Capstone Project Milestone 1: Practice Issue and Evidence Summary Guidelines
Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.
This assignment enables the student to meet the following course outcomes:
- CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO4)
- CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO8)
Milestone 1 consists of the completion of ONE form with two worksheets. Complete both worksheets and submit the form by Sunday, 11:59 p.m. MT at the end of Week 3.
Milestone 1 is worth 175 points (75 points for the Practice Issue and 100 points for the Evidence Summary).
You are required to use the linked article and Worksheets or you will earn a “0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required Worksheet or article will be evaluated for evidence of an academic integrity violation.
After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. It is your responsibility to submit the correct assignment to the correct submission area.
Practice Issue Worksheet Directions
- A tutorial with tips for completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=4905b26a67572323c11b839e3251c96a (Links to an external site.) (Links to an external site.)
- Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from the required List of Approved Systematic Reviews (Links to an external site.).
- Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected.
- Download the required Milestone 1 Practice Issue and Evidence Summary Worksheets (Links to an external site.) (both worksheets appear in ONE file) to document the practice issue presented and approved by your instructor in the Week 2 Discussions.
- Your practice issue will be the same for all three Milestone assignments in this course.
- Please type your answers directly into the worksheet.
Evidence Summary Worksheet Directions
- Develop an evidence summary by following the grading criteria below.
- Document this on the evidence summary portion of the worksheet.
- You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.
- Please type your answers directly into the worksheet.
**Academic Integrity Reminder**
Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.
By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.
Please see the grading criteria and rubrics on this page.
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Student Name Date: March 17, 2018
Refer to the guidelines for specific details on how to complete this assignment.
Type your answers directly into the worksheets below.
Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.
Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.
Practice Issue Worksheet
List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):
The topic of the research is: Effectiveness of Video Discharge Instructions in reducing Hospital Readmissions.
The systematic review used is titled: Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.(2014). Reducing hospital readmission: Current strategies and future directions. Annual Review Of Medicine, 65(1), 471-485. doi: 10.1146/annurev-med-022613-090415
The research has also used an additional source titled: Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58.
What is the nursing practice issue you have identified related to the topic you have chosen?
There has been an increase in hospital readmissions in healthcare and one of the reasons for this phenomenon is how discharge instructions are administered to patients before they leave health facilities.
Fully describe the scope of the practice issue:
The research is limited to addressing issues related to how patients admitted in cardiac units of health facilities receive their discharge instructions. Particularly, the study observes that the most common means of instruction are verbal and written, and it seeks to observe the effectiveness of giving discharge instructions through video.
What is the practice area?
__ ✔ Education
___ Other (List):
How was the practice issue identified? (check all that apply)
___ Safety/risk management concerns
_ ✔ Unsatisfactory patient outcomes
___ Wide variations in practice
___ Significant financial concerns
___ Difference between hospital and community practice
___ Clinical practice issue is a concern
___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
Describe the rationale for your checked selections:
Increase in readmission rates of patients led to the realization that the mode of delivering discharge instructions was not satisfactory or was not effective. It was observed that when instructions were given through verbal and written means, the patients were more likely to be readmitted in healthcare facilities. This means that patient outcomes were not satisfactorily realized when these instruction methods were used.
What evidence must be gathered? (check all that apply)
__ ✔ Literature search
___ Expert Opinion
__ ✔ Patient Preferences ___ Clinical Expertise
___ Financial Analysis
___ Standards (Regulatory, professional, community)
Describe the rationale for your checked selections:
Relevant literature on the how verbal as well as written discharge instructions can be supplemented by video instruction should be consulted to ensure that patient outcomes are achieved in a satisfactory manner. This literature will include: studies conducted by researchers as well as systematic reviews.
The study will also be informed by opinions of patients because they are best placed to determine whether discharge instructions given to them are well understood when offered through verbal, written or video channels.
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
The problem being investigated is: how exercises, mediated by caregivers are instrumental in improving motor coordination in adult patients with stroke. The research involves Patients admitted in healthcare facilities and those at home. All patients with stroke require regular exercises to improve their motor functions and therefore, this research is relevant to every stroke patient.
Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.
Vloothuis, J. D., van Wegen, E. E., Veerbeek, J. M., Konijnenbelt, M., Visser-Meily, J. M., & Kwakkel, G. (2014). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst. Rev.
Identify the objectives of the article:
The research seeks to determine: whether exercises mediated by caregivers help to improve the health of stroke patients, and the impact of this intervention on caregivers.
Provide a statement of the questions being addressed in the work and how these relateto your practice issue:
The questions being addressed include: how does performance of exercises with the help of caregivers affect the health of people living with stroke, and does these kinds of interventions have any effects on the caregivers involved?
The questions being addressed are relevant because their answers will be instrumental in evaluating whether caregiver-mediated interventions for stroke patients are effective in improving patient outcomes. Additionally, the answers will help the researchers to determine whether there will be any burdens to the caregivers.
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
The intervention involves the use of caregivers who are trained by therapists to help stroke patients perform exercises at regular intervals and with consistency. These caregivers will be used because the limited number of therapists does not allow every patient to receive their services. Regular evaluations will be done to determine whether the exercises are contributing to the improvement of physical coordination of body functions in the patients.
Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper.(If an optional supplemental source is also used, include a statement of relevance to it as well.)
The research concluded that exercises which are mediated by caregivers are instrumental in improving the health of people living with stroke and that the financial burden to the caregivers was not high. The research found out that body functions such as walking, standing and flexing muscles improved after interventions involving caregivers. Moreover, caregivers were not reported to have been negatively affected by their involvement in these interventions because their routines were slightly affected and they did not incur more costs.
Outline evidence-based solutions that you will consider for your project.
Some of the solutions I will consider for my project will include introduction of mobile phone applications to help stroke patients monitor their exercises and coordination of muscles and body functions during their regular exercises. Patients using these applications will be able to tell if their health and limb coordination is improved by exercises.
Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.
Studies conducted to determine how mediated exercises are important in achieving patient outcomes have included few trials and reviews and as such, the evidence given may not be entirely objective. Interpretation of the data, therefore, should be done cautiously.
Practice Issue Statement, Scope of Practice, Practice Area
Identifies a practice issue statement that is an independent nursing decision, and is relevant to the systematic review topic chosen from among the approved list provided in the course. Describes the scope of practice issues. Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminate the falls? This is where you begin your initial search into the problem or practice issue identified. Identifies the practice area.
Practice Issue-Rationale for Selections
Identifies how rationale behind how the practice issue was selected as a practice issue/problem. Documents the practice issue in a logical manner.
Types of Evidence Gathered-Rationale for Selections
Identifies and documents types of evidence that must be gathered for review of the Practice Issue. Describes rationale for each type of evidence that is selected.
Practice Problem Description
States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms. Describes practice setting in measureable terms. Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?
Source(s) of Evidence
Identifies a source of evidence that is a nursing topic and is the subject of a systematic review article. Provides a complete reference for the systematic review article that was chosen from the list, as well as any optional scholarly source in support of the project topic.
Article Objectives/Statement of Questions
Identifies the objectives of the article. Identifies questions being addressed by author/s. Explains relationship to the chosen practice issue
Interventions/Main Findings Summary
Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes. Summarizes main findings of the author/s including strength of evidence for each main outcome. Describes the relevance to the Milestone 2 paper.
Evidence-based Solutions and Limitations
Outlines evidence-based solutions to consider for the capstone project. Discusses any limitations to the studies included in the systematic review that he/she believes may impact use of the evidence provided in their project
Total Points: 175