main premise derived from this particular study is that a home-based telemonitoring model can be implemented as a way to monitor blood pressure over time and potentially improve the rate of interventions leading to successful patient outcomes.

Outcomes Comparison

The expected answer to the PICOT question is that home-based telemonitoring would lead to a much lower systolic blood pressure in the target group of patient’s adults. Chronic heart failure patients as compared with traditional face-to-face follow-up visits over six months (Chukwuka Elendu et al., 2023). The reduction should contribute to lower hospitalisation rates and better overall patient’s health outcomes.

When associating the consequences of the four studies to the estimated outcome:

• • Oh, and Cho (2020) noted that blood pressure management is important for avoiding hospitalisation among CHF patients. According to their observations, increased frequency of follow-ups, be it face-to-face or through tele-rehabilitation could enhance patient’s health and was in tandem with their expected decline in systolic BP.
  • Fuchs and Whelton (2020) affirmed to the use of medications in reducing the blood pressure but remarked on the usefulness of taking medications and following up regularly. Though their work was based on drug interventions, the concept of follow-up evaluation (like the case of telemonitoring) supports their study.

• Schwinger (2021) did not directly investigate telemonitoring but endorsed the view that the tracking of physiological indicators in CHF is very important. This supports the hypothesis that with the help of telemonitoring it is possible to obtain feedback on the need for change in treatment which may in turn lower the SBP.

• Selvaraj et al. (2020) supported checking and modifying the medication regimens that decrease systolic pressure on the spot. This study was designed with the direct aim of increasing the likelihood that telemonitoring would enhance blood pressure control beyond that achieved through conventional care. The results of these research works illustrate that home-based telemonitoring might be implemented as a proper method to decrease systolic BP in patients with CHF.The detailed impact of telemonitoring linked to in-person visits needs further examination.

Proposed Evidence-Based Practice Change

The relationship between the PICOT question, the articles and the selected nursing practice problem is well-seen (Jaarsma et al., 2021). In four research articles evidence supports the decision to turn to home-based telemonitoring an effective idea that will enhance the management of systolic blood pressure exhibited by the adult patients with chronic heart failure.

The specific proposed evidence-based practice change is home based telemonitoring systems for CHF patients. This intervention would enable administrators to track systolic blood pressure constantly and maintain constant adjustments of patients’ treatment plans based on their current values (Auger et al., 2024). This approach solves a significant problem of late interventions in conventional face-to-face sessions where patients may suffer from uncontrolled blood pressure.

One suggested approach to evaluating this practice change is the measurement of patient outcomes comprising clinical markers (such as decreased systolic blood pressure) and patient related variables (like quality of life and readmissions) (Akkineni et al., 2020).

It needs to be established if home-based telemonitoring results in improved blood pressure control and reduced hospitalization compared to conventional follow-up clinic visits. This proposed change will likely improve patient success with regards to decreasing systolic blood pressure and optimization of CHF management. It may enhance improved resource management by eliminating the frequent visits that patients have to make to hospitals.

Conclusion

In conclusion, Chronic Heart Failure (CHF) can still be considered a major problem in modern healthcare, and the problem of maintaining within-visible therapeutic range of systolic blood pressure remains the key issue in CHF management.

The evidence presented in the literature to support the present hypothesis indicates that the proposed home-based telemonitoring is indeed a more efficient solution for blood pressure management as compared to traditional face-to-face visits. Research indicates that ongoing patient monitoring traditional or via telemonitoring, is critical in the management of the complications and general patient experience.

According to the synthesis of research articles, home-based telemonitoring for adult CHF patients is recommended as an EBP practice alteration. It is for this reason that this intervention is expected to help increase compliance in the management of systolic blood pressure, reduce hospital admissions increase the quality of life of the patients. Future evaluations should include clinical endpoints, alongside patient-reported endpoints in order to assess the applicability of this approach in real world contexts.