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Nurse-Led Patient Education to Reduce Hospital Readmission Doctor of Nursing Practice Project
Nurse-Led Patient Education to Reduce Hospital Readmission
Doctor of Nursing Practice Project
Presented to the Faculty of Sinclair School of Nursing Graduate Studies
University of Missouri
In Partial Fulfillment of the Requirements for the Degree Doctor of Nursing Practice
by
Morteza Amini IMG FNP MSN EMBA
Committee:
Shawn Zembles DNP APRN CEN CCRN NPD-BC ACNS-BC, Chair
Miriam Butler DNP NP-C FNP-BC, Member
James J. Shariati MD, Member
Background and Significance
Hospital readmissions are a persistent and costly challenge within healthcare systems globally. Described as a ‘wicked problem for leaders’ (Feo et al., 2023), this issue worsens the burden on healthcare systems, particularly with an aging population, increasing patient expectations, and the advancement of medical technology (Teo et al., 2023). High hospital readmission rates significantly contribute to healthcare expenditures and the development of effective strategies to mitigate these rates (Joynt & Jha, 2013). Addressing this problem requires comprehensive, innovative solutions that improve quality care while reducing costs, posing a significant challenge to healthcare leaders worldwide (Pastorino et al., 2019).
Project PICOT/Purpose Statement & Objectives
PICOT Statement:
For adult patients admitted with cardiovascular, respiratory, End-Stage Renal Disease, and surgical conditions (P), does a nurse-led patient education intervention (I), compared to standard discharge education (C), reduce 30-day hospital readmission rates (O) within six months (T)?
Purpose Statement:
This project aims to implement and evaluate the effectiveness of a nurse-led patient education program in reducing 30-day hospital readmission rates for patients with specific diseases categorized within the system.
Objectives:
– Reduce the 30-day readmission rate for cardiovascular, respiratory, skeletal, and urinary diseases by 20%.
– Increase nurses’ participation in the nurse-led patient education program by 35% within 30 days.
Review of Literature
Hospital readmissions burden healthcare systems, underscoring the need for effective interventions. Evidence suggests that facilities with predominant nurse-led interventions report better quality of patient care (Al-Sabei & Ross, 2023). Effective nurse-led patient education has been shown to reduce readmissions for chronic conditions like COPD and acute conditions such as heart failure (Collinsworth et al., 2018; Oh et al., 2023). Systematic reviews corroborate the efficacy of nurse-led interventions in reducing hospital readmissions (Zhong et al., 2023). However, achieving optimal outcomes necessitates addressing patient compliance and resource constraints (Feo et al., 2023).
Methods
Project Design:
The Doctor of Nursing Practice (DNP) project is structured as a quasi-experimental study by the DNP candidate to evaluate the efficacy of nurse-led patient education.
Intervention:
Nurses will deliver a structured education program to patients before discharge, focusing on disease management, medication adherence, and follow-up care. This program aims to equip patients with the necessary knowledge and skills to manage their conditions effectively.
Setting:
The DNP candidate will implement the project at Ambulatory Urgent Care with Surgical Services and its related and affiliated health services in Los Angeles, involving systematic observation and documentation by the project initiator.
Participants:
The study will include adult patients diagnosed with cardiovascular, respiratory, and End-Stage Renal Disease and newly discharged surgical patients.
Sampling:
The project initiator will select a convenience sample of one hundred patients. A power analysis will determine the appropriate sample size.
Measurement Tools and Data Analysis:
– Statistical tests: chi-square test for categorical variables, t-test for continuous variables, and logistic regression for multivariate analysis.
– Measurement of objectives will involve hospital readmission rates and nurse participation in the education program.
Ethical Considerations:
DNP candidate will obtain ethical approval from the Institutional Review Board (IRB), with informed consent secured from all patients and participants.
Budget:
The budget will include costs for educational materials, training sessions for nurses, and in-kind support.
Timeline:
The project will span six months, with regular evaluations and adjustments as needed.
Barriers to Implementation:
Potential barriers include patient non-compliance, nurse workload, and resource limitations.
References
Al-Sabei, S., & Ross, A. (2023). The relationship between nursing leadership and patient readmission rate: A systematic review. Canadian Journal of Nursing Research, 55(3), 267-278. https://doi.org/10.1177/08445621221136257
Collinsworth, A., Brown, R., James, C., Stanford, R., Alemayehu, D., & Priest, E. (2018). The impact of patient education and shared decision-making on hospital readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1325-1332. https://doi.org/10.2147/COPD.S161841
Feo, R., Urry, K., Conroy, T., & Kitson, A. (2023). Why reducing avoidable hospital readmissions is a ‘wicked’ problem for leaders: A qualitative exploration of nursing and allied health perceptions. Journal of Advanced Nursing, 79(3), 1031-1043. https://doi.org/10.1111/jan.15621
Joynt, K., & Jha, A. (2013). Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA, 309(4), 342-343. https://doi.org/10.1001/jama.2012.94856
Oh, S., Choi, H., Oh, E., & Lee, J. (2023). Effectiveness of discharge education using the teach-back method on readmission among heart failure patients: A systematic review and meta-analysis. Patient Education and Counseling, 107. https://doi.org/10.1016/j.pec.2023.04.009
Zhong, C., Wong, C., Hung, C., Yeo, E., Wong, E., & Chung, V. (2023). Contextualizing evidence-based nurse-led interventions for reducing 30-day hospital readmissions using GRADE evidence to decision framework: A Delphi study. Worldviews on Evidence-Based Nursing, 20, 315-329. https://doi.org/10.1111/wvn.12553
Appendices
Appendix A: Nurse-Led Educational Project to Reduce Hospital Readmission
Identification of studies via databases and registers
Identification of studies via databases and registers
Records removed before the screening:
Duplicate records removed (n = 37)
Records marked as ineligible by automation tools (n =0)
Records removed for other reasons (n =0)
Records removed before the screening:
Duplicate records removed (n = 37)
Records marked as ineligible by automation tools (n =0)
Records removed for other reasons (n =0)
Records identified from*:
Databases (n =637)
Registers (n => 5000)
Records identified from*:
Databases (n =637)
Registers (n => 5000)
Identification
Identification
Records excluded**
(n =200)
Records excluded**
(n =200)
Records screened
(n =600)
Records screened
(n =600)
Reports not retrieved
(n =50)
Reports not retrieved
(n =50)
Reports sought for retrieval
(n =400)
Reports sought for retrieval
(n =400)
Screening
Screening
Reports excluded:
Reason 1 (n =100)
Reason 2 (n =100)
Reason 3 (n =50)
etc.
Reports excluded:
Reason 1 (n =100)
Reason 2 (n =100)
Reason 3 (n =50)
etc.
Reports assessed for eligibility
(n =350)
Reports assessed for eligibility
(n =350)
Studies included in the review
(n =100)
Reports of included studies
(n =20)
Studies included in the review
(n =100)
Reports of included studies
(n =20)
Included
Included
Appendix B: Readability Screen Print
Appendix C: Turnitin Score Screen Print (No ACCESS For the full report)
Appendix D: Project Budget
Item
Educational Materials
Printing, pamphlets, handouts
$200
Training Sessions for Nurses
Workshops, expert speakers
$500
In-kind Support
Staff time, hospital resources
$0
Miscellaneous
Snacks, Transportation
$100
Total
$800
Appendix E: Project Timeline
Month
Activity
Month 1
Initial planning, IRB approval
Month 2
Training nurses, developing materials
Month 3
Implementation of nurse-led education
Month 4
Data collection and preliminary analysis
Month 5
Continued data collection and analysis
Month 6
Final data analysis, report writing
Month 7
Submission of final report
Appendix F: DO DNP Residential Project Committee Appointment Request with Signatures