NR 505 Discussion Identification of Area of Interest
NR 505 Discussion Identification of Area of Interest
Evidence-Based Practice Interest from NR500
In NR 500 the Evidence-Based Practice (EBP) interest that was chosen was research of healthcare interventions and how it can lower the rates of unplanned healthcare in the rural population. The use of emergency and unplanned care in rural communities have long been increasing. Unplanned care is defined as the use of healthcare to include all care sought without an advance appointment, such as visits to emergency rooms, unscheduled hospital admissions, and drop-in clinics (Brainard, et, al., 2016). Patients in the rural areas seek unplanned healthcare due to their decreased involvement with health prevention programs, low socioeconomic statuses, decreased health education, delayed diagnosis of diseases, and decreased support from caregivers who assist with chronic illnesses (Brainard, et. al., 2016).
Specialty Track and Evidence-Based Interest from NR500
The FNP specialty track will assist with obtaining advance knowledge that can be used to educate patients in the rural population about ways to improve their health. The quality of health in rural areas suffers due to the lack of exposure to proper healthcare, which includes health education, preventative programs, and confusion about the proper healthcare regimen (Brainard, et, al., 2016). This area of specialty will allow research of evidence-based practices that will be the driving force for many quality improvement initiatives, creation of standardized practices, and development of new or improved healthcare policies (Brainard, et. al, 2016). Compared to the urban population, patients in the rural population seek care that is in the chronic states instead of the initial occurrence of symptoms. This is due in part to their low socioeconomic status and less health education. As a FNP who plans to provide care in rural areas, the opportunity to initiate care, education, and provide preventative measures is great. Evidence-based information can be given to patients in the rural population in order to prevent unplanned healthcare. The use of interventions to improve the populations’ health status can be the main focus of healthcare. For example, the encouragement of self-care, compliance, symptom management, and the adoption of health related behaviors can be key to the prevention of unplanned healthcare.
NR500 Evidence-Based Interest
My area of EBP interest will remain the same. As a FNP, the focus will be to utilize advance studies and guidelines into practice. These interventions will decrease health disparities and reduce the incidence of unplanned healthcare for the rural population, along with the improvement of healthcare cost. With the planned format of health education and preventative measures, patients can become more familiar with their required medical regimen, thus a reduction of unplanned healthcare can occur.
Evidence-Based Interest Importance to Specialty Track
The research of EBP interest is of importance to the FNP specialty track because new approaches and interventions to reduce unplanned healthcare due to chronic disease and illnesses is needed. The FNP specialty track will promote an advancement in advance knowledge, allowing the future FNP to use evidence- based practices to guide decisions in the practice setting. As a FNP, advance knowledge can be used to create interventions that can introduce ways to improve health and ensure consistency in treatment within the rural communities. For example, encouraging patients to use technology to gain increase education about diagnoses and interventions to prevent further health complications. The recipe for moving toward health in rural, underserved areas will need to include a focus of innovation and outcomes using evidence-based practice and technology (Brainard, et, al., 2016). This will assist the rural communities with an improved state of health, decreasing mortality, morbidity, improving healthcare cost, and lowering the rates of unplanned healthcare.
In the rural population (P) does health education, early diagnosis, and health care programs (I) compared to deploying health resources geographically (C) reduce the incidence of unplanned healthcare (O)?
Brainard, J.S., Ford, J.A., Steel, N. & Jones, A.P. (2016). A systemic review of health service interventions to reduce use of unplanned healthcare in rural areas. Journal of Evaluations in Clinical practice, 22(2), 145-155. doi: 10.111/jep.12470
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The use of both qualitative and quantitative inquiries are important when it comes to research. I think that for my project, the use of qualitative research will be more suitable. The way questions guide selection of research methods and how to analyze the collected data can be challenging (Park & Park, 2016). My project is focused on a particular population and gaining opinions about the topic will be beneficial with group discussions. The use of a semi-structured, smaller groups will allow group discussions and a chance to gather accurate data. The qualitative research will also allow a deeper discussion on the topic and deeper insight into the problems. From the gathered information, collected data can begin the formulation of a hypotheses. This method will allow an hypothese to be formed that is more geared toward the issue and may potentially lead to quantitative research. The integration of both qualitative and quantitative research will allow a better statistical analysis framework and a greater chance for resolution. Even though, both qualitative and quantitative research are different, both play an crucial role in healthcare and in improving evidence-based practices. Dr. L, thanks again for your response.
Park, J., & Park, M. (2016). Qualitative versus Quantitative Research Methods: Discovery or Justification? Journal Of Marketing Thought, 3(1), 1-7, doi: 10.15577/jet.2016.03.01.1
Good post this week. I think your passion for battling health disparities in rural areas is very awesome. I come from a very rural part of North Carolina, and they need someone like you to help them. One segment of our population, the migrant population, have big issues with health disparities. There is a lot of diabetes and hypertension in these populations. Because many of our healthcare professionals do not serve this population, they come into our hospitals in ketoacidosis or hypertensive crisis. There is also a lack of Spanish speaking healthcare professionals as well, which could help to educate them. I do see the importance of reducing health disparities through education and healthcare prevention. But, how can we as healthcare professionals not only educate but follow up on these populations and healthcare prevention? We already have issues with healthcare prevention in populations without such deep health disparities. As well, the population you write about having health disparities may not have the ability to afford such technology? They have issues just affording day to day needs.
As mentioned in our reading this week, quantitative and qualitative research are the most popular methods being used. For my project, I decided to do it on patients with chronic pain and how pharmacological or nonpharmacological interventions may affect them in their long-term management. I’m hoping to determine which interventions are more effective and render superior outcomes. As mentioned by Rutberg and Bouikidis (2018), quantitative and qualitative research differ in the sense that quantitative focuses on “quantities” such as numbers and qualitative focuses on observations and experiences. For my project, using the quantitative method, I can focus on the number of patients using a specific method. I would be able to provide statistics for patients using pharmacological methods such as opioids and analgesics, although for this project we are not supposed to focus on specific medications. When using quantitative research, I can ask patients about their personal experience and which intervention they feel has been more effective to them. Given the current rise in opioid abuse, this method may be more challenging.
Rutberg, S., & Bouikidis, C. D. (2018). Exploring the Evidence. Focusing on the Fundamentals: A Simplistic Differentiation Between Qualitative and Quantitative Research. Nephrology Nursing Journal, 45(2), 209-213.
It is interesting to see how research changes based on what types of data are being gathered. For my query, understanding if the use of prophylactic antibiotics reduces the risk of developing surgical site infections, the best type of research would be quantitative. This type of research involves examining different variables and data relationships and “testing the effects of a treatment or intervention on an outcome” (Yates & Leggett, 2016). Quantitative data is based more on measurable facts, has a “higher degree of precision in research”, and removes much of the subjective human matter (Yates & Leggett, 2016). Qualitative research, conversely, is more reflective and subjective. Contexts are taken into consideration including the setting of the research, who the participants are, and what type of data is being gathered. This type of research may be referred to as “central phenomenon” because it looks at the whole picture more so and seeks to gain a better understanding of the subject matter from different angles (Yates & Leggett, 2016). Further, for qualitative data, opinions and reflections of the subjects would be considered which would then be considered more subjective. Yates, J., & Leggett, T. (2016). Qualitative Research: An Introduction. Radiologic Technology, 88(2), 225-231
Both quantitative and qualitative research is important in assisting with progressing Evidence Based Practice. Some topics will push the researcher into using one over the other. My topic related to patient satisfaction with regards to bedside handoff could be composed of quantitative or qualitative research. Surveys that ask patients questions based on a numeric scale fall into the quantitative side, but we could pull qualitative data through nurse leader rounding with patients. Asking specific questions related to the topic will help fill in the blanks when looking at numeric data. We struggle to understand how we receive such glowing comments on surveys and with personal interactions with our patients on a daily basis yet we our numeric data does not reflect the ‘always’ we are looking for. Do patient have a hard time answering surveys as always based on missed time in their memory from their hospitalization? Or did we truly fall short in our care?
In a quantitative study, standardized questionnaires or experiments are used to collect numeric data. “Quantitative research is conducted in a more structured environment that often allows for control over study variables, environment, and research questions. Quantitative research may be used to determine relationships between variables and outcomes” (Rutberg & Bouikidis, 2018). My research focus for this eight weeks is comparing two groups both with acute pain but one group would get narcotic medication while the other group would get non-narcotic medication. Then both groups would be evaluated and assessed an hour after the medication was given. The scenario describes a quantitative research project. There is a control group and an experimental group. For this project, it could go either way meaning either the non-narcotic group or the narcotic group could be either the control or experimental group. Though the feelings and thoughts of individuals with acute pain are important to the research, because they will be rating their pain afterwards, there are ways to measure pain levels. Often times, patients report a pain scale of 10/10 and all vitals are WNL, they are relaxed and no guarding or grimacing are present. In this case, what the person is saying and the physical observations and data do not correlate.
Rutberg, S., & Bouikidis, C. D. (2018). Exploring the evidence. Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-213
You definitely started our week off right!! This is an amazing post. It appears that your NR 500 work was in perfect alignment with your specialty track. This is a wonderful topic with definite validity as evidenced by the research materials that you have gathered.
My current hospital is in a rural area and we get to experience this truth on a routine basis. Due to lack of knowledge, mostly, patients there do not get routine care. When they get sick they frequent the emergency room or the urgent care centers in the area. The city where the hospital is located is small but it does have good resources; people just do not use them. One of our physicians noted that most of his diagnoses are captured in the end stages because most of his patients never receive routine care. He has examples of some 60 year old patients that have not had a physical or a routine doctor visit since they were in their 30’s or younger.
Currently, we are trying to utilize nurse practitioners more in the community to open clinics that are closer to the smaller surrounding cities to get them engaged in going to the doctor on a routine basis. The hospital has done some health fairs to educate the residents about routine care and places that they can go for adequate care. Another approach that the hospital is doing is to start an education forum in the local school systems to get the children of the community educated. Children are the future of this city and they can also be pivotal in getting their parents on the right track. This is a project that is going to take time to fix but I am so glad to see change coming for them.
Thank you for your concern Linda!! I think you are going to make a wonderful FNP and you will make a difference.
This dialogue regarding healthcare disparities in rural areas is amazing! I too am from a rural area in Alabama. It seems many of us are battling the same issues in our communities. Many of our residents do not seek care until their issue is at a critical point. Many do not have a primary care provider. They use the emergency department for primary care. Their visits usually resulted in an inpatient stay. One of the things our facility did to combat the rate of readmissions and poor followup was the implementation of the IMPACT (Impacting Patients Across The Care Transition) Program. The program’s primary focus was on those individuals with CORE diagnoses eg. CHF, Afib, COPD etc. However, as the admit nurse, I was also at liberty to include those individuals identified as high probability of readmission and/or poor hospital follow-up. I would perform education from admission through discharge. At discharge, I would schedule a follow-up appointment within 48-72 hours of discharge. And, I would follow-up via phone call within 24-48 hours of the discharge date. I also provided my contact information for questions and concerns after discharge. After implementing the IMPACT Program, our readmission rates decreased by 50% in six months time. And, our patient compliance with discharge follow-up increased significantly. But, it required diligence on our part with discharge phone calls and assuring patients that we were available for questions and concerns even after discharge! Another, thing that really had an impact on our compliance was the inclusion of family in the patient’s care plan. Some family members were unaware of the severity of their loved one’s health conditions.
I really enjoyed your post. I can completely resonate with the topic as I was just trying to help my mom (who lives out in the country and is very technologically behind the times) figure out how to attach a picture to an email I think that the rural population is greatly under served and uneducated regarding health matters and finding new initiatives to bring improvement to their health care is a critical mission.
One way that I feel will help to close the gap is the use of Telehealth technologies especially those suffering from long-term disease. Patients with chronic illnesses often feel scared and unsure of their condition upon returning home after being treated at a hospital. Providing them with telehealth capabilities and monitoring their health status provides patients with safety and peace of mind. According to research, patients reported feeling safer having someone “monitoring their data” and looking over them (Fitzsimmons, Thompson, Bentley, & Mountain, 2016). For these types of patients who require long-term care, having more convenient and closer access due to technology helps provide a sense of comfort and safety which in turn improves patient satisfaction and health outcomes.
I think about my parents and their resistance to change and trying to understand how a system like this would be beneficial for them. As this is a newer field it is understandable that it may be a hard concept for both patients and physicians to adopt. Having a lack of knowledge on how telehealth is used or how it works not only causes resistance to change but can also create a sense of insecurity and frustration; thorough consistent advocating and training would be required to build a working confidence in the technology so that people like my parents would feel secure in their health care (Gray & Rutledge, 2014).
Good luck Linda; great topic!
Fitzsimmons, D. A., Thompson, J., Bentley, C. L., & Mountain, G. A. (2016). Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study. BMC Health Services Research, 161-12. doi:10.1186/s12913-016-1623-z
Gray, D. C., & Rutledge, C. M. (2014). Using New Communication Technologies: An Educational Strategy Fostering Collaboration and Telehealth Skills in Nurse Practitioners. Journal for Nurse Practitioners, 10(10), 840-844. doi:10.1016/j.nurpra.2014.06.018