Defining The Clinical Question Essay Example | Topics and Well Written Essays - 2500 words

Defining The Clinical Question - Essay Example Some studies have shown that education given to patients may be insufficient. Noncompliance with medication, diet, or symptom monitoring caused 15-64% of hospital readmissions. One way to combat these barriers is to design advanced practice nurse led heart failure clinics for outpatient management of heartfailure . Many studies have shown that heart failure clinics designed with advanced practice nurse post hospital follow-up improved patient education and compliance thus decreasing hospital readmissions (Paul 2008). The types of heart failure patient typically followed in advanced practice nurse led clinics are New York Heart Association Classifications II-IV. These patients were classified based on either echocardiography or radiography evidence of pulmonary congestion or signs or symptoms of heart failure. Background Despite advancements in the management of this debilitating condition, such as introduction of beta blockers, aldosterone antagonist, and angiotensin receptor blocker s mortality and morbidity among heart failure patients remain high. Generally 25-50% of hospitalized patients will be readmitted within 6 months of discharge (Gustafsson, Schou et al. 2009). The most cited incidents for readmissions are noncompliance with drug therapy, poor compliance with dietary restrictions, fluid restrictions, and inadequate medical therapy (Paul 2008). Thus, it appears that the readmission and mortality rates of heart failure patients maybe the result of less than optimal approach by the patient and provider. In terms of mortality the Framingham Study showed that once patient was diagnosed with heart failure the 6 year mortality was 85% for men and 67% for women . Heart failure puts a significant health and financial burden on patient’s families and society. Estimated cost of heart failure in the US is over $35 million according to the American Heart Association. As we all know the incidence of heart failure increases with age. According to the center fo r disease control 70% of the people over the age of 60 have heart failure and the number is expected to rise (Ferguson 2008) . For instance in 2000 approximately 12.7% of the American population was 65 years of age or older. It is estimated in 2020 this number will rise to 16.5%. In an effort to reduce 30 day readmissions, mortality, and overall cost a growing number of hospitals and medical groups are forming evidenced based heart failure clinics to combat this epic problem. The population to be evaluated in this project are patient diagnosed with heart failure with either systolic or diastolic impairment that have recently been hospitalized, The purposed intervention is one week follow up post discharge in a nurse practitioner led heart failure clinic. The patients will then be monitored by nurse practitioner and MD . A comparison will then be made to those patients followed by an MD only . The outcome that is proposed is that patients followed in a nurse practitioner and MD colla borative heart failure clinic will have a decrease in 30 day readmission rates to the hospital . Clinical Question Does the addition of a nurse practitioner to a heart failure clinic reduce 30 day readmission rates for heart failure patients? Keywords: A medline search was conducted using the terms â€Å"

Proposal argument Essay Example | Topics and Well Written Essays - 1750 words

Proposal argument - Essay Example The purpose of this proposal argument is to evaluate the reasons as to why the physical punishments are not the best ways of handling the problems. This proposal argument explains that something could be missing in our attempt to come up with an upright generation. In addition, it is the missing element that this article sheds light on. Children whose parents use amicable mechanisms of discipline possess extraordinary social skills. Parents should avoid using physical punishment because it increases violent behavior among the youth (Sumner, 132). This paper seeks to explain why use of physical punishment increases violent behavior among the youth. A Deeper Perspective to the Problem A correct support measures put in place are the sources of successful behavior change. The current generation may be carried away by events and this is proved by the fact that most of them often get into trouble due to their uncalled for behavior. A survey carried out by the body charged with monitoring f uture generation established that most of the mistakes carried out by the youths are due to their characters. To be specific 97% of the cases reported are due to the behavior. This is clear proof that bad behavior is fast becoming a problem. The big question is whether are we going to watch the youths fall or are we going to be the straw they clutch on. The fact that these perverse actions always soil their reputations in that they put question marks on their records is another reason as to why we should be on the lookout just to help out a brother who is off track (Gershoff, 539). Current Measures Most of the parents have resorted to physical punishment as the corrective method in their attempts to curb bad behavior. Those kinds of parents beat their children; force them to do things that they are not well conversant with and shout at them with the intention of amending and making the youths reformed. They do not know that more often than not, they are wrecking the child based on m aking things right. Physical punishments have been a major cause of injuries in children some of which have resulted into the physical impairments of the children. What is more worrying is that physical punishments have even led to cases of child deaths. Studies carried out to evaluate the extent at which physical punishments have spread in various regions, found that the habit escalated over time. The actuality that physical punishment is practiced throughout all the regions is clear proof that it is growing into a complication and does not benefit the child in any way. Similarly, it is important to observe that any form of physical punishment however soft it may be may intensify and become worse (Burton, 1447). Physical punishment is unsatisfactory because it increases the extent of aggression among children. It is proven beyond doubt that children, who are exposed to lots of physical punishments, are more likely to be characterized by aggressive behavior towards their coequals. I n like manner, the children may employ the brutal mechanisms in working out their problems and at the same time, they can be inconsiderate towards their own parents. What raises the level of concern higher is the fact that this children may end up being violent in future, thereby being insolent and impolite towards