NURS 8114 Framing a Practice Problem as Critical Question With Measurable Outcomes
NURS 8114 Framing a Practice Problem as Critical Question With Measurable Outcomes
NURS 8114 Framing a Practice Problem as Critical Question With Measurable Outcomes
Framing a Practice Problem as a Critical Question with Measurable Outcomes
Practice Problem: Lack of fully informative CHF (Congestive Heart Failure) education to patients at discharge
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Practice Question: Should patients have their euvolemic weight checked as part of discharge teaching?
One of the hallmark symptoms of CHF is non-exertional dyspnea/orthopnea, secondary to intravascular volume overload. To minimize CHF recurrence, one of the self-efficacy tasks that patients are taught is to weigh themselves every morning [after using the restroom] prior to taking daily medications, and if there is a three (3) pound weight gain or more within a three (3) day period, to call their cardiology provider for further instruction – which could mean increasing present doses of oral diuretic or coming into the office for administration of IV diuresis. In my hospital, newly admitted CHF patients are even provided with a scale to keep account of daily weight. All CHF patients are supposed to be weighed daily in the inpatient setting (along with accurate recording of daily intake/output), but unfortunately, this does not always happen. Once patients are volume optimized, steps are taken toward discharge, to include provision of educational materials and discharge teaching from the assigned nurse. This poses my question, “Should patients have their weight checked as part of discharge teaching?” This very simple nursing intervention can potentially prevent a future hospital admission by allowing the opportunity to employ intervention strategies (IV diuresis) in the outpatient setting before intravascular volume becomes too far gone.
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Article #1: Patterns of Weight Change Preceding Hospitalization for Heart Failure
This article summarizes that increases in body weight typically occur up to 1 week preceding hospitalization, and methods implemented to monitor daily weight can improve the clinical outcomes of heart failure patients (Chaudhry, S., Wang, Y., Concato, J, Gil, T. & Krumholz, R.,
2007).
Article #2: Inpatient Weight Monitoring in Heart Failure
This article summarizes the inconsistencies in monitoring daily weight in heart failure patients in the inpatient setting, and the primary [nursing] impediment to this staple of patient care was disruption of patients’ sleep (Indaram, M., 2017).
Article #3: Daily Weight and Fluid Balance Assessment in Patients Admitted with Acute Heart Failure
This article summarizes that close monitoring of net fluid volume status along with accurate daily weight measurements in the hospital admitted CHF patient is crucial to appropriate administration of diuretic therapy. However, these pivotal diagnostic criteria are not always accurately recorded (Al-Refae & Taylor, 2021).
Article #4: Effectiveness of Daily Fluid Balance Charting in Comparison to the Measurement of Body Weight When Used in Guiding Fluid Therapy for Critically Ill Adult Patients: A Systematic Review Protocol
This article summarizes that the routine nursing activity of documenting patients’ daily fluid intake and output (to include output from surgical drains) along with body weight requires diligence but is absolutely necessary and can be considerably challenging in the context of an incapacitated ICU patient. Moreover, there are multiple opportunities for documentation errors such as missed or double entries, or linen items not being removed from the bed before the scale is tarried/zeroed (Davies, H., Gavin, L. & Morgan, D., 2015).
Article #5: Hospital Nurses’ Comfort in and Frequency of Delivering Heart Failure Self-Care Education
This article summarizes that although the expectation for [hospital] nurses is to adequately perform patient discharge education regarding what defines heart failure, medications, diet/fluid restrictions and signs/symptoms of fluid overload, the reality is that most nurses are very uncomfortable educating patients on the most important patient self-care strategies to prevent future hospitalizations (Albert et al, 2015).
Article #6: Interventions to Improve Communication at Hospital Discharge and Rates of Readmission
Just as the title suggests, this article shows a statistical correlation with inadequate discharge teaching and preventable hospital readmission rates (Becker et al., 2021). Discharge education must take into consideration the patient’s ability to comprehend the information given – regarding language/cognitive barriers and anxiety.
Synthesis of Articles
Gleaning from the information in the aforementioned articles, the affected patient care outcome is CHF readmission rate [within 30 days of discharge]. In an effort to reduce CHF readmission, it is incumbent on the discharging nurse to obtain a euvolemic weight on the patient, which will act as a point of reference for the patient for continued monitoring of weight following discharge. Increases in body weight can occur within 1 week preceding hospitalization for CHF, but this potential hospitalization can be averted if the patient is adequately educated on the importance of recognizing significant weight gain and punctually establishing contact with his/her respective cardiologist accordingly for adjustments in diuretic therapy and alleviation of symptoms. Furthermore, hospital administration/management is highly encouraged to provide adequate nursing education and support, so that nurses feel equipped and confident in their ability to provide effective discharge teaching. Reducing costly and avoidable heart failure readmissions can reduce financial strain on hospitals, and also effectively utilize the APRN workforce in the community.
References
Albert, N. M., Cohen, B., Liu, X., Best, C. H., Aspinwall, L., & Pratt, L. (2015). Hospital nurses’ comfort in and frequency of delivering heart failure self-care education. European Journal of Cardiovascular Nursing, 14(5), 431–440. https://doi.org/10.1177/1474515114540756.
Al-Rafae, N., & Taylor, L. (2021) Daily Weight and Fluid Balance Assessment in Patients Admitted with Acute Heart Failure. Heart, 107, A113-114.
Becker, C., Zumbrunn., S., Beck., K., Vincent, A., Loretz, N., Muller, J., Amacher, S., Shaefert, R., & Hunziker, S. (2021). Interventions to Improve Communication at Hospital Discharge and Rates of Readmission: A Systematic Review and Meta-Analysis. JAMA Network Open, 4(8), e2119346. https://doi.org/10.001/jamanetworkopen.202.
Chaudhry, S., Wang, Y., Concato, J, Gil, T. & Krumholz, R. (2007). Patterns of Weight Change Preceding Hospitalization for Heart Failure. Circulation, 116(14), 1549-1554.
Davies, H., Gavin, L., & Morgan, D. (2015). Effectiveness of Daily Fluid Balance Charting in Comparison to the Measurement of Body Weight When Used in Guiding Fluid Therapy for Critically Ill Adult Patients: A Systematic Review Protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(3), 111-123.
Indaram, M. (2017). Inpatient Weight Monitoring in Heart Failure. Journal of Cardiac Failure, 23(8), S103. DOI:https://doi.org/10.1016/j.cardfail.2017.07.299Links to an external site..
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 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 …
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.
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.
Next Week
Week 7: Components of Evidence-Based Practice: Asking a Critical Question
Think about the experience of meeting a new patient and getting to know the person’s health history or the specific problem to be addressed. How do you find out what you think you need to know? Most likely, you ask questions. And the better your questions, the more they can elicit the specific information for successful health maintenance or treatment.
Identifying a practice problem works in much the same way. Specifics are needed to define and refine. Asking a critical question—the why or how or what or when—can clarify the aspect or element that is the core issue. The critical question—and the type, quantity, and quality of evidence it generates—also provides support with answering stakeholder concerns, and particularly whether a practice change is justified.
This week you will begin exploring the components of evidence-based practice with a focus on finding the critical questions in practice problems.
Learning Objectives
Students will:
- Analyze practice problems for critical question development
- Summarize peer-reviewed research to support critical questions
- Justify critical questions for quality improvement initiatives
Learning Resources
Required Readings (click to expand/reduce)
Dang, D., & Dearholt, S. L. (Eds.). (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International.
- Chapter 4, “The Practice Question” (pp. 63–78)
Required Media (click to expand/reduce)
Walden University. (2011). An evidence-based practice model [Video]. Author
Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript
Optional Resources (click to expand/reduce)
Module 4: Components of Evidence-Based Practice
In Module 3 you assembled the components and requirements for quality improvement that applies evidence-based practice. To formulate the practice that delivers the needed improvement, you have to uncover the base: the evidence.
That is a process all its own and the focus of Module 4. This module image implies a familiar symbol of thought and ideas, and in the 4 weeks ahead, the goal of this module is to shine a bright light on steps and strategies in identifying and evaluating evidence to guide best practice in nursing and health care. Each week will examine a key component: Asking a Critical Question (Week 7), Searching the Evidence (Week 8), Appraising the Evidence (Week 9), and Grading the Evidence (Week 10). Your Module 4 Assignment will lead you through this process, and like your work in Module 3, offers a rehearsal for the evidence search in your DNP Project.
What’s Happening in This Module?
Preview your module activities and schedule.
| What do I have to do? | When do I have to do it? |
| Review your Learning Resources | Days 1–7, Weeks 7, 8, 9, and 10 |
| Week 7 Discussion: Framing a Practice Problem as a Critical Question With Measurable Outcomes | Post by Day 3 of Week 7, and respond to your colleagues by Day 6 of Week 7. |
| Week 8 Discussion: Search-Based Questions | Post by Day 3 of Week 8, and respond to your colleagues by Day 6 of Week 8. |
| Module 4 Assignment: Investigating a Critical Practice Question Through a Literature Review | You will begin your Assignment in Week 8 and submit by Day 7 of Week 10. |
| Week 10 Discussion: Clarifying Connections: Practice Problem, Evidence, Changing Practice | Post by Day 3 of Week 10, and respond to your colleagues by Day 6 of Week 10. |
Go to the Week’s Content
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_8114_Week7_Discussion_Rubric
| Excellent90%–100% | Good80%–89% | Fair70%–79% | Poor0%–69% | |||
| Main Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. | 40 (40%) – 44 (44%)Thoroughly responds to the Discussion question(s).Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
35 (35%) – 39 (39%)Responds to most of the Discussion question(s).Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
31 (31%) – 34 (34%)Responds to some of the Discussion question(s).One to two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
0 (0%) – 30 (30%)Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria.Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
||
| Main Posting:Writing | 6 (6%) – 6 (6%)Written clearly and concisely.Contains no grammatical or spelling errors.
Adheres to current APA manual writing rules and style. |
5 (5%) – 5 (5%)Written concisely.May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style. |
4 (4%) – 4 (4%)Written somewhat concisely.May contain more than two spelling or grammatical errors.
Contains some APA formatting errors. |
0 (0%) – 3 (3%)Not written clearly or concisely.Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style. |
||
| Main Posting:Timely and full participation | 9 (9%) – 10 (10%)Meets requirements for timely, full, and active participation.Posts main Discussion by due date. | 8 (8%) – 8 (8%)Meets requirements for full participation.Posts main Discussion by due date. | 7 (7%) – 7 (7%)Posts main Discussion by due date. | 0 (0%) – 6 (6%)Does not meet requirements for full participation.Does not post main Discussion by due date. | ||
| First Response:Post to colleague’s main post that is reflective and justified with credible sources. | 9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting. | 7 (7%) – 7 (7%)Response is on topic and may have some depth. | 0 (0%) – 6 (6%)Response may not be on topic and lacks depth. | ||
| First Response: Writing |
6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)Response posed in the Discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited. |
0 (0%) – 3 (3%)Responses posted in the Discussion lack effective communication.Response to faculty questions are missing.
No credible sources are cited. |
||
| First Response: Timely and full participation |
5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date. | 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date. | 3 (3%) – 3 (3%)Posts by due date. | 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date. | ||
| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.Responds to questions posed by faculty.
The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting. | 7 (7%) – 7 (7%)Response is on topic and may have some depth. | 0 (0%) – 6 (6%)Response may not be on topic and lacks depth. | ||
| Second Response: Writing |
6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.Response to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.
Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)Response posed in the Discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.
Few or no credible sources are cited. |
0 (0%) – 3 (3%)Responses posted in the Discussion lack effective communication.Response to faculty questions are missing.
No credible sources are cited. |
||
| Second Response: Timely and full participation |
5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date. | 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date. | 3 (3%) – 3 (3%)Posts by due date. | 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date. | ||
| Total Points: 100 | ||||||
Name: NURS_8114_Week7_Discussion_Rubric
Your touch on mental health as a critical question is a good one. The mental institutions have suffered a relegation for quite a long time. And I would like to point out the main cause for this rlack of attention. I am hopeful have contributed my cent on this problem and a probable solution
The public’s awareness of conditions in mental institutions began to increase during World War II(de Medeiros et al., 2020).
During WWII, it was found that 1 out of 8 men considered for military service was rejected based on a neurological or psychiatric problem (de Medeiros,et al., 2020). This increased awareness of the prevalence of mental illnesses, and people began to realize the costs associated with admission to mental institutions ()
Since numerous individuals suffering from mental illness had served in the military, many began to believe that more knowledge about mental illness and better services would not only benefit those who served but also national security as a whole (Brower, 2022). To ameliorate the populace’s suffering, Congress passed the National Mental Health Act of 1946, which created the National Institute of Mental Health (NIMH) (Brower, 2022). This agency is to help individuals having mental challenges.
While public opinion of the mentally ill has improved somewhat, it is still often stigmatized. Advocacy movements in support of mental health have emerged (Brower, 2022). These movements focus on reducing stigma, discrimination and increasing support groups and awareness (Brower, 2022).
As hospitalization costs increased, both the federal and state governments were motivated to find less expensive alternatives to hospitalization (Bassuk & Gerson