Similarity Less than 10 %

Instructions attached



Alina Rivero Parets

Florida National University

Nursing Research and Evidence Based

Dr. Nora Hernandez-Pupo

September 21,2021

Introduction to the problem

Transitional nursing is Care provided to patients as they transit from one place to another. Transition can be within the hospital setting, between care settings, within health states, and between providers (Warchol et al., 2019). One of the transitions is discharge from the hospital to home care. Patients are discharged from the hospital before they are completely cured but must be well off to be able to recover at home. The patients are sent home with treatment packages and sometimes may require frequent clinical visits by the nursing for care. The care plan during the transition from hospital to home care includes the treatment goals, the health status of the patient, treatment preferences and family as well as patient education. Coordination is crucial in this care. In some cases, these discharge packages are not well elaborated. Miscommunication and discontinued care may result in adverse effects on the patient. For example, the patient may experience delayed care, unnecessary clinical visits, and stress to the patient or family, and poor health outcomes.

Problem statement

The transition of the hospital to home care is done to enable the client to recover at home. Healthcare professionals discharge clients with strict instructions for the client to continue with care and recover fast. Due to poor communication and nursing care at home, many patients face readmission. Readmission is defined as the return to hospitalization within 30 days of discharge from the same condition. Readmission is among the costliest cases in the hospital setting to manage. Hospitals incur huge costs in managing readmission. The federal government is also affected. The US spends $17.4 billion on readmission costs. Hospitals readmit 20% of patients enrolled in Medicare within 30 days upon discharge and 34% of the clients within 90 days of discharge. Unwanted and unnecessary health care costs amount to $765 billion yearly with preventable admission accounting for $17 billion for Medicare (Warchol et al., 2020). Causes of readmission are varied. Poor resolution of the original problem of the patient is a major cause of readmission. The healthcare provided by professionals just relieves the pain and not the actual problem. In such a case it is likely to reoccur. Discharge of patients too early may be a cause of readmission. The patient is discharged before being stable enough to recover from home. In other cases, inadequate care after discharge may make the condition worse. The nurse has a critical role to play in the provision of care at such transiti

Research Paper Rubric

Phase 2-Design (Due by WEEK 6)

Students will continue their research topic, in this paper students will perform a brief literature review on the topic (Will need at least 5 support articles) and provide the desired methodology for the project. Paper will be approximately 5-6 pages. 

1. Brief literature review

2. Methodology and design of the study (Be detailed )

3. Sampling methodology

4. Necessary tools

5. Any algorithms or flow maps created.

This will be considered a Library Assignment as you will need to visit the library to obtain information.

Outstanding 10 points

Very Good 8 points

Good 6 Points

Unacceptable 4 points

Integration of Knowledge


The paper demonstrates that the author understands and has applied concepts learned in the course.

Concepts are integrated into the writer’s own insights.

The writer provides concluding remarks that show analysis and synthesis of ideas

The paper demonstrates that the author, mostly, understands and has applied concepts learned in the course.

Some conclusions, however, are not supported in the body of the paper

The paper demonstrates that the author, to a certain extent, understands and has applied concepts learned in the course

The paper does not demonstrate that the author has understood, and applied concepts learned in the course.

Topic Focus


The topic is focused narrowly enough for the scope of this assignment.

A thesis statement provides direction for the paper, either by a statement of a position or hypothesis

The topic is focused but lacks direction.

The paper is about a specific topic, but the writer has not established a position.

The topic is too broad for the scope of this assignment.

The topic is not clearly defined

Depth of Discussion

12.5 %

In-depth discussion and elaboration in all sections of the paper.

In-depth discussion and elaboration in most sections of the paper.

The writer has omitted content.

Quotations from others outweigh the writer’s own ideas excessively.

Cursory discussion in all the sections of the paper or brief discussion in only a few sections



Ties together information from all sources.

Paper flows f