NR 505 Week 7: Evidence-based Practice Project Proposal
Nursing Practice Concern/Problem
Patient education at the time of discharge is vital in enabling them to take part in their health and be able to manage their health issues outside of the hospital. Due to the immense benefits of patient education during discharge, patient satisfaction with discharge education currently characterizes an excellent part of hospital reimbursement nationwide, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) scores. In this context, the teach-back method has been proposed as the best way to ensure that the older adult patient retain the discharge instructions taught to them and gain confidence in the management of their health at the time of discharge (Da Hinh et al., 2016). However, this noble practice is reportedly done poorly in many health care settings. Therefore, the nursing practice concern is the provision of ineffective and inadequate patient education during discharge. Essentially, providing ineffective and inadequate patient education at discharge is associated with many adverse impacts to patients such as increasing the chances of readmission, poor disease management, and patient/caregiver medication errors. Eventually, there is likelihood of poor patient satisfaction and outcomes and also reduction in HCAPS results and hospital reimbursement for care rendered (Allen, Hutchinson, Brown & Livingston, 2014).
PICOT Question
For the older adults (over 65), being discharged from the Geriatric Enhanced Medicine (GEM) unit at Columbia University Medical Center (CUMC), can the use of the teach-back method with discharge education, compared to not using the teach-back method with discharge education, improve patient satisfaction within eight weeks, as measured by the HCAHPS survey questions?
Key Stakeholders
The key stakeholders involved include the patients, physicians, patients, nurse practitioners, insurance companies, management of the health facility, and pharmacists. These stakeholders provide valuable resources and necessary support in planning and initiating the proposed teach-back method of providing patient education during patient discharge.
Theoretical Framework
This EBP project will be guided by the Dorothea Orem theory of nursing. The theory is divided into three parts namely theory of self care, theory of self care deficit, and theory of nursing system. According to Orem, self-care connotes practices initiated and performed by a person for personal benefits such as maintaining life, health, and wellness. On the other hand, the theory of self-care deficit specifies when nursing is required. In particular, it states that nursing is needed when an adult is incapable of providing continuous good self care. Therefore, Orem advances five nursing helping techniques including guiding others, teaching another, acting for and doing for others, providing a good environment to foster personal development to realize future demands, and supporting another. Finally, the theory of nursing systems illustrates the manner in which the self care needs of the patients will be met by the nurse, the patient, or both of them. Overall, the major assumptions of this theory are;
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- Individuals should be self-dependent and responsible for own care and the family members who need care.
- Individuals are distinct
- Attaining self-care needs is crucial element of primary care and prevention of poor health.
- An individual’s awareness of possible health challenges is vital in enhancing self-care behaviors.
- Self-care and autonomous care behaviors are learned within the context of socio-cultural.
Essentially, the Orem’s theory is applicable in nursing practice as it assists nurses to enhance the health of patients by making them autonomous. In the present EBP project, providing ways to improve effective discharge teaching to enable patients leave the hospital with more confidence and better understanding of how to manage their health conforms to the provision of theory’s perspective that a patient has skills to create actions that meet personal needs of the patient becomes suitable for self care.
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Literature Review
Over the past decade, the conversion from hospital to home care has been associated with increased risks, especially for older adults with intricate care needs. This risk is associated with many factors including patient’s lack of or poor understanding of discharge instructions. According to Waniga et al. (2016), the time of discharge from the hospital is extremely vulnerable for patients with nearly 19% of patients experiencing adverse events of post discharge such as uncertainty, anxiety, and lack of understanding about discharge instructions. All these lead to readmission rates, and influence the overall perception of the hospital experience. Therefore, non-sophisticated discharge instructions are vital to ensure seamless change from hospital to home, when the care responsibility changes from the providers to patients and care givers (Navanandan et al., 2017). Consequently, nurses play a crucial role in providing discharge instructions to patients.
Moreover, older adults face challenges such as functional capacity, inability for self care, and deteriorated health status. Therefore, before hospital discharge, it is imperative for nurses to provide discharge education that considers the perspectives of the adults to prevent challenges associated with self-care (Ghiasvand et al., 2017). One of the best discharge instructional methods is teach-back method. This method refers to a communication technique used by the nurses to verify whether or not a patient understands what they are told. If the patient understands, he or she is able to accurately teach-back the information. This method is crucial in enhancing the patient understanding of post-discharge care requirements (Griffey et al., 2015). Moreover, it is imperative for nurses to utilize written and visual materials to further increase patient understanding and appeal for various learning methods such as visual and auditory.
Data Collection Methods
The data will be collected using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. HCAHPS connotes a patient satisfaction survey recommended for all health care settings in America. It seeks to produce comparable data on the views of the patient on health care to facilitate objective and focused comparisons between facilities (Piper & Tallman, 2016). The other method entails the use of questionnaires, which consist of a set of questions that are intended to obtain information from respondents. Other methods that can be used include interviews, focused groups, and observations.
Analysis
After completing data collection, the data analysis will begin by manipulating the data in various ways including plotting the data out and seeking correlation or developing a pivot table in Excel. The pivot table is important in fostering sorting the data based on various variables (Grech, 2018). However, if the outcome of the manipulation of the data does not result in the required data, it is necessary to collect more data or revise the original survey questions. Nonetheless, the original analysis of the correlations, trends, and variations is crucial in focusing the data analysis to effectively answer the question and address any objection that may arise.
Expected Outcomes
It has been established that patients who are discharged without proper understanding of discharge instructions tend to develop significant complications. Such complications could lead to adverse patient outcomes such as hospital readmission, medication errors, post-operative infections, and influence of overall perception of hospital experience. Therefore, it is expected that effective methods of providing discharge education such as teach-back method would address such challenges and equip the patients with increased knowledge on self care management.
References
Allen, J., Hutchinson, A., Brown, R., & Livingston, P. (2014). Quality care outcomes followingtransitional care interventions for older people from hospital to home: A systematic review. BMC Health Services Research, 14, 346. doi: 10.1186/1472-6963-14-346.
Ghiasvand, F., Riazi, H., Hajian, S., Kazemi, E., & Firoozi, A. (2017). The effect of a self-care program based on the teach-back method on the postpartum quality of life. Electronic physician, 9(4), 4180–4189. https://doi.org/10.19082/4180
Grech, V. (2018). WASP (Write a Scientific Paper) using Excel–2: Pivot tables. Early human development, 117, 104-109.
Griffey, R. T., Shin, N., Jones, S., Aginam, N., Gross, M., Kinsella, Y., Williams, J. A., Carpenter, C. R., Goodman, M., & Kaphingst, K. A. (2015). The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study. Journal of communication in healthcare, 8(1), 10–21. https://doi.org/10.1179/1753807615Y.0000000001
Ha Dinh, T. T., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), 210–247. https://doi.org/10.11124/jbisrir-2016-2296
Navanandan, N., Schmidt, S. K., Cabrera, N., DiStefano, M. C., & Mistry, R. D. (2017). The caregiver perspective on unscheduled 72-hour return visits to pediatric acute care sites: a focus on discharge processes. Academic pediatrics, 17(7), 755-761.
Piper, L. E., & Tallman, E. (2016). Hospital consumer assessment of healthcare providers and systems: An ethical leadership dilemma to satisfy patients. The health care manager, 35(2), 151-155.
Waniga, H. M., Gerke, T., Shoemaker, A., Bourgoine, D., & Eamranond, P. (2016). The impact of revised discharge instructions on patient satisfaction. Journal of patient experience, 3(3), 64-68.
It is imperative that healthcare providers, communities, state and local public health departments, and other government entities promote high-quality end-of-life care so that the negative consequences of living with and dying from chronic terminal illness can be prevented. The WHO strategy for palliative care recommends educational initiatives directed toward both the public and healthcare professionals. “Examples, such as the Dying Matters Coalition in England and Good life, Good death, Good grief in Scotland, have been established with the aim of engaging society in becoming more open about death, dying and bereavement.” (Brogaard et Al, 2016)
Fit- Knowing whether or not a Nurse practitioner could enhance the election of hospice or palliative care in community residing aging individuals would definitely fit into the target group.
feasibility- It is entirely feasible to incorporate an Np at different levels of healthcare to communicate the importance of quality end-of-life care within the community setting.
Appropriateness- It is certainly appropriate to implement an end-of-life specialist in the form of an advanced degree nurse to educate the aging community on hospice and palliative care
Plan- Identify the need to improve understanding regarding end-of-life care in the community dwelling aging population. Illustrate an interview process designed to better understand participants’ position on electing hospice care when curative treatments are no longer beneficial, and further disclosing their outlook on the impact having an informative conversation with a nurse practitioner. Do– Using a comprehensive interview process, the project leader is able to gather information on participants’ past, ideas, understanding on the subject, as well as their experiences with hospice and palliative care. The researcher will develop a blue print for the interview made up of open-ended questions about hospice underuse and misuse, but at the same time, will allow the conversation to unfold in the way that the subject leads. Follow-up questions should be tailored to individual discussions, and should be based around the respondent’s initial answers. Trust must be established early on between the project coordinator or researcher and participant or subject so that true feelings, thoughts, and actions are shared. Because of the dynamic interaction, the project coordinator or researcher is unable to take notes, so recording of the interview is done with the participant or subject’s permission. The interview is then transcribed from the audio into text format so that the project coordinator or researcher can reflect upon common themes present within the interview and compare responses of different participants or subjects. Study– review the recordings performed during the interview process and document all pertinent information making special note of trends and similarities in responses. Act– follow up with participants to gather any additional information that may be beneficial to improving the underuse and misuse of hospice and palliative care. One way to overcome the roadblock of utilizing the knowledge gathered in this evidence based project would be to incorporate critical listening skills. A critical listener looks beyond the words for the message by picking up on body language, and emotion from the speaker in order to gather a more accurate perception of the message.
Resources needed for my action plan will include: a computer, paper, printer, an environment to analyze the data collected, research assistance to help with data transfer from voice recording to computer program.
Success of this particular study would materialize as literature included in educational developments for the advancement of community based hospice and palliative care.
One future research study that would be useful in extending knowledge on the misuse and underuse of hospice and palliative care would be a study to identify bereaved families’ views on and experiences with end of life care, specifically, how the families viewed availability of staff, symptom control, spiritual support, and overall quality of care.
Brogaard, T., Neergaard, M. A., & Murray, S. A. (2016). Promoting palliative care in the community: a toolkit to improve and develop primary palliative care throughout Europe. Scandinavian Journal of Primary Health Care, 34(1), 3–4. http://doi.org/10.3109/02813432.2016.1152092