NUR 670 Project Evaluation Paper

I just wanted to send you a review of the steps we discussed last night.  This is how I suggest you approach this first portion of your project, but of course you are able to modify this as you like and use as a guideline. There is method to my reasoning here.

Here’s the steps I suggest to complete this portion of the project:

. Choose a broad area of interest (e.g. diabetes)

2. Give the literature on this broad topic a quick review
3. Based on that quick review, narrow / define your area of interest as you see fit and as the literature directs you (e.g. diabetes mellitus type 1)
4. Within that area of interest, choose a population of interest. (e.g. home bound adult patients with diabetes mellitus type 1)
5. Do another quick review of the lit on that population in that area of interest NUR 670 Project Evaluation Paper

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6. Based on that quick review, narrow your population as you see fit and as the literature directs you
7. Give the literature a more in-depth review based on your population of interest within your area of interest
8. Tweak your area of interest and population of interest as you see fit and as the literature directs you and try to focus on a specific issue for this population (e.g. homebound adult patients with DM type 1 and difficulty monitoring blood glucose)
9. Finally do literature search looking for the upstream causes of the downstream issues related to your topic, and pick an issue you would like to learn more about and intervene on at the level of an NP Community Health Leader. This is your topic
10. Create a matrix of the best articles which relate to your topic.
11. Based on all of this, create your answers to Parts I, II,III. Remember to include your matrix with your submission. Check the Boltz book for examples. Refresh your memory on how to do a matrix by going back to your NUR 510 course materials. In the remainder of the paper, you will delve into the actual intervention.

I checked the course page and there is a grading guide in the folder for this project there.  It does not look the same as a typical rubric and that\’s likely where the confusion comes from.

I truly hope this helps you.  This may be a new kind of assignment for you and it may feel overwhelming. Remember to stay focused on the good of the population and to work from the perspective of an APRN. And keep it in perspective; it\’s one small step on your journey to becoming an excellent NP.

Exercise 7.2 You are interested in developing a program to reduce the rate of readmissions for (Diabetes) heart failure at an urban (Primary Care Physician office) academic medical center. There have been many prior initiatives to address this issue. Explain the process you will undertake to develop an effective program including consideration of established best practices and the outcomes of past initiatives.

How might you use the PRECEDE–PROCEED Model to plan, implement, and evaluate the program?

PRECEDE (This is the planning stage. Work with a committee comprised of people who are stakeholders and who have a working understanding of the target population and the issues/problems related to readmission’s.

1. Determine population needs. (Reduce readmission rates.)
2. Identify health determinants of these needs. (What are the characteristics of the population of patients who are readmitted? What are the most common reasons for readmission’s?)
3. Analyze behaviors and environmental determinants of health needs. (What are the educational needs/resource requirements of this population?)
4. Outline factors that predispose, reinforce, or enable behaviors. (Identify factors that contribute to readmission.)
5. Ascertain interventions best suited to change behaviors. (Based on the information that you have garnered, write your objectives and design specific interventions to achieve your objectives.)NUR 670 Project Evaluation Paper

PROCEED

1. Evaluate interventions.
2. Evaluate the impact of the interventions on factors that supported the behavior as well as the behavior itself. (Survey patients and stakeholders.)
3. Evaluate outcomes.

Applying the Evidence – Literature review

Curley (2020) Ch 5

Intervention table 5.5 is on p. 124-126 in Curley (2020) – use for template for literature review

Describe in your own words a clinical problem you would like to examine. Explain why you think it is important to address this problem, carry out a literature review for the clinical question you wrote, and describe how you would apply the PRECEDE: PROCEED model to address your clinical question

TABLE 5.5 p. 124-126 Example

I just wanted to send you a review of the steps we discussed last night.  This is how I suggest you approach this first portion of your project, but of course you are able to modify this as you like and use as a guideline. There is method to my reasoning here.

Here’s the steps I suggest to complete this portion of the project:

11. Choose a broad area of interest (e.g. diabetes)
12. Give the literature on this broad topic a quick review
13. Based on that quick review, narrow / define your area of interest as you see fit and as the literature directs you (e.g. diabetes mellitus type 1)
14. Within that area of interest, choose a population of interest.(e.g. homebound adult patients with diabetes mellitus type 1)
15. Do another quick review of the lit on that population in that area of interest
16. Based on that quick review, narrow your population as you see fit and as the literature directs you
17. Give the literature a more in depth review based on your population of interest within your area of interest
18. Tweak your area of interest and population of interest as you see fit and as the literature directs you and try to focus on a specific issue for this population (e.g. homebound adult patients with DM type 1 and difficulty monitoring blood glucose)
19. Finally do  literature search looking for the upstream causes of the downstream issues related to your topic,and pick an issue you would  like to learn more about and intervene on at the level of an NP Community Health Leader.  This is your topic
20. Create a matrix of the best articles which relate to your topic.
21. Based on all of this, create your answers to Parts I,II,III.  Remember to include your matrix with your submission. Check the Boltz book for examples.  Refresh your memory on how to do a matrix by going back to your NUR 510 course materials. In the remainder of the paper you will delve into the actual intervention.

I checked the course page and there is a grading guide in the folder for this project there.  It does not look the same as a typical rubric and that’s likely where the confusion comes from.

I truly hope this helps you.  This may be a new kind of assignment for you and it may feel overwhelming. Remember to stay focused on the good of the population and to work from the perspective of an APRN. And keep it in perspective; it’s one small step on your journey to becoming an excellent NP.

Reducing the Readmission Rates for Heart Failure (HF) Patients at an Urban Academic Medical Centre: Application of the Precede/ Proceed Model in Developing a Program

As nurse practitioners (NPs), there are many clinical problems that one encounters in practice and which need to be addressed using evidence-based interventions. Some of these clinical problems require the process of clinical inquiry because they exist due to the lack of an efficacious intervention (Melnyk & Fineout-Overholt, 2019). However, the others may have interventions that are evidence-based and known but lack a structured program for implementation and evaluation. One of the clinical problems requiring the latter approach and which this paper is about is the increasing rate of readmission for heart failure patients within a 30-day period after discharge (Howie-Esquivel et al., 2015). This paper is therefore about designing a program aimed at reducing this high readmission rate for heart failure patients, using the precede/ proceed model.NUR 670 Project Evaluation Paper

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The Clinical Problem and Why It Is Important to Address It

Heart failure readmissions within 30 days post discharge is the clinical practice problem that needs to be addressed by this program. HF as a condition is the most common cause of readmission to the hospital in patients aged 65 years and above. It affects close to 6.5 million people in the United States. The number of readmission cases within 30 days after discharge is estimated to stand at 21.4% in the whole country. However, it is estimated that about 12% of these admissions can actually be prevented by well-designed programs of interventions (Charteris & Pounds, 2020). HF has several attributes to it that makes it a significant condition to look at. Among Medicare-covered patients, HF is the most common diagnosis indicated on discharge. It is also the most costly condition to manage and the most common reason for readmission to hospital (Howie-Esquivel et al., 2015). One of the reasons why it is crucial that this practice problem be addressed is that Medicare reimbursement policies at present consider HF readmission within 30 days after discharge a quality improvement (QI) issue. They impose financial penalties to the concerned providers as the thinking is that with quality HF care; these readmissions could have been avoided or forestalled (Howie-Esquivel et al., 2015). Another reason for addressing this clinical problem is that HF readmission soon after discharge is associated with increased hospitalization costs as well as mortality. Lastly but not least, the quick readmission after discharge indicates that there is a gap in behavioral conformity with the required health educational parameters that the patient needs to adhere to. For this reason, a nurse practitioner-led program of health education and behavior change is necessary to effectively reduce HF readmissions within 30 days of discharge.

A Review of Some Evidence-Based Literature on the Clinical Problem

Three studies on nurse-practitioner-led interventions to reduce HF readmission rates within 30 days of discharge are reviewed here.

Table: Literature review of three peer-reviewed articles on the clinical problem of HF hospital readmissions within 30 days of discharge.

Applying the Precede/ Proceed Model to Address the Clinical Problem

PRECEDE stands for predisposing, reinforcing, and enabling constructs in educational/ environmental diagnosis and evaluation. On the other hand, PROCEED stands for policy, regulatory, and organizational constructs in educational and environmental development (Center for Community Health and Development, 2020). In making this program, the stages in the model will be followed as below. However, the first thing to do will be to form a working committee made up of stakeholders with knowledge about the problem. These are a cardiologist, a nurse manager, a case manager (clinical nurse leader), a nutritionist, a pharmacist, a faith-based organization (FBO) representative, and a representative from the local health authorities.   

PRECEDE

This is the stage of planning and comprises of four to five phases. They are:

1. Determining the needs of the population selected: This is the need to reduce readmission rates for HF within the first 30 days after discharge.
2. Identification of the health determinants for the identified need: Majority of the HF patients readmitted within 30 days after discharge are over 65 years of age. The most common reason for readmission among the readmitted patients is a lack of self-care and responsibility for one’s own health (Moore, 2016).

• The behavioral and environmental determinants of health needs: The needs for educational intervention revolve around medication compliance, lifestyle changes, and avoidance of environmental triggers to HF (Hammer & McPhee, 2018). The resources that are needed for this to be done are human resources (a multidisciplinary team).

1. Predisposing, reinforcing, and enabling behaviors: Some of the factors that lead to readmissions include skipping of medications, inappropriate dietary intake, and the lack of a strong social support network.
2. Interventions: The objectives will be (i) to lower the rate of HF readmissions within 30 days after discharge, and (ii) to increase awareness of HF complications and to instil the value of self-care in the HF patients. The intervention according to the body of evidence available will be a nurse-led multidisciplinary educational intervention (Jackevicius et al., 2015; Smith et al., 2015) administered preferably beginning days before discharge.NUR 670 Project Evaluation Paper

PROCEED

This is the stage of implementation and evaluation. The phases are:

1. This is the phase in which the interventions will be evaluated in terms of efficacy, by looking at the patient data (number of readmissions).
2. The impact that the intervention had on readmission rates and the attitudes of the HF patients will be evaluated.

• Lastly, the patient outcomes will be evaluated as a whole to find out if the program has been a success or failure. This can be done through patient surveys on the quality of life physical wellbeing, and emotional stability.

References

Center for Community Health and Development (2020). Precede/ proceed model. http://sites.bu.edu/ciis/files/2016/06/PRECEDEPROCEED-Model-Cheat-Sheet_CGA.pdf

Charteris, E.J., & Pounds, B. (2020). A nurse practitioner–led effort to reduce 30-day heart failure readmissions. Journal of the American Association of Nurse Practitioners, 32(11), 738-744. https://doi.org/10.1097/JXX.0000000000000470

Chava, R., Karki, N., Ketlogetswe, K., & Ayala, T. (2019). Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients: A community hospital based retrospective study. Medicine, 98(27), 1-4. https://doi.org/10.1097/MD.0000000000016233

Dadosky, A., Overbeck, H., Egnaczyk, G., Menon, S., Obrien, T., & Chung, E. (2016). The effect of enhanced patient education on 30-day heart failure readmission rates. Heart & Lung, 45(4), 372. http://dx.doi.org/10.1016/j.hrtlng.2016.05.002

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Howie-Esquivel, J., Carroll, M., Brinker, E., Kao, H., Pantilat, S., Rago, K., De Marco, T. (2015). A strategy to reduce heart failure readmissions and inpatient costs. Cardiology Research, 6(1), 201-208. http://dx.doi.org/10.14740/cr384w

Jackevicius, C.A., de Leon, N.K., Lu, L., Chang, D.S., Warner, A.L., & Mody, F.V. (2015). Impact of a multidisciplinary heart failure post-hospitalization program on heart failure readmission rates. Annals of Pharmacotherapy, 49(11), 1189–1196. https://doi.org/10.1177/1060028015599637 

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best pr

NUR 670 Project Evaluation Paper