Heart failure is a multifaceted clinical condition originating from an impairment of the function and structure of the ventricular filling or ejection of blood throughout the body (Yancy et al., 2016). Approximately 5.7 million Americans have congestive heart failure (Mozaffarian, et at., 2016). The Heart Failure Fact Sheet (2015) emphasized the annual cost of treating HF is $32 billion. Symptom burdens of end stage heart failure include shortness of breath, chest pain, claudication, fatigue, skin breakdown due to swelling and impaired perfusion, depression, anxiety, activity intolerance, cachexia, and sleep breathing disorders (Johnson, 2007). Quality of life for patients with heart failure becomes reduced with the progression of the disease (George & Leasure, 2016). Advanced HF is the measurable indication of extensive heart disease with severe limitations of heart failure symptoms (Advanced Heart Failure, 2015). The complexity of heart failure makes trajectory and prognosis very difficult to determine (Uppal & Rushton, 2014). The unknown trajectory for heart failure makes timing for palliative care referrals unpredictable for providers (Ziehm et al., 2016).
The purpose of palliative care is to improve quality of life for patients as well as caregivers and family members who deal with difficulties surrounding chronic illnesses by providing preventative measures and liberation from suffering (WHO, 2012). The goal of palliative care is to assist with improving the quality of life for patients with chronic complex illnesses (Fasoline & Phillips, 2016). Palliative care targets symptom management and easing chronic disease burdens (Hemani & Letizia, 2008). The standards of palliative care symptom management include: (a) the implementation of a holistic assessment; to identify the cause, (b) the utilization of optimizing pharmacologic elements, (c) reversal of what is reversible, and (c) the incorporation of palliative care within any other symptoms (Johnson, 2007). Palliative care services are also available to the patient and family any time of the day (Seow et al., 2014). The rationale for implementing these services with Advanced HF patients is to improve satisfaction and quality of life.
There are many issues inhibiting the initiation of HF specific palliative care services for end stage heart failure patients (Kavalieratos et al., 2014). Healthcare providers lack the proper education and training for understanding and handling palliative care appropriately (Namasivayam & Barnett, 2016). This creates misperception as well as miscommunication between the healthcare provider, the patient, and the family (Ziehm et al., 2016). Palliative care is oftentimes mistakenly associated with a terminal prognosis (Ziehm et al., 2016). Healthcare providers own the responsibility of acknowledging knowledge gaps and overcoming these barriers in order to allow for heart failure therapies to work congruently together with palliative care management for better care (George & Leasure, 2016).
The purpose of this project is to increase heart failure specific palliative care referrals in the outpatient setting. Furthering provider education with heart failure specific palliative care models and palliative care integration methods will also be covered in order to support the delivery of palliative care to advanced HF patients for a more comprehensive patient centered care service. Building trust while boosting the support of healthcare providers is necessary in order to integrate palliative care services with heart failure management (George & Leasure, 2016).
Oftentimes, providers are faced with the difficult decision of introducing palliative care to the patients with reduced ejection fractions who constantly experience worsening shortness of breath, end stage renal functioning, unresponsiveness to diuretic therapy, activity intolerance, increased fatigue, and repeat readmissions to the hospital (Muhandiramge et al., 2015). Support from the palliative team could optimize heart failure care, chronic symptom burdens, communication between provider and patient, readmission rates, cost of care, accessibility to care, and improve overall quality of life and satisfaction for heart failure patients.
Correlational research will be used to discover the relationship between pre- and post-educational intervention and palliative care referral initiation. In order to measure the advanced practice nurses knowledge and awareness with initiating palliative carereferrals, the amount of palliative care referrals initiated before and after the educational intervention will be recorded.