Reflection apa format reference less than 5 years

18

Transitional Nursing

Phase 5

Alina Rivero Parets

Florida National University

Nursing Research and Evidence Based

Dr. Nora Hernandez-Pupo

November 23, 2021

Introduction

Transitional nursing is the state of transferring patients from their current places of health care to other areas where they continue receiving health attention. Transition can be from one hospital to another, from one provider to another, within health state or care settings and discharging patients from hospital to recover at home. While discharging patients before they fully recover, they are well guided on taking medications at home, given well-elaborated discharge packages, and frequent clinical visits may also be included. However, not all patients recover smoothly as thought to be as some patients are readmitted to hospitals within 30 days of discharge due to worsening the same condition.

Research indicates that 20% of discharged patients are readmitted in the first 30 days and 34% within 90 days, caused by poor nurse-patient communication and low-quality nursing care at home. Early discharge of patients before they gain strength to receive medication at home may also contribute to high chances of Readmission. Readmission processes are costly and cost the government of the USA $17.4 billion every financial year.

Study Purpose

This study is meant to realize the causes of worsening situations of patients after being discharged which leads to Readmission. In the study, we will have analyzed all gaps in the transition process from the hospital to homes, thereby helping formulate strategies to reduce the rate of Readmission. This will reduce the high budgets incurred by the government and hospitals to cater for readmission cases. Also, the study will help the faster recovery of patients due to effective laid plans of illness treatment, therefore, releasing patients and families from sadness.

The following questions should be answered after the research:

1. Hospital management roles in ensuring readmission reduction

2. Steps to be taken by hospitals before the transition

3. Communication strategies between health service providers and patients to avoid misunderstanding

4. Role of nurses during the transition and the progress of patients at home

5. The role of patients and those living with them in ensuring rules and recovery.

Literature review

About 34% of discharged patients end up being readmitted to the hospital due to worsened conditions within three months of discharge. This is caused to the lack of standard discharge processes and well-laid strategies for health service continuity to the patients. Therefore, nurses are required to give guidance to patients and post-discharge providers to ensure patients' full recovery. Effective communication through regular clinic visits will help nurses monitor the patient's progress and make proper decisions on change of medication plans.

Nursing intervention during discharge

Nurses should ensure that patients are stable before discharging them to a state that will be easier to manage at transitional places. Also, frequent follow-ups should be to know whether they can follow the medication procedures given during discharge. Nurses should liaise with those responsible for taking care of the patient after release and educate them on how to handle the situations for best results. The first week or two are the most critical for patients to take care of themselves without nurses. Therefore it is necessary to keep in touch throughout on-call or texting to know the progress and give directions. Nurses need to consider the transitional place environment before discharging a patient since some have very poor, non-conducive homesteads for medication processes to run smoothly. Well utilized and easily accessible evidence-based tools are essential in assisting nurses and NCMs in managing patient's transition optimally.

Methodology

Intervention Mapping is considered a systematic and iterative six-phase process that assists in developing an intervention kind of system based on theoretical, empirical, and even practical information. IM was initially utilized appropriately in the identified health promotion kind of domain to come up with programs for the issue of smoking cessation as well as stroke prevention, HIV prevention and leg ulcer management. There is the use of PRECEDE PROCEED MODEL to effectively analyze and illustrate the identified scale along with causes and even impacts regarding Health issues and in the identification of the targeted group.

Participants and Procedure 

  A literature search on the identified frequency and impacts regarding ineffective hospital discharge issues will be performed. There will be the performance of a significant kind of qualitative research on the identified patient handovers between the recognized acute care healthcare centres and the primary care in the US. This will be vital in determining the behavioural and environmental Level determinants impacting ineffective healthcare centres discharge. The study to be performed will adhere to RATS which stands for relevance and soundness, Transparency and appropriate guidelines for the qualitative types of research. Analysis of data will comprise a multi-method kind of qualitative study inclusive of the individual and the focus group kinds of interviews, process maps, and the artefacts Analysis.  

 

Intervention Results, performance Goals & change Goals 

There was also the identification of the desired results regarding the intervention and formulated particular objective performance for the identified target population, like writing a complete, accurate, and even timely discharge letter by a recognized hospital physician. This led to a step by step kind of checklist regarding what needs to be achieved to attain the most effective results. It is vital to identify the necessary steps required to be taken to impact performance goals and eventually the intervention results. There was the identification of essential determinants like lack of knowledge and comprehensive understanding between the healthcare center and the primary care types of providers required to be altered and combined with the performance goals to design alteration goals.  

Sampling methodology 

Stratified method of sampling 

In the stratified sampling method, the identified population is divided into subgroups or even strata that share the same features. It is usually utilized when the researchers reasonably anticipate the determined measurements regarding the interest to vary between the distinct kinds of subgroups. There is the need to make sure there is representation from all the identified subgroups. In this kind of sampling Methodology, the identified study

A sample is usually obtained via taking equal and fair sample sizes from each of the given strata. In stratified sampling, it is also vital to select non-equal sample sizes from each of the identified strata. 

 This is vital in ensuring the achievement of a highly realistic and accurate estimation regarding the health outcomes of nurses across the region. At the same time, there would be an over-representation of the nurses from the identified healthcare centres for simple random sampling. It is vital to understand that the given sample was effectively stratified ought to be considered at the specified analysis stage. This kind of sampling Methodology helps in the improvement of accuracy as well as representativeness regarding the outcomes by the reduction of the sampling bias (Valliant et al., 2018).  

Necessary tools 

The necessary tools are audio recorders as well as form plus online kind of questionnaire. The audio recorder is utilized for the critical aim of recording sound on the discs and tapes, and films. The type of audio information is considered highly suitable since it can effectively meet the key needs regarding a wide range of individuals and offer alternatives to the printing of data gathering tools (Narasimharao et al., 2017). Form plus is associated with letting an individual effectively create strong forms to assist in collecting the information needed. It is vital in creating online forms for getting actionable trends and measurable kinds of responses.  

Flow Map

Implementation 

The section will discuss the steps of implementation and how the project will be completed. The measures include data sampling, participant selection, data gathering, and analysis. The thesis of study will be focused throughout the research project, and issues in the transition from hospital to home and readmissions will be kept in mind. The details of the implementation process are as follows.  

Steps

Choosing Participants  

The sampling process is an essential step in the implementation because it demonstrates the researcher's knowledge of how much he has a grasp on his knowledge and how he will continue the further research. The success of research depends on the sampling process because it is seen that inappropriate sampling gives inappropriate outcomes.  

The first step will focus on the participants who have been through the readmissions in the hospitals. The nurses will also be involved in the research, and the data will be collected from those who have suffered from severe issues and got Readmission. The patients who never faced Readmission issues or who do not have such concepts will not be considered for the study.  Moreover, it will be seen that the participants should understand the English language, and they should provide honest reviews. The research will be carried out with 50 participants, and some of them will be nurses.  Others will be the patients who have the experience of readmissions in the hospital.

Nurses working with the readmissions of patients will be preferred because the participants should have sound knowledge about the reasons and issues in this context. There are different patients, and at the same time, there are nurses in various specialized areas, so it will be necessary for the researcher to choose the nurses specialized in the context under study. They should have vast experience working with patients who suffer from the issues of admissions. Moreover, the patients are also exhausted because of their illness, so all these factors will be

The research is usually done physically because it is easy for the researcher and consider (Maki, 2021).  the participants to interact. The situation at present is not suitable for physical interaction, so the research will be conducted in alternative ways.  

The hospital administration will be contacted, and they will be informed of the research.  They will be told all the research protocols, including the nurses and the patients in the study.  There will be 50 participants, and they will be contacted in their free time, and interviews will be taken by telephone (Wong, 2021). 

Ethical Standards 

The researcher needs to follow the ethical standards and protocols, and they are discussed as follows. 

Consent 

There are specific protocols in the research, and it is the first rule that they should be informed of the research details. They should know the purpose of the study, and their volunteer response and consent are necessary. The researcher must make the participants understand why they are contacted and the expected outcomes of the researcher. Their roles and responsibility in the research will be defined, and they will be informed about how and when they will be contacted (Valliant, 2018).  

Confidentiality 

The privacy and confidentiality of participants and institutions are the essential concerns of the study. The research will ensure that the investigation will be conducted with complete confidentiality and no information will be disclosed. In the context of confidentiality, the researcher will assure that the personal details of participants remain a secret. Once the information is collected, all the details will be hidden, and the unknown codes will be given for identification. Doctors and nurses are trained and supposed to keep secrets on any patients to protect their dignity.

Autonomy 

All the institutions and participants will be asked to ensure their volunteer consent in written form. They should ensure that they are part of the research with no pressure and with their will. They will choose to stop responding and withdraw from the study with their choice (Oh, 2021)

Beneficence

It has already been assured that the participants will be told of all the possible risks in the research. Nursing is a sacred profession, ensuring that the study will not affect their duties and career. They will be contacted in their free time, and they will be given proper time to respond. All the patients and their families will be respected, and their dignity will be maintained throughout the research.  

Data Analysis 

Data analysis is an essential process, and complete research success is based on it.  If the researcher uses the appropriate research tools, the results will be analyzed accurately, and the desired outcomes will be achieved. The primary statistical tools will be used in the research. The charts and flowcharts will be used for the data analysis, and the results will be interrupted in detail (McHugh, 2021). 

Training 

The researcher will interrupt the results and inform the hospital management of the gaps and the common reasons for the readmissions of patients. So, the nurses will be given training accordingly. There are two essential steps involved in the implementation: the timeline schedule and budget planning.  

Gantt chart 

Week	1	2	3	4	5	6	7	8
Sample Collection
Ethical Standards Training
Data Collection
Data Analysis
Training for Data analysis
Report Finalization

Budget 

The budget planning is shown in the table below. The researcher has to decide the budget as early as possible because he has to arrange the resources of funds. The high costs will be the training of nurses after the declaration of results. The advertisement is also necessary for participant selection. The details of the budget are shown as follows.

Budget

Item	Cost ($)
Promotion and advertisement	400
Training	1500
Survey expenditure	1500
Analyzing results	2000
Training for research	8,000
Total	13,400

As part of this research, the primary goal is to explain and the correct set of examination of the correlations between early provider follow-up and the nursing care coordination or intensity management kind of intensity. Before presenting a series of comparisons between groups for readmission and Employees provident fund (EPF) within 14 days, this assignment will show sample characteristics. The correlations between the variables will also be given in a bivariate form. Finally, each of the study goals will be successfully handled by the statistical analysis results (Allen et al., 2018). 

Results 

During the following research, the critical upstream components that affect the provision of transitional care for the specified senior group were discovered. For example, the identified providers and nurses may successfully adjust the transitional style of care for senior individuals to the recognized population aspects like cardiovascular illness load and the downstream elements like the neighbourhood disadvantages; among others, Nursing research should continue to expand on this sort of individual-level. Even population-level interventions to achieve better results for patients (Rasmussen et al., 2021). 

Sample Characteristics 

Following the extraction of instances that met the inclusion criteria, exclusions, and data cleaning, a final study sample of 1280 cases was accomplished. The mean age was 79.5, with 50.7 per cent of participants being female and 25.9 per cent non-white. A total of 94.9% of the study participants were enrolled in the well-known Medicare program. A total of 3.6% of the population was covered by private insurance. The average length of stay in the hospital was five days, and roughly 31.8% of patients were discharged with recognized home treatment (DelBoccio et al., 2017)

According to the recognized health-related system area, the principal homes of the subject were effectively distributed throughout the defined west, which was 34.5%, the main which made up 18.4%, and the east, which made up 47.1% areas. This included the six most essential counties in the state. According to the research, 92.0% of participants lived in urban areas, and 20.2% lived in the most impoverished districts. Thirteen per cent of the final sample was found to have a 30-day readmission rate of 13 per cent (Allen et al., 2018). 

In the seven days after the study began, 34.1% of individuals had EPF, and 60.1% of those subjects had EPF within the 14 days. 46.3% of the identified sample tad at most minuscule one Care Coordination and Transition Management (CCTM) interaction within 30 days after discharge, and 38.8 percent had at least one CCTM contact during the first three days following discharge. The following tables summarize the patient characteristics by readmission status and EPF throughout the 14 days (Menezes et al., 2019). 

Table 1  

Patient Characteristics and 30-Day Readmission Status 

 Readmission

Total

No

Yes

p-

N=1280

N=1114 (87.0%)

N=166 (13.0%)

value

Age*	79	73, 94	80	73,94	78	71,93	.031
Sex Female	649	50.7%	567	50.9%	82	49.4%	.718
Male Race	631	49.3%	547	49.1%	84	50.6%	.059
white	948	74.1%	835	75.0%	113	68.1%
non-white	332	25.9%	279	25.0%	53	31.9%
Length of stay*	4	3,10	4	3,10	4	3,14	.069

2

Discharge disposition Home	873	68.2%	763	68.5%	110	66.3%	.565
Home health	407	31.8%	351	31.5%	56	33.7%
Comorbidity Index* Neighborhood least disadvantaged	37 1022	27,62 79.8%	36 900	26,62 80.8%	44 122	32,65 73.5%	<.001 .029
most disadvantaged	258	20.2%	214	19.2%	44	26.5%

Comparison of Groups 

Note that six factors, including age, comorbidity index, neighbourhood disadvantage, EPF identification within 7 and 14 days, and two CCTM contacts, were associated with the question of Readmission. More than a third of the patients classified as being at high risk of being readmitted were younger, had more comorbidities, and resided in a less affluent area than those who did not have Readmission. According to the analysis, most patients with detected readmissions had fewer CCTM interactions and more periodic provider follow-ups in the indicated 7 or 14 days than patients with no readmissions. CCTM intensity was not associated with readmissions, as previously stated (Weeks et al., 2018). 

Table 2  

Relationship among the variables 

Early Provider Follow-up

	No			Yes		p-value
Age* Sex	80		72, 87	79		73, 86	.159 <.001
Female	293		57.3%	356		46.3%
Male	218		42.7%	413		53.7%
Race							<.001
White	344		67.3%	604		78.5%
non-white	167		32.7%	165		21.5%
Length of stay*	4		3, 6	4		2, 6	.030

Discharge disposition Home	327	64.0%	546	71.0%	.008
Home health	184	36.0%	223	29.0%
Comorbidity Index*	38	27, 51	36	26, 47	.027
Neighborhood least disadvantaged	377	73.8%	645	83.9%	<.001
most disadvantaged	134	26.2%	124	16.1%
30-day readmission	80	15.7%	86	11.2%	.020
CCTM Intensity* CCTM contact completed	0	0, 1	1	0, 2	<.001
within 3 days	150	29.4%	346	45.0%	<.001
within 30 days	179	35.0%	413	53.7%	<.001
Number of CCTM contacts None	332	65.0%	356	46.3%	<.001
1 contact	72	14.1%	199	25.9%	<.001
2 contacts	53	10.4%	101	13.1%	0.137
3 contacts	25	4.9%	53	6.9%	0.143
4 contacts	19	3.7%	33	4.3%	0.611
5 contacts	10	2.0%	27	3.5%	0.104

Most subjects had bivariate correlations ranging from modest to moderate between the study's linked variable and the covariates. The figure below effectively summarizes the discovered orientations concerning the observed correlations. 

Table 3 

Multivariable Analysis of Factors Associated with 30-Day Readmission 

Variable	B	SE	Wald	df	OR	95% CI	p-value
EPF within 14 days	-.364	.169	4.613	1	.695	.499, .969	.032
CCTM, 2 contacts	.511	.227	5.075	1	1.666	1.069, 2.598	.024

Comorbidity Index .023 .006 16.324 1 1.023 1.012, 1.034 <.001

Limitations 

A weakness of the identified research was that the identified sample was obtained from a single health-related system, which might harm the external validity of the recognized context-dependent form of mediation that was found. Because the transitional care type of activities is unique to this specific kind of health-related system, the found association between the identified early provider type of follow-up and the nursing type of CCTM may not take place in the other types of health-related system. There was no data to back up these nursing practices. Still, they did follow the American Association of Critical Care Nurses (AACN) paradigm at the time (DelBoccio et al., 2017). There may also be issues with accuracy and matching when using retrospective data in the main study from the identified medical records and billing kind of data in the recognized primary research. In addition, the readmission type of data obtained from the original investigation may have specific limitations due to the usefulness of just the recognized health system administrative data source for the identification of hospitals.

Conclusion

The intricate relationship between early provider type of follow-up, CCTM intensity, hospital readmission, and even neighbourhood disadvantage has been established. "Comorbidity and living in a disadvantaged area were both associated with higher chances of Readmission. Before 14 days, patients who had an EPF were 30 per cent less likely to be readmitted than patients who did not have an EPF. lowered EPF was linked to neighbourhood deprivation and comorbidities.

During the 14-day study. Furthermore, CCTM intensity was higher in those with diagnosed comorbidity, but neighbourhood disadvantage was reduced in those with CCTM intensity (Weeks et al., 2018). A clear link between the early provider type of follow-up and reduced readmissions among elderly HF sufferers was also found, regardless of their neighbourhood disadvantage. Within 14 days of a patient's return to the hospital, the intensity of nursing CCTM did not affect EPF. Although EPF was positively correlated with CCTM intensity and effectively decreased by neighbourhood disadvantage throughout the 14 days, EPF was not connected with CCTM intensity. More CCTM contacts were seen in patients who had early follow-up visits and resided in low to moderate neighbourhood disadvantage (Naylor et al., 2018).

Implications and limitations of future research

The future researcher should involve those patients who have taken medication out of hospitals for a long and know the strategies they use to maintain good health. People suffering from diseases like hypertension, diabetes, HIV can provide a better idea of how to fight infections without the assistance of health officers since they have maintained good health for a long. Also, researchers should use more comprehensive methods to avoid biasness of data and involve people from all social classes

References

1. De Regge, De Pourcq, Miniboom, Mortimer & Eeckloo, K. (2017). The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Services Research, 13 

2. Warchol, Monestime, Mayer & Chien, (2019). Strategies to reduce hospital readmission rates in a non-Medicaid-expansion state. Perspectives in health information management, 16(summer).

3. Chen, Wijesundara, Patterson, Cutrona, Aiello, S., McManus, & Houston, (2021). Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses' and patients' perspectives. BMC Health Services Research, 9 

4. Maki, Nagai, Ando & Tamakoshi (2021). Structure and predictors of in-hospital nursing care leading to a reduction in early Readmission among patients with schizophrenia in Japan: A cross-sectional study. PLoS One, 16(4), e0250771. 

5. McHugh, Aiken, Sloane, Windsor, Douglas, & Yates, (2021).  Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet, 1911. 

6. Oh & Kim, (2021). Effectiveness of discharge education with the teach-back method on 30-day Readmission: a systematic review. Journal of patient safety, 17(4), 305-310. 

Valliant, Dever, & Kreuter, F. (2018). Practical tools for designing and weighting survey samples. 

7. Wong, Cheung, Hong, Yeoh, Hung, Yip, & Chung, (2021). Effectiveness of nurse-led peri-discharge interventions for reducing 30-day hospital readmissions: A network meta-analysis. International Journal of Nursing Studies,