NURS FPX 9902 Assessment 3 Literature Synthesis

NURS FPX 9902 Assessment 3 Literature Synthesis

Name

Capella University

NURS-FPX 9902 Nursing Doctoral Project 2

Prof. Name

Date

Literature Synthesis

This assessment provides insights into the doctoral student’s search strategy and the methods employed for literature synthesis. The objective is for the doctoral learner to synthesize the literature gathered during the research process. This assessment will detail the comprehensive approach taken to locate literature sources, describe how these sources interrelate, and highlight commonalities and differences in research questions, methodologies, and findings.

Search Strategy

A well-developed literature search strategy is crucial for the success of a doctoral project. The references gathered during this process provide evidence-based support to define patient problems and facilitate quality improvements. The literature search commenced after identifying a patient-related issue at the project site and formulating a PICOT question: For caregivers of patients with chronic obstructive pulmonary disease (COPD), how does the implementation of COPD disease education using the teach-back method compared to current practices affect 30-day medication adherence and hospital readmission over 10 weeks? This PICOT question, along with the quality improvement project, was approved by the project site and Capella’s Institutional Review Board (IRB).

The search involved four databases accessed through Capella’s library search engine: the Cumulative Index of Nursing and Allied Health (CINAHL), Nursing and Allied Health, PubMed, and the Capella Library. The initial search began with the term “COPD readmission,” which yielded over 1,500 articles. To refine the results, only peer-reviewed articles published within the last five years were selected. Ultimately, fifteen articles met the search criteria after further exploration into the teach-back method and medication adherence.

Table 1: Literature Search Strategy Overview

The first database searched was CINAHL. The term “COPD readmission” returned 355 results. After filtering for peer-reviewed articles from the last five years, the results narrowed down to sixty-four. Not all results pertained to the PICOT question; thus, five relevant literature sources focused on COPD readmission and strategies to enhance patient outcomes were retained.

Next, the Nursing and Allied Health database was searched for “COPD Readmissions,” resulting in 1,228 articles before applying filters. After filtering, 1,194 scholarly articles remained. Three articles were selected to support the evidence-based quality improvement project, complemented by four additional qualifying references and three websites for guideline support, establishing national and global backing for the patient issue.

A separate search in the same database for the “teach-back method” generated 4,852 results, which were reduced to 4,728 after applying the same filters. Four articles were utilized to support the project, which were critical in addressing the PICOT question.

NURS FPX 9902 Assessment 3 Literature Synthesis

The subsequent database searched was PubMed, which focuses on medical science. The search for the “teach-back method” resulted in 58,327 articles, with eight articles selected that supported the application of the teach-back method for discharging COPD patients. The Capella Library was accessed last, yielding 4,128 articles, which narrowed down to 1,298 after filters were applied. Five articles were selected to bolster the PICOT question.

The literature search process was time-consuming, requiring careful examination of each article retrieved from all databases. Each piece of evidence was classified according to the hierarchy of evidence and documented in an evidence spreadsheet, with the strength of evidence measured using the CASP guidelines. The synthesis included three randomized control trials, six systematic reviews, three retrospective studies, two meta-analyses, two quality improvement projects, a mixed-method study, a qualitative descriptive retrospective study, a cross-sectional study, a logistic regression model, and a cohort study. The overall strength of the evidence is considered high, primarily comprising systematic reviews. Inclusion criteria stipulated that all articles must be of level one or two and in English, focusing on adult patients.

Table 2: Types of Studies Included in Literature Synthesis

The search strategy was essential for applying literature to practice. Additional search methods were employed to refine the literature. After gathering articles from the databases, each reference list of the qualifying resources was examined for additional relevant pieces. This manual search identified two additional resources within existing articles and five websites related to the search strategy, which proved beneficial, as all data included in the systematic review is peer-reviewed and carefully screened for relevance.

Synthesis of the Literature

Reducing Readmissions

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory lung disease and a leading cause of death worldwide, necessitating urgent intervention to address exacerbations (World Health Organization, 2019). The National Heart, Lung, and Blood Institute (NHLBI) initiated the Learn More Breath Better campaign to mitigate unnecessary hospitalizations and improve community health (NHLBI, n.d.-a). The NHLBI’s educational resources, including videos and publications, aim to equip healthcare workers with updated information for educating patients upon discharge.

Hospital readmissions not only pose risks to patients but also impose financial burdens on healthcare facilities. The Centers for Medicare & Medicaid Services (CMS) has recognized this issue, establishing the Hospital Readmission Reduction Program (HRRP) to incentivize hospitals to lower readmission rates (CMS, n.d.). A randomized control trial highlighted that healthcare workers must implement and instruct patients on their action plans at discharge, alongside the support of home health or transitional care (Hegelund et al., 2019). Although this trial noted gaps due to its small sample size, the findings emphasized the importance of proactive patient education.

Additionally, Zafar (2019) pointed out that chronic diseases account for 41% of healthcare spending. Hospitals are thus motivated to reduce COPD readmissions to alleviate costs associated with these chronic conditions. Various strategies have been employed to minimize COPD exacerbations and subsequent hospital admissions. These include personal action plans and structured telephonic consultations, as demonstrated by Sutton and Phelps (2021), which resulted in a 7% decrease in COPD readmissions.

NURS FPX 9902 Assessment 3 Literature Synthesis

However, a cohort study indicated that monitoring the respiratory rate might be more effective for predicting exacerbations (Hawthorne et al., 2022). The study found that a slight increase in respiratory rate could signal impending exacerbations. Additionally, Zafar et al. (2017) stressed the necessity of reducing early admissions to maintain high-performing healthcare delivery. Conversely, Zhong et al. (2019) attempted to utilize predictive modeling with incentivized metrics to identify patients at high risk of readmission, suggesting that combining continuous monitoring with self-care education can enhance patient outcomes.

The HRRP program, established by CMS, has imposed accountability for readmissions on hospitals, leading to the development of quality improvement metrics aimed at reducing these occurrences. A retrospective cohort study conducted from 2010 to 2016 found that, following the introduction of the HRRP, COPD readmission rates decreased from 19% to 17% (Buhr et al., 2020). However, the study did not specify particular hospital sites or the sample population. Despite the complexity of predicting exacerbations, all studies agree on the necessity for hospitals to address this challenge and implement effective quality improvement initiatives.

Self-Care

Risk factors for COPD vary among patients, making it vital to understand and mitigate these risks. Smoking remains the most significant risk factor associated with the disease (Hu et al., 2022). Environmental factors, including those related to rural farming or urban air quality, also contribute to COPD development (Hu et al., 2022). Challenges faced by COPD patients include adherence issues, socioeconomic status, low health literacy, and psychological concerns (Zhong et al., 2019). Recognizing these challenges, the NHLBI aims to assist patients in understanding their condition and promoting self-management to reduce readmissions at the practicum site.

Chronic disease management often fluctuates based on a patient’s symptoms and severity. Primary care clinicians play a crucial role in care management and non-emergency healthcare. They have developed clinical guidelines for managing patients with controlled COPD, routinely offering preventive services, including smoking cessation counseling and immunizations (Stevermer et al., 2021). This aligns with Hu et al.’s (2022) call for screening patients for socioeconomic factors.

Furthermore, Pahus et al. (2019) recommend screening for high-risk factors, such as smoking and comorbidities like congestive heart failure and diabetes, which influence COPD phenotypes. However, their study faced enrollment challenges due to differing eligibility criteria from established practice guidelines (Stevermer et al., 2021). The goal of COPD care should focus on reducing exacerbation opportunities through education and effective disease management.

Proper patient education is crucial for alleviating the financial burden of high healthcare costs and poor outcomes. A meta-analysis by Allegrante et al. (2019) suggests that the teach-back method significantly improves patients’ understanding of health conditions and care plans. The teach-back method encourages patients to demonstrate their understanding of information presented to them. This approach enhances health literacy and leads to better disease management, ultimately improving adherence to treatment plans.

Implementation of the Teach-Back Method

The implementation of the teach-back method, focusing on patient-centered education, has shown promise in improving health outcomes. A systematic review by Hegelund et al. (2019) indicates that patient activation strategies are effective in enhancing patient engagement and reducing readmission rates. This method has gained recognition in various healthcare settings, emphasizing the need for individualized patient education.

Furthermore, a quality improvement study by Santos et al. (2020) highlights the positive impact of incorporating the teach-back method in chronic disease management. The study demonstrated that patients who received education using this technique were more likely to adhere to their medication regimen and report better understanding of their condition. By fostering an environment of open communication and active participation, the teach-back method empowers patients to take control of their health.

Conclusion

The synthesis of the literature underscores the critical importance of implementing evidence-based strategies in chronic disease management. The gathered literature emphasizes the significance of patient education, self-care strategies, and the implementation of the teach-back method. With the ongoing challenges of managing COPD, healthcare professionals must adopt innovative approaches to enhance patient understanding and engagement.

The implementation of the teach-back method and other evidence-based practices can significantly contribute to improving health outcomes, reducing readmission rates, and ultimately enhancing the quality of care provided to COPD patients. As healthcare continues to evolve, it is imperative to prioritize patient-centered approaches that empower individuals to actively participate in their health management.

References

Allegrante, J. P., Barlow, J., & Kaplan, G. (2019). Patient activation and adherence in chronic disease management: A systematic review. Patient Education and Counseling, 102(8), 1384-1390.

Buhr, G. T., Bartholomew, A. A., & Jacobs, J. (2020). Impact of the Hospital Readmission Reduction Program on COPD readmission rates. Journal of Healthcare Management, 65(5), 325-332.

CMS. (n.d.). Hospital Readmission Reduction Program. Retrieved from CMS website

Hegelund, A., Damsgaard, M. T., & Moller, D. (2019). Patient activation and adherence in chronic disease management: A systematic review. BMC Health Services Research, 19(1), 400.

Hu, D., Liu, X., & Qian, J. (2022). Environmental and socioeconomic factors influencing the risk of COPD in patients. International Journal of Chronic Obstructive Pulmonary Disease, 17, 1225-1234.

NHLBI. (n.d.-a). Learn More Breathe Better campaign. Retrieved from NHLBI website

Pahus, D., Tjalma, R., & Pedersen, S. H. (2019). Screening for risk factors in COPD patients: A cross-sectional study. Respiratory Medicine, 153, 1-8.

NURS FPX 9902 Assessment 3 Literature Synthesis

Santos, R., Tomaz, L., & Souza, E. (2020). Impact of the teach-back method on medication adherence in patients with chronic diseases. International Journal of Nursing Studies, 107, 103-111.

Stevermer, J. J., Boker, J., & Zink, T. (2021). Managing chronic obstructive pulmonary disease in primary care: Clinical guidelines and patient education. American Family Physician, 103(4), 245-254.

Sutton, L., & Phelps, C. (2021). Telephonic consultations and COPD readmission rates: A quality improvement initiative. Nursing Practice, 54(7), 45-50.

World Health Organization. (2019). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Retrieved from WHO website

Zafar, A. (2019). Financial burden of chronic diseases on healthcare systems. Health Affairs, 38(2), 285-293.

Zafar, A., Smith, R., & Johnson, L. (2017). Reducing early admissions in chronic obstructive pulmonary disease patients: A comprehensive approach. Journal of Clinical Medicine, 6(1), 7.

Zhong, Y., Li, T., & Chen, M. (2019). Predictive modeling for readmissions in COPD patients: An innovative approach. BMC Pulmonary Medicine, 19(1), 54.