NR 451 Week 2: The Clinical Question
Chamberlain University NR 451 Week 2: The Clinical Question– Step-By-Step Guide
This guide will demonstrate how to complete the Chamberlain University NR 451 Week 2: The Clinical Question assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NR 451 Week 2: The Clinical Question
Whether one passes or fails an academic assignment such as the Chamberlain University NR 451 Week 2: The Clinical Question depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NR 451 Week 2: The Clinical Question
The introduction for the Chamberlain University NR 451 Week 2: The Clinical Question is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NR 451 Week 2: The Clinical Question
After the introduction, move into the main part of the NR 451 Week 2: The Clinical Question assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NR 451 Week 2: The Clinical Question
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NR 451 Week 2: The Clinical Question
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NR 451 Week 2: The Clinical Question
The systematic review that I chose was obstetrics with a focus on skin to skin care. I currently work on a pediatric unit where NAS babies are transferred after they are stable following birth. I have seen many children sit on this unit for a month too two months going through withdrawal. These children have myoclonic tremors, increased muscle tone, inconsolable irritability, and an overall rough start in life. Most of these children don’t have a high parental involvement; but I was wondering what the affects would be on their weaning process if they had daily skin to skin. I want to know if their negative symptoms would dissipate faster, would they come off the drugs faster, and would their overall health improve quicker allowing them to either go home or be placed in foster care. I believe it is important to my current practice because we have a large population of mothers that go through the methadone clinic in town. If we found a way to improve family centered care while simultaneously shortening the weaning process for the infant and minimizing withdrawal symptoms it could mean the difference between these babies staying with us for a few weeks compared to a few months. “:Newborns with moderate to severe NAS are typically treated with oral opioids, and then weaned over days to weeks. Pharmacologically treated NAS is prolonged and costly, with lengths of stay of 2 to 12 weeks and estimated charges of $90 000 per admission (Holmes et al).” Research practice gap is when there is evidence based research supporting a specific practice but it hasn’t been implemented into actual patient care.
Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics,137(6). doi:10.1542/peds.2015-2929
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Sample Answer 2 for NR 451 Week 2: The Clinical Question
For this weeks’ discussion topic, I have chosen the review on skin to skin contact between newborn and mother. My clinical question is as follows,” Could SSC be used as treatment for tachypnea as opposed to tachypnea being criteria to interrupt SSC within the transition period? I developed this clinical question, because there has been a significant increase in admission to NICU for newborn tachypnea since protocol for SSC has been adopted in the labor and delivery area. This is unfortunate, as once admitted to the NICU, we have standard orders for high flow cannula, IVF initiation both of which require extended time to wean and discontinue these interventions. Very often, we see the tachypnea as very intermittent, with no work of breathing or other symptoms of distress, and resolves quickly after separation from mom.
This of course, causes stress for both infant and mother due to separation. In addition, a NICU admission and care is much more expensive than normal newborn care. This places additional cost and financial burden of the organization as staffing is necessary due to higher census. Also, additional financial concerns become the responsibility of the family/insurance provider. Do not misunderstand, if an infant is experiencing increased work of breathing, or other signs of distress, a NICU admission is definitely needed for closer observation as well as clinical support such as temperature regulation, glucose and volume management, oxygen supplementation, etc., however, as stated above, many times within an hour or two these newborns have stabilized and often still remain in NICU setting after mom goes home.
There seems to be a gap between criteria for the transitioning infant as opposed to the normal newborn and compromised intensive care neonate protocol. If allowing the infant to remain with mom utilizing skin to skin contact, it has been suggested that this can facilitate stabilization of temperature, glucose metabolism, heartrate and respiration within the first 24 hours of life. In our hospital setting, if an infant is breathing over 60, it is taken to NICU for observation. If after six hours the infant has not self-resolved, it becomes a NICU admission with standard admission orders initiated. If protocol could include using SSC as intervention for mild tachypnea, absent of any other respiratory or distress symptoms, with close observation during the process for signs and symptoms of declining condition, this could decrease the number of mother /infant dyads being separated, as well as decrease NICU admissions for non-critical care.
The “transition area” had been staffed and “run” by mother-baby until August 1,2017, when NICU took over, however, no policy changes have been made as far as how these infants are managed. I would like to take this idea to our unit council which is made up of physicians, management, and nursing staff to identify the gap and facilitate change of some type for this patient population. I feel change will bring about both improved patient satisfaction and outcome, as well as be a cost containment advantage. I have a personal thought on why we are seeing the increase for tachypnea. It is very common now to have induction as well as caesarean deliveries, both of these scenarios increase the amount of lung fluid that an infant has to reabsorb from the lung. When infants are placed on mothers’ chest immediately after delivery, the amount of crying and stimulation is decreased as opposed to older practice when nursing staff stimulated infants at the warmer for 30-60 seconds post-delivery.
I feel this lack of stimulation decreases the “opening up” of alveoli that infants previously had when taken by nursing staff to warmer and vigorously stimulated to cry for 30-60 seconds. My observation is that if an infant is crying vigorously the mothers’ generally console to stop the infants from crying. If the SSC is started initially after birth, and the infant lacks a period of good crying to increase pulmonary pressure to facilitate fluid redistribution, it is compensatory to increase respiration rate. So, are we actually setting up these infants to fail by initiating SSC but “punishing” them for a compensatory response to increase lung fluid retention? Should slightly higher respiratory rates with no signs of distress be acceptable in the initial transition time? Now this is just my general thought process, I have conducted no research or study. So, I am very excited about this project as it will definitely help me in determining what evidence, what practices are being used in other facilities with improved outcome.
Sample Answer 3 for NR 451 Week 2: The Clinical Question
According to The Easley Progress, SC newspaper (2015), Baptist Easley was able to reduce readmission rates by 20%. Some of the interventions implemented were: establishing cooperation between the hospitals and a “care transitions community” comprised of local home-health agencies and skilled nurse facilities; in-home visits to patients in need; coordination with their primary physician and/or other community providers; phone calls to patients who were identified as high-risk patients. As a result, this community had 5,031 avoidable re-admissions. (The Easley Progress, SC, 2015).
According to the Preventing Avoidable Readmissions article posted in the U.S. Department of Health Care and Human Services (2017) “Patients being discharged from the hospital who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information, according to an AHRQ-funded study”.
The article further lists a number of tools hospitals can use to reduce the readmission rates. These tools are: RED (Re-Engineered Discharged); Project BOOST (discharge bundle); CUSP Toolkit (Patient and family engagement module); Guide to Patient and Family Engagement in Hospital Quality and Safety; MARQUIS tool kit (Multi-Center Medication Reconciliation Quality Improvement Study), (Preventing Avoidable Readmissions, 2017). In addition, hospitals can have access Quality Improvement Clinical Tools website which gives specific discharge planning documents based on most common diagnosis seen in the Hospital (Preventing Avoidable Readmissions, 2017).
Based on recent research, it appears that carefully identifying the individual patient needs and giving personalized discharge instructions can significantly reduce readmissions rates, one patient at a time. It takes a combination of resources, strategies and tools to achieve the goal of preventing avoidable readmissions.
According to Statistical Brief #199 of the Agency for Healthcare Research and Quality (2015) from the US Department of Health and Human Services website, the readmission rates between 2009 and 2013 was higher among patients covered by Medicare, followed by Medicaid, un-insured individuals and lastly private insured. This drives me to the conclusion that the older population which is typically on Medicare would be at a higher risk for readmission.
References
(2015, September 17). Baptist Easley recognized for preventing hospital readmissions. Easley Progress, The (SC).
Barrett, Wier, Jiang and Steiner (December, 2015). All-Cause Readmissions by Payer and Age, 2009-2013. Retrieved from U.S. Department of Health and Human Services, National Quality Strategy. 2013 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care.
Preventing Avoidable Readmissions. (February, 2017). Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/impptdis/index.html
Sample Answer 4 for NR 451 Week 2: The Clinical Question
I work on a medical surgical unit and I find that most of our elderly patients who are readmitted to our units are those who have limited resources to follow up with their care when they go home. One challenge has to do with the limited insurance coverage with Medicare, which does not cover some prescription drugs used at home, and some follow-up diagnostic test. Elderly patients who cannot take care of themselves and do not have a strong family support have difficulties as well because home health resources for any long period of time are limited due to their insurance coverage. According to the article, Improving Hospital Discharge Planning for Elderly Patients. Health Care Financing Review, “The two major forces influencing the discharge-planning process over the last decade and a half are the Medicare prospective payment system (PPS) and the rise of managed care, both of which have created incentives to shorten hospital stays. The incentives under PPS actually created a disadvantageous situation for Medicare by encouraging the early discharge of patients into post-acute care (PAC); this care was paid for by Medicare but was not under PPS (Morrisey, Sloan, and Valvona, 1988Links to an external site.; Neu, Harrison, and Heilbrunn, 1989Links to an external site.; Neu and Harrison, 1988Links to an external site.).”
We can examine the various challenges faced when addressing the effectiveness of early discharge planning for elderly and what process we can implementation to lower the readmission rate for these older adults. The authors of “Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: A systematic review and meta-analysis.” use a systematic review to compare the effectiveness of early discharge planning for acutely admitted older adult to usual care.
References:
Fox, M. T., Persaud, M., Maimets, I., Brooks, D., O’Brien, K., & Tregunno, D. (2013). Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: A systematic review and meta-analysis. BMC Geriatrics, 13(1), 1. doi:10.1186/1471-2318-13-70
Chamberlain Library Permalink: http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=89638554&site=eds-live&scope=siteLinks to an external site.
Potthoff, S., Kane, R. L., & Franco, S. J. (1997). Improving Hospital Discharge Planning for Elderly Patients. Health Care Financing Review, 19(2), 47–72.
NR 451 Week 3 Assignment
Practice Issue Worksheet
List the topic and include the citation for the systematic review you have selected: The Hospital discharge planning for reduction of readmission of patients The systematic review article that has been used is the article by Fox et al., (2013) on the effectiveness of early discharge planning in acutely ill or injured old adults. | ||
What is the practice issue you have identified related to the topic you have chosen? The practice issue that has been put forward is the development of a training plan for the older population regarding o the management of their condition after they are discharged. This is related to the topic under study since the readmission rates can be reduced by ensuring that the patients are able to manage their conditions at home. | ||
Define the scope of the practice issue: The scope of practice can be described by the use of the PICOT question as indicated below P (Population)- Old patients in the healthcare facility having acute illness or having an injury I (Intervention)- The development of an early discharge planning for the patients C (Comparison)- The use of usual care plan O (Outcome)- A reduction in the cases of readmission of older patients to the hospitals T (Time)- 3 months | ||
What is the practice area? __x_ Clinical ___ Education ___ Administration ___ Other (List): | ||
How was the practice issue identified? (check all that apply) _x__ Safety/risk management concerns _x__ Unsatisfactory patient outcomes ___ Wide variations in practice ___ Significant financial concerns
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___ Difference between hospital and community practice __x_ Clinical practice issue is a concern ___ Procedure or process is a time waster ___ Clinical practice issue has no scientific base __ Other: | |
Describe the rationale for your checked selections: The increasing cases of readmission of the elderly patients in hospitals have led to the increase in concerns. Along these lines, the problem has been identified from the concerns on the risks of readmission to the hospitals since it leads to an increase in costs of healthcare maintenance of the patient. Moreover, the expectations of the patients while being discharged is to ensure that there are no mistakes but the increase in the readmission has led to mistrust on the outcomes. The increase in readmission of elderly patients is as well an issue of concern in the medical practice. | ||
What evidence must be gathered? (check all that apply) | ||
__x_ Literature search ___ Guidelines ___ Expert Opinion ___ Patient Preferences | _x__ Clinical Expertise ___ Financial Analysis ___ Standards (Regulatory, professional, community) ___ Other | |
Describe the rationale for your checked selections: There has been advance research on the ways that can be used in reducing the cases of readmission of elderly patients. Along these lines, the literature search will be a critical step that will help in collecting information on the plan. Moreover, the clinical experts will help in the provision of information on the ways that can be implemented to minimize readmission rates in the healthcare organizations. | ||
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms: The increasing cases of readmission have mainly been identified to influence the elderly patients. Along these lines, there is a need for the development of measures that can be implemented in reducing the cases. The old population is mainly associated with longer stays in the healthcare facilities and the need for the development of an early discharge plan for the patients as elucidated by Fox et al., (2013) is a stepping stone for minimizing the cases of readmission. Readmission has a variety of challenges include the fact that there is an increase in the cost of managing the healthcare conditions of the elderly patient. Moreover, readmission will put the quality of services offered in hospitals in question. As such, there will be a reduction in the trusts that the patients will have in the healthcare organization due to the readmission cases. |
Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Fox, M. T., Persaud, M., Maimets, I., Brooks, D., O’Brien, K., & Tregunno, D. (2013). Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis. BMC geriatrics, 13(1), 70.
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Identify the objectives of the article. The aim of the study by Fox et al., (2013) is to assess the effectiveness of early discharge planning for the older patient show have been admitted with the acute illness or injuries. Provide a statement of the questions being addressed in the work and how they relate to your practice issue: What is the effectiveness of early discharge plan on the older patient show have been admitted with the acute illness or injuries? |
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes. The authors have presented that the intervention for minimizing readmissions on the healthcare organization is the provision of an effective plan that will help the patients in the transition after discharge. In this regard, the elderly patients are provided with a discharge plan from the time of their admission. The authors deduce that the availability of an early plan for the patients in comparison with the usual care helps in reducing the cases of readmission of the elderly patients. This is attributed to the fact that the there is an improvement in the quality of life of the patients who have had a discharge plan from the time of their admission. Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. The findings indicate that many studies have indicated that an early discharge planning is crucial at the time that the patients are in an acute state for the reduction of readmission. Specifically, the findings are applicable for old patients and are performed by the nurses within the first 24 hours before the patient is discharged. Along these lines, the patient does not get enough information on the ways of managing their condition. The discharged plans that have been identified to be supported by a variety of researchers include the assessment of the needs of the elderly patients while at home. Moreover, the other discharge plans include the provision of education to the patients o the necessary adjustments that could help in reducing the cases or readmission and the transfer of information to the community health provided on the management of the care of the elderly patients. Additionally, the proposal of the follow-up plans is adduced to be of help in reducing the cases of readmission. The results indicate that the reviews indicated that the follow-up method that is identifiable include the use of telephone calls or a mobile phone application that could provide a report on the patient conditions. |
Outline evidence-based solutions that you will consider for your project. Due to the intensity of the cases of readmission, the evidence based solution that will be proposed for the project is the education of the patients on the ways of managing their conditions before discharge. Along these lines, the patient should receive care from the nurses from the time of their admission to help in ensuring that there is enough information on the possible challenges that will be faced after their discharge. In addition, the patients should be educated on the effects of readmission on the psychological well-being and the cost of hospitalization. Moreover, the patients are trained on the use of technological devices such as the mobile application that reports the vital signs of the elderly patient or a regular basis. This will help the healthcare providers in monitoring the health of the patient. Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project. One of the limitations of the review is that there are limited study methods for the research topic. This is attributed to the fact that only nine studies have been used. The precision is as well influenced by the sample size and the conclusion made by the researchers may be affected by the fact that there is no heterogeneity. This will have an impact on the utilization of the article since it can be asserted that the issue at hand may not have had enough research studies in the past. As such, the process of discharge planning may receive a measurable amount of resistance during the implementation.
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