Evidence-Based Practice and Applied Nursing Research

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Describe, Explain and Discuss

Describe the Process or Procedure, and then Include Reasons/Supporting Evidence Why this Needs to be Changed

Effective discharge from a health care facility requires careful planning and continuing assessment of the client’s needs during the stay. Ideally, discharge planning should begin soon after the client’s admission to the health care facility. The purpose of discharge planning process is to assist the client to make a smooth transition from one setting or level of care to another without impending the already achieved progress. Discharge planning is directed towards teaching the client and significant others about the condition and its effects on lifestyle, providing instructions for performing self-care activities, informing the client of any dietary or activity restrictions, and arranging for any follow-up care that may be necessary (Funnell & Koutoukidis, 2008).

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Discharge planning is a team approach, involving the client and significant others, the medical officer, nurses, and other health care team members, such as the occupational therapist, physiotherapist, and dietician. The steps involved in discharge planning are:

  1. Assessing the client and their significant others
  2. Analysing data to identify specific needs
  3. Planning to meet those needs
  4. Implementing the plan
  5. Evaluating the discharge planning process and the results

Discharge planning should be changed, because with shorter hospital stays, patient with chronic illnesses may be discharged before their exacerbation is resolved. Elderly patients in particular are prone to early or inappropriate procedural discharge. An evidence-based discharge process ensures that nurses strategically individualize the unique steps recommended within each practice with a coherent and astute patient focused plan of discharge. Through an evidence-based discharge plan, the nurse patient relationship progresses through steps that promote patient trust, lead to the identification of coping skills and assets, and result in a sense of hope and a future in life. The lack of concise and specific documentation of patient’s information calls for the evidence-based practice in the discharge process of a patient.

Inadequate preparation for discharge is a cause of adverse events and readmission. The discharge plan should be changed in order to provide patients and families with the knowledge and skills required to meet ongoing health needs. This is because it is difficult to provide clients with information they need within the evening before or the morning of discharge. Evidence-based practice is required to ensure availability and the ability to use adaptive coping skills. Evidence-based assessment and diagnostic tools have to ensure that treatment plans incorporate contemporary interventions, backed by high-level evidence of discharge when available (Funnell & Koutoukidis, 2008).

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Explain Who Determined the Basis for the Practice

The basis for patient discharge was determined by the medical officer, nurses, and other health care team members, such as the occupational therapist, physiotherapist, and dietician. The medical doctor played the major role of carrying out the assessments. The medical doctor visited the patient and caregivers for discharge planning within 48 hours of patient admission and at least every six hours throughout the stay. The medical doctor determined the mode of discharge. He also gave instructions for self-care activities, diet, and medication, besides watching out for symptoms of complications or drug side effects. On the other hand, the nurse issued the correct settings for any equipment required and gave us a planned follow-up appointment at doctor’s office. Explain the decision maker’s rationale for instituting or supporting the current procedure or practice

The rationale for discharge-planning by the medical doctor was both continuity of care and cost-effectiveness. Federal legislation increased fiscal restraints, and third-party payers put into consideration cost containment measures. The medical doctor used critical pathways to assist in providing optimal care, while limiting length of stay and costs. Because of shortened hospital stay, it was unrealistic to teach the patient everything they need to know. The medical doctor indicated that referral to a home health agency for follow-up teaching was necessary. In this context, the hospital nurse prepared the patient with sufficient information and supplies to manage home for at least a few days until the home health nurse arrives. Explain why the decision makers decided to implement the practice or procedure

The evidence-based discharge plan was implemented because a systematic review of comprehensive discharge planning protocols concluded that evidence from RCTs was not available to support the general adoption of discharge planning protocols or discharge support schemes as means of improving discharge outcomes. It was noted that discharge planning interventions for older patients with congestive heart failure identified that, for most studies, the intervention was not explicitly described. The evidence-based discharge planning assist in preparing for discharge by encouraging self-care as appropriate, assessing patient’s and primary caregiver’s understanding of knowledge or skills, required after discharge. The evidence-based discharge plan helps in identifying patient’s teaching needed for post-discharge care and assists in developing a plan that considers healthcare and social needs of the patient (Holland, Knafl & Bowles, 2013). Evidence-based discharge plan helps in documenting the patient’s discharge plans on the patients chart and monitoring readiness for discharge.

Explain the Clinical Implications Your Suggested Change Might Have on Patients

Evidence-based discharge planning facilitates use computer-generated summaries of pertinent discharge information to improve patient care after discharge. It also provides patients with copies of the pertinent information at the time of discharge. The procedure results in the use of medication reconciliation to avoid medical errors such as omissions, duplications, dosing errors, or drug interactions. The suggested change will enable the use of electronically reconciled medication lists to provide patients with a better understanding of medication administration instructions and potential adverse effects of the discharge medication (Lockhart, 2012). The application of the new practice promotes high-quality teaching that improves a patient’s readiness for discharge. The evidence-based discharge plan enables the use of a discharge planning checklist to help patients and family members to consider practical aspects of being discharged to go home.

The new evidence-based discharge planning process offers a comprehensive assessment in order to provide direction for effective discharge-planning. The suggested change ensures that additional information obtained during the hospital stay is documented and considered, as discharge planning progresses (Lockhart, 2012). In addition, the new procedure enables the nurse to work with a family in assessing their own strengths, and important foundation for a home care plan. The assessment tool helps to make the discharge planning process more objective. The new evidence-based discharge process ensures that daily physician and nursing rounds frequently provide an opportunity for discussion of discharge planning. Planning for hospital discharge using the evidence-based discharge planning incorporates information from multiple disciplines (Holland, Knafl & Bowles, 2013). Explain the implications your suggested change might have on the practice setting

The suggested change in the discharge process ensures that there is appropriate level and quality of care throughout all stages of a patient’s illness. It will also ensure that the outcomes are mutually accepted by a patient and caregivers and promote ongoing communication about progress. Holland, Knafl & Bowles (2013) noted that evidence-based discharge process can decrease hospital readmission and increase patient satisfaction. The new discharge plan promotes effective communication. With evidence-based discharge plan communication issues are minimized because the plan ensures that health care facilities have a discharge coordinator or a case manager, responsible for thoroughly assessing a patient’s health care needs at discharge. The discharge planning interventions focus on helping patients achieve maximum functioning.

The suggested change improves understanding of healthcare needs and ability to achieve self-care at home. The supported inclusion of family member in teaching sessions provides patient with available resource. The new procedure determines timing and approach to instruction (Nosbusch, Weiss & Bobay, 2011). Different types of educational materials are effective with different individual learning styles; hence, the new procedure assesses barriers to learning such as fatigue, pain, and lack of motivation.

Discuss How You Would Involve Key Stakeholders in the Decision to Change the Procedure or Comply with a Proposed Change

To make discharge planning a major part of the organization, management structures and cost accounting systems, and budgets should be partially redesigned around defined clinical groupings. An effective discharge process involves several individuals including data analysts, social workers, nurses, physicians, and medical doctors. These key stakeholders should be involved, because discharge planning is not and cannot be the function of a single individual. The evidence-based discharge planning can be used to align financial incentives between hospitals and physicians (Melnyk & Fineout-Overholt, 2011). To implement the proposed discharge planning, all the stakeholders, including social workers, facility managers, physicians, nurses, and all groups involved in the discharge process, should identify and fix operational bottlenecks that prevent effective implementation of evidence-based discharge planning process.

The first step is to create an organizational mandate for discharge planning, starting with physicians. The second step involves investing aggressively in data support systems. The third step is blow up the ineffective and incomplete case management system and use a physician led process to create a new one. The fourth step is to aggressively create and implement new clinical guidelines (Melnyk & Fineout-Overholt, 2011). The facility should create a variety of physician, social workers, clinicians, nursing practitioner’s forums, both formal and informal, in order to as to motivate nurse and physician participation in the improvement efforts.

Discuss Specific Difficulties You May Encounter in Applying the Research to Practices and Procedures in Your Practice Setting

The process of applying the research to practices and procedures in the facilities will face various difficulties. This is because the practice represents a combination of consensus driven factors that have not been rigorously tested. The ideas presented from the research represent complex ideas that may not be appropriate in the facility and may include relatively vague constructs. Making the operational plan requires an innate understanding of the research literature in order to translate the broad concepts into operational practice (Nosbusch, Weiss & Bobay, 2011). The research is complex, lengthy, and is a difficult process that is likely to result in inconsistent and ineffective implementation without extensive technical assistance, monitoring, and coaching. It is not clear how these principles may interact with each other in real setting of a health care facility. Discuss the specific barriers you could encounter in attempting to institute a change in procedure in your practice setting

Some of the eminent barriers include lack of awareness and understanding of evidence-based practice in discharge planning. The lack of a detailed plan is a major barrier to implementing the change to evidence-based discharge planning. The second barrier is the lack of association with researchers and lack of ability to locate and find relevant research. Lack of the research value in nursing practice will be a major barrier.

The barrier of fatigue typically will present itself when the implementation phase of the discharge planning is exceedingly long. Known existing barriers to the use of evidence-based discharge planning include a lack of time, resources, evidence authority, and support. Internal barriers will include a lack of motivation and resistance to change (Godshall, 2009). Nurses and physicians may lack responsibility in the uptake of evidence-based nursing. Another barrier may result from the failure to believe that evidence-based practice will result in more positive outcomes than the traditional care. Finally, demands by patients for certain types of care, lack of administrative support, and large patient loads may be major sources of barriers.

Identify at Least Two Strategies that You and Your Team Could Use to Overcome these Barriers You Identified

The staff should be assisted to understand how a change to the new discharge planning can improve the quality and cost-effectiveness of patient care, appealing to their emotions with concrete examples of how lack of the procedure can result in adverse outcomes. An excellent strategy for overcoming fatigue in the entire process is through creating small successes along the course of the change project and to recognize individuals for their efforts. Recognition and appreciation are very important in demonstrating the value of individual’s efforts and sustaining enthusiasm along the course of the process. Other methods of overcoming barriers include boosting awareness and building participation and engagement. Explain how you would implement your new process or procedure, based on the research findings

The implementation of the procedure will include identification of the procedure and defining the scope of practice question. The third step will involve assigning responsibility for leadership in different sections of the procedure. Recruiting a multidisciplinary team that will be involved in the entire process of facilitating the implementation of discharge planning procedure is determined. A search for evidence in discharge planning is conducted, and evidence is screened for inclusion criteria, abstracted, appraised using a rating scale, and then summarized. Recommendations are made based on the strength, quality, and quantity of the evidence (Godshall, 2009). Finally, a plan is constructed for implementation of appropriate and feasible recommendations. Implementation, evaluation, and dissemination follow. The transition of the new discharge plan is incorporated into the facilities quality improvement framework to communicate effective changes and engage the organization in adopting these changes.

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