You will write responses based on questions related to the course/program outcomes; and to the progression of your nursing project. No word count. You must write in complete sentences and use proper grammar and syntax. Remember, this is your last course, and you are demonstrating that you can express written thoughts proficiently.

One of your course outcomes stated “apply evidence-based practice and analyze the role for a baccalaureate prepared registered nurse in a particular aspect of professional nursing practice”. As you reflect on your course project, I know that you have had to reflect on how you have had to develop a leadership or quality improvement project that spans several courses (e.g., review literature about a practice problem in one course, propose a practice change based on an evidence-based model in a second course, and then present the practice change to appropriate stakeholders in a third course). For instance, in the process of completing this program, each of you have taken course materials related to nursing informatics, professional nursing, evidence-based practice research course, health assessment, leadership, community nursing and pathophysiology.

Now reflect back about how these courses and your practice experiences have helped you to meet this course outcome? And how your clinical project supports this outcome?

Sentara College of Health Sciences

NUR 430- Course Student Learning Outcome Response(s) Rubric

100 Excellent — Quality information with all “required elements included”.  Quality denotes completeness, precision, clarity, thoroughness, significance, relevance, accuracy, exhibits full span of knowledge of a subject and specific topics are focused upon, amplified and explored.

92 Good — All “required elements” included.  Information is complete, precise, clear, thorough, significant, relevant and accurate.

84 Average — Accurate and complete information with all “required elements” included.

77 Poor — Information is inaccurate and/or incomplete with 1 or more required elements omitted. Needs improvement.        

0

Not done

— Did not do the required elements or characteristics or submitted more than 3 days late.

Sentara College of Health Sciences

NUR 430: Outcome Log

Not done

Not done

Not done

Not done

2

Reducing Stroke Readmissions in the Acute Care Setting

Michelle L Wallace

NUR 430

Professor Roberts

Introduction:

Cardiovascular diseases, obesity, cancer, and stroke are some of the leading diseases in the world, and they are the most frequent causes of death in recent past years. Stroke is the condition when there is a blockage of blood supply, and oxygen to any part of the brain. Unfortunately, his will cause the death of brain cells. This capstone project is about stroke readmissions that are increasing with passing time. There are efforts being made to reduce stroke readmissions to hospitals, and there are a lot of factors involved. Patients should be given proper awareness, and nurses should be educated so they may treat the patients with the appropriate care necessary. According to the American Heart Association, 389 deaths occur each day due to a stroke in 2016 (Sunil, 2013). This proposal will discuss the different ways to reduce the stroke causes and readmissions in the hospital.

Purpose:

The purpose of the project is to discuss the different causes of stroke and other cardiovascular diseases and further, it will discuss the ways of prevention and treatment as well. It is a common observation that stroke readmissions are increasing day by day, and patients are not getting enough care and treatment in hospitals. It is observed that may stroke patients are admitted to the hospital, go home after treatment; and unfortunately, have to re visit hospitals again and again. The awareness level has to be increased and the education level has to be enhanced as well. The community should be engaged in the different training sessions and proper guidance should be given to them (Stephanie Rennke, 2015). There are different strategies for reducing stroke readmissions in the hospitals. First, it should be noticed that the immune system and nervous system of the patients are weak, and they have to build immunity and the concept of self-care should be introduced. The families and peer groups should be supportive enough and diet recommendations should be given to them. Subsequently, it would be the duty of the nurses to provide education to patients hopefully resulting in the reduction of stroke readmissions.

Personal Reflections:

There are different significant issues regarding ailments and medical experts are presenting their strategies to control these issues; however, I have selected stroke for the proposal. Stroke and its incidence are increasing day by day, and the western countries are most at risk. Sedentary lifestyles are increasing, and the junk food prevalence is enhanced in western countries as well. We as a people are so busy with jobs and business, there is very little time to incorporate a healthy lifestyle. Unfortunately, there is a lack of routine exercise as a nation. On the other hand, the ratio of smokers is also increasing, in which is a major contributor to stroke. The awareness level has to be increased and nurses should be educated as well (Hefzy, 2017). So, I am studying these risks to assist in finding a solution.

Activities:

I have planned several steps and activities for reducing the stroke readmissions in the hospitals. education level to the nurses and to increase the awareness level to the community. The first step is to engage with the stroke coordinator for my facility. Fortunately, the stroke coordinator is my preceptor. Together, we will attend the stroke alerts for the hospital. We will also attend the stroke rounds with the inpatient rehab physician, and therapy. When doing this, we will be able to see what resources the patients are lacking that may be causing the stroke. We will then begin to provide information the patient will need to be successful. It is vital to be aware of pertinent information such as family support. All of this data will better allow staff to understand possible strategies to reduce stroke readmissions. This will also give the nurse the proper avenue to take in providing education to his or her patient. The next step is to meet the families and peer groups of the patients, as they will be involved in the care of the patient as well. Together we will find out the triggers, and work as a unit to prevent further readmissions. It is important to know what issues they feel will lead them back to hospital. Lastly, the final step will convince the patients to modify their lifestyle and change their dietary intake. The dietary intake will be increased in fruits, vegetables, and fiber and to reduce the extra fats and cholesterol (Christina Condon, Sarah Lycan, & Pamela Duncan, 2015).

Outcomes: Planned

My planned outcomes are to show the decrease in stroke readmission in hospitals and to increase the education level and training of nurses. The stroke prevalence will be reduced and people will try to modify their lifestyle and will adopt a healthy diet to reduce the diseases. Some of the literature is as follows. Clinics are tested with reconsidering their medical clinic’s transitional consideration rehearses, to lessen 30-day readmission rates, forestall antagonistic occasions, and guarantee protected progress of patients from emergency clinic to home. Regardless of the expanding consideration regarding transitional consideration, there are hardly any distributed investigations that have indicated huge decreases in readmission rates, especially for patients with stroke and other neurologic findings. The fruitful emergency clinic started transitional consideration programs incorporate a “connecting” system with both pre-discharge and post-discharge mediations and committed advances supplier required at numerous focuses in time. In spite of the fact that multi-component techniques including tolerant commitment, utilization of a devoted change supplier, and assistance of correspondence with outpatient suppliers require time and assets, there is proof that neuro hospitalists can execute a transitional consideration program with the point of improving patient wellbeing over the continuum of care (Kristen, 2015).

Outcome: Evidence-Based Research

Centers are tried with rethinking their restorative facility’s transitional thought practices, to diminish 30-day readmission rates, prevent adversarial events, and assure a shielded advancement of patients from crisis facility to home. Notwithstanding the extending thought in regards to transitional thought, there are not really any conveyed examinations that have shown enormous quantities in readmission rates, particularly for patients with stroke and other neurologic discoveries. Productive crisis facility began transitional thought programs consolidate an “interfacing” framework with both pre-discharge and post-discharge intercessions, and submitted progresses provider required at various concentrations in time. Notwithstanding the way that multicomponent systems including tolerant responsibility, usage of a committed change provider, and the help of correspondence with outpatient providers require time and resources, there is evidence that neuro hospitalists can execute a transitional thought program with the purpose of improving patient prosperity over the continuum of care.

Hansen and associates played out a methodical audit of 43 intercessions to diminish 30-day medical clinic readmission. Overall, the nature of concentrates was low, with just 16 being randomized controlled preliminaries (RCTs). Most examinations (56%) tried the impact of single-segment mediations, while the rest of the groups. The creators portrayed a scientific categorization of mediation parts including general classes of pre-discharge intercessions (e.g., tolerant training, release arranging, drug compromise, arrangement planned before release); post-discharge intercessions (e.g., opportune development, convenient PCP correspondence, follow-up call, persistent hotline, home visit); and connecting mediations (e.g., change mentor, quiet focused release directions, supplier progression). Of the 16 RCTs, just 5 yielded critical decreases in clinic readmission. One of these gave early release arranging (a solitary segment intercession) to high-chance patients. One little pilot study and three bigger investigations actualized multicomponent mediation packs, which brought about supreme decreases in 30-day readmission of 3.6 to 28 rate focuses (Sunil, 2013).

A special clinical requirement of the agency:

The patients need to have appropriate follow-up appointments as ordered, the patients in turn need to modify their lifestyle and take medications as ordered.

Proposed schedule/timeline:

The proposed time is 14 weeks to complete the process, and all the six steps will be carried out without the allotted time.

Collaboration with the preceptor:

The preceptor will continue to assist in providing resources as gathered. Also giving insight as necessary. Lastly, meeting to address concerns from preceptee. Preceptor also provides extra support by permitting preceptee to attend stroke alerts, and stroke rounds. Proposed evaluative criteria:

It is necessary for patients to follow the discharge instructions from the physician. This is to include a healthy diet, and adequate exercise weekly. The patient will also begin smoking cessation if necessary. Furthermore, the patient will attend monthly stroke support groups, and take medications as prescribed. These medications are to include blood pressure, blood thinners, and cholesterol medications.

Evaluative criteria discussed:

The readmission of stroke patients will be observed and monitored carefully; this is to reduce the instances of stroke readmissions.

Conclusion

Stroke is the condition when blood supply to any part of the brain. The capstone project is about reducing stroke readmissions. This will occur by ensuring the patient knows the risk factors, take the prescribed medications, following a heart healthy diet, and exercising. The efforts are being made to reduce the stroke readmissions to hospitals and it involves a lot of factors. The patients should be given proper awareness and nurses should be educated so they may treat the patients with care. The strategies should be designed and should be followed to reduce readmissions (Bumpus, 2017).

References

Bumpus, S. M. (2017). Transitional Care to Reduce Cardiac Readmissions: 5-Year Results from the BRIDGE Clinic. Family Medicine and Disease Prevention.

Christina Condon, M. N., Sarah Lycan, M. N., & Pamela Duncan, P. P. (2015). Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program. AHA .

Hefzy, H. K. (2017). A Transition of Care Program to Reduce Stroke Related Hospital Readmissions. INTERNATIONAL STROKE CONFERENCE MODERATED POSTER ABSTRACTS.

Kristen. (2015). Reducing Stroke Readmissions in HOspitals. Nursing Journal.

Stephanie Rennke. (2015). Transitional Care Strategies From Hospital to Home. NCBI, 35-42.