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Professor and class,
The approved systematic review I decided to go with discharge plans to prevent hospital readmission for acute exacerbation in children with chronic respiratory illness.
Question: How does discharge planning affect children diagnosed with chronic respiratory illness, re hospitalization rates in a 60 day period?
P- Children diagnosed with chronic respiratory illness.
I- Detailed discharge planning upon initial hospitalization period.
C- No discharge teaching during initial hospitalization.
O- Re hospitalization within 60 days period.
T- Time 60 days.
In the past year the home health agency that I’m currently employed was granted permission to start providing services for pediatric patients. Within this population we serve the vast majority suffer from chronic respiratory diseases. The clients diagnosis include tracheostomy, ventilator dependency and oxygen dependency. A trend observed among several patients is re hospitalizations for the same diagnosis within a few months. Even though discharge instructions is provided via paper documentation no formal teaching is completed per parents verbalization during the hospitalization period. My view of the lack of education / teaching is due to the diagnosis being chronic, discharge planners may assume parents are knowledgeable. Tools that I utilize during the teaching period are reinforcement of disease process is certainly required to prevent re hospitalizations of chronic respiratory illness patients. Detail sign and symptoms to monitor on a daily basis along with vital signs parameters as a guide. The importance to report change in condition to MD immediately in order not to delay early intervention preventing hospitalization. Furthermore new and improved treatments can help with managing chronic respiratory diseases at home. Documenting daily activities can assist in assessing when change in condition initially occurred. The RN assessment following hospitalization reveals parents / guardians require detail teaching and reinforcement of caring for children diagnosed with chronic respiratory diseases at home. Adherence to medications, follow up with specialist, infection control methods and precautions are always provided upon my assessment in efforts to prevent re hospitalization.
Research gap is when inadequate data retricts potential to attain a conclusive resolution to proposed evidence based questions. ( Elsevier, 2013). Gap happens between current data and immediate day to day clinical practice.
References:
Chamberlain College of Nursing. (2018). NR-451 Week 2: Characteristics of Nursing Practice [Online Lesson]. Downers Grove, IL.
Elsevier B. V ( 2013). The theory-practice gap and skill acquisition : Collegian, Volume 18, Issue 2, PP 93-98.
ReplyReply to Comment
Pauli PROFESSOR’S RESPONSE AND FEEDBACK TO ORIGINAL ASSIGNMENT.
Jan 11, 2018Jan 11 at 9:04am
Manage Discussion Entry
LucilleNice job on your post and exploring the issue of re- admissions as related to children with chronic respiratory disease (Tis the season for wheezing!). Will you be using the Hall systematic review as the basis for your project then? When you progress into the milestones you will want to include the readmission rates on your unit or at your facility as well as how those rates compare to national benchmarks. This data will support the claim that an issue exists. Your nurse manager can provide this information, or obtain this information for you. In such a case, you will use “personal communication” as your APA citation. Here are some additional resources that you may find beneficial for this topic:
https://www.ahrq.gov/professionals/systems/hospital/red/toolkit/redtool5.htmlLinks to an external site.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128446/Links to an external site.
https://www.cms.gov/Links to an external site.
http://hospitalmedicine.ucsf.edu/downloads/assessing_the_impact_of_nurse_post-discharge_telephone_calls_harrison.pdfLinks to an external site.
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.htmlLinks to an external site.
http://www.ihi.org/Topics/Readmissions/Pages/default.aspxLinks to an external site.
https://pso.ahrq.gov/TopicsLinks to an external site.
https://www.medicare.gov/hospitalcompare/readmission-reduction-program.htmlLinks to an external site.
https://www.ahrq.gov/sites/default/files/publications/files/medreadmissions.pdfLinks to an external site.
https://www.ahcancal.org/quality_improvement/qualityinitiative/Pages/Hospital-Readmissions.aspxLinks to an external site.
https://www.healthypeople.gov/Links to an external site.Best Regards,Dr. Valerie Pauli
ReplyReply to Comment
This is the original question the assignment should be based on, included is the professors response to the question. ADDITIONAL INFORMATION BELOW.
Week 3: Capstone Project: Milestone 1: Practice Issue and Evidence Summary Worksheet (graded)
Submit Assignment
Due Sunday by 11:59pm
Points 175
Submitting a file upload
Capstone Project Milestone 1: Practice Issue and Evidence Summary Guidelines
Updated 11/14/2017
Purpose
Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO4)
CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO8)
Due Dates
Milestone 1 consists of the completion of ONE form with two worksheets called the Practice Issue and Evidence Summary Worksheets. (Links to an external site.)Links to an external site. Complete both worksheets and submit the form by Sunday, 11:59 p.m. MT at the end of Week 3.
Points
Milestone 1 is worth 175 points (75 points for the Practice Issue and 100 points for the Evidence Summary).
Practice Issue Worksheet Directions
A tutorial with tips for completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=4905b26a67572323c11b839e3251c96a (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site.
Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from the List of Approved Systematic Reviews (Links to an external site.)Links to an external site..
Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected. THE ONE I SELECTED IS ABOVE.
Use the worksheet to document the practice issue presented and approved by your instructor in the Week 2 Discussions.
Your practice issue will be the same for all three Milestone assignments in this course.
Please type your answers directly into the worksheet.
Evidence Summary Worksheet Directions
Develop an evidence summary by following the grading criteria below.
Document this on the evidence summary portion of the worksheet.
You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.
Please type your answers directly into the worksheet.
**Academic Integrity Reminder**
Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.
By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.
Please see the grading criteria and rubrics on this page.
NOTE: Please use your browser’s File setting to save or print this page.
Rubric
NR451_Milestone1
NR451_Milestone1
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomePractice issue statement, scope of practice, practice areaIdentifies a Practice issue statement that is an independent nursing decision, and is relevant to the systematic review topic chosen from among the list provided in the course. Describes the scope of practice issues. Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminate the falls? This is where you begin your initial search into the problem or practice issue identified. Identifies the practice area.
20.0 pts
Practice issue is identified based on the systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is fully described. Practice area identified.
18.0 pts
Practice issue is identified but is not clear, however it is based on the systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is described in simple terms. Practice area identified.
16.0 pts
Practice issue is identified but is not clearly related to a nursing practice issue, however it is based on the systematic review topic chosen. Practice issue is not an independent nursing decision. Scope of practice issue is described but is not logical in comparison to Practice Issue described. Practice area identified.
8.0 pts
Practice issue is unclear. Practice issue is not based on the systematic review topic. Practice Issue is not an independent nursing decision. Scope of practice issue is not described. Practice area identified.
0.0 pts
Practice issue is not identified; practice issue is not an independent nursing decision; scope of practice issue is not described; practice area is not identified.
20.0 pts
This criterion is linked to a Learning OutcomePractice issue identification, rationale for selectionsIdentifies how rationale behind how the practice issue was selected as a practice issue/problem Documents the practice issue in a logical manner.
35.0 pts
Documents how the practice issue was identified. Rationale for responses is logical and described thoroughly.
33.0 pts
Documents how the practice issue was identified. Rationale for responses is logical and briefly described.
30.0 pts
Documents how the practice issue was identified. Rationale for responses is somewhat logical and vaguely described.
15.0 pts
Vaguely describes how the practice issue was identified. Rationale for responses is somewhat logical and vaguely described.
0.0 pts
Does not document how the practice issue was identified. Rationale is not completed. This section of the form is blank.
35.0 pts
This criterion is linked to a Learning OutcomeTypes of evidence to gather, rationale for selectionsIdentifies and documents types of evidence that must be gathered for review of the Practice Issue. Describes rationale for each type of evidence that is selected.
20.0 pts
Identifies and documents what types of evidence is needed for review. Thoroughly describes rationale for all checked types of evidence selected.
18.0 pts
Identifies and documents what types of evidence is needed for review. Briefly describes rationale for all checked types of evidence selected.
16.0 pts
Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence.
8.0 pts
Does not document more than one type of evidence that is needed for review and does not include rationale for selected type of evidence.
0.0 pts
Does not document types of evidence or rationale.
20.0 pts
This criterion is linked to a Learning OutcomePractice problemStates practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms. Describes practice setting in measureable terms. Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?
10.0 pts
-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is identified -Magnitude of problem is discussed. -The practice issue is stated in measurable terms.
9.0 pts
-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is discussed. -The practice issue is stated in measurable terms.
8.0 pts
-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated in measurable terms.
4.0 pts
-Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated but not measurable.
0.0 pts
-Practice problem is not in own words -There are no references to the population of interest. -Setting and magnitude of problem is not discussed -The practice issue is not stated in measurable terms.
10.0 pts
This criterion is linked to a Learning OutcomeSource of evidenceIdentifies a source of evidence that is a nursing topic that is the subject of a systematic review article. Provides a complete reference for the systematic review article that was chosen from the list provided.
20.0 pts
-Source is a Systematic Review article chosen from the approved list. -Complete APA formatted reference is given for Systematic Review article with no errors. -The source must be relevant to the practice issue identified.
18.0 pts
-Source is a Systematic Review article chosen from the approved list. -A reference is given, but it has APA formatting errors. -The source must be relevant to the practice issue identified.
16.0 pts
-Source is a Systematic Review article chosen from the approved list. -No reference is provided. -The source must be relevant to the practice issue identified.
8.0 pts
-Source of evidence is a research article or systematic review no on the approved list. -A reference for the article or systematic review is given. -The source is not relevant to the practice issue identified.
0.0 pts
-Source of evidence is not provided, or is not a research article or systematic review. -Reference is missing.
20.0 pts
This criterion is linked to a Learning OutcomeObjectives of the article/Statement of questionsIdentifies the objectives of the article. Identifies questions being addressed by author/s. Explains relationship to the chosen practice issue
20.0 pts
-Objectives of article are identified. -Questions addressed by author/s are thorough. -Relationship to your practice issue is explained.
18.0 pts
-Objectives of article are identified. -Questions addressed by author/s are explained but not thorough. -Relationship to your practice issue is explained.
16.0 pts
-Objectives of article are identified. -Questions addressed by author/s are not thorough. -Relationship to your practice issue is vague.
8.0 pts
-Objectives of article are identified. -Questions addressed by author/s is missing. -Relationship to your practice issue is not explained.
0.0 pts
-Objectives of article are not identified. -Questions addressed in article and relationship to own practice is not identified.
20.0 pts
This criterion is linked to a Learning OutcomeInterventions/Main findings summarySummarizes, in own words, suggested interventions by the author/s to improve patient outcomes. Summarizes main findings of the author/s including strength of evidence for each main outcome. Describes the relevance to the Milestone 2 paper.
30.0 pts
-Thoroughly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Thoroughly summarized main findings of the author/s. -Included strength of evidence for each main outcome.
27.0 pts
-Briefly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Briefly summarized main findings of the author/s. -Included strength of evidence for each main outcome.
25.0 pts
-Vaguely summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Vaguely summarized main findings of the author/s. -Included strength of evidence for most of main outcomes.
12.0 pts
-Summary of interventions is not in own words. -Summarized main findings of the author/s is not apparent. -Did not include strength of evidence for any of the main outcome.
0.0 pts
-Summary of the interventions the author(s) suggest to improve patient outcomes is missing. -Summary of the main findings of the author is missing. -The strength of the evidence for outcomes are missing.
30.0 pts
This criterion is linked to a Learning OutcomeEvidence-based solutions and limitationOutlines evidence-based solutions to consider for the capstone project. Discusses any limitations to the studies included in the systematic review that he/she believes may impact use of the evidence provided in their project
20.0 pts
-Outline of evidence-based solutions considered for project is documented and clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project.
18.0 pts
-Outline of evidence-based solutions being considered for project is documented but not clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project.
16.0 pts
-Outline of evidence-based solutions considered for project is documented but not clear. Discussed most limitations to the studies performed. Documents limitations believed may impact use in project.
8.0 pts
-Outline of evidence-based solutions being considered for project is not documented. -Discussed most limitations to the studies performed. Documents limitations believed may impact use in project.
0.0 pts
-Outline of evidence-based solutions, limitations of studies and potential impact to project is missing.
20.0 pts
Total Points: 175.0
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