Chamberlain College of NursingNR451 RN Capstone Course
Capstone Project Milestone 1:
Practice Issue and Evidence Summary Worksheets
Student Name: Date:
1. Refer to the guidelines for specific details on how to complete this assignment.
2. Type your answers directly into the worksheets below.
3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.
4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.
Practice Issue Worksheet
|List the topic and include the citation for the systematic review you have selected:
The topic is Hospital Readmissions.
Citation for systematic review is Hall, K. K., Chang, A. B., & O’Grady, K.F. (2016). Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol). Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD012315. DOI: 10.1002/14651858.CD012315.
Chamberlain Library Permalink:
|What is the practice issue you have identified related to the topic you have chosen?
The rehospitalization trend after discharge on grounds of the same illness which prompts the hospital personal to come up with procedures that would help reduce such occurrences.
|Define the scope of the practice issue:
The clinical issue in this case is the worrying trend in readmissions from diagnoses such as tracheostomy. It is a common issue in several facilities that deal in inpatient and outpatient facilities.In this case, it is limited to the recurring and heightened cases of children rehospitalization for respiratory illnesses that they had already been diagnosed and treated for. The scope of time is 60 days and the various interventions proposed are with regards to amending the discharge plans appropriately.
|What is the practice area?
___ Clinical___ Education
___ Other (List):
|How was the practice issue identified?(check all that apply)
___ Safety/risk management concerns
___ Unsatisfactory patient outcomes___ Wide variations in practice
___ Significant financial concerns
|___ Difference between hospital and community practice
___ Clinical practice issue is a concern___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
|Describe the rationale for your checked selections:
The issue of readmissions after a diagnosis and discharge can be noted through managementconcerns since they are in a position to monitor patient activity and take note of repeat patients. In addition, the very fact that there was a large number of readmissions in the Unite demonstrated that the outcomes of these treatments were unsatisfactory and the patients themselves were not impressed that they had to return for the same procedures to conducted when they had already paid for such services. Finally, the manner in which the patients were discharged was wanting. They were not educated in detail over what their treatment would look like after leaving the facility. No detaileddescriptions of warning signs were offered, this in itself was a point of concern. The remedy was focused on discharge procedures because it is at this point that the patient’s seem to get lost and lose contact with the facilty.
|What evidence must be gathered? (check all that apply)|
___ Literature search
___ Expert Opinion___ Patient Preferences
___ Clinical Expertise
___ Financial Analysis___ Standards (Regulatory, professional, community)
|Describe the rationale for your checked selections:
Literature research is essential in gathering data on the various trends that have been observed by other scholars in the rates of readmission on hospitals and specifically to certain diseases.Additionally, guidelines from scholars and approved manuals are important as they demonstrate what is considered the best practice in such cases. Expert opinion would be gathered from hospital management, nurses and doctors, it would ne invaluable in giving a localized view of the issue at the hospital level. Experts are often at par with current research and have first hand experience in the field. My clinical expertise within the duration I was at the facility as well as that of fellow staff members is important as well. It may not be documented but it can shed a light on how things are implemented on the ground with regards to diagnoses, discharge procedures and readmission rates. Regulatory standards and legal provisions are paramount in this research since they show the direction that facilities are expected to turn in case of certain cases. They could demonstrate weakness in facility practices or they themselves could have fundamental flaws. The regulations that are relevant are those that pertain to hospital discharge procedures and cases of return patients. These regulations and procedures can be from the government or industrial bodies and policies.
Directions: Please type your answers directly into the worksheet.
|Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
The practice problem is rehospitalization for the same diagnosis within two months. The patients (children) with chronic respiratory conditions have been noted to return to the facilityafter 60 days of discharge. This is a significant problem since over 60% of the patients are affected. This is a problem that has had the registered nurse’s attention and they have hypothesized on some of the possible causes that may contribute to this phenomenon.
|Type the complete APA reference for the systematic review article you chose from the list provided, It must be relevant to the practice issue you described above.
Hall, K. K., Chang, A. B., & O’Grady, K.F. (2016). Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness (Protocol). Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD012315. DOI: 10.1002/14651858.CD012315.
Chamberlain Library Permalink:
|Identify the objectives of the article.
The article is a protocol that evaluates the effectiveness of discharge plans that are assigned to individual case workers and non-caseworker plans as far as prevention of hospitalization of children with chronic respiratory diseases are concerned, in particular, asthma and bronchiectasis.
Provide a statement of the questions being addressed in the work and how they relate to yourpractice issue:
The questions being tackled in the article are whether case assigned discharge plans are effective as opposed to self-management plans in preventing rehospitalization stemming from exacerbated chronic illnesses in children. This relates to my work because I am conducting a case at my work facility that examines the potential cases for readmission for the same diagnosis in children with chronic illnesses.
|Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
The intervention that the authors suggest to improve patient outcomes is the assignment of a caseworker to a patient upon admission. This would work through a variety of ways that include;enhancing the communication between the patients and service providers, a rapport that improves efficacy of self-management plans. This approach also allows for coordinated care beyond the medical facility and into the patient’s home. Finally, it would result in improved education in this area and in the health industry as a whole.
Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper.
The article found that traditional discharge plans are often based on the medical staff’s evaluation of a patient and his/ her condition. They fail to accommodate for other aspects of the condition such as emotions that may impact the patient. These are common in an environment away from the controlled hospital scenario. On the other hand, the article found that Self-management plans are an invaluable improvement over the traditional systems of hospital discharge but still lacking in the aspect of follow up procedures that allow patients to benefit from first hand experience and help. The authors finalize by establishing that the case assigned model might work mush better since it is patient specific and allows for a follow up session at home, which is dynamic and important in tackling possible issues that may arise and prevent rehospitalization of the children. The evidence offered for this data and interventions is in the form of references to appropriate journals and credible authors. It is an exploratory research that relies of preestablished information from credible sources.
|Outline evidence-based solutions that you will consider for your project.
The evidence based solutions that I would consider for my project are;
use of the case assigned physician approach.
Educating the patients on the approaches that they would employ in managing the chronic conditions at home, in this case, the parents would be the ones given the education on how to take care of their children.
Another solution is providing avenues for prompt reporting form the patients to the assigned officers. This helps avert situations where the guardians are not sure how to handle the patient’s condition.
Finally, I would advocate for adherence to procedures and medication as a viable method of halting or reducing the issue of rehospitalization.
Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.
The limitation to the study performed is the fact that it has relied heavily on previously established information and there are no fresh experimentsconducted by the authors. This means that what I would find within the research has already been covered in the literaturereview section of my paper. As a matter of fact, some of the data is about 8 years old and some is from 2001. The latest data used is from 2016. This would mean that I would have to find current data on the issue from reliable journals that have been published lately. Additionally, the authors discuss how their approach might work, as opposed to whether it actually works. This means that it has not been tested but the probability of it working is high, according to the author. This leaves such information in an unreliable context that may not be useful for this research. However, the paper is useful in pointing me in the direction which the research on the topic is focused.
|NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 4/22/17 GH||6|
Week 4: Capstone Project: Milestone 2: Design Proposal (graded)
CAPSTONE PROJECT MILESTONE 2: DESIGN FOR CHANGE PROPOSAL GUIDELINES
You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.
This assignment enables the student to meet the following course outcomes.
- CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO1)
- CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)