Evidence-Based Practice Project: Literature Review Assignment

Cardiovascular diseases (CVDs) are a significant burden among adults in the United States and are among the leading causes of death in adults in United States (Global Burden of Cardiovascular Diseases Collaboration, 2018). CVDs are a broad category that includes conditions such as coronary heart disease, stroke, and hypertension. According to the Centers for Disease Control and Prevention (CDC), heart disease is responsible for more deaths than any other type of CVD. The problem noted among patients with cardiovascular diseases is low knowledge levels regarding disease management and prevention of complications. In the organization where the nurse works, patients with cardiovascular diseases demonstrate poor progress and increased morbidity and complications related to poor management at home. Evidence-Based Practice Project: Literature Review Assignment

Standard patient health education conducted for the patients by clinicians and nutritionists during reviews in our healthcare organization does not provide sufficient impact in terms of increasing patients’ knowledge and helping them to prevent disease progression and prevention of complications actively. Inadequate knowledge about CVDs, self-management, symptoms, drug use or adherence, and secondary prevention methods among patients causes negative outcomes such as morbidity and mortality. Many patients who develop CVDs do not know how to improve their outcomes besides taking the prescribed drugs and diet. Besides, many people with CHD who do not receive timely treatment or notice adverse symptoms early may experience disease complications. Thus, sufficient knowledge among patients of cardiovascular diseases is critical. The current evidence-based project seeks to mitigate the problem of inadequate patient education and poor patient outcomes by adopting interventions informed by the best evidence from research studies.

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The PICOT question for this EBP project is: In patients with cardiovascular disease (P), does nurse-led education (I), compared to standard patient education (C), affect clinical outcomes (O) within nine months (T)?

Search Methods

In this case, the author, the MSN student in this case, searched for articles on nurse-led education for patients with cardiovascular disease and its effect on clinical outcomes. The literature search occurred in PubMed, CINAHL, and Cochrane Library databases. The author used the keywords selected from the PICOT question:  patients with cardiovascular disease, nurse-led patient education, formal patient education, patient outcomes, and clinical outcomes. The search also involved using Boolean connector “AND” to combine searches and select articles written in English and published online within the last five years. The author included studies that compared nurse-led education to standard patient education. The search yielded 12 articles. After reading each article, the author used the above criteria to select the eight studies that best represented the research on this topic. The literature review results are as follows and are discussed in the literature synthesis section below. Evidence-Based Practice Project: Literature Review Assignment

Synthesis of the Literature

Awoke et al. (2019) conducted a quasi-experimental study that investigated the effect of nurse-led education on patients with cardiovascular disease. The subjects for the study were 29 patients with heart failure undergoing treatment at two urban healthcare facilities in the North Eastern region of the U.S. The intervention was a systematic education program run by nurses that followed heart associations’ recommended practices. Patients had to complete the Dutch Heart Failure Knowledge and the Self-care Heart Failure assessments. The study found that nurse-led education was associated with improved knowledge, self-care, and reduced readmission for individuals with heart failure. This article supports the PICOT by providing valuable information to help healthcare providers offer better care to their patients. It also shows that nurse-led education can be an effective way to improve patient outcomes and satisfaction.

In another study by Bagheri et al. (2022), the researcher sought to determine the impact of nurse-led education on self-efficacy and clinical outcomes for patients with the acute coronary syndrome. The sample for the study was 120 patients on treatment for the acute coronary syndrome. The study methods included randomization of participants into two groups, implementation of nurse-led counseling, and education for the intervention group. The study revealed that nurse-led education, compared to standard patient education, resulted in increased control of symptoms, cardiac self‐efficacy, and self-efficacy within nine months. This article is crucial for informing the project’s PICOT because it affirms that nurse-led counseling and education can improve patient self-efficacy in managing their cardiovascular diseases. This result could lead to better long-term outcomes for these patients.

A similar study by Son et al. (2020) sought to determine the effect of nurse-led interventions such as patient education on patient care outcomes for heart failure patients. In their systematic review of studies and meta-analysis, the researchers reviewed quantitative studies that sought to investigate the effect of nurse-led education on clinical outcomes. Studies were selected from online databases focusing on nurse-led self-care education as the main intervention. The total number of participants in the studies was 1167. The key findings included a 25.2% decrease in all-cause readmissions, as noted in five studies, and a 40% risk reduction for patients with heart failure. The systematic review also revealed a 29.4% risk reduction in all causes of mortality among the patients. The study supports the PICOT question by affirming how nurse-led educational programs can positively impact the clinical outcomes of patients with CVDs.  Evidence-Based Practice Project: Literature Review Assignment

The study by Cui et al. (2019), also reviewed in this essay, entailed randomizing participants and implementing nurse-led educational programs to determine its impact on hospital readmissions and self-management for adult patients with chronic heart failure. The subjects for the study were 90 patients recruited from a rural Chinese population.   The study methods included managing the control group using standard care and implementing an educational program delivered by nurses to the intervention group. Evaluation of symptoms, medication compliance, and dietary modifications occurred in the twelve months of intervention. The key findings included higher mean scores for symptom control and dietary changes in the intervention group than among participants in the control group. The study also resulted in fewer readmissions (10.3%) in the intervention group compared to (27.1%) in the control group. The article supports the project’s PICOT because it provides crucial evidence that nurse-led education on lifestyle interventions effectively improves clinical outcomes, symptom control, and dietary modifications for patients being managed for cardiovascular diseases such as CHF.

A nurse-led education and interventions to improve cardiovascular health could effectively treat patients with atrial fibrillation. The study by Hickey et al. (2019) sought to evaluate the effect of a nurse-led program on improving patients’ cardiac lifestyle for patients with atrial fibrillation (AFib). The researchers involved 53 patients with  AFib and treated them at the Columbia University Medical Center. The study methods involved completing an assessment by the participants at the beginning, followed by intervention. The intervention consisted of motivational speeches, telehealth communication program assistance, nurse-led interviews, and the provision of various learning resources for the sample population to consider. All interventions sought to enhance self-management and healthy behavior. The key findings included an average of 3-lb ± 13-lb reduction in body weight and a 5-mmHg decrease in systolic B.P. for patients in the intervention group. The study backs the PICOT since it informs the nurse of the data showing that nurse-led educational initiatives successfully enhance clinical outcomes for CVDs, as envisioned by the proposed evidenced based practice. Evidence-Based Practice Project: Literature Review Assignment

Similarly, the study by Huesken et al (2021) sought to determine the impact of nurse-led education on the clinical outcome of patients with CVD. In their study, Huesken et al. (2021) involved 150 patients admitted with heart failure to determine the impact of led-led education on knowledge about the disease and self-care interventions. Patients participated in six months of nurse-led educational sessions after completing a baseline questionnaire with questions on self-care practices and disease awareness. Upon data analysis, the researchers found that following the nurse-led education sessions, knowledge levels of the condition and self-care considerably increased. The article clearly supports the PICOT for the current study because it reveals that the proposed EBP practice can improve patient care outcomes when adopted in the management of CVDs.

More studies demonstrate that nurse-led education and counseling could improve cardiovascular health for patients with CVDs such as coronary artery disease (CAD). In a study by Nurmeksela et al. (2021) that included a one-year follow-up, the researchers included 78 patients to investigate the impact of nurse-led education on risk reduction for patients with CAD. The study methods included nurse-led counseling sessions for patients two to four weeks prior to discharge and one-year follow-up. Nurses communicated with the patients via phone calls after discharge and counseled them. Data analysis revealed that nurse-led education resulted in increased adoption of lifestyle changes, decreased waist circumference, and risk reduction. The intervention also improved patients’ blood levels of total cholesterol, triglycerides, and low-density lipoproteins. The article supports the PICOT by affirming the significance of nurses in leading patient education to improve the clinical outcomes for patients with cardiovascular diseases.

The study by Rice et al. (2018) also supports the PICOT for the current EBP project because it demonstrates the effectiveness of nurse-led patient education in improving patient-care outcomes in managing cardiovascular diseases. In their systematic review of randomized controlled trials, Rice et al. (2018) included studies whose samples were patients aged 18 years and above and on treatment for CHF. Following the search and selection of relevant RCTs from  PubMed, Google Scholar, and  CINAHL, the researchers analyzed how nurse-led patient education on heart failure affected patients’ quality of life, readmission rate, and clinical outcomes. The researchers found that nurse-led education on H.F. reduced hospitalization and improved patients’ quality of life and clinical outcomes. Evidence-Based Practice Project: Literature Review Assignment

Comparison of Articles

The articles reviewed in this essay clearly support the proposed EBP intervention for the current project by demonstrating how nurse-led education for different CVDs resulted in improved patient care outcomes. The similarities among the studies included the adoption of nurse-led education and the inclusion of patients with CVDs. The differences across the studies include the inclusion of varying numbers of study participants, interest in varying CVDs, and the use of different study designs and methods. For example, some studies involved randomization of participants, follow-up, and systematic review. The articles addressed different themes ranging from the impact of nurse-led education on self-efficacy, self-management, clinical outcomes, and knowledge about the disease. The study methods also varied from baseline patient assessment on knowledge, evaluation of perceived self-efficacy, implementation of nurse-led education and counseling, search for literature from online databases, follow-up, laboratory tests, and assessment of patient symptoms.

The researchers conclude by recapitulating how nurse-led education, counseling, and patient management programs improved clinical outcomes. The literature review has noted no controversies regarding the methods, designs, participants, analysis, or findings. However, a few limitations are noted. Several studies, such as Cui et al. (2019), were limited by small sample sizes that could not represent the greater patient population. Besides, the study by Awoke et al. (2019) only involved 29 patients from the North Eastern region of the U.S. The studies by Nurmeksela et al. (2021) and Awoke et al. (2019) were limited by sample selection that involved convenience selection of patients, unlike random or systematic sampling that could result in unbiased representation.   The study by Bagheri et al. (2022) was limited by a small sample size (75) chosen from a single academic hospital hence reducing its generalizability to the patient population in Iran and other parts of the world. Other limitations of the study were the short time   (up to 1‐month) between intervention and evaluation, the use of the same researchers in nurse-led education and evaluation (which could result in bias), and the use of self‐report data. Evidence-Based Practice Project: Literature Review Assignment

The literature review reveals gaps in knowledge regarding the cost implication of replacing standard patient education with nurse-led education and how to improve nurse-led education practice. Suggestions for future studies include the need for randomized controlled studies and more studies to provide sufficient data. Nurmeksela et al. (2021) proposed that future studies should seek to provide more data on how nurses can strengthen counseling and patients’ self-management. According to Bagheri et al. (2022), further studies should provide more longitudinal regarding the impact of nurse‐led education on long‐term cardiovascular health self‐efficacy, prevention of adverse events, and objective clinical outcomes.

Conclusion

In summary, the literature review reveals that nurse-led education effectively improves the clinical outcomes of patients with cardiovascular diseases. Besides, the reviewed studies affirm that by adopting the evidence-based practice proposed in this project, the nurse and healthcare organization will witness improved patient care outcomes for their client population diagnosed with CVDs. The literature highlighted that nurse education could include follow-up for patients discharged to home treatment, phone calls, and in-person counseling sessions. Thus, the nurse will consider adopting the approaches because evidence from the studies reveals positive outcomes when implemented for patients with CVDs. Evidence-Based Practice Project: Literature Review Assignment

References

Awoke, M. S., Baptiste, D. L., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure. Contemporary Nurse, 55(1), 15-26.

Bagheri, H., Shakeri, S., Nazari, A. M., Goli, S., Khajeh, M., Mardani, A., & Vlaisavljevic, Z. (2022). Effectiveness of nurse‐led counselling and education on self‐efficacy of patients with acute coronary syndrome: A randomized controlled trial. Nursing open, 9(1), 775-784.

Cui, X., Zhou, X., Ma, L. L., Sun, T. W., Bishop, L., Gardiner, F. W., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in China. Rural and Remote Health, 19(2), 47-54.

Global Burden of Cardiovascular Diseases Collaboration. (2018). The Burden of Cardiovascular Diseases Among U.S. States, 1990-2016. JAMA Cardio, 3(5):375–389. doi:10.1001/jamacardio.2018.0385

Hickey, K. T., Wan, E., Garan, H., Biviano, A. B., Morrow, J. P., Sciacca, R. R., Reading, M., Koleck, T. A., Caceres, B., Zhang, Y., Goldenthal, I., Riga, T. C., & Masterson Creber, R. (2019). A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population. The Journal of innovations in cardiac rhythm management, 10(9), 3826–3835. https://doi.org/10.19102/icrm.2019.100902

Huesken, A., Hoffmann, R., & Ayed, S. (2021). Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients. International journal of nursing sciences, 8(2), 161-167.

Nurmeksela, A., Pihlainen, V., Kettunen, T., Laukkanen, J., & Peltokoski, J. (2021). Nurse‐led counseling for coronary artery disease patients: A 1‐year follow‐up study. Nursing & Health Sciences, 23(3), 678-687.

Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Education and Counseling, 101(3), 363-374.

Son, Y. J., Choi, J., & Lee, H. J. (2020). Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 17(18), 6559. https://doi.org/10.3390/ijerph17186559

A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT.

In a paper of 1,250-1,500, select eight of the ten articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:

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Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.
Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.
Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT. Evidence-Based Practice Project: Literature Review Assignment
Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).
Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
Conclusion – Provide a summary statement of what you found in the literature.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

You are required to cite eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. Evidence-Based Practice Project: Literature Review Assignment