+1(978)310-4246 credencewriters@gmail.com
  

Module 4 Evidence Based Practice: Finding the Evidence
Submit by the due date and time listed in your syllabus.
Overview
This assignment will allow you to create an evidence-based practice project that includes the
development of a PICO question and follows the initial steps of the Iowa Model. You will share
your findings using an APA formatted paper.
Submitting your assignment
•
Save this document to your desktop as a Word document.
•
Open the document from your desktop and review the assignment instructions and
grading rubric.
•
Create a separate Word document for your paper.
•
Return to the course and upload your paper and your approved nursing research article
to the assignment submission link. Please note: if you forget to upload your nursing
quantitative research article, a 5 point penalty will be applied to your paper.
•
Make sure that everything is right before you submit. You only have one chance to
submit this assignment, and that attempt is what will be graded. No corrections or resets
will be permitted once you submit. This is necessary to ensure that the plagiarism
checker works properly.
Grading Rubric
See the grading rubric for the assignment to understand exactly how you will be graded. If there
is any discrepancy between these instructions and the rubric, the rubric will be the final authority
as to how the assignment will be graded.
Instructions for Completing Your Assignment
o
Step one: Using the topic list from module 2, identify a nursing clinical practice topic that you
would like to explore.
o
Step two: Use the PICO(T) question in the final form approved by your instructor or coach. If
your question was not approved in module 2, you may continue to dialogue with your coach or
instructor up until Wednesday of week 4. If you still have not had a question approved by that
time read the instructions for developing a PICO(T) question carefully and be sure to follow
them. Coaches and instructors will not advise you regarding PICO(T) questions after Wednesday
of week 4.
o
Step three: Search for a nursing quantitative research article that relates to your PICO question
using Academic Search Complete, CINHAL, Pubmed, Google Scholar, or any other database that
contains nursing research articles. Please note: you can use the article that you submitted in
Module Two to meet this requirement so long as it was approved.
o The article you will find must meet the following mandatory requirements:
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 1
â–ª
â–ª
â–ª
â–ª
â–ª
â–ª
It must be based on the approved topic list unless other arrangements were
made with your instructor or coach.
It must be from a nursing research journal or have a nurse as an author.
It must be no more than 5 years old from the current publication year.
It must include implications and / or interventions that are applicable to nursing
practice.
It may not be a qualitative article, systematic review, meta-synthesis, metaanalysis, meta-summary, integrative review, retrospective study, evidence
based practice project, or quality improvement article. For more information on
how to recognize these types of article see Grove & Gray (2019) pp. 21-23.
It may not be a clinical information article or “how-to” article.
o
Step Four: Collecting More Evidence (Do the research)
â–ª Find a credible scholarly or government resource published within the past 5 years that
provides you with at least two facts (ex. costs, morbidity, mortality, safety, or other related statistics) for why your clinical problem is important (provide statistics). (The internet is a great place to get this information…just don’t forget to cite this information
and add it to your reference page).
â–ª Find a clinical practice guideline that relates to your question. It must have information
that relates to the role of the nurse. The guideline must be the most recent version or
published within the past five years. (It is true that guidelines are not always updated
within 5 years so you will need to discuss this.) There are several websites listed in your
textbook that can help with searching for guidelines. The UTA library also has resources
for clinical practice guidelines. If the source you use is not actually a clinical practice
guideline you will lose a substantial amount of points on your paper.
▪ Find a clinical “how-to” article, a nursing professional practice website, a systematic literature review, a meta-analysis, or some other credible academic resource published
within the past 5 years that relates to your practice question.
â–ª Hint: Did you notice that you will be finding a total of four different sources of information for your PICO question? To re-cap, these four sources are:
• Statistics you are reporting in paragraph one.
• Nursing quantitative research article for paragraphs 2, 3, and 4
• Clinical Practice Guideline (paragraph 5)
• A source of your choosing (paragraph 6)
o
Step Five: Write up your findings in APA format and submit them to assignment portal by the
due date and time listed in your syllabus. Here’s how to write up your findings:
â–ª Start with a 7th edition APA cover page. An example is provided by the instructor. The
paper itself (not including cover page and references should be six pages or less)
â–ª Paragraph #1: This is your opening paragraph. Start with an introduction statement.
What is your PICO question? Describe why was it important (share the dollars, morbidity
/ mortality, statistics, safety stats you found with citation)? Paragraph #1 does not have
a heading. You should put the title of your whole paper in the center in bold font where
a heading would go. For the rest of the paragraphs, use the following headings:
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 2
â–ª
â–ª
â–ª
â–ª
â–ª
â–ª
Summary of Research Article, Major Variables, Strengths and Weaknesses, Practice
Guideline, Fourth Resource, Conclusion.
Paragraph #2: What did your nursing quantitative research article add to your
knowledge on this topic? State the design. Researchers use all sorts of different terms
to describe designs, but you should use one of the broad terms mentioned in our textbook (descriptive, correlational, predictive correlational, model testing, experimental, or
quasi-experimental). State the sampling method (also using one of the sampling method
terms discussed in your textbook), and setting of the study (this should only take one
sentence: e.g. “Smith and Johnson conducted a predictive correlational study using a
convenience sample from a psychiatric outpatient clinic.”). State the major findings of
the study (maximum 3 findings). The findings you share should come from the results or
discussion settings and should be relevant to your PICO question and your practice as a
nurse.
Paragraph #3. Mention the major research variables in your article. Do not include demographic variables unless they are important to the results of the study. For each major variable, give a conceptual and operational definition (if the authors did not give a
conceptual definition you can say “not given”). However, you can always say something
about the operational definitions for variables because the authors must discuss the
way in which variables are measured. Give the level of measurement for each variable
(nominal, ordinal, interval, or ratio).
Paragraph #4: Using the skills you have learned in your critique of a research article, describe two strengths or two weaknesses (or one strength and one weakness) that you
found as you read this article. Go back to what you learned in your article critique about
sampling methods, measurement methods (ex. questionnaires), and data collection (how
did they collect the data to make sure you are being thorough in your assessment. Be
specific, so that your instructor, if reading the article, can find them too. Do not re-state
the limitations provided by the authors of your study unless they have to do with the
study’s sampling, measurement methods, or data collection. Do not discuss the research design or the descriptive or inferential statistics used by the authors as a strength
or weakness of the study, as this is not related to with the study’s sampling, measurement methods, or data collection.
Paragraph #5: What is the name and of the clinical practice guideline that you found?
Give a weblink and an APA citation for the guideline. Share at least three facts that you
found within the guideline that are relevant to the PICO question and your practice as a
BSN nurse and cite the guideline appropriately. Make sure the source you cite is actually
a clinical practice guideline with advice directed toward healthcare professionals.
Paragraph #6: Identify the fourth resource you found (clinical “how-to” article, a systematic literature review, or a meta-analysis) that relates to your practice question. Share
at least three facts that you found within this source that is relevant to the PICO question and your practice as a nurse, and cite appropriately.
Paragraph #7 (and #8 if needed): re-state your PICO question and briefly summarize
what you have learned through your search. Include information from each of your
sources, and be sure to cite them all. Then, give specific recommendations for nursing
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 3
â–ª
practice. What would you recommend, if anything, as a change in practice for nurses?
Why? Remember, this is your closing paragraph(s).
Note to students about writing up your findings:
o This is a formal APA paper. Look at the Rubric for more APA information for this paper.
o Your paper must be between four and seven pages (double spaced). Use the following headings for paragraphs 2 through 7: Summary of Research Article, Major Variables, Strengths and Weaknesses, Practice Guideline, Fourth Resource, Conclusion.
These headings should all be centered and in bold font. Do not use a heading for the
first paragraph. Instead, use the title and center it in bold font.
o Don’t use first person language (I, my, we, etc.) and don’t directly address the
reader (you need to, etc.).
o Turn your paper (as a word document) and article (in pdf format) that you used for
paragraphs 2, 3, and 4 in to the assignment submission link in Module Four at the
due date and time listed in your syllabus.
o Possible points for this assignment: 100 points
Rubric
Evidence Based Practice Project:Finding the Evidence v2
Evidence Based Practice Project:Finding the Evidence v2
Criteria
Ratings Pts
This criterion is linked to a Learning Outcome Nursing research article selected.
5 to >0 pts
0 pts
Accomplished
Needs Improvement
Research article is a quantitative article,
Research article is not nursing
nursing focused, and is 5 years or less from focused or is a qualitative article,
5
current publication date. Article must be systematic review, meta-synthesis,
pts
uploaded as a pdf file. Please note: if you meta-analysis, meta-summary,
forget to upload your nursing quantitative integrative review, clinical
research article, a 5 point penalty will be information article or “how-to”
applied to your paper
article. No article uploaded.
This criterion is linked to a Learning Outcome Opening Paragraph(Paragraph #1)
10 to >8 pts
8 to >5 pts
5 to >0 pts
Accomplished
Proficient
Needs Improvement
10
Introduction statement(s)
No introduction
No introduction
pts
present. PICO question with all statement(s). PICO
statement(s). PICO
elements present. Statement of statement is
statement grossly
importance with two facts such incomplete. Statement incomplete or missing.
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 4
Criteria
of importance
Statement of
incomplete or missing. importance missing.
Citation is incomplete No citation
or missing.
as costs, morbidity, mortality,
safety. Include related statistics
with citation and is 5 years or
less from current publication
date.
This criterion is linked to a Learning Outcome General Format
5 to >4 pts
4 to >0 pts
Completely met
0 pts
Partially met
Paper is between four to seven double
Not met
Paper more than
spaced pages in length (not including
Paper greater than
seven pages, or less
cover page and references). Paper
seven pages, or
than four pages,
includes the following headings:
less than four
headings missing,
Summary of Research Article, Major
pages, and
or incorrect
Variables, Strengths and Weaknesses,
headings missing
headings. 4 – 1
Practice Guideline, Fourth Resource,
or incorrect.
points
Conclusion 5 points
This criterion is linked to a Learning Outcome Summary paragraph for your
nursing quantitative research article. (Paragraph #2)
15 to >13 pts
Accomplished
NOTE: If your primary research
13 to >5 pts
5 to >0 pts
article did not meet the criteria for Proficient
Needs Improvement
being accepted, you will likely get Design, sampling Design, sampling
few or no points for this section!
method, or setting method, and setting not
Correctly identified design,
incorrect.
identified. No major
sampling method, and setting of
Identified findings findings clearly
study. Design should be specified are not the most
identified from the
as one of the following:
important findings. article. No findings
descriptive, correlational,
Only one finding from the results or
predictive correlational, model
includes results or discussion sections No
testing, quasi-experimental, or
discussion
attempt to connect the
experimental. Sampling method
sections. Major
major findings from the
given should be one of the methods findings not
article back to the PICO
discussed in the textbook.
clearly tied to
question. No attempt to
Identified major findings of study. PICO question.
connect the major
Major findings include information Facts not clearly findings from the article
from the Results and / or
connected to your back to your nursing
Discussion sections. Major findings nursing practice. practice.
clearly tied to PICO question. Facts
connected to your nursing practice.
This criterion is linked to a Learning Outcome Major research variables
(Paragraph #3)
10 to >8 pts
8 to >0 pts
0 pts
Accomplished
Proficient
Needs
NOTE: If your primary research article Some major variables Improvement
did not meet the criteria for being
missing or variables Paragraph
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Ratings Pts
5
pts
15
pts
10
pts
Page 5
Criteria
Ratings Pts
accepted, you will likely get few or no
included that are not missing.
points for this section! All major
actually major
variables included. If the design is
variables. Incorrect or
experimental or quasi-experimental or
missing conceptual or
predictive correlational the dependent and operational
independent variables should be
definitions. Incorrect
identified. Conceptual definition for each or missing levels of
variable mentioned or its absence noted. measurement.
Operational definition for each variable
mentioned. Correct level of measurement
given for each variable.
This criterion is linked to a Learning Outcome Two additional strengths or
weaknesses from your nursing quantitative research article. (Paragraph #4)
10 to >8 pts
Accomplished
NOTE: If your primary research article
8 to >5 pts
did not meet the criteria for being
5 to >0 pts
Proficient
accepted, you will likely get few or no
Needs
Only one strength /
points for this section! Two strengths
Improvement
or weakness
or two weaknesses or one strength and
Strength /
explained well with
one weakness are specifically
weaknesses
10
second strength /
identified from your nursing
identified are not
pts
weakness only
quantitative research article. The
based on these
identified. Strengths
student choices for strengths /
three critique
/ weaknesses not
weaknesses must focus on the methods
skills. No
based on sample,
used by the authors for sampling,
strengths /
measurement
measurement methods used (ex. a
weaknesses
methods, or data
questionnaire), or how the data was
identified.
collection.
collected (data collection) with
examples from the student’s research
article.
This criterion is linked to a Learning Outcome Clinical practice guideline
summary.(Paragraph #5)
10 to >8 pts
8 to >5 pts
5 to >0 pts
Accomplished
Proficient
Needs Improvement
NOTE: If you do not use an
Name of the clinical
What is given is not a
actual clinical practice guideline practice guideline or
clinical practice
you will get few or no points for website not clearly
guideline. Name of
this section! Name and specific identified. Fewer than
10
the clinical practice
website (including internet link) three facts clearly
pts
guideline and website
of the clinical practice guideline identified that were
not stated. No clearly
identified. Guideline is the most found within the
identified facts from
recent version or published
guideline or facts not
the guideline. Facts
within the past five years. Three specifically related to
not tied to PICO
facts clearly identified that were the practice of the
question or nursing
found within the guideline and nurse. Facts vaguely
practice.
relate to the practice of a BSN. tied to PICO question.
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 6
Criteria
Ratings Pts
Facts clearly tied to PICO
Facts vaguely
question. Facts connected to your connected to your
nursing practice.
nursing practice.
This criterion is linked to a Learning Outcome “Fourth resource”
summary.(Paragraph #6)
8 to >5 pts
5 to >0 pts
10 to >8 pts
Proficient
Needs Improvement
Accomplished
Less than three facts No facts clearly identified from
Three facts clearly
clearly identified
the fourth resource. Fourth
identified from the fourth
10
from the fourth
resource is not an academic
resource which is 5 years
pts
resource. Facts not source. No attempt to connect
or less from current
clearly tied to PICO facts from the fourth resource
publication date. Facts
question. Facts not back to the PICO question. No
clearly tied to PICO
clearly connected
attempt to connect facts from
question. Facts connected
your nursing
the fourth resource back to
to your nursing practice.
practice.
your nursing practice.
This criterion is linked to a Learning Outcome Closing Paragraph(s)(Paragraph
#7, and #8 if needed)
8 to >5 pts
10 to >8 pts
5 to >0 pts
Proficient
Accomplished
Needs Improvement
Missing one or more of
PICO question is restated.
No PICO question. Poor
10
the following elements:
A summary of what was
or no attempt to
pts
PICO question. A
learned (from all sources)
summarize information
summary of what was
is present. Sources are
from the resources. No /
learned.
cited. Recommendations
vague recommendations
Recommendations for
for practice are offered.
for practice are offered.
practice.
This criterion is linked to a Learning Outcome APA Style and Formatting
15 to >14 pts
14 to >0 pts
0 pts
Accomplished
Needs Improvement
Not Proficient
APA formatting for this
APA formatting for this APA formatting for this
paper will follow the
paper will follow the
paper will follow the
guidelines for general
guidelines for general
guidelines for general
formatting, in textformatting, in textformatting, in textcitations, margins,
citations, margins,
citations, margins,
headings (if desired)
headings (if desired)
headings (if desired)
15
alignment and line spacing, alignment and line
alignment and line
pts
font type and size,
spacing, font type and
spacing, font type and
paragraph indentation,
size, paragraph
size, paragraph
page headers, and the
indentation, page
indentation, page headers,
reference page as explained headers, and the
and the reference page as
in the 7th edition of the
reference page as
explained in the 7th
APA Manual. Helpful
explained in the 7th
edition of the APA
Hints: • Do not use 1st
edition of the APA
Manual. Helpful Hints: •
person in a formal paper. • Manual. Helpful Hints: • Do not use 1st person in a
Do not use direct quotes, Do not use 1st person in formal paper. • Do not
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 7
Criteria
Ratings Pts
instead summarize and
a formal paper. • Do not use direct quotes, instead
paraphrase what you are
use direct quotes, instead summarize and
reading. Direct quotes will summarize and
paraphrase what you are
receive multiple point
paraphrase what you are reading. Direct quotes
deductions. These
reading. Direct quotes
will receive multiple
deductions are separate
will receive multiple
point deductions. These
from the 15 points for
point deductions. These deductions are separate
APA. In other words, there deductions are separate from the 15 points for
is no limit to the number of from the 15 points for
APA. Up to fifty points
points that can be deducted APA. Up to fifty points can be deducted for direct
for excess direct quotes. • can be deducted for
quotes. • Please do not
Please do not forget to use direct quotes. • Please do forget to use the approved
the approved CONHI cover not forget to use the
CONHI cover page. Each
page. The first time an
approved CONHI cover error of spelling,
APA error is discovered, it page. Each error of
grammar, capitalization
will be pointed out to you spelling, grammar,
or APA usage will
and a point will be
capitalization or APA
receive a one point
deducted from your paper. usage will receive a one deduction. Maximum
Maximum number of
point deduction.
number of points
points deducted for APA Maximum number of
deducted for APA errors:
errors: 15 points
points deducted for APA 15 points
errors: 15 points
This criterion is linked to a Learning Outcome Excessive Direct Quotes
0 pts
0 pts
0
Direct Quotes
No Direct
pts
Five points will be deducted for each direct quote up to a
Quotes
maximum of fifty points.
Total Points: 100
©2017 UTA School of Nursing, Revised June 27, 2022
of 8
Page 8
In
the
NEWS
Improving Discharge Procedures to Reduce
Hospital Readmissions
Photo © Shutterstock.
Nurses prove key to helping patients understand and adhere to
care needs after a hospital stay.
H
ospital discharge procedures can be confusing and
anxiety inducing for patients and caregivers as they try
to make sense of the often complicated instructions for medication
and follow-up care. There may be
multiple providers contributing
to the paperwork handed to patients, including clinical specialists, therapists, and social workers,
each focused on different posthospital goals.
Unplanned readmissions of patients due to lapses in posthospital
care account for an estimated $20
billion annually for Medicare patients alone. Hospitals are under
increasing pressure to improve the
situation because of a provision of
the Affordable Care Act called the
Hospital Readmissions Reduction
Program, which penalizes hospitals financially if they have higherthan-expected 30-day readmission
rates for certain conditions.
New research highlights the
important role of nurses in discharge planning and coordinating communication among
providers, patients, and caregivers. Their work has been shown
to not only reduce readmissions
12
AJN â–¼ December 2021 â–¼ Vol. 121, No. 12
but also improve outcomes. A recent JAMA Network Open study
found communication interventions at discharge are significantly associated with fewer
hospital readmissions, higher
treatment adherence, and higher
patient satisfaction, leading to
improved transitions of care.
To assess the effectiveness of enhanced communication at discharge, researchers at University
Hospital Basel in Switzerland undertook a systematic review and
meta-analysis of randomized clinical trials of patients receiving communication interventions compared
with control groups. They evaluated hospital readmissions as well
as treatment adherence, satisfaction,
mortality, and knowledge of medication or diagnoses after 30 days.
A total of 60 trials with 16,070
patients from 18 countries were
included in the qualitative part of
the researchers’ analysis and 19
trials with 3,953 patients from
seven countries made up the
quantitative portion. Compared
with usual care in the control
groups, communication interventions at discharge in the intervention groups were significantly
associated with lower readmission rates (9.1% versus 13.5%),
higher adherence to treatment
regimen (86.1% versus 79%),
and greater patient satisfaction
(60.9% versus 49.5%).
Such results require communication skills that integrate patients’
needs, perceptions, social considerations, and health knowledge.
The discharge process is sometimes complicated by poor health
literacy and cognitive or language
issues that can lead to treatment
failures, preventable readmissions,
and patient dissatisfaction.
Several interventions, such as
medication counseling and disease education, were directly
linked to lower readmission
rates. This suggests that helping
patients understand their diagnoses, medications, and therapeutic
regimens lowers the odds of rehospitalization. The researchers
found that patients with chronic
conditions like respiratory illnesses benefited the most from
communication interventions.
Community care transition
programs, where hospitals partner with community agencies
to help newly discharged patients access resources needed
to recover, have also had significant success in reducing readmissions in some health systems.
The programs typically utilize
nurses as “transition coaches” to
educate, communicate, and follow-up with patients before and
after discharge, adjusting the approach based on the person’s
health literacy and social needs.
One nurse-led program saw expected readmission rates cut by
more than half. In another, nurses
working with patients with heart
failure were able to use their communication skills and ability to
work across clinical and social
service disciplines to improve patient knowledge and treatment
adherence, resulting in improved
quality of life and fewer hospital
admissions.—Liz Seegert
Becker C, et al. JAMA Netw Open 2021;
4(8):e2119346.
ajnonline.com
152
Journal of Neuroscience Nursing
Using Technology to Enhance Discharge
Teaching and Improve Coping for Patients
After Stroke
Melissa A. Schneider, Katrina A. Howard
ABSTRACT
Background: A diagnosis of stroke is a life-changing event. Effective discharge teaching after a stroke is
crucial for recovery, but the overload of information can be overwhelming for patients and caregivers.
Purpose: The purpose of this study was to examine differences in discharge readiness and postdischarge
coping in patients admitted for stroke after the use of individualized postdischarge information/education
provided via a technology package (including patient online portal access, e-mail/secure messaging)
compared with current standard discharge teaching methods (verbal/written instructions). Methods: This
study used a descriptive comparative design to evaluate the difference between the nonintervention group
A and the intervention group B. Patients in group B received additional discharge information via secured
e-mail messaging at postdischarge days 2, 6, and 10. Two validated tools, Readiness for Hospital Discharge
Form and Post-Discharge Coping Difficulty Scale, were used. Results: One hundred patients were recruited
for the study, but the final number of complete data sets collected was 86V42 in group A and 44 in group B.
There was no statistically significant difference between the groups in discharge readiness. There was a significant
difference in coping scores between the 2 groups, with the technology group exhibiting higher coping.
Conclusions: New technology affords new options to improve discharge readiness and contribute to positive
patient coping after stroke. The researchers hope that this study will contribute to the growing body of evidence
showing success using aspects of technology to enhance discharge teaching and follow-up after discharge.
Keywords: computer, discharge, patient education, stroke, technology
S
troke is the most common cause of adult longterm disability, and nearly 800 000 people in
the United States have a stroke every year.1
Patients admitted to the hospital with this diagnosis
usually have to deal with many unexpected changes
and uncertainty about the future.2 Although discharge
planning ideally begins on admission, patients admitted for stroke and their caregivers can be overwhelmed by all of the new information that they
need to process.3 Patient care needs extend beyond
discharge. Once they are home, the burden of management for recovery falls on the patients and their
caregivers.4,5 Discharge instructions can be complex,
and patients, most notably older adults, do not always
understand the instructions.6 One of the goals of discharge teaching is to give the patient a sense of preparedness for the transition from hospital to home.5
Questions or comments about this article may be directed to
Melissa A. Schneider, RN-BC DNP ONC CNRN, at mschneider@
wellspan.org. She is a Clinical Nurse Educator, WellSpan York
Hospital, and Nursing Faculty, York College of Pennsylvania,
York, PA.
Katrina A. Howard, RN BS, is Nurse Manager, WellSpan York
Hospital, York, PA.
The authors declare no conflicts of interest.
Copyright B 2017 American Association of Neuroscience Nurses
DOI: 10.1097/JNN.0000000000000275
Effective discharge preparation is critical for positive
patient outcomes, and ineffective preparation can
contribute to increased hospital readmission rates.7,8
The patient’s perception of adequate discharge education is oftentimes very different from the nurse’s
perception.7 Active involvement of the patients and
their caregivers is necessary for successful discharge
readiness.9 Weiss et al5 discovered that, although most
patients receive the necessary information by discharge, when they questioned those same patients
after discharge, there were identified gaps in the
patients’ knowledge. Although nurses devote time to
patient education, studies show that patients receive
insufficient information and are uncertain about their
follow-up care.10
Using technology as an adjunct for discharge teaching and follow-up is one possible way to help patients
and caregivers manage the ‘‘information overload’’
and better cope when they are at home. Standard discharge teaching usually includes verbal instructions
and written handouts, but studies show that using
new technology, such as automated telephone calls,
e-mail, secure messaging, and/or texting, reinforces
discharge teaching and improves compliance.10Y13 Not
only does this have the potential to lead to a decrease
in complications and readmissions rates, but new evidence suggests that contact with patients soon after
Copyright © 2017 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
Volume 49 & Number 3 & June 2017
discharge improves outcomes and patient compliance
with instructions and increases patient satisfaction
scores.14 Because of increasing costs, patients can
no longer stay in the hospital until fully recovered.4
Because the recovery process extends into the home
setting, effective preparation for discharge is critical, and patients are likely to verbalize decreased
satisfaction with care if they have unmet needs at
discharge.7 Patients who have a better understanding of discharge instructions are 30% less likely to
be readmitted.10
Nurses have a significant role in providing optimal
discharge care, but there are a number of challenges to
achieving this goal. These include decreased time for
nurses to educate patients, shorter length of stay, increasingly diverse patient population, more complicated patients with higher acuities, and a decrease in
the number of nurses overall.7,10 An added challenge
is that patient discharge needs are very individualized,
and so discharge planning/teaching must be tailored
to meet the needs of the patient. Nurses need to draw
on other resources to enhance discharge teaching, give
patients more confidence to manage care at home, and
ensure that discharge needs are being met.
Background
A review of the literature revealed that there are studies to support the development of specific discharge
teaching guidelines to improve patient compliance,
confidence, and coping at home. There are many research projects exploring the use of technology such
as automated telephone calls, secure e-mail messaging, and texting to enhance discharge teaching and
improve patient coping postdischarge. However, currently, there is a paucity of studies examining these
options in the population with stroke.
Weiss et al5 have completed multiple research
studies about discharge readiness and coping postdischarge, some of these in medical-surgical populations.4 From this research, several scoring tools were
developed and validated to measure discharge readiness and coping.8 Two of these tools, Readiness for
Hospital Discharge Form and Post-Discharge Coping
Difficulty Scale, were used in the current study.
Albrecht et al6 discovered that there are multiple
factors that contribute to noncomprehension of instructions in older adults discharged from medicalsurgical units. These include age, male sex, social
isolation, and complexity of diagnosis.
Many stroke survivors are discharged from the
acute care hospital in a relatively short time. Return
to home means less contact with nursing and rehabilitation professionals, which results in reduced support and fragmented care during the transition period.3
Communication does not end at
discharge. Technological evolutions
afford new means to improve
follow-up after discharge.
Pringle et al9 found that a greater awareness of patient/
caregiver feelings about discharge readiness helped
focus discharge preparation and ease hospital to home
transition. White et al2 cited lack of information as a
contributing factor for anxiety and uncertainty after
stroke. They suggest that any interventions that
address fears and educate patients about risk factors
to prevent future strokes foster coping. In their study,
Ostwald et al3 developed specific educational guidelines to meet individual patient and caregiver educational needs for this patient population and used
various strategies to ensure success.
The literature supports the use of multiple strategies, including current technology, to ease the transition to home, improve comprehension of instructions,
and ensure follow-up. There have been several studies
in patients discharged from the emergency department. Sharp et al15 used e-mail reminders to encourage follow-up appointments after discharge from the
emergency department and discovered that patients
really liked the reminders, but there was no statistically significant difference in adherence to follow-up
appointments. In the same population, Crumpton and
Scaletta14 used automated telephone call reminders
and discovered that patients actually preferred e-mail
and/or texting options. Telephone calls by an actual
staff member, although more costly, resulted in increased patient satisfaction.14 A simple telephone call
can make a difference as in the study by Holzemer
et al16 where they showed positive results using telephone calls to reinforce the importance of secondary
prevention strategies and follow-up after stroke.
However, an intervention using available technology
can increase success, as shown in the study by Sherrard
et al12 where automated reminders at regular intervals
increased medication compliance in postYcardiac surgery patients.
In the diabetic population, telephone call follow-ups
and short messaging showed a statistically significant
improvement in glycosylated hemoglobin (HbA1c)
levels for both options.17 Bjerke and colleagues18 also
used a short messaging service as a communication
tool. Their findings suggest that the ability to access a
‘‘perceived support person’’ at any time made patients
feel ‘‘more connected.’’ Holt et al11 had success with
reinforcing discharge instructions using mobile phone
Copyright © 2017 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
153
154
Journal of Neuroscience Nursing
technology. Because patients with a better understanding of discharge instructions are 30% less likely
to be readmitted, Bailey19 used a computer application to enhance discharge teaching, which allowed
nurses to record instructions and upload attachments.
Short messaging service has also been used to promote
positive health behaviors such as weight loss and
smoking cessation.20 A 2010 poll discovered that
almost 80% of all adults in the United States use the
Internet, so McNeill et al21 developed a Web site for
patients to provide access to healthcare information.
They suggest that social media access can be used to
deliver and receive important information to patients.
The use of patient portals by hospitals and health
systems is increasing worldwide.10
Purpose of the Study
The purpose of this study was to examine differences
in discharge readiness and postdischarge coping in
patients admitted for stroke after the use of individualized postdischarge information/education provided
via a technology package (including patient online
portal access, e-mail/secure messaging) compared with
current standard discharge teaching methods (verbal/
written instructions).
Design/Methods
This study used a descriptive comparative design to
evaluate the difference between the nonintervention
group A and the intervention group B. Subjects were
recruited from a 55-bed acute care ortho/neuro trauma
unit. Only those patients with a diagnosis of stroke or
transient ischemic attack (TIA) were asked about participation in the study. Other inclusion criteria were
adult patients 18 years or older and access to computer/
mobile device when discharged home (group B only).
Patients were excluded if they were being discharged
to a skilled nursing facility/long-term care and if
they were cognitively impaired and/or not capable of
giving informed consent. Vulnerable populations were
not included.
After explanation of the project and informed consent information, patients who wished to participate
signed the consent form. In group A, the Readiness
for Hospital Discharge Form was completed on the
day of discharge. At 2 weeks after discharge, a telephone call was made to the patient, and the Postdischarge Coping Scale was administered at that time.
This tool has been validated as administered by telephone. Group B also completed the Readiness for
Hospital Discharge Form on the day of discharge.
They were then assisted in signing up, if previous
access did not exist, for a patient online portal and
given instructions for its use. This allowed them to
send and retrieve secure e-mail messages. If patients
wanted to participate in the study and were able to
give consent but wanted a family member to receive
the messages on their behalf, ‘‘proxy’’ access was
set up for the family member. Reminders and reinforcements of discharge teaching were sent via secure e-mail messaging; these scripted messages were
based on the core measures for stroke as stated by the
National Stroke Association. Three scripted messages
were sent at postdischarge days 2, 6, and 10. The day
2 message included a review about the signs/
symptoms of stroke and calling 911 if these symptoms occur. There was also a reminder about following up with the primary care provider and/or neurologist.
The message sent on day 6 discussed risk factors for
stroke. This was tailored based on the patient’s individual risk factors. Attachments could be included
for additional education. The final scripted message
on day 10 provided information about emotional
changes/feelings that the patient may experience after
a stroke and what to do if these feelings occur. The
group B patients were able to reply with questions or
concerns to a monitored secure e-mail box. Only the
investigators had access to this mailbox. At 2 weeks
postdischarge, a telephone call was made to the patient, and the Post-discharge Coping Scale was administered at that time.
At the conclusion of data collection, 30-day readmission data were obtained, reviewed, and compared
between the 2 groups. Only patients readmitted with
stroke symptoms were counted in the data. This included exacerbation/return or previous symptoms or
new symptoms diagnosed as stroke or TIA.
Results/Discussion
At the completion of data collection, the results were
reviewed by the hospital research department. The
statistician analyzed the results using SPSS software
(version 21). Although 100 total patients consented to
participate in the study, the final number of complete
data sets was 86, with 42 in group A and 44 in group
B. The reason for the incomplete data sets is that the
researchers were unable to reconnect with these patients after discharge by telephone although several
attempts were made to reach them. A prospective power
analysis indicated that the power level was strong (990).
Independent-sample t tests were conducted to compare readiness and coping for both groups. For the
readiness scores, higher scores signified higher readiness. There was no significant difference in readiness
scores for the 2 groups (Table 1).
For coping scores, lower scores signified higher
coping. For example, these patients perceived less
stressors and indicated that they felt more confident
Copyright © 2017 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
Volume 49 & Number 3 & June 2017
TABLE 1.
Mean Readiness and Coping
Scores by Group
Group A
Group B
Mean (SD)
Mean (SD)
Readiness
54.64 (12.33)
55.35 (12.01)
0.773
Coping
38.08 (17.69)
18.18 (16.99)
G0.001
Sig.
in their ability to manage their care at home. By decreasing additional stressors and the potential for additional complications that impede recovery, patient
outcomes can be positively affected. There was a significant difference in coping scores between groups A
and B (Table 1). Nonparametric tests confirmed
these results. For group B, additional analysis was
done for the 15 patients who the researchers could
confirm actually opened and/or replied to the secure
e-mail messages. This subset of patients had coping
scores that were even lower than the overall group B.
The mean (SD) coping score for this group was 12
(12.7). Although not all patients took advantage of the
Web site and secure e-mails, it is important to note
that they had the ability to access the site at any time if
they chose to do so.
The demographics and comorbidities of the 2 groups
were also compared to determine whether the groups
were similarly matched (see Table 2 for age, sex, and
Charlson Comorbidity Index [CCI] score). All of the
patients in both groups were admitted with stroketype symptoms and were diagnosed with stroke or
TIA. Comorbidities were assessed using the comorbidity component of the CCI. This tool measures the
severity of disease and is a predictor of mortality.
The CCI assigns a weighted score to specific classifications including cerebrovascular disease, chronic
obstructive pulmonary disease, renal disease, diabetes,
cardiac disease, peripheral vascular disease, liver
disease, and cancer. It is interesting to note that, although group B was younger on average, their CCI
scores were higher, which suggests that this group had
more significant comorbidities than group A. Thirtyday readmission rates were also compared for both
groups. There was no statistically significant difference in the readmission rates between the 2 groups
(Table 2).
professionals other means to educate patients/caregivers
and improve follow-up after discharge. For busy nurses,
having other options available beyond standard discharge teaching methods can help to ensure that patients and caregivers receive and retain the necessary
information, even if teaching time during the hospital
stay is limited. Communication should not end at discharge. Using standardized messaging and/or automated reminders is 1 way to achieve the goal of
information retention and patient compliance of discharge instructions. After the initial setup, this intervention is relatively easy to use and can be made
available for nurses, patients, and caregivers. The patients had the option to access the online information
at any time, which may give them more of a sense of
connectiveness. Several times during this study, the
researchers were able to respond to patients’ questions/
concerns using the secure e-mail option and also send
attachments to clarify patient inquiries once they were
home. By spreading out the information, it may help to
eliminate some of the patients’ feelings of information
overload. Finally, numerous patients in both groups
expressed gratitude for the telephone call at 2 weeks
postdischarge. Although not the purpose of this study,
anecdotally, it is important to consider that telephone
calls may be another way for follow-up that is easy to
do and can increase patient satisfaction.
Study Limitations
This study had several limitations. It was conducted in
one institution with a small sample size. Although
patients in group B agreed to sign up for access to the
health Web site and the secure e-mail messaging
option, not all of them accessed the information or
read the e-mail messages. The online connection was
available immediately after discharge, but patients did
not always take advantage of it. The researchers had
hoped to also use a texting option, which probably
would have helped to remind patients to access the
online resources and read the e-mail messages.
However, this option was not available until data collection was nearly complete so it was not able to be
TABLE 2.
Patient Demographics
Group A (N = 42)
Group B (N = 44)
Mean age, y
66.6
62.5
Implications for Practice
No. male
22
21
Because education and discharge readiness are crucial
to improve patient coping and outcomes, nurses need
alternatives to standard discharge teaching methods to
help patients and caregivers manage all of the information required for the transition to home. As
technology continues to evolve, it affords healthcare
No. female
20
23
Mean CCI score
1.46
1.96
Readmissions
2
3
Note. CCI = Charlson Comorbidity Index.
Copyright © 2017 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
155
156
Journal of Neuroscience Nursing
analyzed with this study. Comparing the National
Institutes of Health Stroke Scale scores would have
given additional information about illness severity;
however, nurses on the unit only recently received the
education to be able to do the National Institutes of
Health Stroke Scale with all patients with stroke. Before
this time, which was during the data collection period,
the scores were not consistently documented. During
the follow-up telephone call, asking an additional
question about why the patient did not use the online
option would have been helpful to determine additional
barriers to success. Although these results are encouraging, increased coping could have been related to
other factors that were not specifically measured in
this study. As technology continues to evolve, more
research in this area is needed.
Conclusions
The amount of information that patients and caregivers need for a successful transition from hospital to
home can be overwhelming. This is especially true for
patients admitted with a diagnosis of stroke. It is also
challenging for nurses to adequately prepare patients
for discharge particularly when time is limited. New
technology affords new options, such as automated
telephone calls, e-mail, secure messaging, and/or texting, to improve discharge readiness and contribute to
positive patient coping after stroke. The researchers
hope that this study will contribute to the growing body
of evidence showing success using aspects of technology to enhance discharge teaching and follow-up after
discharge and encourage other nurses to try some of
these options.
Acknowledgments
The authors would like to thank the following for
their assistance in this research project: Dr Margaret
Marino and the York College research students, who
‘‘jump started’’ the literature search; Hannah Ritzman
& Emilia Pedersoli, for assistance with data collection; Pat Wallace & Lori Kurilla from website
services; Rod Grim & Ted Bell from Emig Research
Center; Dr Marianne Weiss for permission to use her
data tools; and the patients and staff of Tower 3,
WellSpan York Hospital.
References
1. Stroke Association. About stroke. Available at: http://www.
strokeassociation.org/STROKEORG/AboutStroke/Impact-ofStroke-Stroke-statistics. Accessed June 28, 2016.
2. White CL, Barrientos R, Dunn K. Dimensions of uncertainty
after stroke: perspectives of the stroke survivor and family
caregiver. J Neurosci Nurs. 2014;46(4):233Y240.
3. Ostwald SK, Davis S, Hersch G, et al. Evidence-based educational guidelines for stroke survivors after discharge home.
J Neurosci Nurs. 2008;40(3):173Y191.
4. Fitzgerald Miller J, Piacentine LB, Weiss M. Coping difficulties
after hospitalization. Clin Nurs Res. 2008;17(4):278Y296.
5. Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients.
Clin Nurse Spec. 2007;21(1):31Y42.
6. Albrecht JS, Gruber-Baldini AL, Hirshon JM, et al. Hospital
discharge instructions: comprehension and compliance
among older adults. J Gen Intern Med. 2014;29(11):1491Y1498.
7. Maloney LR, Weiss ME. Patients’ perceptions of hospital
discharge informational content. Clin Nurs Res. 2008;17(3):
200Y219.
8. Weiss ME, Costa LL, Yakusheva O, et al. Validation of
patient and nurse short forms of the readiness for hospital
discharge scale and their relationship to return to the hospital.
Health Serv Res. 2014;49(1):304Y317.
9. Pringle J, Hendry C, McLafferty E. A review of the early
discharge experiences of stroke survivors and their carers.
J Clin Nurs. 2008;17(18):2384Y2397.
10. Cassano C. Interactive technology is shaping patient education and improving patient experience. 2016. Available at:
http://nursing.advanceweb.com/Features/Articles/TechnologyPatient-Education.aspx. Accessed October 6, 2016.
11. Holt JE, Flint EP, Bowers MT. Got the picture? Using
mobile phone technology to reinforce discharge instructions.
Am J Nurs. 2011;111(8):47Y51.
12. Sherrard H, Struthers C, Kearns SA, et al. Using technology
to create a medication safety net for cardiac surgery patients:
a nurse-led randomized control trial. Can J Cardiovasc Nurs.
2009;19(3):9Y15.
13. Arora S. Text message program improves outcomes, decreases ED utilization among ED patients with poorly controlled diabetes. ED Manag. 2014;26(3):20Y23.
14. Crumpton C, Scaletta T. Hospitals leverage nursing staff,
IT tools to reach out to patients following discharge from
the ED. ED Manag. 2014;26(2):17Y20.
15. Sharp B, Singal B, Pulia M, et al. You’ve got mail I and
need follow-up: the effect and patient perception of e-mail
follow-up reminders after emergency department discharge.
Acad Emerg Med. 2015;22(1):47Y53.
16. Holzemer EM, Thanavaro J, Malmstrom TK, et al. Modifying
risk factors after TIA and stroke: the impact of intensive
education. J Nurse Pract. 2011;7(5):372Y377.
17. Zolfaghari M, Mousavifar SA, Pedram S, et al. The impact
of nurse short message services and telephone follow-ups
on diabetic adherence: which one is more effective? J Clin
Nurs. 2012;21(13Y14):1922Y1931.
18. Bjerke TN, Kummervold PE, Christiansen EK, et al. ‘‘It
made me feel connected’’Van exploratory study on the use
of mobile SMS in follow-up care for substance abusers.
J Addict Nurs. 2008;19:195Y200.
19. Bailey C. Reducing readmissions through discharge communication: a new HIPAA-compliant app offers ‘‘live’’ instruction at the bedside. Nurs Manage. 2012;43(12 Safety
Solutions):14Y16.
20. Zhuang R, Xiang Y, Han T, et al. Cell phone-based health
education messaging improves health literacy. Afr Health
Sci. 2016;16(1):311Y318.
21. McNeill A, Underwood AS, Wisniewski A, et al. Development of a social networking site for patients and families: A
doctoral level nursing informatics project. Online J Nurs
Inform. 2014;17(1). Available at: http://ojni.org/issues/?
p=2394. Accessed June 24, 2016.
Copyright © 2017 American Association of Neuroscience Nurses. Unauthorized reproduction of this article is prohibited.
Student Name Lucienne Chalas_______________
Write your topic and final PICO(T) question below:
My topic: Discharge teaching following stroke__________________________
My PICO(T): For CVA patient’s does the use of technology enhance discharge teaching and
coping as compared with current discharge teaching? ________________
My article:
1. Published within the last five years?
Yes_x__
No___
2. Has a nurse author OR published in a nursing journal?
3. Is a single report of a quantitative research study?
4. Is a prospective study?
Yes_x__
Yes__x_
Yes_x__
No___
No___
No___
5. Give an APA style reference of the article here:
_Schneider, M. A., & Howard, K. A. (2017). Using technology to enhance discharge teaching and improve coping for patients after stroke. Journal of Neuroscience Nursing, 49(3), 152–156.
https://doi.org/10.1097/jnn.0000000000000275
__________________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_________
In order to be acceptable, you must be able to say yes to the four questions above.
Remember, your article cannot be a retrospective study, a mixed methods study, a qualitative
study, a systematic review, a quality improvement article, or an evidence-based practice
article.
Upload this form on Canvas and be sure to upload your quantitative nursing research
article in pdf form as well.

Purchase answer to see full
attachment

  
error: Content is protected !!