Emma is assigned to care for a 64-year-old patient readmitted with heart failure (HF). Emma recognizes the patient’s name during shift report as the reporting nurse 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 HF exacerbations but is concerned by the dismissive comments by her peer. She is determined to spend time with this patient on this admission and find out more about his home environment, support system, 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 engages in a conversation with the client about his dietary habits at home. He reports that his wife passed away one year ago from breast cancer, and he has been preparing his own meals since that time by using easy-to-prepare and 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 instruction and further education about monitoring his fluid retention with daily weights. He seems engaged in exploring different food preparations and was unaware that foods could exacerbate his heart failure. When Emma asked 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 because the print was so small. Emma reflects on how preventative education opportunities were missed and increased costs were incurred by the patient and the health care organization as a result.