Respond 

 

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.

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Respond to this 

  

Statistical Significance as described by Wasserstein & Lazar (2016) is the “P” value of less than .05, which Pstands for probability. The probability of the research that was not due to chance and that something significant has occurred. The value of the “P” in the study denotes that the true difference between the control and experimental compared groups is as big or if not bigger than reported in the study.  The “p” value depends on three factors such as the degree of the effect or the performance difference between the selected group; the number of participants; and the data distribution which commonly measured as variance and standard deviation (Pintea, 2010).

Clinical significance of results or clinical importance is used to assess and evaluate the effects ofinterventions or outcomes that may be relevant to the target subject. To assess clinical significance, it isimportant to perform a systematic and complete evaluation between the advantagesand disadvantages effects of the study (Guyatt et.al, 2013). It is the difference between the two therapyresults that are proven to justify, modify or change the standard of care.

In my opinion, there is a possibility that research study results can support the acceptance of the nullhypothesis and develop clinical significance.  An example that I came across was the study conducted byLockyer, Hodgson, Dumville, and Cullum (2013) on wound care. The study reported that 74% (32/43) of thereviewed articles have no clear and solid primary outcome and included a finding that was not significant forthe study. This can happen if the selected sample of the research was too small and missed in describing orestablishing the relationship and difference between the groups being studied. It can also happen if thestatistical test was weak, and the measure utilized during the research was defective or unreliable. Andlastly, if the method that was applied to develop an intervention missed identifying the significant variables orideas of the study (Polit & Beck, 2014).

I believe that questioning the credibility of the result from a qualitative study may contribute to clinicalsignificance in my practice area. Credibility refers to facts and certainty of data collected and theresearcher’s interpretation and understanding of results (Polit and Beck, 2014). Qualitative research is focused on exploring ones’ experiences, establishing trust and rapport and describing a comprehensive understanding of a phenomenon. The researcher in a qualitative study must demonstrate engagement withthe participants/informants to validate if the data and conclusion were accurately interpreted.

An example is a qualitative inquiry of patients diagnosed with breast cancer (Pederson et.al,2013). Thequalitative study in the discovery of emotions, experiences, and challenges of cancer patients throughout thedisease process helps to recognize the needed support and care from the health care providers (Cope,2014). Measuring outcomes is important in any research. Data collected must be accurately analyzed andinterpreted. Defining if the outcome is effective and significant comprises of accurate and concisejudgments. As future leaders, we must recognize the credibility of the study and the need for furtherresearch before the application of any new intervention or information into practice.

References:

Cope, D. G. (2014). Methods and Meanings: Credibility and Trustworthiness of Qualitative Research. Oncology Nursing Forum, 41(1), 89–91. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.1188/14.ONF.89-91

Guyatt, G., Oxman, AD., Sultan, S., Brozek, J., Glasziou, P., Alonso-Coello, P., Atkins. D., Kunz, R., Montori, V., Jaeschke, R., Rind, D., Dahm, P., Akl, EA., Meerpohl, J., Vist, G., Berliner, E., Norris, S., Falck-Ytter, .Y., &Schunemann, HJ.( 2013). Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes. J Clin Epidemiol, 66(2):151–157.

Lockyer, S., Hodgson, R., Dumville, J.C., & Cullum, N. (2013). “Spin” in wound care research: The reporting and interpretation of randomized controlled trials with statistically nonsignificant primary outcomes results or unspecified primary outcomes. Trails, 14(1), 371

Pintea, S. (2010). The Relevance of Results in Clinical Research: Statistical, Practical, and Clinical Significance. Journal of Cognitive & Behavioral Psychotherapies, 10(1), 101–114. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=60820813&site=eds-live&scope=site

Pederson, A.E., Hack, T.F., McClemont, S.E., & Taylor-Brown, J. (2013). An exploration of the patient navigator role: Perspectives of younger women with breast cancer. Oncology Nursing Forum, 41, 77–88. doi: 10.1188/14.ONF.77-88

Polit, D.F., & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence for nursing practice (8th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Wasserstein, RL., & Lazar, NA. (2016). The ASA’s statement on p-values: context, process, and purpose. Am Stat.,70:129-133. Retrieved from https://doi.org/10.1080/000313 05.2016.1154108

  

Unit 2 Assignment: EHR Certification & Release of Information

Course outcome addressed in this Assignment:

· HI510-1: Given access to a health information system, evaluate whether it meets Meaningful Use, including goals, components, criteria, certification, attestation, and MU program outcomes.

Description:

The field of health information is subject to many laws, regulations, requirements, and standards. The interaction between regulation and health influences the daily operations of healthcare providers. Sharing data between two separate organizations can be a delicate balance between the patient and organizations. Knowing the regulations that govern health information and the release of information is imperative. Failing to adhere to and think about the rules and regulations when forming decisions and policy can expose the organization and provider to unwarranted risk. In this Assignment, you will review select two EMR systems and review them for compliance with Meaningful Use and EMR certification requirements. You will also review release of information requirements.

Instructions:

Select two EMR systems from the list below.

· OpenMRS
https://openmrs.org

· VistA
http://worldvista.org/AboutVistA

· FreeMED
http://freemedsoftware.org/

· OpenEMR
https://www.open-emr.org/

· One Touch EMR
https://www.onetouchemr.com/

· Solismed
https://www.solismed.com/demo.html

Assignment Requirements

Create a 5–6-page document that addresses the following:

1. Provide an introduction of the two systems that have been selected for comparison. In your comparison discuss the features offered by each system.

2. Discuss meaningful use (MU) and its phases.

3. Do the systems that you have selected meet MU requirements? Discuss whether the system is compliant with MU program outcomes and certification including:

1.  

· Goals, components, criteria, certification, and MU program outcomes.

· Medicare MU program requirements

· Medicaid MU program requirements

4. Discuss how MU has improved data quality.

5. Discuss release of medical information and how MU law applies.

Conduct research to answer the discussion points and questions and be sure to fully describe and support your answers and cite sources when necessary. This is a fact-based Assignment that should not include unsupported opinion.

  

Let’s suppose you have just started working in a long-term care facility, as a nurse, and you have a client who has been living there for several years. He/she does not want to participate in any activities, only comes out of their room for meals, walks a bit hunched over with a cane, is not well groomed, and does not seem to have made any true friendships with the other residents. This person can be male or female and seems to be angry most of the time when interacting with others.

How would you go about establishing a rapport with this person? If the client accepts you, what questions would you ask him/her in order to identify the reasons for why they do not participate in activities and what did the client tell you? Depending on their answer, do you think they suffer from low self-esteem, disturbed body image, fears of some kind, anxiety, or hopelessness? Finally, list several interventions you would find in the care plan that could help this person to gain happiness in life and why they may be helpful.

 What Performance Improvement (PI) projects are currently in place in your organization (past or present) to improve patient satisfaction and/or quality care? 

Why is this important? 

What is the role of your nursing leaders? 

Are bedside nurses involved in these initiatives and what role do they play as a part of this project? 

And, is shared governance a part of these projects? 

*Must include at least one peer reviewed nursing journal article from 2014-2019. Must be in APA