Literature Review

Literature Review

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Heart failure has been a growing burden globally (Koser K. D., Ball L. S., Homa J. K. & Mehta V., 2018) and it is one of the reasons for hospitalizations and early (30 day) readmission in the United States. Those mostly affected by heart failure are old people above 65 years. Devan S., et al, (2014) says there been an increased priority for researchers, clinicians and different stakeholders to prevent heart failure readmission. Several strategies have been put in place (Peter, D., et al, (2015)) such as increasing the number of qualified nurses, intense patient training and patient follow-ups and home care among others. This PICOT focused on patient training as a good intervention for reducing 30-day heart failure readmission. This paper reviews various literature that focus on patient training.

Research Comparison

Hospital readmissions are as result of poor patient outcomes which can be attributed to poor care transitions. Peter, D., et al, (2015) and Devan S., et al, (2014) acknowledges that when care transitions are poorly executed, it increases the chances of a patient getting readmitted. Devan S., et al, (2014) studied on interventions to reduce heart failure readmission. They reviewed various literature where they initially screened eighty eight articles which were later reduced to 40 relevant articles. Their study shows that transition of care can be improved through patient training, counseling and post-discharge follow-ups. Teach-back (Devan S., et al, (2014), is a training strategy that most researchers suggest to be used as it improves levels of understanding.

Peter, D., et al, (2015) did a “patient and family caregiver education” that involved 12 health care professionals. The group was required to analyze the current state of care education and the results to be used in drawing interventions to address patient and family care training. The study acknowledges the fact that patients fail to seek clarifications on post discharge care and they end up missing out important care steps resulting in readmission. It is the responsibility of the nurses to offer high quality care to the patients. However, this is not always the case. According to Peter, D., et al, (2015), nurses and other hospital staff have conflicting priorities and many patients do not receive any form of training. They also stress the need to improve patient training and evaluate the level of patient understanding as far as discharge instructions are concerned. There should be enough number of qualified nurses to be able to deliver their duties satisfactorily. A research by Giuliano, K, (2016), shows a positive relationship between nurse staffing and patient outcomes. Peter, D., et al, (2015) conclude that teach-back, also known as tell-back should be incorporated in patient teaching to enable patient-trainer interaction and ease understanding.

Koser K. D., (2018), did a study was to analyze patient outcomes from a dedicated HFC, which was fitted with various interventions to reduce heart failure readmission. Their study analyzed 415 adults enrolled in an independent outpatient heart failure clinic. The result of their study shows that the patients in the HFC were less likely to be readmitted within 30 days of discharge. According to literature review done by Diana Lyn et al, (2014), in such of evidence supporting patient education, enhanced patient education that targets self-care management brings about significant reduction in rates of early readmission. Diana Lyn et al, (2014), study reviewed articles that focused on old humans aged above 65 years between the years 2006 and 2011. The search used approximately 773 articles which consisted of editorials, reviews and published articles.

Srisuk, N., Cameron, J., Ski, C. F., & Thompson, D. R., (2017), compared outcomes for patients who received usual care and those who received planned education program. Their research showed that the patients who went through the education program had more confidence and better self‐care maintenance. Their study was performed in southern Thailand and it involved a hundred patient‐carer dyads who attended heart clinics. Akbari, M., & Celik, S. S., (2015), performed a 9 months study involving 100 patients who were going through CABG surgery, where the patients under study were given discharge training and study booklets before surgery and after discharge. The other patients received the usual care. Their study focused on the effects of training and counseling on patient outcomes. According to Akbari, M., & Celik, S. S., (2015), patient training and counseling improves patient care and reduce hospital readmission.

Limitations of Research

The literature reviewed had limitations, Diana L. et al (2014), reported varying results and the study population had high heterogeneity and therefore it negatively influenced the patient’s outcomes. Some results were not conclusive, and the study was limited to descriptive (statistical) analysis. Lack of enough sample population representation is a limitation that most of the studies faced. Giuliano KK. et al, (2016), sample population is only restricted to “Best Hospitals” and Srisuk N. et al, (2016) restricted their study to rural Thailand, and therefore it did not adequately represent patients with heart failure.

The study, Akbari M. et al, (2015), were limited in solving and eliminating all the psychological, social, physical problems faced by heart failure patients after they are discharged. Teaching the patients on how to manage the heart failure condition was not a priority and therefore was left to the day of discharge. Peter, D. et al, (2015), also faced limitations of nurse’s inconsistency in identifying key learners and the extent to which patients understood the teachings.


The review of literature shows that 30-day heart failure hospital readmission can be significantly reduced. It is evident that lack of proper care after discharge is a big contributor to early readmission (Peter, D., et al, (2015) and Devan S., et al, (2014)). It is therefore recommended that health facilities should put in place proper measures to ensure that patients are given the necessary education and follow-ups done after discharge. There is still a challenge for researchers to provide the specific steps that will ensure that the old age, who are mostly affected by heart failure, understands the instructions and that they do not easily forget, considering their ages. Clear literature should also be put forward that documents the agreed upon standards on how to carry out patient education. Low literacy on patient education should also be strongly addressed (Cloonan, P., Wood, J., & Riley, J. B., 2013).


Koser K. D., Ball L. S., Homa J. K. & Mehta V. (2018). An Outpatient Heart Failure Clinic Reduces 30 Day Readmission and Mortality Rates for Discharged Patients: Process and Preliminary Outcomes. Journal of Nursing Research.

Devan S., Janice F., Daryl D., & Patricia S. L. (2014). Interventions to prevent heart failure readmissions: The rationale for nurse-led heart failure programs. Journal of Nursing Education and Practice.

Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration.

Giuliano, K. K., Danesh, V., & Funk, M. (2016). The Relationship Between Nurse Staffing and 30-Day Readmission for Adults with Heart Failure. Journal of nursing administration.

Diana L., Hayley M., Lisa G., & Laura A. (2014). A nurse-guided patient-centered heart failure education program. Journal of Nursing Education and Practice.

Srisuk, N., Cameron, J., Ski, C. F., & Thompson, D. R. (2017). Randomized controlled trial of family-based education for patients with heart failure and their carers. Journal of Advanced Nursing.

Akbari, M., & Celik, S. S. (2015). The effects of discharge training and counseling on post-discharge problems in patients undergoing coronary artery bypass graft surgery. Iranian journal of nursing and midwifery research, 20(4).

Cloonan, P., Wood, J., & Riley, J. B. (2013). Reducing 30 day readmissions health literacy strategies. Journal of nursing administration

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