Translating Evidence Into Practice Paper
In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.Translating Evidence Into Practice Paper
To prepare:
Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
Explore possible consequences of failing to adopt the evidence-based practice that you identified.
Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
Restate your PICOT question and its significance to nursing practice.
Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?
Instructor (Linda Robinson)Translating Evidence Into Practice Paper
PICOT Question and Essence to Nursing Practice
PICOT question: Among Medicare patients discharged with a diagnosis of CHF (P) how does discharge planning (I) compared to follow-up via telephone calls(C) prevent readmission within 30days (O) post discharge?
In clinical practice, patients who have been diagnosed and admitted of heart failure are at high risk of readmission on the 3rd day after discharge. Researchers and clinicians have associated readmissions with poor quality of care which predisposes the same patients to a high risk of mortalities, morbidities and additional medical costs which could otherwise be prevented. Readmissions are also a major contributing factor to a patient’s deteriorating health status which results in poor health outcomes (Masri et al., 2018). Some of the currently available interventions to address this issue such as adequate staffing to improve nurses’ work environment have yielded fewer results. In the patient’s best interest, nurses are encouraged to actively take part in evidence-based research in identifying evidence-based solutions to address this issue since they directly interact with these patients at the point of care (Shan et al., 2014). Previous studies have proven that the most ideal interventions are those which increase the support given to patients at the point of care during admission, at the time of discharge and promote communication afterward. Only then can the lives and health outcomes of these patients improve.
Summary of Article Findings
The articles cited different factors as the major contributors to hospital readmissions among patients with heart failure such as in-hospital treatment complications, inadequate care coordination, poor quality of care coordination, patients not being adequately educated and insufficient follow-up. Among all the strategies that were outlined, the one that seemed to be the most beneficial was discharge planning and coordinated care. Coordinated care among nurses, members of healthcare teams and patient-centric approaches proved to be more successful when compared to single nurse approaches that centered on the management of the condition (Wan et. al., 2017). Discharge planning was also identified as a comprehensive intervention approach that is associated with significantly reducing readmission rates and all-cause mortalities in patients with heart failure. The purpose of discharge planning is to improve how services are coordinated from the hospital to the outpatient setting and at home based on a patient’s needs (Ziaeian & Fonarow 2016). Discharge planning involves; regular follow-up visits, patient education on medications and diet, social and emotional support and coordination among healthcare providers.Translating Evidence Into Practice Paper
Similarly, Chamberlain et al., (2018) in their study noted that most readmissions among patients with congestive heart failure 30 days after hospitalization were congestive heart failure, renal complications, and other comorbidities. They highlight that to prevent heart failure readmissions, interventions which promote the continuum of care from hospital to the outpatient clinic, and at home are the most effective. This requires highly coordinated care among healthcare providers and home caregivers. Chamberlain et al., (2018) emphasized on the need to enhance risk stratification measures prior which will increase safety in discharges done at the emergency department or when transitioning patients whose risk is not yet advanced to alternate treatment pathways to prevent readmissions, which will also conserve resources (Chamberlain et al., 2018). A perfect example of a risk stratification model that can be used is the RAHF scale. Nurses in hospital settings can use this scale to approximate the unique risk of an individual to be readmitted within 30 days after discharge. Risk stratification measures need to be combined with social work, support from community health partners and pharmacy (Chamberlain et al., 2018)
How the Identified Evidence-Based Practice Contributes To Better Outcomes
Discharge planning increases the time nurses take to directly interact with patients before being released to go home. Nurses use this time to increase their connection with patients and specifically use it for the patient’s benefit to: discuss the drugs prescribed, frequency and dosing, to talk about dietary modifications, physical activity, linkage with primary care providers and making schedules for outpatient follow-up(Ziaeian & Fonarow 2016). Therefore, the discharge summaries will be comprehensive enough to include all this information which can serve as the patient’s reminder when out of the hospital. Through clinical decision making and coordinated care, discharge planning helps to prevent premature discharges which may otherwise result in early readmissions in patients with heart failure (Ziaeian & Fonarow 2016). Translating Evidence Into Practice Paper
It should also be noted that the RAHF scale helps nurses to improve clinical decision making on the management of patients and to prevent any premature discharges among patients whose risk of readmission is high by accurately determining an individual’s readmission risk (Chamberlain et al., 2018). Therefore, nurses can use the RAHF scale to identify patients with heart failure who are at a high risk of readmission based on clinical and demographic factors such as age, race and underlying comorbidities. Based on the identified risks, nurses can thereafter implement personalized preventive and precautionary care strategies with the aim of reducing the rates of hospital readmissions (Chamberlain et al., 2018).
Strategy for Disseminating the Identified Evidence-Based Practice in the Practice Setting
The significance of discharge planning, care coordination and risk stratification measures as the evidence-based practice strategies of preventing to prevent readmissions in patients with heart failure will first be disseminated through an ongoing nurses training program. The purpose of this training will be to educate nurses on why it is important to implement this practice, how it benefits the patient, the hospital and the nurses. Training will also increase staff understanding of this change of practice as a measure of reducing opposition. Handouts and brochures which explain and demonstrate the aforementioned interventions will also be issues during the training. During implementation, a new policy which outlines the factors that should be included in discharge summaries to make them more comprehensive, the formation of healthcare teams to promote coordinated care and the adoption of the RAHF scale for risk stratification will be implemented. Each nurse will be required to abide by this policy when providing care to patients with heart failure, pre, and post discharge. Besides, a discharge checklist for patients with heart failure will be developed for every inpatient ward and the emergency department as an enabling tool for nurses to counter-check whether or not all the discharge planning requirements for a patient have been met. Translating Evidence Into Practice Paper
References
Chamberlain R, Sond J, Mahendraraj K, Lau C & Siracuse B. (2018). Determining 30-day readmission risk for heart failure patients: the Readmission After Heart Failure scale. International Journal of General Medicine. 2018(11), 127–141.
Masri A, Althouse A, McKibben J, Thomas B, Mathier M, Ramani R, Teuteberg J, Marroquin, Lee J, Suresh R & Mulukutla M. (2018). Outcomes of Heart Failure Admissions under Observation versus Short Inpatient Stay. Journal of the American Heart Association. 2018(7).
Shan D, Finder J, Dichoso D & Lewis P. (2014). Interventions to prevent heart failure readmissions: The rationale for nurse-led heart failure programs. Journal of Nursing Education and Practice. 4(11).
Wan T, Terry A, Conn E, McKee B, Tregerman R & Barbaro S. (2017). Strategies to Modify the Risk of Heart Failure Readmission. Health Serv Res Manag Epidemiol. 2017(4).
Ziaeian B & Fonarow G. (2016). The Prevention of Hospital Readmissions in Heart Failure. Prog Cardiovasc Dis. 58(4), 379–385.Translating Evidence Into Practice Paper