Progressive DSM programs in the outpatient setting have positively influenced HF patient QOL as reflected in improved exercise tolerance and a reduction in emergency care and hospital admissions. For programs to be ef...
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Progressive DSM programs in the outpatient setting have positively influenced HF patient QOL as reflected in improved exercise tolerance and a reduction in emergency care and hospital admissions. For programs to be effective, pharmacologic and nonpharmacologic therapies must be incorporated. Nurses are active team members and can influence the success of the program, especially if they are knowledgeable and technically capable in management processes. Use of practice guidelines, standards of care, or algorithms allow for increased nurse autonomy and improve patient access to care and response times. The need to expand the DSM concept throughout the continuum of care is great. Future program development and outcomes research is necessary to provide direction in the implementation of high-quality, cost-effective programs.
RF is a unique situation. It is specific in diagnosis and yet, at the same time, broad in concept. It can be acutely life threatening or chronic in presentation and need for intervention. Patients are cared for in ICU...
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RF is a unique situation. It is specific in diagnosis and yet, at the same time, broad in concept. It can be acutely life threatening or chronic in presentation and need for intervention. Patients are cared for in ICUs, medical-surgical floors, and nursing homes as well as at home. When RF is a complicating condition of an already hospitalized patient, the road to recovery may be long and complicated. It is important that the health care team provides education and counseling so that the patient and family can cope with the changing events and the potentially long road to recovery. Outcome data from all the sites of care are currently lacking for a comparative analysis of the most effective site. All the sites of care discussed in this article are cost-effective alternatives to the ICU, but there is a lack of standards and evidence of measurable outcomes such as the quality and cost relationship. Outcome data are needed to document the cost of care and the relationship of that cost to specific outcomes such as final discharge disposition, survival, complications, and quality of life. Health care provides have a much clearer image of the care that can be provided in the multiple sites available. Unfortunately, patients and families do not have that same level of understanding. For many patients and families, regardless of what the facility is called, it is not the acute hospital, and that is where they wish to remain until discharge home. Clarification and standardization are needed regarding the terminology used to describe the various sites of care. It is important that integrated health care institutions provide education and counseling to patients and families regarding the continuum of care and the many alternatives along that path.
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