Phase 1 and 2 attached
PHASE 1 2
PHASE 1- PLANNING
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 transition (Rezapour-Nasrabad, 2018).
Significance of the study
The significance of this study is to inform nurses of the gaps within the hospital-home tr
1
9
Phase 2- Design
Phase 2- Design
Brief literature review
For too many patients, the healthcare door is one that they consider to be a revolving one. Approximately 20% regarding the Medicare patients usually leave the healthcare centers only for them to be readmitted within a months time. The failure to come up with the standard discharge processes, efficient preparation of patients and the family caregivers for discharge, effective education of patients in regard to medications and communicate appropriately with the identified post discharge providers is all associated with causing readmissions (Chen et al., 2021).
Through effective coordination as well as communication, planning and education, nurses as well as the nurse case administrators can play a key role in the reduction of readmissions. Beginning at the admission phase, there is the possibility of the mitigation of readmission risks at the various points in the cases of pre discharge as well as post discharge periods via effective determination of the readiness for discharge by the patients as well as the compilation of an extensive as well as accurate form of discharge summary, coordination of care with numerous settings as well as providers and much more.
Nursing Interventions during the Process of Discharge
Most of the studies usually connect readmissions with the lack of effective and fast follow up by the identified primary care type of providers as well as other kinds of healthcare experts. Patients ought to possess an effective follow up appointment that is scheduled within 48 hours to am average of7 days after they have been discharged. There are numerous strategies in this case which can be used which are the development of scheduling kinds of agreements with the local clinics like the system affiliated ambulatory care kinds of clinics. There is also the creation of processes for the assignment of patients to an identified PCP if they lack one. It is also vital to facilitate effective education of patients as well as the home caregivers on the significance associated with timely as well as effective follow up (Lee et al., 2021).
Post discharge nursing related interventions
The identified period immediately after any kind of patient discharge is one that is considered to be a vulnerable time for the patients one whereby rapid alterations can take place. Having a follow up with the identified patients as well as the home types of caregivers soon after the identified discharge can minimize confusion as well as effectively reinforce the follow up kind of plans. The most common topics to be discussed in the first post discharge phone call entails the medications as well as pending services and more (Wong et al., 2021).
Discharge to a setting
Phase 3-Implementation (Due by WEEK 9)
Phase 3 of the research project is the implementation
phase. The implementation phase will be written
state as we will not be implementing the actual
project. This phase focuses on providing steps by
steps instructions on how the program will be
implemented, a table describing the time frame of
the project, if any budget needs to be considering,
and any resources or statistically tools required. The
length of this paper should be around 5-6 pages.
Outstanding
10 points
Very Good
8 points
Good
6 Points
Unacceptable
4 points
Integration of
Knowledge
12.5%
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
12.5%
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
<
· Score
6.48 / 10
· Integration of Knowledge
25% of total result
1.5
Oustanding
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.
2.5
Very Good
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.
2
Good
The paper demonstrates that the author, to a certain extent, understands and has applied concepts learned in the course.
1.5
Unacceptable
The paper does not demonstrate that the author has understood, and applied concepts learned in the course.
1
Criterion Feedback
Please read the detailed feedback within this paper- several areas of concern that need to be corrected prior to final submission
· Topic Focus
25% of total result
1.5
Oustanding
Topic Focus 12.5% 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
2.5
Very Good
The topic is focused but lacks direction. The paper is about a specific topic, but the writer has not established a position.
2
Good
The topic is too broad for the scope of this assignment.
1.5
Unacceptable
The topic is not clearly defined.
1
Criterion Feedback
Topic needs to be more focused and developed – not clearly articulated within the paper
See feedback
· Depth of Discussion
13% of total result
0.78
Oustanding
In-depth discussion and elaboration in all sections of the paper.
1.3
Very Good
In-depth discussion and elaboration in most sections of the paper.
1.04
Good
The writer has omitted content. Quotations from others outweigh the writer’s own ideas excessively.
0.78
Unacceptable
Cursory discussion in all the sections of the paper or brief discussion in only a few sections
0.52
Criterion Feedback
Multiple areas of development needed- missing key information on the discussion
See feedback
Sample size, inclusion, exclusion criteria, flow charts or graphs, a p
10/27/21, 10:23 AM Originality Report
https://fnu.blackboard.com/webapps/mdb-sa-BB5df44c85137e1/originalityReport/ultra?attemptId=173d9541-025d-410c-be46-5bbe3404c63e&course_… 1/5
%40
%7
SafeAssign Originality Report
Nursing Research and Evidence Based-DL-MSN1 Nora Hernandez-P… • Phase 3 UPLOAD Due Saturday at 2359
%47Total Score: High riskAlina Rivero Parets
Submission UUID: 70a1e1c0-4d3b-de6d-6300-f81fc9016590
Total Number of Reports
1
Highest Match
47 %
Phase3.docx
Average Match
47 %
Submitted on
10/27/21
10:22 AM EDT
Average Word Count
1,568
Highest: Phase3.docx
%47Additional content
Institutional database (1)
My paper
Global database (7)
Student paper Student paper Student paper
Student paper Student paper Student paper
Student paper
Top sources (3)
Excluded sources (0)
View Originality Report – Old Design
Word Count: 1,568
Phase3.docx
1
8 4 5
6 7 3
2
1 My paper 8 Student paper 4 Student paper
1 8
Phase 3
Alina Rivero Parets
Florida National University
Nursing Research and Evidence Based
Dr. Nora Hernandez-Pupo
October 27, 2021
Phase 3: Implementation
The section will discuss the steps of implementation and how the project will be completed. The steps include data sampling, participant selection, data gathering,
and analysis. The thesis of study will be focused throughout the research project, and issues in the transition from hospital to home and re-admissions will be kept in
mind. The details of the implementation process are as follows. Steps
Choosing Participants The sampling process is an important step in the implementation because it demonstrates the researcher’s knowledge of how much he has a
grasp on his knowledge and how he will continue the further research. The success of research depends on the sampling process because it is seen that inappropri-
ate sampling gives inappropriate outcomes. The researcher needs to be careful in this process, and it helps him make sound decisions regarding the researcher. The
sampling technique will help the researcher to make a careful decision despite stratified sampling. The sampling techniques and methods depend on the subjects un-
der investigation because the researcher knows what subjects are aligned with the research or what are not (Chen, 2021). The first step will focus on the participants
who have been through the re-admissions in the hospitals. The nurses will also be involved in the research, and the data will be collected from those who have suf-
fered from severe issues and got re-admission. The patients who never faced the issues of re-admission or who do not have such concepts will not be considered for
the stud
Why work with us?
Authenticity:
All of our papers are authentic, as each paper of ours is composed according to your unique requirements. Confidentiality: We value you data. Our company is extremely efficient in guarding the privacy of our clients. 100% Money Back Guarantee: In the event you cancel your order, you get your money back as soon as possible, we give a 100% refund. 24/7 Support: Our team members are available via email, live chat, and phone. Revision Policy: You can apply for a revision if you think your paper could be better. In this case, your paper will be revised either by the specialist assigned to you or by another writer.How the Platform Works
- Click on 'Place Your Order' tab on the menu or click on 'Order Now' tab at the bottom and a new order page will appear
- Fill in your requirements depending on your needs under the 'PAPER DETAILS' area
- In the next section, fill in the academic level, required number of pages, paper deadline as provided in the drop-down menus.
- To enter your registration details, click on 'CREATE ACCOUNT & SIGN IN'. This step allows you to create an account with us for purposes of record-keeping. Click on 'PROCEED TO CHECK OUT' at the bottom of the page
- The next section requires you to fill in the payment details. Follow the guided process and soon your order will be available for our team to work on.