Scholarly Product for Dissemination
For this assignment you will prepare a scholarly product that reports your progress (or results) and implications of your DNP project to a designated audience. If you are not in the implementation or evaluation phases of your DNP project you may report on a project that you have worked on during your practicum experiences with the practicum site. While you are not required to actually present your work it will be beneficial for you to prepare your product for dissemination now while you can receive feedback from your peers and faculty committee.
Your scholarly product may be in the form of a manuscript for publication, project summary and evaluation report, conference proceedings, poster presentation, program evaluation report, grant proposal, media or technology-based deliverable, or a different faculty approved product. The scholarly product is due to your Instructor by Day 7 of Week 10 so you may receive feedback on it before finalizing your DNP Project Paper (a DNP program requirement). Unless otherwise arranged with your Project committee, your final product must include the following information, and must be written in a style appropriate for your intended audience:
Background, Purpose, and Nature of the Project
Describe the larger problem or issue you explored in your DNP Project. Explain how this problem or issue affects nursing practice and the overall health care system, and describe how your DNP Project explored possible strategies for addressing the problem or issue.
Research Design, Setting, and Data Collection
Briefly explain the methods you used to carry out your DNP Project, including any relevant theoretical frameworks or models. Identify the practice setting and context in which you conducted your project, as well as the sample/population as applicable. Outline your data collection methods and justify why you chose these methods.
Presentation of Results
Explain the results of your DNP Project. Include any relevant graphs, tables, charts, models, or other visual representations of your data/results. Include a short description of each visual, what it displays, and how it relates to your project.
Interpretation of Findings, and Implications for Evidence-Based Practice
Share the results of your DNP Project, and provide an interpretation of your findings. Describe how the results can be translated into evidence-based practice. Explain how this would impact the main problem or issue you explored in your DNP Project.
Abstract
Impact of Nurse Education Program on 30-Day Readmissions among Ischemic Stroke Patients
by
Mariana Tsucuneli
MS, Walden University, 2018
BS, Davenport University, 2014
Mariana Tsucuneli
Proposal Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
May 2020
Abstract
Unplanned 30-day readmissions among patients diagnosed with Ischemic stroke (IS) is a major public health problem in the United States (US). The Affordable Healthcare Act introduced financial penalties and incentives for facilities to encourage care plans aimed to reducing 30-day readmissions rates for stroke and other five illnesses. Facilities with high rates of 30-day readmissions for IS patients, are therefore penalized by the centers for Medicare and Medicaid services in addition to receiving poor scores on the quality of care they provide. The proposed project will be a staff education program aimed to improve post-acute stroke transitional care to reduce 30-day readmission rates. The project will be guided by the question; among nurses caring for IS patients, does an educational program focused on active engagement and caring for patients compared to standard practice, reduce the 30-day readmission rates? The design of the educational intervention, its implementation, and evaluation will be guided by the competency, outcomes, and performance assessment (COPA) model focused on the integration of interactive learning, practice-based outcomes, and competency assessment.
Keywords: 30-day readmissions, care bundle, ischemic stroke, educational program.
Impact of a Nurse Education Program on 30-Day Readmissions among Ischemic Stroke Patients
by
Mariana Tsucuneli
MS, Walden University, 2018
BS, Davenport University, 2014
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
May 2020
Table of Contents
1Section 1: Nature of the Project
1Introduction
2Problem Statement
3Purpose
4Nature of the Doctoral Project
6Significance
7Summary
9Section 2: Background and Context
9Introduction
9Concepts, Model and Theories
9Model
11Theory
13Concepts
13Relevance to Nursing Practice
15Local Background and Context
17Role of the DNP Student
18Summary
19Section 3: Collection and Analysis of Evidence
19Introduction
19Practice-focused Question
20Sources of Evidence
22Nature of the Data
22Participants
23Procedures
24Ethical Considerations
24Analysis and Synthesis
24Summary
26References
31Appendix: Educational Program
Section 1: Nature of the Project
Introduction
Patient readmission within 30 days following initial stay and discharge is a common problem in the United States (US) occurring at an estimated 14% of all hospital admissions (Hughes & Witham, 2018). The 30-day readmission rates in US hospitals are used as quality measures, and the hospital readmission reduction program (HRRP) established in the Affordable Care Act provides financial incentives to healthcare facilities with lowered readmission rates (Centers for Medicare and Medicaid [CMS], 2019). The CMS also fines hospitals with high 30-day readmission rates relative to other healthcare facilities under the HRRP (CMS, 2019). Using 30-day readmission rates as a quality measure also affects facilities with high re-hospitalization frequency and is used as an indicator of inadequate care provision (Vahidy et al., 2017). Hospital readmission is also associated with other problems for the facility, including longer stays and a higher risk of complications for the patient (Hughes & Witham, 2018).
Ischemic stroke (IS) is one of the health conditions whose 30-day readmission is monitored by the CMS under the HRRP (CMS, 2019). Approximately 12% of IS patients are readmitted to hospitals within 30 days of discharge in the US (Vahidy et al., 2017). Readmissions due to IS are considered high risk and the use of the readmission rates as a measure of quality is prioritized at the national level (Andrews & Freburger, 2015). The type of post-acute stroke care has been associated with transitional care outcomes including 30-day readmissions and recovery (Poston, 2018). Educational interventions for nurses have been associated with improved patient and quality of healthcare outcomes in stroke care (Jones et al., 2018). The proposed DNP project will involve developing a nurse educational program focused on transitional care for IS patients associated with reducing 30-day readmissions. The developed program will be implemented to all the nursing staff working at post-acute IS ward in a rehabilitation center in the north-eastern US. The expected social change will be in transitional behaviors among the nurses to include checking for risk factors for post-acute stroke disorders. The anticipated implications for social change will be the reduction of risk of post-acute stroke disorders and 30-day readmissions among stroke survivors.
Problem Statement
The target healthcare facility is an inpatient rehabilitation facility with a stroke unit which has prevalent unplanned 30-day readmissions. Up to 60% of the patients admitted at the facility have more than one comorbidity. Among patients with stroke, comorbidities such as respiratory diseases and urinary tract infections are associated with high risk of 30-day readmissions (Poston, 2018). Inadequate transitional care including failure to identify post-stroke disorders, risk factors, and lack of social engagement among IS patients have also been associated with increased rates of 30-day readmissions (Poston, 2018). A brief needs assessment established that there was a gap in adequate transitional care knowledge among the nurses as well as harmonization of the care procedures among all post-acute stroke patients.
Stroke is among the leading causes of mortality and long-term disability (Poston, 2018). With the aging population rising, IS prevalence is expected to increase with projections of up to 20.5% surge by 2030. Improving the quality of transitional care in healthcare facilities is expected to help prevent the occurrence of post-stroke conditions requiring hospital readmissions (Poston, 2018). Additionally, understanding IS, and its risk factors could lead to a more focused quality of care, potentially reducing the risk of readmissions (Andrews & Freburger, 2015). In a facility with high 30-day readmission rates among IS patients, a staff educational intervention aimed to improve the understanding of post-acute stroke readmission risk factors would be helpful in reducing the prevalence of re-hospitalizations.
The nursing workforce is the most involved of all healthcare providers in patient care (American Association of Colleges of Nursing [AACN], 2019). In the treatment of IS, up to 60% of the survivors require post-acute care services in rehabilitation, skilled nursing facilities, and in-home healthcare; services that are primarily provided by nurses (Poston, 2018). Nurses, therefore, have the ability to transform the quality and type of healthcare provided to post-acute stroke patients. With improved awareness, the nurses will be able to identify post-transition issues early enough and address them to avoid re-hospitalizations (Poston, 2018). A nurse educational program on patient engagement and risk factors for post-stroke disorders requiring acute care is significant and would improve prevention of 30-day readmissions, (Nakibuuka et al., 2016). The project will, therefore, contribute…
