8.7 Spotlight Application

Emma is assigned to care for an 64-year-old patient readmitted with congestive heart failure. Emma recognizes the patient’s name during shift report as the reporting nurse “snottily” comments how this patient was a “frequent flyer” and he was just discharged last week. The reporting nurse spends little time describing the patient’s actual condition and focuses comments on how the patient “might as well put his name plaque on the door” because he is here so frequently. Emma does agree that the patient has been readmitted very frequently with CHF exacerbation but is concerned at the dismissive and uncaring comments by her peer. She vows to determine more about what is going on with the patient. Emma is determined to spend time more time with the patient on this admission and wants to find out about his home environment and self-care.

Reflective Questions

• How do the frequent readmissions affect the client’s health care costs and the hospital’s reimbursement levels by Medicare and private insurance companies?
• What additional nursing interventions might help prevent future frequent readmissions and reduce costs?

Emma is on Day 3 of caring for the patient and engages in a conversation about his dietary habits at home. The patient reports that his wife passed away one year ago from breast cancer. He has been preparing his own meals since that time and focuses on easy to prep and relatively cheap foods. Canned soups, boxed meals, and chips are common staples in his diet. Through Emma’s conversation with the patient, she can see that the patient needs dietary teaching and instruction about sodium levels. He seems engaged in exploring different food preparations and simply was unaware that ease and convenience foods could exacerbate his heart failure. When Emma questioned if he had been taught about this on previous admissions, he stated that no one took the time to talk with him about his home situation. He reports that he received pamphlets but never really took the time to read them. Emma reflects on how preventative education was missed and the costs that were incurred for the patient and health care organization as a result.