Capstone Project Milestone 1
Does an outreach program led by a Registered Nurse who follows up on a patient after discharge for home safety checks, medication compliance, and teaching, possibly improve patient outcomes and decrease readmission after 6 months?
Population – Registered Nurses
Intervention – Outreach program led by an RN
Comparison – Outreach program with RN leadership with follow-ups on patient after discharge vs. regular outreach programs without discharge follow-ups
Outcome – Patient Outcomes, Patient Readmission Rates after a Period of 6 Months
Step II
There are numerous areas or fields of allied health and medicine where nurses can find them in; there are primary, secondary, and tertiary healthcare settings. Most nurses are in the secondary and tertiary health settings. These are nurses who care for patients who already have diagnosed medical conditions. Typically, these are the ones who work in hospitals, clinics, and medical centers. It is the patients who come to them. This is why the problem solving and case management approach that nurses in these settings use is a problem-based one. They only work towards the goal of solving the patient’s chief complaint and stop at that. This is based on the premise that asks why nurses have to fix something that is not broke or someone who does not have any health problem. This has been identified as one of the main reasons why most educational institutions disregard the importance of after discharge patient follow-ups (on home safety checks, medication compliance, and patient education) . Now, it appears that this negatively-affecting practice has been carried over to the primary care setting . Outreach programs such as the ones that the proposed PICO-based evidence-based paper is trying to assess belong to the primary healthcare setting. Because of the ongoing culture that promotes disregard for after discharge follow-ups, it is the patients across all nursing healthcare settings who suffer.
Step III
These practices issues were identified as a result of professional observation and research. Regarding the observation part, it is practically obvious that all the nurses, especially in healthcare settings where they are easily outnumbered by their patients (i.e. high nurse to patients handled ratio), care about is to take care of the patients’ immediate needs so that they can be discharged out of the hospital and so they can cater to the needs of other patients—i.e. the incoming ones . On the surface, this strategy may appear positive as it indeed improves the patient-handling capacity of the subject medication institution. However, the aspect of care that gets impacted is the quality. Because of too much focus on patient turnover rates, the nurses develop the mindset that can be characterized by their disregard on the importance of patient follow-ups . Researching further on the issue, the author was able to gather numerous evidences about the presence of absence of follow-ups on patients in the primary care setting (e.g. outreach programs).
Step IV
Ideally the evidences that must be gathered should be a combination of primary and secondary sources. However, for the initial study, a literature review that utilizes primarily secondary sources must be preferred. This is to serve as an introduction to the PICO-based research question.
Step V
In terms of the keywords that will be used to improve the search results for the evidence-based review, they must be directly relevant to the PICO variables. Here are some of the top keywords that should be used plus the Boolean terms that will be utilized:
Nurse Outreach Programs
Nurse Outreach Programs AND Patient Follow-ups
Patient Follow-ups AND Primary Care
References
Buerhaus, P., Donelan, K., Ulrich, B., Norman, L., Desroches, C., & Dittus, R. (2007). Impact of the nurse shortage on hospital patient care: comparative perspectives. Health Affairs, 853-862.
Hernandez, A., Greiner, M., Fonarow, G., Hammill, B., Heidenreich, P., Yancy, C., et al. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 1716-1722.
Hess, P., Reingold, J., Jones, J., Fellman, M., Knowles, P., Ravenell, J., et al. (2007). Barbershops as hypertension detection, referral, and follow-up centers for black men. Hypertension, 1040-1046.
Lloyd, A., Clegg, J., Lange, J., Stevenson, A., Post, J., Lloyd, D., et al. (2013). Safety and effectiveness of a nurse-led outreach program for assessment and treatment of chronic hepatitis C in the custodial setting. Clinical Infectious Diseases, 1078-1084.
