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NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes


In patients age 25 – 65 with congestive heart failure, how effective is weekly patient contact and comprehensive education, compared to the standardized discharge plan 2 – 4 weeks follow up, in lowering readmissions rates for reoccurrence of symptoms, within 30 days of hospital discharge?

Summary of the Articles that Support the Critical Question

Even though guideline have been improved heart failure continues to have a high hospital readmission rate. Heart failure care transition and hospital readmissions have been at the top of the list for discussions of health policies, for some time now. The retrospective analysis of >11 million Medicare receivers discovered that roughly 20% of heart failure patients were readmitted within 30 days of hospital discharge (Leavitt, 2020).  Penalties for continue heart failure 30-day hospital readmission through the Hospital Readmissions Reduction Program, have been the push behind improving discharge policies and procedures (Horne, 2020).  Unfortunately, this push for change has said to resulted in patient safety concerns and worsening of patient’s health. Well-organized and effective procedures are recommended for transitional care of heart failure patients. The goal is to reduce 30 hospital readmissions. The patients will require education surrounding self-care and disease management. The groups that receive the intervention had a decrease in 30 hospital readmissions when compared to the controlled groups.

Explanation of the Critical Question

The problem is increased hospital readmission rates among 25 – 65-year-old heart failure patients. The effectiveness of weekly patient contact and a comprehensive education discharge plan will be analyzed and compared to patients receiving the standard 2 – 4-week discharge follow up. 30-day readmission rates for heart failure exacerbation will be compared.

The Value of Addressing Heart Failure Admission Rate

Reducing monetary expenses and refining patient outcomes are the key quality goals of today. Evidence based practices give the opportunity to decrease the cost of heart failure 30 day readmissions. Studies have shown some improvement with heart failure discharge outcomes, however more research is needed. Successful transition to home post discharge for heart failure patients will take the patient and family to be involved. Managing care independently is the goal. The discharge plan will require comprehensive education on healthy diet, self-monitoring, increased activity, adequate medication regimen, close contact with health care provider. These materials are included in standard discharge planning, however some patient have a difficult time comprehending health care and understanding medical terms. The value in addressing heart failure readmission rates is providing help to those struggling with managing heart failure.

Quality Improvement Initiative

This would be a great quality improvement initiative. Heart failure patient are at risk for mortality.
Almost .33% of heart failure patient die within 1 year of diagnosis (Sawan, 2018).  Even with the advancement in therapy and heart failure monitoring device therapy, heart failure continues to be accountable for 9 deaths as the leading or contributing cause (Sawan, 2018). Quality improvement in heart failure treatment have been made, however there is lots more work to be done. Motivating the healthcare systems to improve heart patient’s outcomes may require additional incentives. Quality Improvement initiatives will uncover the key factors in improving the problems related to heart failure readmission rates.

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes


Horne, Benjamin D; Roberts, Colleen A; Rasmusson, Kismet D; Buckway, Jason; Alharethi, Rami. (2020). Risk score–guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality. The American Heart Journal; Philadelphia Vol. 219, (Jan 2020): 78-88.

Sawan Jalnapurkar; Zhao, Xin; Heidenreich, Paul A; Bhatt, Deepak L; Smith, Eric E. (2018). A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get with The Guidelines-Heart Failure.  The American Heart Journal; Philadelphia Vol. 200

Leavitt, Mary Ann; Hain, Debra J; Keller, Kathryn B; Newman, David. (2020). Testing the Effect of a Home Health Heart Failure Intervention on Hospital Readmissions, Heart Failure Knowledge, Self-Care, and Quality of Life. Journal of Gerontological Nursing; Thorofare Vol. 46, Iss. 2, (Feb 2020): 32-40. DOI:10.3928/00989134-20191118-01

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

Photo Credit: steheap / Adobe Stock

To prepare:

  • Identify the practice problem as the focus of your Discussion post. You may use the same practice problem from earlier weeks or
    NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

    NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

    a different one.

  • Review the chapter on practice questions in the Dang and Dearholt text and the Week 7 Media. With guidance from the Learning Resources, cast your practice problem as a critical question.
  • Search the Walden Library for 2–3 scholarly articles that address your critical question.
  • Analyze the articles to identify evidence that would guide quality improvement.
  • Return to the stakeholders that were the audience for your Module 3 Assignment. Identify the specific quality improvement component in the evidence. Then consider how you would present it to that set of stakeholders to secure agreement and action.

With these thoughts in mind …

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By Day 3 of Week 7

Post a brief explanation of your critical question. Then, summarize the 2–3 articles you identified that address your critical question. Using the same language you would use with stakeholders, explain the critical question and the value of addressing it as a quality improvement initiative. Be specific. Cite the scholarly articles and other resources to support your post.

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Week 7 Main Discussion Post

How do nurses in Intermediate Care telemetry units perceive burnout, and how can it be mitigated in the workplace?

Due to prolonged mental and physical demands, along with managing a complex workload, nurses frequently develop burnout (Bianchini & Copeland, 2021). The World Health Organization has just redefined burnout on the ICD-11. Burnout Syndrome is caused by a stressful work environment, and workplace interventions to foster a healthy work environment are recommended (American Medical Association. 2019; Bianchini & Copeland, 2021). Burnout syndrome is characterized by emotional tiredness, depersonalization, and decreased job satisfaction (Bianchini & Copeland, 2021). Almost half of all nurses experience burnout during their careers (Bianchini & Copeland, 2021; Schlak, 2021). Burnout in the nursing profession has been associated to higher patient care errors, high turnover rates, decreased patient satisfaction, increased health care expenses, and increased professional and personal stress for the nurse (Sováriová Soóssová, 2021).

Currently, on the IMC telemetry unit, a significant number of long-time, experienced nurses are leaving the hospital in search of brighter pastures, resulting in a high turnover rate. Each turnover might cost the facility more than $80,000. (Adams et al). Personnel availability on the unit is diminished due to staff turnover. When there are insufficient nurses on staff, the facility must limit the number of admissions on the unit. This can result in patients spending hours in the emergency room waiting for a bed (Personal communication, July 13, 2021). This subsequently crowds the Emergency Department, increases the patient’s wait time, and may prevent someone in need of more urgent care from being improperly triaged due to a lack of capacity. Additionally, the facility can be diverted, resulting in fewer local hospital space. The fall in patient satisfaction can impact hospital reimbursement.

Many patient care items, such as outstanding lab results, patient evaluation, and information that the nurse fails to relay during report, will not be followed up on if the nurses on the unit are burned out and lack motivation to complete their patient care responsibilities. Patient safety and nurse burnout are directly related (Sováriová Soósová, 2021).

Maintaining nurse-patient ratios, a team-based approach, fostering communication, and transformational leadership are ways for minimizing stress in the workplace that contribute to the promotion of a positive work environment. Personal and professional stress reduction strategies include yoga, mindfulness, and stress management training programs (Zhang et al, 2020). It has been shown that a favorable supportive work atmosphere, enough staffing, and teamwork between physicians and nurses, as well as leadership, reduce burnout (Schlak et al, 2021; Zhang et al, 2020).

To effectively manage and avoid nursing burnout, methods to promote a good work environment must be undertaken. (Sováriová Soósová, 2021).


Adams, A., Hollingsworth, A., & Osman, A. (2019). The Implementation of a       Cultural Change Toolkit

to Reduce Nursing Burnout and Mitigate Nurse                 Turnover in the Emergency Department. Journal of Emergency Nursing,        45(4),    452–456. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jen.2019.03.004

American Medical Association. (2019, July 23). WHO adds burnout to ICD-11. What it means for

physicians. https://www.ama-assn.org/practice-management/physician-health/who-adds-burnout-icd-11-what-it-means-physicians

Bianchini, C., & Copeland, D. (2021). The Use of Mindfulness-Based        Interventions to Mitigate

Stress and Burnout in Nurses. Journal for Nurses in         Professional Development, 37(2), 101–106.

Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021). Leveraging                the

Work Environment         to Minimize the Negative Impact of Nurse Burnout on Patient   Outcomes. International Journal of Environmental Research and Public Health, 18(2).          https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020610

Sováriová Soósová, M. (2021). Association between Nurses’ Burnout, Hospital Patient Safety Climate

and Quality of Nursing Care. Central European Journal of Nursing &        Midwifery, 12(1), 245–256. https://doi-       org.ezp.waldenulibrary.org/10.15452/CEJNM.2021.12.0039

Zhang, X.-J., Song, Y., Jiang, T., Ding, N., & Shi, T.-Y. (2020). Interventions to reduce burnout of

physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi-org.ezp.waldenulibrary.org/10.1097/MD.0000000000020992

Read a selection of your colleagues’ posts.

By Day 6 of Week 7

Respond to at least two of your colleagues on 2 different days by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 7 Discussion Rubric

Post by Day 3 of Week 7 and Respond by Day 6 of Week 7

To Participate in this Discussion:

Week 7 Discussion

What’s Coming Up in Week 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week you will expand your literature search to answer the critical question you developed in the Week 7 Discussion. Be aware that your Week 8 Discussion is designed to support an effective search in the Walden Library. The literature search is Part 1 of your Module Assignment, which will be due in Week 10.

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Main Question Post

Critical Question

Will a nurse education program boost their expertise and confidence to instruct patients with newly diagnosed or poorly controlled diabetes on self-management techniques?

The paucity of diabetes education provided to newly diagnosed or poorly controlled patients at this student’s facility sparked this issue. No Certified Diabetes Educators are on staff, and no one is expressly allocated to give patient education to this population. The burden rests on the nursing staff, who confront obstacles such as time limits owing to nurse-patient ratios, knowledge gaps regarding disease subtleties and therapies, and an absence of an organized resource to employ during patient education sessions. Karimy et al. (2018), Swanson and Maltinsky (2019), and Shabibi et al. (2017) all conducted research on diabetic patients and discovered same fundamental outcomes. As patient education and knowledge grew, self-efficacy and self-management practices also rose. According to Karimy et al. (2018), there was a strong association between education level and self-care behaviors, such that as education level grew, so did self-care behaviors (p. 3).

As more experienced nurses at the facility migrate into Nurse Practitioner roles, take travel assignments, or ascend to leadership positions, the amount of experience at the bedside has reduced dramatically. Numerous young nurses who are just beginning their careers lack the necessary expertise and confidence to educate this patient population.

Abstracts of Published Articles

Rochfort et al. (2018) conducted a comprehensive study to investigate whether physician training programs may effectively enhance chronic disease patient outcomes. The authors highlighted how patient education might be utilized to enhance patient autonomy and self-management abilities. However, for education exchanges to be effective, the healthcare provider must be proactive and well-prepared. Education for clinicians is an excellent technique of preparation. The authors state, “existing data demonstrates that health professional training is connected with increased uptake and execution of patient self-management programs” (p. 164). When healthcare personnel got training in knowledge and abilities, they were better able to convey these abilities to patients. The results were enhanced self-management, improved lifestyle habits, increased self-efficacy, and the perception of a higher quality of life. Due to the low quantity of data available on this topic, the researchers recommended that further studies of this type be done.

Stoffers and Hatler (2017) conducted a pilot study based on the Self-Efficacy Theory to determine whether training nurses in motivational interviewing techniques could increase their confidence when educating diabetic patients. “Patient education occurs seldom because many nurses lack confidence in the approaches and substance essential for transmitting knowledge to patients,” they write (p. 189). Consequently, they believe that enhancing nurses’ expertise and confidence in providing diabetes education is essential to ensuring that this patient population receives the necessary instruction.

Motivational interviewing is evidence-based and focuses on determining why patients are unable to modify their behavior. After identifying the causes, the practitioner engages with the patient to encourage the required modifications (Stoffers & Hatler, 2017). In this study, the intervention consisted of a three-hour didactic teaching session followed by six patient simulations. The research enhanced nurses’ confidence in delivering patient education. Six months after the intervention, data collection demonstrated continuous gains.

Stakeholder Explanation

In our current practice, patients with newly diagnosed or poorly controlled diabetes receive little information regarding self-management measures. The dietician discusses meal options with the patient, but no additional formal education is provided. In order to complete this patient education, the nursing staff encounters a variety of obstacles, including time limits owing to nurse-patient ratios, a lack of understanding regarding the intricacies of this complex condition, and the absence of an organized resource to use during patient education sessions.

It is well recognized that successful self-management improves outcomes and reduces complications in diabetic patients, and a number of research studies have demonstrated beneficial connections between patient education and the capacity to engage in self-management activities. In 2017, Stoffers and Hatler claimed that the first step in ensuring that this patient population received the essential education was to prepare the nursing staff to administer it. The educational activity conducted by the researchers for nurses resulted in a sustained increase in the nurses’ knowledge and confidence in giving diabetes education to the diabetic community. Similar investigations undertaken by other researchers have verified this outcome.

I would like to suggest a Quality Improvement program based on Stoffers and Hatler’s. I would like to arrange a three- to four-hour training session for all medical-surgical and step-down nurses to enhance their knowledge of diabetes, current therapies, and technological advancements. The training will also cover how to teach people with diabetes the necessary self-management skills. The nurses will then be presented a patient resource binder, which they will utilize to provide individualized diabetes education to newly diagnosed or poorly controlled patients. Currently, a registered nurse participating in the Professional Development Clinical Ladder is compiling this binder.

I believe that this will enhance both health results and patient happiness. It will also increase provider satisfaction among our hospitalists, our patients’ primary care physicians, and our endocrinologists. A higher HCAHPS rating and a better reputation in the community result from an increase in patient satisfaction. Our company’s mission is printed on the hallway walls every day: “We are committed to the protection and improvement of human life above everything else.” This project will allow us to carry out our mission.

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