RESUMEN
Congestive heart failure is a chronic, debilitating illness, with increasing prevalence in the elderly. It is one of the most common causes for hospital admission, and associated treatment costs are estimated at $20.2 billion. Despite improved survival with medical therapy, beneficial effects on quality of life have not been consistently reported. In addition, optimum medical therapy, as recommended by evidence-based guidelines, are not always implemented. Counseling and education involving dietary modifications, activity recommendations, medication management, self-monitoring, prognosis, coping skills, social support, caregiver stress, and spiritual needs are critical components in the management of heart failure through initial diagnosis to end of life. Within the last decade, close follow-up for congestive heart failure has been associated with decreased hospitalizations, reduced hospital length of stay, improved functional status, better compliance, lower costs, and improved survival. Research trials have mainly been observational and small, and they have used different interventions. Little has been written regarding outpatient management of the patient with advanced congestive heart failure, and none of the current published guidelines addresses recommendations for the New York Heart Association class IV (other than for transplant candidacy). New models of close follow-up for chronic and advanced congestive heart failure should be investigated. These models could be implemented in urban and rural settings and be supported by private insurance or Medicare.
Asunto(s)
Atención Ambulatoria/métodos , Insuficiencia Cardíaca/terapia , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados Paliativos/métodos , Humanos , Evaluación de Resultado en la Atención de Salud/organización & administración , Guías de Práctica Clínica como AsuntoAsunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Atención Primaria de Salud/organización & administración , United States Department of Veterans Affairs , Veteranos , Anciano , California , Estudios de Seguimiento , Humanos , Modelos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
Nurse practitioners (NPs) are in demand nationwide as primary care providers both in the inpatient and outpatient settings. Lack of prescriptive privileges and/or a narrow scope of practice can be practice limiting. This article provides a written template for prescribing authority, generic scope of practice, and furnishing policy, including evaluative process, for nurse practitioners who wish to obtain prescriptive privileges. Developed at the Palo Alto Veterans Affairs Health Care System, these documents can be used by NPs nationwide. They can be adapted to each provider's unique practice, whether in the hospital, clinic, or private practice setting.
Asunto(s)
Prescripciones de Medicamentos/normas , Enfermeras Practicantes/normas , Guías de Práctica Clínica como Asunto , Autonomía Profesional , Enfermedad Aguda/enfermería , Atención Ambulatoria/normas , Monitoreo de Drogas/normas , Humanos , Evaluación en Enfermería , Registros de Enfermería , Planificación de Atención al Paciente , Atención Primaria de Salud/normasRESUMEN
Healthcare priorities and use have changed dramatically over the last several years. Expansion of the nurse practitioner (NP) role has been a hallmark of the restructuring efforts, which have emphasized primary care and the use of nonphysician specialists. NPs are practicing in a wider range of settings than ever before, including acute hospital settings, outpatient clinics, and specialty services. While the Veterans Health Administration (VHA) has employed NPs since the early 1970s, their practice has been limited at many VHA medical centers. Such was the case at the Veterans Affairs Palo Alto Health Care System (VAPAHCS), when physicians produced a scope of practice (SOP) for NPs that was practice limiting. This article highlights the historical progress of NPs in defining their practice, discusses barriers to NP practice at the VAPAHCS, outlines strategies to overcome barriers, and discusses future possibilities for advanced practice nursing within the VA.