D028 – CPE Task 1: Clinical Practice Experience Details

MSN Core Word E-Portfolio Template

Instructions for Course Completion

Completion of this course requires students to successfully document their Clinical Practice Experience (CPE) activities using the designated CPE Record. This record serves as a structured method for demonstrating competency achievement and includes multiple required deliverables used for formal evaluation. Detailed descriptions of these requirements are available in the “Supporting Documents” section within the Assessment Task Overview.

Students are expected to compile all required components—such as reflective analyses, discussion responses, and supporting evidence—into this e-portfolio template for each course phase. Previously developed documents may be embedded directly into this Word document by inserting them as text files. To do so, students should place the cursor at the intended insertion point, select Insert, choose Object, expand the dropdown menu, select Text from File, and then locate and insert the appropriate document. This process may be repeated as necessary to ensure all required artifacts are included in the final portfolio submission.

D028 CPE Schedule Table

The following table presents a recommended timeline for completing the course deliverables. Students may adapt this schedule to align with their individual learning plans and are encouraged to insert this table into their e-portfolio and complete the anticipated dates accordingly.

What Is the Hospital Readmissions Reduction Program (HRRP)?

The Hospital Readmissions Reduction Program (HRRP) is a quality improvement initiative established by the Centers for Medicare & Medicaid Services (CMS) with the goal of decreasing avoidable hospital readmissions following discharge. The program applies financial penalties to hospitals with higher-than-expected readmission rates for specific diagnoses and procedures, including acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and elective total hip or knee arthroplasty (Centers for Medicare & Medicaid Services [CMS], n.d.).

To support improvement efforts, CMS distributes annual confidential Hospital-Specific Reports to healthcare organizations. These reports allow advanced practice nurses and healthcare leaders to evaluate performance trends, identify gaps in transitional care, and implement targeted, evidence-based interventions. By improving discharge planning, care coordination, and follow-up processes, HRRP initiatives aim to enhance patient outcomes while simultaneously reducing healthcare expenditures.

Patient Case Scenario

The selected patient is a 55-year-old Hispanic male admitted after experiencing an acute myocardial infarction. His presenting symptoms included chest tightness, nausea, and shortness of breath that began while performing light physical activity (gardening). His medical history is notable for hypertension, obesity, and hyperlipidemia, all of which increase cardiovascular risk.

The patient’s family history further elevates his risk profile, as his father died from a myocardial infarction at age 62, and his mother has a history of type II diabetes, hypertension, and osteoporosis. Lifestyle assessment reveals frequent consumption of meals outside the home, including fast food and cafeteria dining approximately six to eight times weekly. He consumes coffee and soda daily, drinks alcohol socially on weekends, and engages in minimal physical activity, limited to a brief walk once per week. Additionally, he has not seen his primary care provider in the past seven months, indicating gaps in preventive and chronic disease management.

What Are Social Determinants of Health (SDOH) and How Do They Affect the Patient?

Social determinants of health refer to the social, economic, and environmental conditions that shape individual health outcomes across the lifespan (Healthy People 2030, n.d.). These determinants influence access to healthcare, health-related behaviors, and the ability to maintain wellness.

For this patient, the most influential SDOH category is the neighborhood and built environment. Limited access to affordable, nutritious food options within his community has contributed to reliance on restaurant and fast-food meals, increasing his intake of sodium, saturated fats, and calories. These dietary patterns exacerbate cardiovascular risk factors such as obesity, hypertension, and hyperlipidemia, thereby increasing the likelihood of hospital readmission following an acute cardiac event.

Intervention

A targeted intervention to address this determinant involves referral to a registered dietitian or dietary health coach. This professional can collaborate with the patient to create realistic, heart-healthy meal plans that accommodate his lifestyle while emphasizing portion control, healthier menu choices when dining out, and gradual behavior modification. Actively involving the patient in goal setting and meal planning enhances adherence, empowers self-management, and reduces the probability of preventable readmissions.

What Evidence-Based Practices Can Reduce Hospital Readmission?

Reducing readmission risk following myocardial infarction requires comprehensive secondary prevention strategies. One of the most well-supported evidence-based interventions is participation in cardiac rehabilitation programs. Cardiac rehabilitation integrates supervised physical activity, nutrition education, behavioral counseling, and risk factor modification to improve cardiovascular outcomes (Grochulska et al., 2021).

Research demonstrates that cardiac rehabilitation significantly reduces mortality, recurrent cardiac events, and hospital readmissions. For this patient, enrollment in a structured cardiac rehabilitation program would support gradual increases in physical activity, reinforce medication adherence, promote dietary changes, and provide psychosocial support, all of which contribute to sustained recovery (American Heart Association [AHA], 2024).

What Public Health Interventions Can Support the Patient?

Effective public health interventions should operate across multiple levels to maximize impact and sustainability.

What Are the Five Standards of Transitions of Care?

The American Case Management Association has outlined five standards designed to improve transitions of care and reduce avoidable readmissions (American Case Management Association [ACMA], 2023).

How Should Care Transitions Be Communicated to Stakeholders?

Clear and timely communication is essential to ensure continuity of care following hospital discharge. For this patient, key stakeholders include the primary care provider, cardiologist, and cardiac rehabilitation team.

The primary care provider should receive comprehensive discharge summaries detailing the hospitalization course, procedures performed, medication changes, and follow-up requirements. The cardiologist requires updates regarding recovery progress, diagnostic findings, and rehabilitation plans. The cardiac rehabilitation team should be notified promptly to initiate individualized exercise and education programs and provide ongoing progress reports to both the patient and the broader care team. Effective communication among these stakeholders reduces fragmentation of care and minimizes readmission risk.

Reflection

Throughout my experience working in the emergency department, the emphasis was often placed on rapid assessment and discharge, with limited focus on long-term outcomes. This assignment prompted a critical reevaluation of that approach by highlighting the importance of continuity of care beyond hospitalization.

By analyzing a hypothetical myocardial infarction case, I gained deeper insight into how social determinants, lifestyle behaviors, and clinical history intersect to influence patient outcomes. The exploration of Transitions of Care standards underscored the necessity of structured discharge planning, medication safety, and stakeholder communication.

Additionally, understanding the goals and mechanisms of the HRRP enhanced my appreciation of system-level strategies aimed at improving quality and accountability. As an advanced practice nurse, I now recognize my responsibility in coordinating care, educating patients, addressing social barriers, and advocating for evidence-based practices that support successful recovery and reduce preventable readmissions.

References

American Case Management Association. (2023). Transitions of care standards. https://transitionsofcare.org/wp-content/uploads/2023/06/ACMA-Transitions-of-Care-Standards_Final_06132023.pdf

American Heart Association. (2024, April 24). What is cardiac rehabilitation? https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation

Centers for Medicare & Medicaid Services. (n.d.). Hospital readmissions reduction program (HRRP). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp

Grochulska, A., Glowinski, S., & Bryndal, A. (2021). Cardiac rehabilitation and physical performance in patients after myocardial infarction: Preliminary research. Journal of Clinical Medicine, 10(11), 2253. https://doi.org/10.3390/jcm10112253

Healthy People 2030. (n.d.). Neighborhood and built environment. https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment

Healthy People 2030. (n.d.). Social determinants of health. https://health.gov/healthypeople/priority-areas/social-determinants-health