In patients with CHF, would a scheduled education program with booklet versus just education handouts decrease 30 day hospital admissions over a 3 month period?”

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As a reminder to those who may have not read my posts in the past six
weeks, my PICOT question is: In patients with CHF, would a scheduled
education program with booklet versus just education handouts decrease
30 day hospital admissions over a 3 month period?” Heart failure
readmission rates cause the Center for Medicare and Medicaid Services to
now give hefty penalties to organizations within thirty days so there
is currently a tremendous amount of research surrounding this topic.
There are two major research studies that really follow the PET model
that I am aiming for with this study. My goal is to have approximately
60 test subjects from my primary care practice who fall within the
categories of having a low ejection fraction, diagnosed with heart
failure, and who do not have severe comorbidities including other
systems. I will split this group into a control group and an
intervention group. The control group will receive a three-month
educational program and booklet while the other will receive the
standardized care that has been used in the office.

            The PDSA model was created by Edward Deming and is a
great way to implement change and improve quality of care. The PDSA
stands for Plan, Do, Act, and Study (Donnelly & Kirk, 2015). The key
through the literature research review was that patients’ who had
better education about their disease process, diet, exercise, lifestyle
modifications, medications, and treatment plan, ultimately had better
outcomes than those who are simply receiving the standardized care.
Through review of quantitative and qualitative research literature, it
was evident that the influence and key tools to self-management
precluded better patient outcomes, lower readmission rates, decrease in
length of stay in the hospital, and improved quality of life. Using the
PDSA model, I will outline my plan and figure out the ultimate goal of
this process. This PICOT question would require planning who will be
doing the education session, who will create the booklet, how we will
fund this project, and how to select as well as the selection process
for our test subjects (as well as informed consent). This also includes
the approval of an ethics committee for this research in order to
protect the test subjects. The “Do” would be to start the research
program by following the two groups and providing the education and
reference channels to the patients as see fit. It is important to
document throughout the course of this research in order to gain the
most information possible. The “Study” would be at the conclusion of the
three-month period when all the finalized data is collected and
analyzed. This is where the researcher would see if their predicaments
were correct and how they related to the research literature. The final
step is “Act” and this will involve assessing the overall cycle and
looking where to make changes to being the next PDSA cycle. In a world
of health care where it is constantly changing and evolving, it is
important that processes are being assessed in order to change and
improve. Following the three-month process of education, intervention,
and data collection, it is really important to focus on what worked
during the process, what didn’t, and what changes can be made to reach
the goal of healthier and happier patients.

            One article I found had a very similar PICOT and used a
PET method that seemed very relevant to my PDSA. It used a similar
number of subjects and also slipt them into groups over a three month
period. It had very positive results in a sense that the patients who
were in the intervention group were very satisfied with their quality of
life and managed to stay out of the hospital. As nurses and a future
nurse practitioner, isn’t that what our goal of all this EBP is for – to
improve patient outcomes? I think to truly take my study one step
further would be to also perform a qualitative study and take a closer
look at their perception of the education, self-management, and possibly
ways to improve my program.

Alireza, A., Tahereh, N., & Mansoureh, A. (2018). Effect of the
self-management education program on the quality of life in people with
chronic heart failure: A randomized controlled trial. Electronic Physician, 10(7), 7028-7037. doi:10.19082/7028

Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Education
For Primary Care: An Official Publication Of The Association Of Course
Organisers, National Association Of GP Tutors, World Organisation Of
Family Doctors, 26(4), 279–281. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.

            oclc.org/login.aspx?direct=true&db=mdc&AN=26253069&site=ehost-live&scope=site

 

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Applied Epidemiology

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Applied Epidemiology

On September 11, 2001, terrorist attacks created a grave disaster that included the destruction of the World Trade Center in New York. The day after 9/11, epidemiologists were asked to assess the environment around Ground Zero for potential hazards that might put those engaged in rescue and recovery at risk of harm. Beside the dust, what toxins might be in the air? Was the air quality safe or should rescue workers wear canister respirators or particle masks? What other protections might be necessary in the days following the disaster?

In this Discussion, you will look at the impact of a disaster through the lens of an epidemiologist, addressing such questions as, “What epidemiological considerations arise in the wake of a disaster? And, what makes disaster planning or emergency preparedness effective in terms of mitigating or preventing negative aftereffects?”

To prepare:

  • Identify      a disaster that led to a population health issue. Consider this disaster      through the lens of an epidemiologist, using the information presented in      the Learning Resources to examine the epidemiological considerations      resulting from the disaster. Conduct additional research as necessary      using the Walden Library and credible websites.
  • Ask      yourself, “What factors made the community’s and/or nation’s response      effective or ineffective? What aspects of disaster planning or emergency      preparedness did the community have in place that helped it cope with the      disaster and resulting population health issue?”

By tomorrow 05/08/2018 10 pm, write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below”

Post a cohesive scholarly response that addresses the following:

1) Identify the disaster and resulting population health issue.

2) Describe the epidemiological considerations resulting from this disaster. Support your response with specific examples and evidence from the literature.

3) Discuss the factors that made the community’s and/or nation’s response effective or ineffective.

Required Readings

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L. & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed). Burlington, MA: Jones & Bartlett Learning.

Chapter 15, “Risk Management and Law”

This chapter discusses the role of the U.S. legal system to foster the health of populations with emphasis on the U.S. Supreme Court’s decision on the Patient Protection and Affordable Care Act.

Chapter 16, “Making the Case for Population Health Management: The Business Value of Better Health”

This chapter explores why good health is good business, the cost of good health and the potential provide to be realized when workforce health is improved.

Chapter 3, “Policy Implications for Population Health: Health Promotion and Wellness”

The chapter provides an overview of the intricacies of federal policy making and the key policy components necessary to advance the health of populations.

Chapter 5, “The Political Landscape in Relation to the Health and Wealth of Nations”

The chapter describes the relationship between national health and population health and the constitutional structures that influence health policy.

Chapter 20, “The Future of Population Health at the Workplace: Moving Upstream”

This chapter focuses on the future of population health in the workplace and the new knowledge that is driving future trends in population health.

Admi, H., Eilon, Y., Hyams, G., & Utitz, L. (2011). Management of mass casualty events: The Israeli experience. Journal of Nursing Scholarship, 43(2), 211–219.

This article examines the Israeli model of emergency preparedness and management, including nurses’ clinical and managerial involvement in mass casualty events.

Beam, E. L., Boulter, K. C., Freihaut, F., Schwedhelm, S., & Smith, P. W. (2010). The Nebraska experience in biocontainment patient care. Public Health Nursing, 27(2), 140–147.

Nurses are often on the front lines when emergencies happen. This article examines public health planning and management strategies for infectious disease outbreaks and bioterrorism attacks.

Honoré, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinski, J., & Koh, H. K. (2011). Creating a framework for getting quality into the public health system. Health Affairs, 30(4), 737–745.

In this article, the authors examine health care reform and the Affordable Care Act in light of public health’s priorities of improving population health.

Sprung, C. L., Cohen, R., & Adini, B. (2010). Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Medicine, 36(Supplement 1), S4–S10.

This reading describes the efforts put forth as a result of a task force established by the European Society of Intensive Care Medicine in December 2007. The chapter examines the purpose and development of standard operating procedures (SOPs) to better address population needs during an infectious disease breakout or disaster.

Richards, G. A., & Sprung, C. L. (2010). Chapter 9. Educational process. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Intensive Care Medicine, 36(Supplement 1), S70–S79.

As noted in this chapter, planning and education are imperative to adequately prepare intensive care units (ICUs) and hospitals for an influenza pandemic or mass disaster. The authors provide standard operating procedures (SOPs) and recommendations.

Federal Emergency Management Agency. (2011). Retrieved from http://www.fema.gov/

Explore the Federal Emergency Management Agency website, whose mission is to “support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.”

Required Media

Laureate Education (Producer). (2012). Epidemiology and population health: Population health issues, part 1 [Video file]. Baltimore, MD: Author.

In part 1 of this week’s media, the presenters discuss how epidemiology can be utilized to improve population health.

Laureate Education (Producer). (2012). Epidemiology and population health: Population health issues, part 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

In part 2, Dr. Hull discusses lessons learned from global efforts to eradicate polio.

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“Professional Roles and Responsibilities”Family nurse practitioners (FNPs) are graduate-educated, nationally-certified and state licensed advanced practice registered nurses (APRNs) who care for medically stable patients across the lifespan, from infants to geriatric patients.

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“Professional Roles and Responsibilities”Family nurse practitioners (FNPs) are graduate-educated, nationally-certified and state licensed advanced practice registered nurses (APRNs) who care for medically stable patients across the lifespan, from infants to geriatric patients. Share your thoughts

  1. What are the educational requirements to practice as a FNP?
  2. According to the American Association of Colleges of Nursing (AACN), what is the recommended terminal degree to prepare nurse practitioners.
  3. Who determines the scope of practice for FNPs?
  4. Who defines it? Who Credentials and what is the role of a Professional and Political Organization in defining the role?
  5. See rubric

Discussion 3:

Much of the ongoing debate over scope-of-practice (SoP) laws that govern the practice of nurse practitioners (NPs) across the country focuses on the cost of and access to health care and on whether these laws legitimately promote patient safety or are simply anticompetitive restrictions on NPs’ ability to compete with physicians. After completing the following CE activity at Medscape https://www.medscape.org/viewarticle/506277_1 ( sign for the free account), please answer the following questions:Should an NP who is educationally prepared as an acute care NP work in an adult primary care setting?   Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?Are there any restrictions for the FNP to treat patients with mood disorders and to prescribe them antipsychotics or SSRIs ?                                            Discussion 4:

CS/SB 614 authorizes  an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include: Presigning blank prescription forms. Prescribing a Schedule II for office use. Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions. Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance. Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice. Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice. Prescribing, dispensing, or administering a controlled substance to himself or herself. Prescribing, dispensing, or administering laetrile. Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act. Promoting or advertising controlled substances.After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations? 

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Working in a cancer unit, I have learned that no matter what treatments, or surgeries doctors choose, unfortunately a lot of the time the cancer wins.

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Cristina Garcia Martinez 

1 posts

Re:Topic 10 DQ 2

Working in a cancer unit, I have learned that no matter what treatments, or surgeries doctors choose, unfortunately a lot of the time the cancer wins. However, as a nurse I have learned that even though I am unable to make a difference in their overall diagnosis outcome, I can make a difference in their care and well being by using evidence based practice. For example, I found that our unit has the highest CLABSI rate compared to the rest of the entire hospital. So clearly we are doing something wrong, and we need to find that problem and fix it. Our patients are already going through enough and it’s up to us as BSN prepared nurses to implement EBP in the clinical setting to protect our patients from these unnecessary and preventable infections. Making changes over time based on evidence is necessary in order to keep up with our continuously changing health care. BSN prepared nurses understanding of EBP across patient care gives them the unique ability to act as partners with other health professionals and to lead the improvement and redesign of the health care system (IOM, 2010). The first way I will continue to integrate evidence is by staying up to date with the changing health care system. It’s important to be aware of the changes going on outside of our work environment because the can make all the difference in your practice. I feel that nurses tend to get “comfortable” in the way they practice nursing. However, nursing and the health care system will continue to change and we must keep up with those changes. Second, I will make sure that I advocate for the nurses in our workplace by always asking questions, and requesting that our unit receives continuous training in changes occurring out in the nursing world.

 Reference:

Institute of Medicine (2010). The Future of Nursing: Leading Change and Advancing Health. Retrieved from https://campaignforaction.org/resource/future-nursing-iom-report/

 

Josphina Chavara 

1 posts

Re:Topic 10 DQ 2

When an EBP is utilized by a nurse, he or she knows that the EBP stems from the result of trials, experiments, tests, routine examinations, and best practices that took a closer examination on the results and the intended results. The BSN-prepare nurse is confident that the EBP utilized is not something that comes from random ideas put together; it is the result of tried and true procedure that improves upon and evolves the nurse’s understanding of what treatment/medication/action works best for the patient currently. Furthermore, the EBP goes through several rigorous sets of eyes to see its role in improving healthcare. According to the Online Journal of Issues in Nursing (2013), for EBP to be successfully adopted and sustained, it needs to be supported and adopted by “individual care providers, microsystem and system leaders, as well as policy makers.” In doing so, the EBP must also be regulated and approved on a federal, state and local level.  The EBP is a testament of stability, reliability, and effectiveness, so BSN-prepared RNs are able to provide a level of care that comes with a form of elevated awareness on best practices and procedure for the patient. This author plans on using the best possible system of care for her patients, and in doing so will provide EBP-supported actions from the moment of patient admittance. I already have a reputation with my patients for having a relatable and comfortable presence, and my work colleagues are aware that I am a strong supporter of using the latest known treatments for my patients.The other plan I have it to ask my fellow nurses to embrace EBP and challenge them to bring their own EBP that they feel passionate about and bring it in to the workplace as considerations for work. The biggest obstacle for something like this would be nurses who would feel like EBP is a waste of time unless they’ve been explicitly directed by the nurse manager or a doctor. In a way, I can understand their hesitance; the safest thing to do in an industry that is rife with mistreatment and clinical error is to simply only act when directed. The other main obstacle is time, as in the time needed to train nurses to be familiar with the EBP. However, EBP’s strength comes from its proven roots and authenticity, and therefore it would only make sense to convince nurses of how it improves their impact as a nurse and changes the lives of patients for the better. Reference: The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. (2013, May). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html

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