Sample Answer for NR 505 Week 7: EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL Included After Question
NR 505 Week 7: EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL
NR 505 Week 7: EVIDENCE-BASED PRACTICE CHANGE 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
A Sample Answer For the Assignment: NR 505 Week 7: EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL
Title: NR 505 Week 7: EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL
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
EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 3
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;
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.
EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 4
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
EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 5
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.
EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 6
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.
EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 7
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.
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
|
Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three or more of the following elements
|
| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in the all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three of the following elements
|
| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
|
Demonstrated 3 of the following:
|
Demonstrated 2 of the following:
|
Demonstrated 1 or less of the following:
|
||
| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
|
Failed to demonstrate the following:
|
||||
| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Also Check Out: NR 505 Week 7: Data Collection, Analysis, Evaluation, Dissemination of Results, and Conclusion