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List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

The topic is the use of caregiver- mediated exercises (CME) to improve the quality of life of patients with stroke and their performance function ability. The article can be accessed from Cochrane Library, JDM, V., & Mulder, M. (2016). Caregiver-mediated exercises for improving outcomes after stroke (Review). Retrieved from DOI: 10.1002/14651858.CD011058.pub2

What is the nursing practice issue you have identified related to the topic you have chosen?

The issue identified in the topic is the role of caregivers in promoting maximum participation of patients in exercises so that they can promote a better transition from rehabilitation to their homes while reducing their length of stay in the hospital and enabling discharge of the patients earlier than before with fewer patients having to be readmitted again.

Fully describe the scope of the practice issue:

One of the ways of interventions for patients with stroke is through exercises. The caregivers ensure that they train the patients on exercises that promote wellness and improve their health conditions. While the caregivers guide the patients, they respond more positively and are ready to be discharged. It is the role of caregiver-mediated exercise that improve the patient conditions so that they can be discharged. With effective CME, patients can become more able to function even outside the health care settings and can be discharged with fewer people having to be readmitted again and this reduces the care giver burden in the hospital settings. Also, patients who are given only the usual care and no extra CME interventions are more likely to get readmitted.

What is the practice area?

__√_ Clinical

___ Education

___ Administration

___ Other (List):

How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns

___ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

__√_ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

It is between the transition from the hospital setting to the home or community setting that the care givers can be able to determine the impact of CME in reducing patient readmissions. If the CME is effective, fewer patients return to the hospital for readmission. On the contrary, if the CME is not effective, more patients get back to the hospital from the community. The period between discharge from the hospital and when the patient is settled in their home/community settings is when one can be able to assess whether the right training was conducted.

What evidence must be gathered? (check all that apply)

__√_ Literature search

__√_ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

__√_ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections:

The evidence that is required in assessing the practice issue is the use of literature review that has already been done earlier by other researchers, assessment of the guidelines given by caregivers during CME and analysis of the standards of care during CME administration to patients with stroke.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The identified populations are patients with stroke. The practice problem is the facilitation of caregiver mediated exercise to the patients so as to improve their quality of life after the intervention and the setting is the transition from hospitals to home. When patients with stroke are not well guided on the exercises to undertake, sometimes the usual care is not just enough for them.

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Cochrane Library, JDM, V., & Mulder, M. (2016). Caregiver-mediated exercises for improving outcomes after stroke (Review). Retrieved from DOI: 10.1002/14651858.CD011058.pub2

Identify the objectives of the article:

The objective of the article is to determine whether caregiver-mediated exercises could improve the function ability of stroke patients as well as their quality of life while at the same time have a positive impact on the burden that caregivers have.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The question raised is whether caregiver mediated exercise would reduce the function ability of stroke patients. This is related to my practice issue of patient readmissions because, if the function ability of the patients doesn’t improve before discharge, then they are likely to get readmitted again since they cannot control their conditions at the home settings.

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

To improve the outcomes in stroke patients, the authors have indicated that the systematic reviews conducted shown that spending more time on training on the exercise therapy can lead to better outcomes with the patients having a better functional performance. This means that the caregivers should spend a considerable amount of time everyday training the patients with the target being the patients to improve on their standing, walking and making transfers.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)

The findings of the research are that CME can reduce the length of stay in the hospital, equip patients with self-management tips, and improve their quality of life as well as that of the care givers.

The aim of the milestone project is to determine whether involving case managers during discharge can reduce readmissions. This is relevant because the case managers can critically analyze patients and determine if they are ready to be discharged or they need to spend some few days in the hospital so that they can fully recover to avoid getting readmitted soon after discharge.

Outline evidence-based solutions that you will consider for your project.

For my project, the solutions will include active participation of case managers during admission and discharge of patients, use of a checklist to determine if patients can be discharged once they are identified to perform most of the basic activities; this will be dependent on type of illness, re-evaluation of the patient by the doctor or physician to confirm that they can be discharged and follow-up on patients’ progress.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

Time lag- The period between of publication of the evidence-based solutions and its implementation may take a lot of time therefore making the evidence irrelevance by the time it is implemented.

NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 2/5/2018 DP

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