Case 28
Phase 3 Research Project Paper
Jose Duarte
Instructor: Aciel Sagrera-Mulen
Nursing Research and Evidence-Based Practice
Florida National University
04/07/2024
Evaluating the Impact of Transitional Nursing on Patient Outcomes
This research study aimed to explore the impact of transitional nursing interventions on reducing patient readmission rates across various healthcare settings. Previous phases involved identifying the research problem, literature review, and methodology design. The study employed a mixed-methods approach, combining a retrospective cohort study to analyze quantitative data on readmission rates and patient outcomes, with qualitative interviews and focus groups to gain insights from transitional nurses, patients, and families regarding their experiences and perspectives on care transitions. The integration of these findings holds the potential to inform evidence-based guidelines and protocols for transitional nursing practice.
Results
Quantitative Results
The retrospective cohort study involved 1,250 patients, with 625 patients in the intervention group who received transitional nursing care and 625 patients in the control group who received standard care. Propensity score matching was applied to ensure that the two groups were comparable in terms of age, gender, comorbidities, and severity of illness.
The results obtained showed that the two groups varied significantly. In 30-day readmission rates between the two groups, the intervention group's was 12.8%, and the control group's was higher at 18.4%. Logistic regression analysis showed that patients who received transitional nursing care had a 37% lower risk of readmission within 30 days compared to the control group (Odds Ratio = 0.63, 95% CI: 0.49-0.81, p < 0.001).
The intervention team also experienced a shorter mean stay time than the control group was noted. The mean length of stay for the engaged group was 5.2 days (SD=3.1) versus 6.7 days (SD=4.2) for the control group. The observed effect was statically significant (p < 0.001).
The given study tested different patient outcomes including functional measurements, self-care capability, and quality of life factors. The experimental group had a significant improvement in these outcomes compared to the control group. On the other hand, the mean of functional status scores (by means of the Katz Index of Independence in Activities of Daily Living) at discharge was 5.8 (SD=1.2) for the intervention group and 4.9 (SD=1.6) for the control group (P< 0.001).
Besides this, those who belonged to the intervention group showed a superior ability to be independent in self-care which was measured with the Index of Self-Care for Heart Failure (SCHFI). The condition’s mean SCHFI score equaled 68.5 (SD = 11.3), and for the control group, it was 59.2 (SD = 14.8), with a significant difference between both groups (p <0.001). This underlies that the transitional nursing care interventions indeed had a vital domain in influencing patients' competence to independently manage their states and to stick with self-care regimens after discharge.
The quality of life of patients was also clearly better in the intervention group based on the data in the SF-36 Health Survey. The PCS mean physical component score of the intervention was 46,7 (SD = 9,2), which was in contrast to 41,5 (SD = 10,6) in the control group as p<0,001. In parallel, the mean MCS value was higher in the intervention group ((49.8, SD = 8.9) than in the control group (44.1, SD = 11.4) leading to a statistically significant difference (p < 0.001).
These quantitative results highlight the positive impact of transitional nursing interventions on various patient outcomes, including readmission rates, length of stay, functional status, self-care ability, and quality of life. The findings suggest that the comprehensive care provided by transitional nurses, including discharge planning, patient education, and follow-up support, played a crucial role in facilitating smoother care transitions and improving patient outcomes.
Qualitative Results
1. Interviews with Transitional Nurses:
Thematic analysis of the interviews with transitional nurses revealed several recurring themes and patterns. One prominent theme was the importance of effective communication and collaboration among healthcare providers, patients, and families. Transitional nurses emphasized the need for clear and consistent communication channels to ensure seamless care transitions and prevent readmissions.
The other topic that frequently appeared in the discussions was the difficulty of imparting patient education and involvement. Transitional nurses agree that they should give patients and their families full information on self-management, medication adherence as well as follow-up care for these individuals to learn how to care for their health. Thus, healthcare providers should go for the option of patient involvement with stipulations that in cases where the patient has low health literacy, or a difficult medical scenario is considered.
Transition nurses also had to describe the stumbling blocks they encountered in practice, such as difficulties in finding resources, overflowing work, and lack of uniform procedures. They specified more supportive and encouraging environment for their role is effective in reducing readmissions as well as patient outcomes.
1. Focus Groups with Patients and Families:
The focus groups with patients and families who received transitional nursing care provided valuable insights into their experiences. One common theme was the appreciation for the support and guidance provided by the transitional nurses during the care transition process. Patients and families reported feeling more prepared and confident in managing their care after discharge, reducing their anxiety and stress levels.
Though the participants included critical details, some areas needed improvement. The particular patients and families complained about the need to make the education and follow-up support more customized for their specific problems and situations. Finally, some identified what they had been going through in trying to figure out the healthcare system complex and at the same time coordinate care among several providers.
Furthermore, participants indicated that the prompt communication between the corresponding transitional nurse, primary care physician, or specialist was considered a crucial point. They criticized non-compliance episodes when communication or coordination efforts were not effective enough, thus readmissions could occur, or patients may end up with negative outcomes.
Discussion
The results from this research can be worth a lot as it is a demonstration of how transitional nursing interventions may help in reducing patient readmissions and in enhancing patient outcomes generally. The statistically significant results show that the patients who got transitional nursing care spent fewer days in the hospital being readmitted and discharged sooner than the patients who owned to standard care. This study just adds to the already proven effectiveness of transitional care in reducing readmissions, the results of the study by Weiss et al. (2019).
Additionally, the findings showed that the intervention group had excellent functional status, self-care performance, and quality of life after being discharged compared to the control group. Those outcomes support the significance of transitional care which is not just aimed at the reduction of readmissions, but it also emphasizes general patient outcomes and well-being.
The qualitative results corroborated the quantitative data and gave nurses from the transition team, patients, and family members all a new perspective on the process. The interviews of the nurses in transition asserted the significance of communicating information and collaborating between the healthcare providers, patients, and family members which consequently led to a smooth patient transfer. Such a discovery corresponds to the study conducted by Earl et al., 2020, which underlined the significance of interdisciplinary cooperation when it comes to reducing the risk of readmissions.
Additionally, the transitional nurses were found to share some of the challenges they face in their jobs, like limited resources, heavy workloads, and a lack of standardization protocols. Based on these results, we conclude that it is necessary to acknowledge the vital contribution of the transitional nursing role to the healthcare system and to come up with a policy framework that includes evidence-based guidelines.
The researcher had one-on-one sessions with the patients and families to know their roads to recovery and what areas need to be improved in transitional nursing care. People participating in the characters of transitioning nurses felt thankful for the support and guidance provided by them, but they also asked for individual education and personal support. Uncovering the link between patient education self-care and self-engagement is consistent with the studies stressing this point of view (Sili et al., 2023).
The result that was derived from a hypothesis explicitly answers the research questions by identifying the primary determinants of patient readmissions, those being poor discharge plans, lack of communication, and limited education for patients. This study also focuses on the identification of the strategies and interventions used by transitional nurses which include assessing the readiness for discharge, bridging programs, and self-care education (Weiss et al., 2019). Such strategies have proved useful in reducing readmission rates in different healthcare settings.
Moreover, the key messages outlined from qualitative findings highlight the essence of appropriate communication and partnership between healthcare providers, patients, and families, but also obstacles and difficulties that may arise from transitioning nurses. Such information can be utilized to develop recommendation-based guidelines and protocols regarding transitional nursing practice, which recall the key research problem.
Generally, the findings from this hypothetical study demonstrate the decisive role of the care provided by nurses during the transition increases patient satisfaction and reduces readmission. Together, quantitative and qualitative results offer us a thorough picture of different approaches, issues, and best practices that are used in transitional nursing care guiding the development of evidence-based policies and interventions for the provision of better and more qualitative care.
Limitations
Whilst the study has some revealing facts, it still has certain flaws. One potential gray area is the historical character of the quantitative data that could be subject to biases and not complete information. Notably, the qualitative data originates from an individual's subjective experience that is not always applicable to every healthcare setting. Prospective study designs, more extensive samples, and multicenter research are some of the ways along which future research could be carried out to strengthen the generalizability and the robustness of the conclusions.
Conclusion
In conclusion, this study's findings highlight the significant impact of transitional nursing interventions on reducing patient readmissions, enhancing patient outcomes, and facilitating seamless care transitions. The integrated quantitative and qualitative results provide a comprehensive understanding of the strategies, challenges, and best practices in transitional nursing care. These findings have the potential to inform evidence-based guidelines, protocols, and policies, ultimately improving transitional nursing practice and delivering high-quality, patient-centered care.
References
Sili, A., Zaghini, F., Monaco, D., Molin, A., Mosca, N., Piredda, M., … & Fiorini, J. (2023). Specialized nurse-led care of chronic wounds during hospitalization and after discharge: a randomized controlled trial. Advances in Skin & Wound Care, 36(1), 24-29. https://doi.org/10.1097/01.asw.0000897444.78712.fb
Weiss, M., Yakusheva, O., Bobay, K., Costa, L., Hughes, R., Nuccio, S., … & Bang, J. (2019). Effect of implementing discharge readiness assessment in adult medical-surgical units on 30-day return to hospital. Jama Network Open, 2(1), e187387. https://doi.org/10.1001/jamanetworkopen.2018.7387
Earl, T., Katapodis, N., & Schneiderman, S. (2020). Care transitions. In Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK555516/