For the older adults (over 65), being discharged from the Geriatric Enhanced Medicine (GEM)
\nunit at Columbia University Medical Center (CUMC), can the use of the teach-back method with
\ndischarge education, compared to not using the teach-back method with discharge education, improve
\npatient satisfaction within eight weeks, as measured by the HCAHPS survey questions?<\/p>\n

Key Stakeholders<\/h3>\n

The key stakeholders involved include the patients, physicians, patients, nurse practitioners,
\ninsurance companies, management of the health facility, and pharmacists. These stakeholders provide<\/p>\n

EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 3
\nvaluable resources and necessary support in planning and initiating the proposed teach-back method of
\nproviding patient education during patient discharge.<\/p>\n

Theoretical Framework<\/h3>\n

This EBP project will be guided by the Dorothea Orem theory of nursing. The theory is divided
\ninto three parts namely theory of self care, theory of self care deficit, and theory of nursing system.
\nAccording to Orem, self-care connotes practices initiated and performed by a person for personal
\nbenefits such as maintaining life, health, and wellness. On the other hand, the theory of self-care deficit
\nspecifies when nursing is required. In particular, it states that nursing is needed when an adult is
\nincapable of providing continuous good self care. Therefore, Orem advances five nursing helping
\ntechniques including guiding others, teaching another, acting for and doing for others, providing a good
\nenvironment to foster personal development to realize future demands, and supporting another. Finally,
\nthe theory of nursing systems illustrates the manner in which the self care needs of the patients will be
\nmet by the nurse, the patient, or both of them. Overall, the major assumptions of this theory are;
\n\uf0d8 Individuals should be self-dependent and responsible for own care and the family members who
\nneed care.
\n\uf0d8 Individuals are distinct
\n\uf0d8 Attaining self-care needs is crucial element of primary care and prevention of poor health.
\n\uf0d8 An individual\u2019s awareness of possible health challenges is vital in enhancing self-care behaviors.
\n\uf0d8 Self-care and autonomous care behaviors are learned within the context of socio-cultural.
\nEssentially, the Orem\u2019s theory is applicable in nursing practice as it assists nurses to enhance the
\nhealth of patients by making them autonomous. In the present EBP project, providing ways to improve
\neffective discharge teaching to enable patients leave the hospital with more confidence and better
\nunderstanding of how to manage their health conforms to the provision of theory\u2019s perspective that a
\npatient has skills to create actions that meet personal needs of the patient becomes suitable for self care.<\/p>\n

EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 4<\/h3>\n

Literature Review<\/h4>\n

Over the past decade, the conversion from hospital to home care has been associated with
\nincreased risks, especially for older adults with intricate care needs. This risk is associated with many
\nfactors including patient\u2019s lack of or poor understanding of discharge instructions. According to Waniga
\net al. (2016), the time of discharge from the hospital is extremely vulnerable for patients with nearly
\n19% of patients experiencing adverse events of post discharge such as uncertainty, anxiety, and lack of
\nunderstanding about discharge instructions. All these lead to readmission rates, and influence the overall
\nperception of the hospital experience. Therefore, non-sophisticated discharge instructions are vital to
\nensure seamless change from hospital to home, when the care responsibility changes from the providers
\nto patients and care givers (Navanandan et al., 2017). Consequently, nurses play a crucial role in
\nproviding discharge instructions to patients.
\nMoreover, older adults face challenges such as functional capacity, inability for self care, and
\ndeteriorated health status. Therefore, before hospital discharge, it is imperative for nurses to provide
\ndischarge education that considers the perspectives of the adults to prevent challenges associated with
\nself-care (Ghiasvand et al., 2017). One of the best discharge instructional methods is teach-back method.
\nThis method refers to a communication technique used by the nurses to verify whether or not a patient
\nunderstands what they are told. If the patient understands, he or she is able to accurately teach-back the
\ninformation. This method is crucial in enhancing the patient understanding of post-discharge care
\nrequirements (Griffey et al., 2015). Moreover, it is imperative for nurses to utilize written and visual
\nmaterials to further increase patient understanding and appeal for various learning methods such as
\nvisual and auditory.<\/p>\n

Data Collection Methods<\/h3>\n

The data will be collected using the Hospital Consumer Assessment of Healthcare Providers and
\nSystems (HCAHPS) surveys. HCAHPS connotes a patient satisfaction survey recommended for all<\/p>\n

EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 5
\nhealth care settings in America. It seeks to produce comparable data on the views of the patient on
\nhealth care to facilitate objective and focused comparisons between facilities (Piper &amp; Tallman, 2016).
\nThe other method entails the use of questionnaires, which consist of a set of questions that are intended
\nto obtain information from respondents. Other methods that can be used include interviews, focused
\ngroups, and observations.<\/p>\n

Analysis<\/h3>\n

After completing data collection, the data analysis will begin by manipulating the data in various
\nways including plotting the data out and seeking correlation or developing a pivot table in Excel. The
\npivot table is important in fostering sorting the data based on various variables (Grech, 2018). However,
\nif the outcome of the manipulation of the data does not result in the required data, it is necessary to
\ncollect more data or revise the original survey questions. Nonetheless, the original analysis of the
\ncorrelations, trends, and variations is crucial in focusing the data analysis to effectively answer the
\nquestion and address any objection that may arise.<\/p>\n

Expected Outcomes<\/h3>\n

It has been established that patients who are discharged without proper understanding of
\ndischarge instructions tend to develop significant complications. Such complications could lead to
\nadverse patient outcomes such as hospital readmission, medication errors, post-operative infections, and
\ninfluence of overall perception of hospital experience. Therefore, it is expected that effective methods of
\nproviding discharge education such as teach-back method would address such challenges and equip the
\npatients with increased knowledge on self care management.<\/p>\n

EVIDENCE-BASED PRACTICE CHANGE PROJECT PROPOSAL 6<\/h3>\n