Discussion: Nursing Research Phase 5 Paper

Discussion: Nursing Research Phase 5 Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Nursing Research Phase 5 Paper Please create an abstract for phase 5 of the nursing research project (phase 5 is a combination of 1-4). Discussion: Nursing Research Phase 5 Paper I already combined the papers together (phase 1-4) please review the paper and make sure is all in past tense (I already reviewed most of the paper It should be a minor fix) I also had some points deducted for tittle and subtitles not being in proper APA format Can you please make sure The paper has the corrects APA format Disregard Masters Essentials after the references phase_5.docx Patients 65 Years And Older Living In Miami Florida Struggling To Transition From Hospital To Home Or Long Term Care Setting Nayvi Brennan Florida National University Professor: Jorge Hirigoyen 11/16/2019 Introduction The paper explores the continuity of care provided to older Hispanic adults 65 to 80 years old with a chronic condition who faces other risks factors such as social barriers, difficulties in managing their healthcare needs, as well as challenges in carrying out daily activities, especially during acute illness. The need to recognize and determine the efficient strategies to improve continuity of care provided to older adults and the outcomes to the health and care for older adults is critical and essential. Discussion: Nursing Research Phase 5 Paper Clinical research was conducted with the ultimate aim of improving treatment options for patients, develop alternative options, and reduce hospital readmissions. The objective of this nursing research was to find out why older Hispanic adults are struggling to transition from hospital to home or other health care settings. The article provides a detailed analysis of the problem and continuity of care. The results of the study will also help the different stakeholders and policymakers on the best approaches to adopt in a bid to improve the welfare of the patients. Treatment options or plans must be subjected to questioning to make sure that they are acceptable within the set standards (Colorafi & Evans, 2016). Further, it is key to ensure that all results from clinical and nursing researches are validated. It will, therefore, be vital to ensure that the findings in this study reduce instances of duplication or replication of research efforts, while at the same time, uphold the transparency of the study (Tappen, 2016). These will, therefore, ensure that no single decision is made without enough reasoning and conclusion. Discussion: Nursing Research Phase 5 Paper Identifying the Problem Among over 20 million Medicare beneficial, more than 40% have a chronic condition (Verhaegh, et al., 2014). Older adults who suffer from a chronic condition, other risks such as social barriers or functioning deficits add to the difficulty in providing their health care needs. Besides of the frequent episodes of the illness, the older adults compared to other chronic condition patients, these patients experience a higher rate of healthcare services such as emergency department visits, hospitalizations, and physicians which adds to their health care costs. Research from various studies has proven that poor healthcare provided to older adults often results in too devastating economic and human problems. Such problem associated with the poorly managed health care provided among the older adults including; inadequate communication, poor continuity of care, poor patients’ engagement, poor follow up, inadequate collaboration among patients and the health care providers, and gaps that exist as patients move between hospitalizations as well as care settings (Verhaegh, et al., 2014). Limited hospitalization and poor follows up are among the most troublesome consequences. Though some re-hospitalizations are necessary and cannot be avoided, 20% of those faced by older patients are estimated to be preventable if well care and managed (Hirshman, Toles, Huang & Naylor, 2019). Moreover, to the human burden, the societal costs related to older adults’ health care services are significant. Studies indicate that health care services provided for medical beneficiaries with five or more chronic conditions make up of about 74% of the total health care cost spent. The majority of these costs are as a result of high rates of avoidable hospitalizations (Allen, Hutchinson, Brown, & Livingston, 2017). Healthcare providers, who focus on continuity of care such as transitional nursing aims at enhancing patient’s experience, reduce health care cost, increase population health. Particularly, transitional nursing which is set of limited services that are provided during an acute illness episode across healthcare settings has been recognized as an efficient approach to improve and manage health care services provided to older adults. Evidence-based show that the transitional care model has consistently proven to be efficient in enhancing economic and health outcomes for older patients. (Verhaegh, et al., 2014) Significance of the Problem In recent years there have been increased issues of poor health care provided to older adults with chronic illness. Due to this, there have been numerous models that target to resolve the issues such as the transitional care model which is a nurse based model that targets to provide efficient health care service to older adults with chronic illness. The issues are significant to nursing as it threatens the ability of healthcare nurses to meet the ethical requirement and role for providing basic health care (Verhaegh, et al., 2014). The increased number of older patients with chronic illness who are at a high risk of facing other risks factors pose a significant threat to health care services systems. Managing healthcare service provided to older adults, improves health outcomes, patients’ experiences and enhances better use of the available resources. Health care service provided to older adults includes a range of services aimed to ensure the continuity of care for older adults across multiple healthcare teams and healthcare settings like homes to hospitals. Nursing as a professional should present policy, practice, and research that can address the issues. (Allen, Hutchinson, Brown, & Livingston, 2017) Most older adults with a chronic condition who require to transit from one health care setting to another normally experiences risks of poor outcomes as they move between various settings to health care providers. In the recent years, there have been increased cases of older adults too with a chronic condition to transit to various settings because of other risks such as a frequent episode of acute illness, for nursing, rehabilitative and medical before they transit again to home (Hirshman, Toles, Huang & Naylor, 2019). Properly and efficient health care during the older adults transition from one health care settings to another to enhances their health outcomes. Purpose The purpose of the study was to identify the reason for poor health care outcomes: studies indicate that most older adults who move between health care settings for medical and other health care services experience poor health outcomes during their transit. Dependence on others, low socioeconomic status, and advances ages play a significant role in the vulnerability for the poor outcomes. Patient and their caregivers often have a burden to self- manage health tasks, such as taking the correct medications, monitoring changes, medical treatments and managing follows ups. Besides, the paper aims to identify ways in which poor health care outcomes can be enhanced and improved to ensure that older adults receive better health care outcomes. Properly and efficient health care during the older adults transition from one health care settings to another to enhances their health outcomes. Research Questions What are the main factors affecting transition from hospital to home or other health care setting of older Hispanic adults living in Miami, Fl? Are health care providers prepared and ready to provide sufficient service to the older adult with a chronic condition? Within the selected population, which patients have the highest readmission rate? What are the major factors that lead to poor health care outcomes? What are the best ways in which health care providers can deal with poor outcomes? How could the transitional nursing be allied with transitional care model to ensure enhanced health outcome? How can we help this population transition without difficulty and reduce readmission rate. Literature Review Now days older adults are facing many challenges in healthcare. Literature review was conducted in order to identify why this is happening. In a study conducted by Dyrsad, Laugaland & Storm in 2015, it points out that older patient have minimal participation in the hospital from the admission up to the time they are discharged. In improving the quality of healthcare provided in hospitals, there is certain information that needs to be available to the healthcare providers. This is based on the fact the level of participation for different groups during admission up to discharge in the hospitals vary. The article focuses on the level of participation for older people in the hospital (Dyrstad, Laugaland & Storm, 2015). As indicated by Dyrstad, Laugaland and Storm, among the facts that limit the participation of the older people in the hospital are the time constraints for the healthcare professionals and the high number of patients. It is noted that improving the involvement of the patients is one of the ways of improving the quality of health care (Dyrstad, Laugaland & Storm, 2015). Therefore, there is the need to create awareness among the healthcare professionals on the factors that affect the participation of older patients in health care. This is based on the fact that improving the patient of the older patients in the hospital is critical to improving the quality of patient care. A study published by the Journal of Clinical Nursing was able to identify that patients with low socioeconomic have poor results during a post-hospital transition. This article explores the problems which this group of patients encounters during the period. The report focuses on the experience of these patients during hospitalization period, alignment of the team care goals, health behaviors, socioeconomic constraints, and self-efficacy (Kangovi et al…, 2014). According to the article, patients feel powerless when they are hospitalized; hence, they are not able to participate from hospitalization to discharge. There is also a lack of alignment of the patients and health professional goals. This result in scenarios where health care professionals suggested what patients cannot afford after hospitalization. Further, Kangovi and his colleagues in the article argue that there is a lack of saliency behaviors because instead of focusing on the discharge instructions after hospitalization, patients concentrate on the pressing socio-economic challenges (Kangovi et al…, 2014). The financial difficulties cause the patients not to follow discharge instructions. Therefore, the authors propose for the designing of policies to improve the post host outcomes with a particular focus for the collaboration of the hospitals and other social support groups. A study conducted by Allen, Hutchinson, Brown & Livingston, (2018), other major challenges are identified. There is a significant need for nurses and health care providers to focus on continuing to provide quality care to older Hispanic adults with chronic conditions, even getting discharged. According to Allen, Hutchinson, Brown & Livingston (2018), the patients also face other risk factors like challenges in managing their health needs, carrying out basic daily activities, and social barriers, among others. The realization on these challenges is an indication that with coordinated and dedicated care provision, nurses and healthcare providers can be able to continue offering quality care to patients, as observed by Allen et al., (2018). The study conducted by Allen, Hutchinson, Brown & Livingston, (2017), has insisted on the need of quality care by arguing that transition for health care services from the hospital to home should include effective communication between the practitioners involved, a framework for assessment, preparation, and planning. The understanding in this context is that medication reconciliation supported by follow?up care and self?management education will help older Hispanic patients avoid readmission or help them in the recovery process (Allen et al., 2017). Further, Allen et al. (2017), through their study, have also revealed that it is important to consider four thematic areas in the provision of care. These areas include; who will be the caretaker, what standards must we adhere to, what involves a proper discharge, and finally, how to adjust to provide quality care, since these are key to the quality transition. Brown (2018), in Transitions of care; In Chronic Illness Care , also notes that the world’s population is aging, but despite this happening, advanced medical procedures and medical science has made it increasingly possible for people with advanced diseases to stay longer. Brown (2018) has also observed chronic care has dominated the American healthcare system over the last ten years, and therefore there is the need to onboard and practice the effective management of treatment options for Hispanic adults aged 65 and above and with chronic diseases. Finally, the study by Brown (2018), also found out that the process of discharging patients and taking them to home care is seen as a social process as it involves aspects of negotiation and navigation of dependence and independence between the health care providers and the recipients of care. Hirschman, Shaid, McCauley, Pauly, and Naylor, (2015), have in their studies on continuity of care noted that the transitional care model is all about providing intervention to older adults who have high risks of deprived healthcare. The argument put forward in their study is on ensuring that there need to recognize, develop, and determine the effective and efficient strategies that can be used to improve the continuity of care without interruptions. Bookey?Bassett, Markle?Reid, Mckey & Akhtar?Danesh, (2017) have also revealed that transitional care should be able to facilitate the safe and timely transfer of patients across the two settings without compromising quality care. This would, in a significant way to reduce the cases of hospital readmissions and also strengthen community health programs related to the management of chronic diseases among the older Hispanic population. Bookey?Bassett et al., (2017), have also revealed that there is also the challenge that arises as a result of a limited understanding of how to actively and successfully involve care providers and care recipients in transitional care. This has made provision of care for an older Hispanic population a challenge. My study will focus on Hispanic patients 65 year old and older in Miami, FL struggling to transition from hospital to home or long term care setting as a target population. The purpose will be to identify specific issues affecting the transition. Studies mentioned above focus on other populations and issues affecting healthcare. The purpose of this study is to help facilitate transition from hospital to home or long term care setting. Methodology and Design of the Study This research aimed to find out a concept or rather approaches that can be used to promote a positive, successful, and working inter-professional relationship and collaboration for health care providers, health facilities, and other professionals in the provision of care. The research focused on the older Hispanic adults, an aspect that will make it different from the rest and dependable in providing important data sets and patterns about challenges they face while transitioning from hospital care to home care. Specifically, Hispanic adults aged 65 years and older living in Miami, Florida were targeted. Finding data on the nature of chronic diseases, their prognosis, and other factors will involve collaborating with agencies like the Center for Diseases Control, among others. The study involved patients’ assessments and interviews as well as the use of secondary data that relates to the management of chronic diseases for older adults. The study mainly depended on qualitative research designs and methodologies since they are highly preferred in the fields of nursing and other associated fields. The research designs and methodologies involved phenomenology, narrative inquiry, grounded theory, and ethnography (Tappen, 2016). The purpose of phenomenology in this study was help the researchers in finding and describing the areas of interest which individuals live in and interact with. Phenomenological studies are important in helping capture the experience of individuals about a subject of study. Using phenomenology ensured that the study is developed only through reliable and information that can be validated. Inclusion and exclusion criteria was used ensure that only those who have had an experience with a chronic disease will be interviewed. Discussion: Nursing Research Phase 5 Paper In a bid to understand what social or family-related traits or factors have on chronic disease, the study used ethnography. Ethnography aims to seek a deeper understanding of the community, group, or even a specific family. The final methodology used narrative inquiry, especially from the patient, family members, or caregivers. The narrative inquiry helped in capturing the experiences of individuals and probably find a connection between their narratives and chronic diseases (Wang & Geale, 2015). Sampling Methodology The sampling method is simply a way to select the members of a population who are qualified for this study. The Study was conducted with the support of two local hospitals, West Gables Hospital and Hialeah Hospital using random sampling. The study aimed to achieve results and data that can be used in decision and policy-making and towards making permanent interventions on how to assist caregiver’s transition caregiving from a hospital setting to a home setting without compromising the quality of care given (Tappen, 2016). In achieving this; simple random sampling was used since it will help in selecting a fairly representative. The study avoided using convenience sampling and voluntary response sampling as they might give biased results, which could, in turn, affect the outcomes. In essence, sampling methodology was used because it provided a fair and unbiased representation, which guaranteed that all population groups are represented. Necessary Tools The study was highly organized, rigorous, and comprehensive to ensure that the results obtained can be used in the decision and planning processes of the management and treatment of chronic diseases among older adults. Several organizational and project management tools were used especially in carrying out the interviews, collecting data, recording data, and finally, to ease the access of the obtained data sets and results. The tools included; event calendars, screening and enrollment logs, data summary sheets, instrument scoring tables, and protocol & eligibility checklists. These tools created efficiency, promote a professional outlook and a positive image, provide a sense of control during the study, maintain the integrity of the collected data and minimize errors (Tappen, 2016). Algorithms and Flow Maps Based on the design and an analysis of the entire research study process, flow maps and data table were used in order to present the collected data. Algorithms and flow maps are usually preferred in instances where the flow or process is uniform and not random. The methodologies and designs used in the research study are popular and widely used in nursing and healthcare, making it easy for researchers to implement without the flow maps (Tappen, 2016). The objectives, goals, and constraints of the research study are also well laid down, thus removing any aspect of ambiguity that might confuse the researchers. Finally, the scope of the study is narrow and does not involve aspects like medical test selection, therapy & prognosis, and diagnosis. The study was implemented in stages to ensure that we fully onboard our partners and sponsors. We are going to involve Agency for Healthcare Research and Quality, Health Resources and Services Administration, Centre for Diseases Control and Prevention, the Centers for Medicare and Medicaid Services (CMS), and other agencies as the study might require. Our study adheres to Good Clinical Practice guidelines (GCPs) as set out by the Federal Government and other regulators. Implementation Phase The project focused on finding concepts and approaches that will be used to promote a positive and successful working relationship for health care transition for older Hispanics with chronic diseases. We implemented this project in phases to ensure continuity and completion of each phase and stage. According to Kadu & Stolee (2015), transitioning care is a systematic approach that is used to study, identify challenges facing patients who transition from hospital care to home-based care, and at the same time, prevent hospital readmissions from occurring. The implementation involved assessment, diagnosis, planning, and evaluation. The implementation of the study was also included the study design, identification of the site, development, monitoring of sites, and their management. In a bid to ensure that implementation was not affected by issues to do with data, the project focused on data management, quality, and integrity (Kadu & Stolee, 2015). Furthermore, the study team was also focus on biostatistics and statistical analysis while at the same time, protocol development was used while working with our partners and stakeholders. The communities were involved in the studies, and therefore, it was important to assess their preparedness. Research operations and logistical support also played a key role in strengthening the study. The implementation skills needed from nurses and caretakers are cognitive, interpersonal, and technical skills. Cognitive skills will be vital in problem-solving, critical thinking, and creativity. Interpersonal skills focused on helping to address issues to do with communication (Kadu & Stolee, 2015). Technical skills were required in the implementation process. According to Friesen?Storms et al,. (2015) ; Leff, Soones & DeCherrie, (2016), the process of implementing nursing projects involves reassessing the client, determining the nurses’ needs for assistance, implementing nursing interventions, supervising delegated care, and documentation. Discussion: Nursing Research Phase 5 Paper Project management tools were used to ensure that it is consistent in implementation, coordination, and deliverables. We monitored the project and make adjustments based on the milestones and goals set. The nursing team also recorded any variances that might be experienced during the implementation process. The project reviewed weekly to ensure that any challenges and discrepancies from the main goals are noted and corrected. We updated sponsors and other critical stakeholders on the status of our clinical study and adopt recommendations. Status reports generated during the implementation phase showed the anticipated endpoint, cost of study, the schedule, as well as the quality of deliverables. West Gables and Hialeah Hospital worked with the team to ensure that the project goes full scale. Before the implementation, there was a need to ensure that the central clinical site monitoring is done. The monitoring was important in ensuring compliance with the set standards and protocols, follow the Good Clinical Practices, the Federal government regulations, as well as other institutions concerned with the subject of study (Smith & Johnson, 2019). The implementation fallowed the clearly set guidelines as it relates to clinical research studies. The implementation plan was bolstered by a Clinical Monitoring Plan that has set guidelines on issues of complexity of the study, human subject risk, and nature of the study. The project management team understanded that the implementation of the project depended on the quality of communication with the involved stakeholders. According to Kadu & Stolee (2015), communication involved debriefing, follow-ups, visit reports, and Action Item Tracking. In finality, the preparation for the implementation of the study also focused on on-site assessment review, protocol compliance, the integrity of data and samples, human subjects protection, staff training, protocol compliance, and laboratory SOPs and compliance. Time Frame of the Project The success of the study was purely be driven by the use of quality approaches towards the project. The study involved many activities ranging from assessment to evaluation. Additionally, since the project involved different stakeholders, there was the need to onboard them for ease of implementation of the project. The communities to be involved was trained on the importance of this study. These steps further made the project a reality. The entire project was achieved in milestones, thereby narrowing the chances of failure. Working in different phases also reduce the pressure on available resources committed in the study. Activity Duration Cost Assessment 2 months $8,000 Data Collection 3 months $14,010 Data Organization and Analysis 1 month $3,200 Nursing Diagnosis 3.5 months $36,175 Planning 6 months $84,014 Implementation 9 months $112,068 Evaluation 3 months $8,953 The entire project from the assessment phase to the evaluation phase required 27.5 months and a financial commitment of $266,420. The budget was broken down into units that were seen the different stakeholders investing to make the study a reality. Resources and Statistical Tools Patient assessment after transitioning from hospital to home-based care and clinical data collection required a dedicated approach (Leff, Soones & DeCherrie, 2016). Our study was implemented in a way that enhances data collection through clinical observations, specimen collection, clinical measurements, data and information documentation, and in some instances, the manipulation of the collected outcomes. Interventions and study procedures for older Hispanics with chronic illnesses involved the administration of investigational drugs, other treatment options, and detailed evaluation to reveal the implications of the treatment options on the health of the patients. The resources used in the clinical study were also used in phenotyping to find out the natural history of chronic illnesses. According to Friesen?Storms et al,. (2015), the study team should also focus on training caregivers and caretakers on the best way to physiologically monitor patients and help them in the recovery process. The study carried out with the input of the partner hospital and other agencies in Florida and from the Federal government and, therefore, required comprehensive tools and resources. There was a team of dedicated health practitioners and professionals whose expertise were required in guiding the clinical nursing officers from carrying out the study successfully. The study was engaging, rigorous, and comprehensive to ensure that it makes important inferences that are supported by facts and can be used in minimizing cases of readmission into hospitals after they are discharged. Discussion: Nursing Research Phase 5 Paper Significant activities in the study involved interviews, data collection, data recording, and storage of the data for use in the future. Tools that were used in this case included data sheets and screening tools (Ali & Bhaskar, 2016). The team consisted of Registered Nurses who trained and educated patients during the period of the study. This will be instrumental in reducing cases of hospital readmissions. Clinical Nurse Specialists, Nursing Educators, and Public Health Nurses also required to strengthen the human resources team and further to guide the team on the ground. All these efforts invested in helping generate consistent and valuable data that can be used in decision making. Data collected in the study was manipulated by the use of the Bradford Hill criteria, while the Statistical Package for the Social Sciences (SPSS). The project team also made use of Microsoft Excel and the Statistical Analysis Software (SAS) (Ali & Bhaskar, 2016; Chen, Carlin, & Hobbs, 2018). Instant Data Entry Application (IDEA) was used in capturing data during the period of the project. This application reduced instances of losing data and at the same time, help to develop a relationship of data sets. Google Forms and Zoho Survey tools were used in administering surveys to the different target populations (Chen, Carlin, & Hobbs, 2018). OpenRefine was also important in linking data sets. Airtable, a cloud-based database, was used in the study because it has capabilities for capturing data and displaying information. Data integration was done by using the Talendi tool (Ali & Bhaskar, 2016). According to Smith & Johnson, (2019), such projects involved a lot of activities, especially in assessment, planning, and implementation. Creating quality results was instrumental in the study because the data collected and the results will be shared with our partners and other stakeholders like the Centre for Diseases Control, and other agencies working to improve public health (Kadu & Stolee, 2015). Scoro was the best software to use in project management since combines all aspects of project management and made it easy to improve the project as needed. Since the study involved finding ways by which nurses can continue offering quality care to older Hispanic adults with chronic conditions, it was important to consider comparing data with other countries. Discussion: Nursing Research Phase 5 Paper Baseline Data The baseline data was collected before the research study started. These data include demographics, the characteristics of the patients, and other characteristics that are key in the assessment of patients with chronic illnesses. All participants selected were Hispanic male or females living in the Miami, Florida area with admission diagnosis of exacerbation of current chronic illness. Chronic illnesses included Congestive Heart Failure, Chronic Pulmonary Obstructive diseases and Diabetes. The age rage of the participants was taken to be between 65 to 80 years old. The average weight of the participants was at a mean age of 81.5 kilograms, while the Body Mass Index (kg/m2) was at 31.8. These data sets were important in setting the basis for the research study. Participants Age Range 65-70 years old 134 patients 71-75 years old 131 patients 76-80 years old 85 patients Average age 72.3 years old Total participants 350 patients Chronic Illness exacerbation as admitting diagnosis COPD Exacerbation 94 patients CHF Exacerbation 122 patients Complications related to poor management of diabetes 134 patients Total participants 350 patients Gaussian Distribution The research study can be termed as a biological study because, on the one hand, it was about chronic illnesses, aging, and the recovery process of patients while, on the other hand, it was trying to find ways of reducing readmissions in the hospital. These aspects make most biological variables to cluster around a central value. This, too, can be explained by the statistical tools used in interpreting the data sets. The variables, despite this clustering, have symmetrically positive and negative attributes (Leung, 2015; Polit, 2017). The research study indicated that out of the 500 participants, only a mere half were focusing on improving their wellbeing by being at home. The rest were not aware as to whether taking treatment at home would be of any help in their recovery process. These behaviors are attributed to normal or Gaussian distribution. Adverse Events Experienced by the Study Participants The research study was not without several adverse events, as some aspects did not work as planned. There were several unanticipated adverse events, especially when participants cited as the new setting as to ha