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First Name Last Name, Title; Professor, Title; Course Name

Department and/or School


Proposal and Conclusion


Literature Review

Your Poster Title Goes Here:

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Heart Failure Management


Heart Failure Management

Heart failure is a life-long condition with high hospitalization, morbidity, and mortality

rates. The condition disproportionally affects older people. Heart failure is a progressive disease

characterized by the diminished cardiac capacity to pump blood to the rest of the body and meet

cellular demand for oxygen and nutrients. The result is shortness of breath, fatigue, fluid

retention, reduced exercise tolerance, and frequent hospitalization (Dumitru, 2023). Age-related

changes in physiology, multiple comorbidities, and polypharmacy complicate the management of

the condition in older adults. Consequently, they may benefit from a dual therapy of medical and

non-medical interventions, such as lifestyle changes that limit exposure to risk factors such as

high lipid diet, smoking, and inactivity (Reynolds et al., 2018). Therefore, the present study

explores heart failure management in older adults and hypothesizes that patient education can

reduce hospital admission within six to nine months.

Significance of the Practice Problem

Effective management of heart failure among older adults (65 years or older) should be

prioritized because advancing age is a non-modifiable risk factor. About 1% of individuals ≥ 50

years have HF, doubling with each decade of life, and the population (≥ 65 years) is projected to

increase from 51 million in 2017 to 95 million in 2060 (Li et al., 2020). Similarly, cases of heart

failure hospitalization rose from 1,060,540 in 2008 to 1,270,360 in 2018, with a median age of

73 years, suggesting the current care model may be inadequate to reduce readmission (Clark et

al., 2022). Increasing admission rates of older adults with heart failure suggest they require

additional interventions to improve out-of-hospital management of the condition. According to

(Al Habeeb, 2022), less effective management of heart failure leads to worsening dyspnea, fluid


retention in the foot and hands, fatigue, diminished functional capacity, and ultimately declining

well-being and quality of life. Frequent hospitalization also contributes to higher healthcare costs

(Dumitru, 2023). An aging population and inadequate care delivery contribute to high

hospitalization and care costs. Therefore, improving the current care model by increasing out-of-

hospital care can reduce heart failure-related hospitalization.

Purpose Statement

The present study aims to propose patient education as a complementary non-medical

intervention to improve self-management of heart failure for older adults aged 65 years or older

and explore its impact on health outcomes and well-being within six to nine months

timeframe.Presently, the heart failure care model includes standard medical care and follow-up.

However, according to Moertl et al. (2017), patient education is a critical preventive strategy that

equips older people with specific knowledge on self-management and avoidance of risk factors

that could aggravate the disease, leading to avoidable hospital admission. The research will

pursue the purpose through the following three specific objectives within six to nine months.To

improve clinical outcomes of older adults ( ≥ 65 years) with heart failure by educating them and

their caregivers (at home) on the importance of compliance with medical prescription and dosage

to avoid adverse effects of medication errors and the need for hospitalization.To reduce

avoidable hospital admission for older adults ( ≥ 65 years) with heart failure by using patient

education to develop their awareness and knowledge of risk factors that can exacerbate the

condition, leading to avoidable readmissions.To improve the overall health and well-being of

older adults ( ≥ 65 years) by educating them about symptoms and their management and the need

to seek medical care when they persist to avoid unnecessary hospital visits.


PICOT Question

The PICOT question provides a theoretical framework to develop a specific and

achievable research question within a particular time frame. The question model is, in older

adults ≥ 65 years (population) and older , does implementing a comprehensive and targeted

patient education program (intervention) compared to the current standard care (comparison)

lead to reduced hospital admissions (outcome) within six to nine months timeframe (timing)?

Population (P): The target demographic comprises older patients diagnosed with heart

failure and seeking medical care in the Home health care. The group comprises people aged 65

or older, although the age range may vary based on the healthcare policies and norms of the

selected Home health Agency (Moertl et al., 2017).

Intervention (I): The proposed intervention is to develop a thorough disease

management program to meet the demands of older adults diagnosed with heart failure. The

program is patient education on medication compliance, risk factors for worsening the condition,

and symptoms management or the need to seek medical care (Moertl et al., 2017). The program

addresses heart failure by empowering patients to carry out self-management in out-of-hospital


Comparison (C): The comparison intervention is standard care for older people with

heart failure in Home health Agency. The current recommended care entails regular clinician

visits, medication prescriptions, and general guidance on proper diet and lifestyle. Although

standard care may also vary across healthcare facilities and departments, the current study selects

a particular healthcare setting and heart failure department that delivers care using the same



Outcome (O): The primary outcome of interest is reducing heart failure hospital

admissions for older adults. The outcome assesses whether the proposed patient education

program can lower hospitalization rates among older adults with heart failure within six to nine

months intervention period. The study assumes that reduced hospital admission could be a

surrogate marker for improved clinical outcomes (medication compliance) and health and well-

being (symptom management) (Reynolds et al., 2018).

Timeframe (T): The patient education intervention program and evaluation timeframe is

six to nine months. The brief duration allows for assessing short-term outcomes, such as

hospitalization rate, but also provides insights into the feasibility and effectiveness of the disease

management program within a longer time.

Describe the Vulnerable Population

Managing heart failure in older adults presents several unique challenges from the rest of

the population, which healthcare professionals should incorporate into care models to improve

health outcomes. Age-related changes in physiology and multiple comorbidities complicate the

management of heart failure in the ≥ 65 years patient cohort. In addition, each comorbidity

requires a different set of medications, leading to polypharmacy that renders older adults more

susceptible to missed doses and ultimate adverse medical effects. The aging process is also

characterized by a notable decrease in cardiovascular function, which renders elderly individuals

more vulnerable to the development of heart failure or worsening the condition (Dumitru, 2023).

The presence of comorbid illnesses, such as hypertension and diabetes, adds complexity to

managing cardiac complications. Moreover, increased vulnerability to cardiovascular conditions

could be attributable to various social determinants of health, such as reduced access to


healthcare services, financial limitations, and limited social support. Finally, older adults with

heart failure may present atypical symptoms such as confusion, fatigue, or generalized weakness,

which could be mistaken for other conditions or overlooked. Therefore, declining physiological

reserve, comorbidities, and polypharmacy require a more comprehensive and targeted

intervention to improve therapeutic safety and efficacy.


The study proposes a customized patient education program to develop awareness and

knowledge of heart failure to improve self-management and, ultimately, positive clinical

outcomes. The proposed program is founded on the premise that older patients with heart failure

management occur mainly in out-of-hospital settings, which would benefit from self-

management. Some hospitalization cases may be avoidable due to missed or wrong doses,

improper diet, or other substances that may exacerbate the condition requiring medical care.

Healthcare staff participating in the proposed program are nurses in the cardiology department in

Home health Agency . They will be responsible for liaising with other healthcare professionals to

develop training pamphlets and customize them to each patient’s specific needs based on their

history and the medical information provided (AlHabeeb, 2022). The program prioritizes patient

education in medication compliance, symptom management, dietary guidance, regular

monitoring, and physical activities. The nurses can also liaise with community leaders, social

workers, resources, and support organizations to offer continuous aid and information to patients

and their careers. The intervention will take six to nine months and be customized to address the

unique requirements of the senior demographic. Therefore, the proposed intervention is patient

education to develop and improve heart failure self-management among older adults.


Theoretical Framework/Nursing Theory

The theoretical nursing framework to underpin the study, develop, and implement the

intervention is Kurt Lewin’s Change Theory. The model is a well-established theory in

organizational psychology and change management, which the present research adopts as the

theoretical foundation (Wojciechowski et al., 2016). Within the concept of treating chronic

illnesses like heart failure, Lewin’s Change Theory offers a valid and practical framework

emphasizing the importance of planned, proactive, and patient-centered approaches in resolving

complicated issues. Lewin’s Change Theory is ideal because the proposed patient education

program aims to modify the current care model by including patient education as an integral part

of treatment. The program also includes educating the patient, caregivers, and social workers to

assist older adults in managing heart failure in a home setting. Hence, Lewin’s theory provides a

foundation and manual for creating and implementing patient education. The idea that patient-

centered care should go beyond the traditional episodic healthcare contacts is at the core of

Lewin’s Change Theory (Wojciechowski et al., 2016). The Lewis framework promotes

changing how healthcare is delivered to become a proactive, planned system that helps patients

through self-management. Therefore, incorporating patient education into standardized heart

failure care requires proactive monitoring, cooperative decision-making, and self-management


Management of heart failure in older adults is problematic due to age-related physical

and mental deterioration, multiple medications, and comorbidities. However, the current care

model needs to recognize and incorporate the unique attributes of older adults, leading to

increased hospitalization cases and suggesting inadequate care delivery. Frequent hospital


admissions also increase the cost of care and the economic burden for the patient and family.

Consequently, the present study proposes patient education as a complementary intervention to

standard care to reduce hospitalization rates. Patient education can improve overall health and

socioeconomic outcomes by empowering the patient to self-manage the disease and reduce the

need for medical assistance.

Over the last few years, a growing body of the existing scholarly work has focused on the

prevalence of chronic heart failure (CHF), especially among older adults. For example, Manz et

al. (2022) contend that the risk of CHF increases dramatically with age and that older people are

more likely to suffer from this debilitating condition. Age-related cardiac muscle weakness and

decreased blood pumping efficiency cause fluid to accumulate in the lungs and other tissues.

CHF is a serious health problem that frequently necessitates hospitalizations and expensive

healthcare expenses since it impairs the heart’s ability to pump due to aging, hypertension, and

coronary artery disease. Among the reasons for hospital readmissions in patients with CHF are

noncompliance with treatment regimens and dietary restrictions, recurring infections, and repeat

cardiac episodes. Athilingam et al. (2019) also found that the complex nature of CHF requires

interventions that could help patients lower the risk of unnecessary hospital readmissions, even

as they improve the quality of their lives and avoid high medical costs. Even though the study

relied on findings obtained from a relatively small sample, its conclusions and recommendations

offer valuable insights into how CHF impacts patients’ clinical outcomes and overall quality of

life. These discoveries are undeniably significant and highlight critical aspects that healthcare

providers should focus on while attempting to understand CHF and its impact on older persons.


Furthermore, researchers used their findings to highlight some factors contributing to

inadequate CHF management among seniors in home healthcare settings. For example, Granata

et al. (2023) report that in certain circumstances, patients and caregivers are not effectively

informed about the ailment, its management, and the significance of following treatment

programs. Healthcare professionals frequently fail to adequately teach patients and caregivers

about CHF, how to manage it, and how crucial it is to stick to prescribed treatment plans.

Fundamental information concerning CHF cannot be delivered or understood when physicians

and patients/caregivers cannot effectively communicate. For instance, while explaining CHF

self-care to elderly patients who have difficulty understanding the language and instructions

used, clinicians may utilize sophisticated medical terminology. Without such knowledge, patients

with CHF may engage in poor self-care practices and find it challenging to comply with

medication prescriptions, thereby exposing themselves to an elevated risk of exacerbations (Chen

et al., 2022). Moreover, as Luhr et al. (2018) claim, the lack of proper communication skills

prevents clinicians from exchanging information with patients and guiding them in managing

CHF and its symptoms. For patients aged 65 and above , age-related hearing and cognitive

impairments can further impede them from obtaining guidance for managing CHF, making it

difficult for them to optimize their health needs. Addressing these issues can, thus, allow

healthcare providers to make a significant step in the right direction regarding managing the risk

and prevalence of CHF among older adults.

Multiple studies have also analyzed how healthcare providers can implement

comprehensive patient education programs targeting patients with an enhanced risk of CHF. Guo

et al. (2019) state in their article that efforts to implement a patient education program like a


hospital-community-family-based–based telehealth program (HCF-based) for older persons

should be preceded by an assessment to evaluate each patient’s requirements and limitations.

During the assessment, clinicians should consider issues such as patients’ health literacy and

cognitive abilities. Equally important, such initiatives should recognize the importance of

involving caregivers, as they often play a crucial role in supporting and assisting elderly CHF

patients in their daily care routines (Mathew & Thukha, 2018). The educational content used in

the program also needs to be tailored to align with the unique needs of patients 65 years and

above , including simplified language and visual aids. Using complex medical jargon could

impede healthcare providers from helping patients understand the content being taught to them,

despite their willingness to be proactive in managing their health needs. As Rice et al. (2018)

argue, investing in a multi-modal approach that combines several techniques, such as written

materials, verbal communication, and videos, could allow clinicians to overcome these

challenges and accommodate patients’ different learning styles and preferences. Hence, these

considerations should be a priority for healthcare providers when on helping older adults to

manage CHF.

As researchers investigate the effectiveness of using patient education programs, like

HCF-based telehealth programs for older adults, they have evaluated some of the primary

benefits of this program’s intervention and its impacts on the target population. Individualized

treatment plans, medication management, and way-of-life adjustments are among the

interventions addressed by this education program. Besides, unnecessary hospitalizations can be

avoided by utilizing telemedicine for ongoing monitoring and prompt actions. For example,

Jaarsma et al. (2020) obtained data from a large sample of patients and concluded that patient


education programs help patients adhere to treatment plans. When compared to their counterparts

who do not receive such education, patients who participate in these programs become better

positioned to follow the instructions furnished to them by their caregivers and avoid poor self-

care practices. Moreover, this strategy helps patients to observe dietary restrictions, lifestyle

modifications, and other recommendations provided to them by clinicians within home health

care settings (Mathew & Thukha, 2018). Patients with the necessary knowledge and abilities to

manage their disease at home can better manage their symptoms and avoid behaviors that could

otherwise expose them to exacerbations and lead to unnecessary re-hospitalization. Thus,

participating in patient education programs, such as HCF-based telehealth might assist older

people with CHF to improve their clinical outcomes and general quality of life despite the

hurdles that age brings.

Other studies have focused on how patient education programs like the HCF-based

telehealth programs can be augmented using modern technologies to optimize their efficacy,

particularly with regard to older adults with CHF. According to Bernocchi et al. (2018),

developments in tele-rehabilitation technology have allowed healthcare personnel to teach

patients with CHF from a distance and coach them on how to manage their symptoms without

relying on their caregivers. The researchers’ employment of a robust approach to derive their

conclusions, which are incredibly relevant to the PICOT topic, is a fundamental strength of this

study. However, due to the small sample size, the usefulness and generalizability of its findings

may be limited. Nonetheless, the study adds to clinician’s understanding of how healthcare

personnel might use modern tools to improve patient education in home health care settings.

These observations are similar to those of Athilingam et al. (2019), who stress that clinicians can


utilize mobile apps like the CHF Info App to educate CHF patients and send them medication

reminders. By taking advantage of these developments, healthcare providers can make the most

out of patient education programs and offer quality care to older adults struggling with CHF.

While the benefits of patient education programs are unquestionably profound, other

researchers have highlighted the potential drawbacks of this strategy, offering valuable insights

that could guide medical practitioners in helping older adults with CHF. For example, Awoke et

al. (2019) claim that implementing comprehensive patient education programs can be resource-

intensive, especially for health organizations with limited resources. When healthcare providers

decide to embrace such a program, they have to consider the availability of resources, including

funds and time to be used in training caregivers, obtaining the materials for educating patients,

and investing in modern technologies. Even though this study focused primarily on how patient

education programs impact older adults’ risk of readmission, it provides critical lessons that care

providers should take into account when designing and implementing the intervention. Besides,

Bernocchi et al. (2018) underscore how the process of tailoring educational materials to meet

older adults’ unique needs can be challenging. Healthcare providers have to navigate cognitive

impairments, language barriers, and varying levels of health literacy when designing such

programs. These observations demonstrate the need for clinicians to anticipate the potential

shortcomings of patient education programs and take active steps to mitigate these weaknesses as

they strive to improve the clinical outcomes of patients with CHF. They also indicate that future

research should evaluate long-term outcomes, optimal education frequency/duration, and

telehealth delivery methods. Comparing outcomes across diverse populations could help tailor

programs. Future studies should also examine effective ways to improve caregiver education and


involvement. Enhanced CHF education represents a valuable tool to limit complications,

improve quality of life, and reduce hospital readmissions for vulnerable older adults.

Other relevant aspects for healthcare providers to consider when employing patient

education programs to help older persons manage CHF include the obstacles associated with

modern technologies. Heiney et al. (2020) share the findings of a study that looked into how

clinicians might use smartphone apps to teach patients about controlling CHF symptoms.

According to the researchers, some patients in home healthcare settings, particularly those in

underprivileged neighborhoods, may lack access to smartphones or the Internet due to their low

financial status. These patients may also struggle to understand digital resources and may be

confused and frustrated as a result. Even though this study was conducted on African-American

seniors, the findings apply to all older people with CHF. Furthermore, Athilingam et al. (2019)

indicate that some patients may have technical difficulties, such as software malfunctions or

connectivity challenges, which may disrupt the learning process. These patients may also find it

difficult to acquire the necessary knowledge and skills to manage their health needs. Without the

personal touch associated with face-to-face interactions, technology-based education programs

may fail to address patients’ needs and concerns. Thus, as healthcare providers leverage these

technologies to increase the effectiveness of patient education programs, they should utilize a

patient-centered approach that would enable them to mitigate the intervention’s shortcomings.

Besides, addressing CHF necessitates using statistical data highlighting the complications

and readmission rates associated with the condition. Utilizing large-scale databases and

electronic health records can provide valuable insights. For instance, analyzing the frequency of

readmissions data, the reasons behind them, and the associated costs offers a comprehensive


understanding of the problem. Visual representations such as graphs and charts can effectively

convey this statistical information, aiding in determining patterns and areas that require targeted


Tackling CHF among older adults in Home Health Care settings is accompanied by

challenges and opportunities. As healthcare institutions delve deeper into the realm of patient

education programs, they must remain vigilant in tailoring interventions to suit the unique needs

of this vulnerable population. The path forward involves harnessing modern technologies while

recognizing their limitations and addressing resource constraints creatively and efficiently.

Future research must continue to illuminate the way, examining long-term outcomes, optimal

education strategies, and the role of caregivers in this intricate tapestry of CHF management.

These institutions can aspire to improve the lives of those battling CHF in their golden years by

weaving together knowledge, innovation, and compassion.


Implementation of Change in Home Health Care Setting

Addressing the complexities of Chronic Heart Failure (CHF) management in the aged

population necessitates transitioning towards a care strategy that is concentrated on the patient,

achieved through exhaustive education programs designed for the patients themselves. The

execution phase is vital in bringing to realization the latent advantages of this suggestion.

Moreover, the power of technology, embodied by telehealth infrastructures and mobile software,

can serve to magnify the depth and efficacy inherent in patient learning opportunities (Heiney et

al., 2020; Bernocchi et al., 2018). Efficacious management of CHF in older generations can be


realized through the judicious intersection of conventional caregiving methodologies and

technological progress, promoting a broader, more persistent approach overall.

Description of Practice Change

The proposed alteration in procedures concentrates primarily on enlightening aged

patients 65 years and above suffering from Congestive Heart Failure (CHF), who are

beneficiaries of a home health care scheme. To facilitate this change, a blend of written

documents, real-time meetings, multimedia guidance, along with where applicable, telehealth

offerings would be deployed. This all-inclusive tactic is designed to adapt to various methods of

learning and inclinations, thus, confirming that every patient acquires information in a way that

is more readily comprehensible and operative to them. By underscoring the part of the caregiver,

the change ensures uniform execution of these newly assimilated strategies, not only benefitting

the patient’s generous health dividends but also optimizing health outcomes for these aging


Literature Support and Leadership Skills

Skills that define leadership such as the ability to communicate effectively, being

adaptable, making decisions efficiently, and enabling empowerment are pivotal. According to a

theory elaborated upon by Wojciechowski et al. (2016), the Change Theory developed by Kurt

Lewin, which serves as a bedrock theory in managing changes, validates the importance of

proactively emphasizing patient-centred care in long-term illnesses such as CHF. A scrutiny of

the related literature reveals both the significance and potential impediments this approach might

encounter, thereby providing insightful guidance for actualizing such interventions.

Implementation and Assessment


Time Frame

The roll-out strategy, spanning six to nine months, is structured in distinct phases. The

initial two months are reserved for raising awareness and instigating basic educational

undertakings. This early educational period will seamlessly flow into the following months that

amplify the depth of learning experience, address queries, incorporate valuable technological

tools, and ultimately, quantify the achieved results.


The focal point of this intervention is home health care, leveraging the convenience and

comfort of familiar settings for the aged and the straightforward availability for care providers.

Provision of health services at home fosters an atmosphere conducive to learning. Frequently, the

elderly exhibit increased comfort and receptiveness within their personal living spaces, which

reinforces optimal comprehension of information.


The principal individuals engaged in this study will be patients aged 65 and above, their

caretakers, nursing personnel, and other applicable healthcare professionals associated with the

Home Health Agency. The inclusion of community representatives can also offer valuable

perspectives relating to cultural and socioeconomic elements that influence patient care, thereby

enhancing the intervention’s flexibility. Regular feedback garnered from these actors plays a

crucial role in refining the strategy, and guarantees that it remains attuned to the ever-changing

needs and trials encountered in home healthcare environments.



In their study, Granata and his colleagues (2023) pointed out that the deficiency in the

exchange of information between patients, caregivers, and healthcare practitioners can emerge as

a formidable barrier. Other possible impediments may include the deteriorating cognitive

abilities of patients, which might compromise their capacity to grasp new knowledge.

Technological hindrances, especially with the older population, language disparities, and an

anticipated reluctance to accept change can further intensify these challenges. Further

complications can stem from logistic issues like guaranteeing uninterrupted access to necessary

resources or synchronizing agendas for in-person engagements, which could potentially disrupt

the flawless execution of the program.

Internal and External Factors

Factors intrinsic to the health system encompass the preparedness of medical staff to

adopt novel methodologies, resource accessibility, and the active participation of patients.

Outwardly, the effectiveness of the incorporation is shaped by endorsement from community

figureheads, the existence of indispensable technological apparatus, and the economic conditions

of the patients undergoing care (Guo et al., 2019). Furthermore, the influence of outside

regulating principles and evolving healthcare norms should also be accounted for as they

intrinsically play a fundamental role in establishing the degree of adaptability and ultimate

success of the contemplated strategy.

Evaluation of Change Process

The key to successful implementation is continuous assessment.



The primary criterion of success will be identified as a decline in the rates of hospital

admissions over a span of six to nine months. Nevertheless, several secondary indicators merit

attention as well, such as the level of satisfaction of both the patient and caregiver, the degree to

which they comprehend instructional materials, as well as their commitment to following

recommended medication regimens and lifestyle choices. In terms of reducing hospital

admissions, vigilance in observing patient commitment, compliance with medicinal instructions,

and regular, preemptive healthcare monitoring are all crucial underpinnings as well.


The assessment approach will be comprehensive. Patient history will be tracked to

discern instances of hospital reentry, whereas questionnaires enlisted will illuminate perceptions

of both patients and caretakers regarding the educational process. Regular health examinations

will provide an understanding about the overall health improvement of the patients. Digital

health logs serve as a resource to observe the evolution of patient health. Tailored questionnaires

can be utilized to estimate the efficiency of the implemented educational approach.

Stakeholder Involvement

Invited stakeholders

Prominent participants in this context consist of senior patients suffering from congestive

heart failure (CHF), their respective support systems, nursing teams specializing in cardiology,

leaders within the community, and those who hold managerial positions in Home Health Agency.

Far exceeding the direct sphere encompassing CHF patients and their caregivers, the intention is

to engage key figures within the community, who can effectively advocate for this cause within

their particular domains. Collaborating with technology affiliates, the aim is to leverage their


telehealth services; additionally, pharmaceutical collaborators could impart valuable

understanding pertaining to adherence to prescribed medication.

Presentation to Stakeholders

The conveyance of information will be undertaken during formal meetings, utilizing

visual supports such as diagrams, plots, and motion pictures, to offer an exhaustive

comprehension of the suggested modification, its merits, and potential difficulties. Using

granular data, such as the rise in CHF-related hospitalizations from 1,060,540 in 2008 to

1,270,360 in 2018 as pointed out by Clark et al. (2022), can underscore the urgent need for the

change. Addiitonally, executing a sequence of engaging exchanges, potentially comprising

personal accounts from patients who have experienced palpable improvements from this form of

instruction, could prove to be advantageous.


The task of managing congestive heart failure (CHF) in the senior population necessitates

a multi-faceted approach that puts patients first—a strategy underscored in this research project.

It begins by recognizing that the elderly are disproportionately affected by heart failure,

underscoring the urgent need for rethinking and improving home healthcare via personalized

patient education. The review of existing literature gives a balanced viewpoint, establishing a

clear necessity for flexible methods and detailing the existing obstacles, such as the cognitive

decay often encountered among patients and the restrictions arising from technological

limitations. The utilization of cutting-edge technology, including telehealth solutions, is projected

to play a pivotal role, but the peculiar challenges faced by older adults must be taken into

account in its dispensation. A thorough involvement of all relevant stakeholders is critical; these


include not just the patients but the broad range of caregivers, healthcare service providers, and

wider community bodies—harnessing a truly holistic model. By consolidating patient-focused

care, technological innovation and regular feedback, it aims not just to manage CHF, but to

remarkably enhance the life quality for those in the golden years, ensuring that they have access

to all-inclusive care specifically altered for their essentials, right from their residences.



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Issues in Nursing, 21(2), 4.

  • Heart Failure Management
  • Significance of the Practice Problem
  • Purpose Statement
  • PICOT Question
  • Describe the Vulnerable Population
  • Proposal
  • Theoretical Framework/Nursing Theory
  • References

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