Annotated Bibliography of a Healthcare Case Study for 2806NRS

This annotated bibliography, prepared by a student, focuses on a healthcare case study involving an elderly patient with chronic heart failure. The assignment selects and annotates three research articles providing evidence-based guidance for the patient's care. The articles cover clinical guidelines for heart failure management, psychosocial interventions, and understanding end-of-life care. The author justifies the selection of each article, highlighting their strengths and relevance to the case. The bibliography then offers clinical recommendations for the patient, including pharmacological and non-pharmacological interventions such as medication, cognitive behavioral therapy, and motivational interviewing. The importance of nursing support and patient education, especially regarding palliative care, is also emphasized. The assignment demonstrates the application of evidence-based practice in healthcare settings, providing a comprehensive overview of the patient's condition and treatment options.

Running head:HEALTHCARE
Annotated Bibliography of the Case Study
Name of the Student
Name of the University
Author Note

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Annotated Bibliography
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S.,
Hopper, I., Kistler, P., Briffa, T. G., Wong, J., Abhayaratna, W. P., Thomas, L.,
Audehm, R., Newton, P. J., O’Loughlin, J., Connell, C., & Branagan, M. (2018).
National Heart Foundation of Australia and Cardiac Society of Australia and
New Zealand: Australian clinical guidelines for the management of heart failure
2018. Medical Journal of Australia, 209(8), 363-369.
https://doi.org/10.5694/mja18.00647
This paper presents the official guideline of clinical diagnosis and management of
Chronic Heart Failure as described by the National Heart Foundation of Australia as well as
the Cardiac Society of Australia and New Zealand. The risk of Heart Failure can be lowered
by reduced blood pressure and lipid content. Diagnosis is usually confirmed by The
management guidelines include the use of inhibitors of Angiotensin-converting enzymes,
beta-blockers as well as receptor antagonist of mineralocorticoids. These medications
increase the chances of better outcomes in patients with reduced blood flow from the
ventricles. Additional options may also include cardioverter defibrillators that can be
implanted, cardiac resynchronisation therapy and many others. A multidisciplinary team is
often useful in the efficient management of patients of heart failure. The nursing models for
medication optimisation should also be considered seriously for the efficient management of
the disease.

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Im, J., Mak, S., Upshur, R., Steinberg, L., & Kuluski, K. (2019). ‘The Future is
Probably Now’: Understanding of illness, uncertainty and end‐of‐life discussions
in older adults with heart failure and family caregivers. Health Expectations,
22(6), 1331-1340. https://doi.org/10.1111/hex.12980
This paper is a descriptive qualitative study that describes the understanding and
perceptions of end-of-life care amongst the patients of heart failure and their family and
caregivers. It showed that the perceptions were based on the personal experiences of the
patient during the illness. While the participants of the study were well-versed the
management steps of the disease, many seemed to be unaware and unprepared of the
consequences. The patients eventually adjusted to the challenges of the illness and their
opinions and thoughts regarding the illness altered as well. The major factor that influenced
the response of the participants was the uncertainty about the progression of the disease. Most
of them did not fathom the fact that the clinical manifestations of the disease meant that they
were progressing towards the end of life. Most of the patients who took part in this study had
not engaged in the prior discussion about end of life. This showed that having detailed
theoretical knowledge of the disease does to ascertain realistic perceptions.
Jiang, Y., Shorey, S., Seah, B., Chan, W. X., Tam, W. W. S., & Wang, W. (2018,
2018/02/01/). The effectiveness of psychological interventions on self-care,
psychological and health outcomes in patients with chronic heart failure—A
systematic review and meta-analysis. International Journal of Nursing Studies,
78, 16-25. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2017.08.006
The purpose of this paper is to assess the efficiency of the psychosocial interventions
administered to patients of Heart Failure aimed at improving their self-care and ensuring
better psychological outcomes. It is a systematic review and meta-analysis conducted by

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reviewing a total of twenty-nine articles that included twenty-five studies conducted among
3837 patients in total. It showed that psychosocial interventions had a positive effect on the
self-care of patients who did not suffer from depression or cognitive impairment of similar
comorbidities. However, these interventions were not effective over a long time and the
benefits diminished with time. Promoting self-care is one of the most important aspects of the
management of heart failure. The nurses have the critical responsibility of educating a patient
about the self-care and also prevention of reemission. They must also administer
interventions such as cognitive behavioural therapy or motivational interview. Hence, more
nurses must be trained to do the same.
Justification for Articles Chosen
According to Case Study, John is an eighty-year-old man who has a history of chronic
heart failure due to ischemic cardiomyopathy and hypertension. He has been presented in the
facility with tachycardia, peripheral oedema and reported of deteriorating condition over the
past few days. The above three articles related to his condition has been chosen.
The first article has been chosen as it provides a clear guideline on how to take care of
the patients with heart failure, both in terms of pharmacology and some non-pharmacological
interventions (Atherton et al., 2018). This guideline has been developed by the National Heart
Foundation of Australia and Cardiac Society of Australia and New Zealand. This guideline
has been endorsed by a series of official healthcare and government organisations including
Australian Commission on Safety and Quality in Health Care (ACSQHC) and Royal
Australian College of General Practitioners (RACGP), which ensures the validity of the
guideline and the fact that it has been widely accepted the gold standards of management
guidelines for patients of heart failure (heartfoundation.org.au., 2020). The major strength of
this health practice guideline is that it has been developed from contemporary evidence and

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has been graded according to the strength of the evidence. It is highly likely that this
guideline ensures a high benefit-to-harm ratio in the majority of cases (Atherton et al., 2018).
It is based on high quality of clinical evidence. Thus, it is the best step to take while caring
for a patient with heart failure based on evidence-based practice. This guideline is applicable
in case of John as it provides the clear steps for management of heart failure symptoms via
medications in the patients with reduced blood flow from the ventricles. It adds information
on what exactly to do for John’s condition in order to reduce his symptoms and stabilise him.
The paper by Jiang et al. (2018) provides information on the psychosocial
interventions targeted towards improving self-care and psychological health in patients with
heart failure. The major strength of this paper is that it is a systematic review and meta-
analysis. Systematic Reviews are considered to be the highest level of evidence in the
healthcare field and are the basis of most evidence-based practice as it brings all the
necessary information to the healthcare professionals in a single article (Gopalakrishnan &
Ganeshkumar, 2013). This systematic review was conducted by reviewing twenty-nine
articles, of which twenty-five were studies conducted among 3837 patients. This is a very
large sample size, and the risk of bias was assessed via the use of Cochrane Collaboration
tool (Jiang et al., 2018). This paper provides highly generalizable and reliable data that can be
considered to be valid in most cases of patients with heart failure. In John’s case, this data
can be used after he has been stabilised in accordance with the pharmacological interventions.
He needs the psychosocial interventions for an improved quality of life and understanding of
better self-care. Cognitive Behavioural Therapy and Motivational Interview can go a long
way towards making them better psychologically and supporting them. This paper also
highlights the need for proper nurse training and the importance of psychosocial interventions
in patients of heart failure.

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The final paper that has been selected is a descriptive qualitative analysis by Im et al.
(2019). Usually, data collected from a single qualitative study has an Evidence Level VI
(Libguides.winona.edu., 2020), and is not considered to be highly valuable in terms of
clinical practices. However, it is used as evidence only when the scenario of the qualitative
study population is similar to the patient (Bradshaw, Atkinson & Doody, 2017). The strength
of this paper is that it provides insight from not only the patient’s perspective but also the
caregivers as well. The paper described the education the patients and their caregivers had in
regards to end of life care in patients of heart failure. As for relevance, in this case, John is an
80-year-old man with a history of heart failure and hypertension. It has been seen that
patients aged eighty or above with heart failure have a low life expectancy (Díez-Villanueva
& Alfonso, 2016). Based on the study, it has been seen that the patients are often not ready.
So, it is high time that John and his caregivers must be educated in this aspect, and the
qualitative descriptive study describes the ideal way to go about it.
Recommendations for Clinical Practice
For John, there are certain clinical recommendations that can be made to ensure the
best care and quality of life. The first step is to administer the appropriate drugs to him.
Aldosterone antagonists have been proven to be useful in treating elderly patients with heart
failure. It has shown decreased mortality in most patients. However, John should be
monitored closely to reduce the risk of side effects, such as hypotension or renal dysfunction
(Guerra et al., 2017). Beta-Blockers are also useful as a therapeutic approach. Beta-blockers
may also be important for the patient. It has proven to be helpful in stabilising patients with
tachycardia and hence may be administered to John (Gopinathannair & Olshansky, 2015).
After John has been stabilised with the help of medications, he can be administered some
non-pharmacological interventions such as cognitive behavioural therapy (Lundgren,
Andersson & Johansson, 2015). The motivational interview may be combined as well

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(Masterson Creber et al., 2015). It must be remembered that this is to give him the best
quality of life with his condition in his age. He likely does not have very long to live, and
hence he must be prepared for palliative care. He and his caregivers must be explained the
consequences in an empathetic way. Nursing support and education are extremely important
in palliative care and patients with Heart Failure in general (Diop et al., 2017).

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Reference
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I.,
Kistler, P., Briffa, T. G., Wong, J., Abhayaratna, W. P., Thomas, L., Audehm, R.,
Newton, P. J., O’Loughlin, J., Connell, C., & Branagan, M. (2018). National Heart
Foundation of Australia and Cardiac Society of Australia and New Zealand:
Australian clinical guidelines for the management of heart failure 2018. Medical
Journal of Australia, 209(8), 363-369. https://doi.org/10.5694/mja18.00647
Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a qualitative description
approach in health care research. Global qualitative nursing research, 4,
2333393617742282. https://doi.org/10.1177%2F2333393617742282
Díez-Villanueva, P., & Alfonso, F. (2016). Heart failure in the elderly. Journal of geriatric
cardiology : JGC, 13(2), 115–117. https://doi.org/10.11909/j.issn.1671-
5411.2016.02.009
Diop, M. S., Rudolph, J. L., Zimmerman, K. M., Richter, M. A., & Skarf, L. M. (2017).
Palliative Care Interventions for Patients with Heart Failure: A Systematic Review
and Meta-Analysis. Journal of palliative medicine, 20(1), 84–92.
https://doi.org/10.1089/jpm.2016.0330
Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic Reviews and Meta-analysis:
Understanding the Best Evidence in Primary Healthcare. Journal of family medicine
and primary care, 2(1), 9–14. https://doi.org/10.4103/2249-4863.109934
Gopinathannair, R., & Olshansky, B. (2015). Management of tachycardia. F1000prime
reports, 7, 60. https://doi.org/10.12703/P7-60

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Guerra, F., Brambatti, M., Matassini, M. V., & Capucci, A. (2017). Current therapeutic
options for heart failure in elderly patients. BioMed research international, 2017.
https://doi.org/10.1155/2017/1483873
heartfoundation.org.au. (2020). Heart failure. Retrieved 12 April 2020, from
https://www.heartfoundation.org.au/for-professionals/clinical-information/heart-
failure-professionals.
Im, J., Mak, S., Upshur, R., Steinberg, L., & Kuluski, K. (2019). ‘The Future is Probably
Now’: Understanding of illness, uncertainty and end‐of‐life discussions in older adults
with heart failure and family caregivers. Health Expectations, 22(6), 1331-1340.
https://doi.org/10.1111/hex.12980
Jiang, Y., Shorey, S., Seah, B., Chan, W. X., Tam, W. W. S., & Wang, W. (2018,
2018/02/01/). The effectiveness of psychological interventions on self-care,
psychological and health outcomes in patients with chronic heart failure—A
systematic review and meta-analysis. International Journal of Nursing Studies, 78,
16-25. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2017.08.006
Libguides.winona.edu. (2020). Research Hub: Evidence Based Practice Toolkit: Levels of
Evidence. Retrieved 12 April 2020, from https://libguides.winona.edu/c.php?
g=11614&p=61584.
Lundgren, J., Andersson, G., & Johansson, P. (2015). Can cognitive behaviour therapy be
beneficial for heart failure patients?. Current heart failure reports, 12(2), 166-172.
10.1007/s11897-014-0244-2.
Masterson Creber, R., Patey, M., Dickson, V. V., DeCesaris, M., & Riegel, B. (2015).
Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF): study

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design and methods. Contemporary clinical trials, 41, 62–68.
https://doi.org/10.1016/j.cct.2014.12.019