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Clinical environment Problems

Consider the clinical environment in which you are currently working or have recently
worked. Collaborate with a leader or educator in the clinical environment to identify a
problem, issue, or educational deficit upon which to build a proposal for change.
In a paper of no more than 800 words, describe the nature of the problem, issue, or
educational deficit. Include the following in your discussion:
The setting and/or context in which the problem, issue, or educational deficit can be
Detailed description of the problem, issue, or educational deficit.
Impact of the problem, issue, or educational deficit on the work environment, the
quality of care provided by staff, and patient outcomes.
Gravity of the problem, issue, or educational deficit and its significance to nursing.
Proposed solution to address the problem, issue, or educational deficit.
Prepare for the capstone project by listening to the audio interview, “Capstone:

Identify problem
Chronic Heart Failure (CHF) is one of the leading causes for mortality among the
geriatric population. The disease also presents a clinical burden as well as economic burden
to both the patient and their families. Approximately, half of the hospitalizations in these
healthcare facilities are associated with other diseases associated with CHF and
polypharmacy (Huether & McCance, 2012).  In addition, CHF is associated with enormous
cost due to prognosis and is associated with 35% mortality in this nation. In my health
facility, most patients who of patients affected with poor prognosis are patients who are
above 75 years. This is associated to the fact that most of the patients are suffering from other
health disorders such as diabetes, and management of these diseases will require various


types of medications. Although medication is associated with relieve of symptoms and to
improve the patients living condition, there is low health literacy and education deficit of
self-management in this population group is low (Huether & McCance, 2012). 
Lack of adequate knowledge deficit is associated with medication compliance, which
causes further worsening of HF symptoms. Various studies have been conducted to examine
the role of patient education in compliance in HF medication and lifestyle modification.
Study findings indicated that patients with increased knowledge had better CHF outcomes as
compared to patients with low education. The study concluded that increasing patient
knowledge led to a change in patient’s beliefs; and recommended that extra attention should
be paid when interacting with geriatric population diagnosed with CHF (Dains, Bauman, and
Scheibel, 2012).
Frequent hospitalization is triggered by the low health literacy and knowledge on self-
management of the disease. In this healthcare facility, there is high rate of readmission of
geriatric patients diagnosed with CHF, especially in their first 6 months after they have been
discharged from the hospital. The most critical time for readmission is considered to be the
first to be the first 30 -90 days. At my health care facility, the re-admission rates are 25%.
This in turn results in increased costs of management. This has been supported by
immeasurable number of studies in other healthcare facilities and in other nations. The causes
and factors of low patient education in this healthcare facility have not been investigated, but
I can associate it with factors such as low staff ratio and limited time (Dains, Bauman, and
Scheibel, 2012).
CHF education among this population group is extremely important because it
changed their beliefs as well as their attitudes, which enables them to seek the appropriate
health behaviour. This is especially important for this group because CHF is a health disorder


that involves complex management strategies, which sometimes it will involve lifestyle
modification. Therefore, the patient education should follow an instrumental action; which
mainly implies that it will influence the patient behaviour as well as his attitude. In this case,
the education information provided should be done using instructions, laying an emphasis on
the patient needs and what the patient must do to remain healthy and not on what the patient
should know (Huether & McCance, 2012). 
Ideally, the patient education should be done when the patient is admitted, continued
throughout his or her admission period and extended to when the patient is discharged or
during their outpatient clinic. This is because it will improve prognosis and the visits to
hospital admissions. This is not the case at my healthcare facility. The geriatric CHF
education is conducted in group, normally twice a week. There is no follow up to check if the
patient has changed their attitudes and beliefs, and if they have adopted the recommended
lifestyle. Consequently, there are always high incidences of CHF patient re- admission
(Huether & McCance, 2012). 
To address this issue, the recommended solution is to integrate education processes
specific for geriatric population. This should use the following steps; a) assessment of the
patient’s knowledge; b) cognition function, c) patients motivation and attitudes, d) challenges
faced by the patients. This strategy is chosen because it helps in identifying the learning
barriers, the needs that must be assessed which facilitates in education planning.
Individualization of needs is very challenging. However, the nurses can give priority to
general topics such as weight control and diets. This should be followed with trainings on
pharmacological treatments of CHF (Huether & McCance, 2012). 
Other strategies that can be integrated with these strategies include home visits,
monitoring telephone, and community programs. This will help the nurses understand the


family involvement as well as the dynamic involved. This will help the nurses to understand
the necessary education that should be offered at the family level. This will provide an
opportunity to develop the most effective prevention. This will help reduce mortality rates,
low re-admission rates and improve patient’s quality of life. The complexity of managing
CHF is a challenge and the nurse role is to ensure that they interact with the multidisciplinary
teams (Dains, Bauman, and Scheibel, 2012).



Dains, J.E., Bauman, L.C., Scheibel, P. (2012). Advanced Health Assessment and Clinical
Diagnosis in Primary Care.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom
ed.). St. Louis

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