NR 505 Week 1: Identification of Area of Interest Discussion

As a future nurse practitioner, I will be seeing a wide range of diseases and disorders. The topic of interest to me as a nurse practitioner is cardiovascular illness. This illness includes heart attacks, coronary artery illness, arrhythmia and cardiac arrest. When I was in middle school, my grandfather had a cardiac arrest and had to get a heart bypass surgery. I remember his symptoms were shortness of breath, chest pain, high blood pressure and irregular heartbeat. Since I work in PACU, I see many patients with uncontrolled high blood pressure. They are not on any blood pressure medication because they do not have a primary care provider or financial issues. A heart attack occurs when plaque build up clogs the artery that is carrying blood to heart and brain. It is very life-threatening. According to the American Heart Association, cardiovascular disease affects more than one million people in America (American Heart Association, 2023).
Cardiovascular disease is more common for patients over 65 years and older (Khan, 2020). Because of age, changes in heat and blood vessels can increase risk. One of the most beneficial ways to avoid cardiovascular disease is to stop the use of tobacco products (Krist et al., 2020). Secondhand smoking is just as toxic and should be avoided. Another way to avoid the disease is increasing physical activity. This can help manage one’s weight, high blood pressure and cholesterol. If an individual is obese, they are more prone to heart disease. 

A major issue among the population is the lack of resources, knowledge and healthcare barriers when it comes to treating cardiovascular disease. A nurse practitioner is responsible for providing care to patients and helps with managing chronic and acute heart disorders. One big role a nurse practitioner provides is the role of teaching. We have to listen and provide teaching about drugs, illness and how to prevent an illness. After COVID happened, many people stopped going to see primary care providers, and primary care providers put a limit on how many patients they can see everyday. (Lon et al., 2020). Because of this chronic illness such as hypertension is not managed since medication is not prescribed on time. As more nurses are becoming nurse practitioners, we are providing extra help to physicians to help relieve workload. Nurse practitioners can help patients with prescriptions and prescription refills, diet, lifestyle, teaching and preventative care. Nurse practitioners have the training and knowledge on how to manage cardiovascular disease. They can assist with follow up appointments and see new patients which will improve patient health and quality of care. 

NR 505 Week 1: Identification of Area of Interest Discussion

NR 505 Week 1: Identification of Area of Interest Discussion

In examining the heart transplant population, we are looking at a relatively small percentage of the population.  For this reason, it would be difficult to proceed with significant quantitative research as the limited number of possible participants most likely does not allow for a large enough data set.  In general though, qualitative data seems to be a more appropriate type of research for the population. 

            Research for this population would include some demographic data, such as type of heart failure, age of onset, and race/ethnicity, but would have a great deal to do with the experiences of participants, such as their understanding of their disease and of the education they receive concerning the process before, during, and after transplant.  Research could also include the psychosocial aspects of the experience of the patients, which would be difficult to quantify in this type of population.  In my experience with the transplant population, a support system can impact transplant patients at every stage of the transplant process.  Though each patient’s process is incredibly personal and specific to them, there are generalized guidelines, results, and complications that occur relatively commonly and frequently, just as with all areas of medicine. 

NR 505 Week 1: Identification of Area of Interest Discussion

For this discussion the focus is on presenting the area of interest for the evidence-based practice proposal that is required for this course.

1. State your area of research or evidence-based practice (EBP) interest from NR 500; remember that the topic must be consistent with your specialty track.
2. State your MSN program specialty track and defend how your selected area of research or EBP interest from NR 500 is consistent with your selected MSN program track.
3. Would you like to change your area of research or EBP interest from NR 500? Why or why not?
4. If you changed or modified your area of research or EBP interest, please identify the revised area of research.
5. Defend how your area of research/EBP interest is of importance to the MSN program specialty track you have selected—scholarly references are required.
6. Identify an initial PICOT/PICo question that reflects you area of interest for the evidence-based practice proposal that is required for this course.

ORDER NOW FOR INSTRUCTIONS-COMPLIANT, NR 505 Week 1: Identification of Area of Interest Discussion ORIGINAL PAPER

Evidence-Based Practice Interest from NR500

In NR 500 the Evidence-Based Practice (EBP) interest that was chosen was research of healthcare interventions and how it can lower the rates of unplanned healthcare in the rural population.  The use of emergency and unplanned care in rural communities have long been increasing.  Unplanned care is defined as the use of healthcare to include all care sought without an advance appointment, such as visits to emergency rooms, unscheduled hospital admissions, and drop-in clinics (Brainard, et, al., 2016).  Patients in the rural areas seek unplanned healthcare due to their decreased involvement with health prevention programs, low socioeconomic statuses, decreased health education, delayed diagnosis of diseases, and decreased support from caregivers who assist with chronic illnesses (Brainard, et. al., 2016).

Specialty Track and Evidence-Based Interest from NR500

The FNP specialty track will assist with obtaining advance knowledge that can be used to educate patients in the rural population about ways to improve their health. The quality of health in rural areas suffers due to the lack of exposure to proper healthcare, which includes health education, preventative programs, and confusion about the proper healthcare regimen (Brainard, et, al., 2016). This area of specialty will allow research of evidence-based practices that will be the driving force for many quality improvement initiatives, creation of standardized practices, and development of new or improved healthcare policies (Brainard, et. al, 2016).  Compared to the urban population, patients in the rural population seek care that is in the chronic states instead of the initial occurrence of symptoms.  This is due in part to their low socioeconomic status and less health education.  As a FNP who plans to provide care in rural areas, the opportunity to initiate care, education, and provide preventative measures is great.  Evidence-based information can be given to patients in the rural population in order to prevent unplanned healthcare.  The use of interventions to improve the populations’ health status can be the main focus of healthcare.  For example, the encouragement of self-care, compliance, symptom management, and the adoption of health related behaviors can be key to the prevention of unplanned healthcare.

NR500 Evidence-Based Interest

My area of EBP interest will remain the same.  As a FNP, the focus will be to utilize advance studies and guidelines into practice.  These interventions will decrease health disparities and reduce the incidence of unplanned healthcare for the rural population, along with the improvement of healthcare cost.  With the planned format of health education and preventative measures, patients can become more familiar with their required medical regimen, thus a reduction of unplanned healthcare can occur.

Evidence-Based Interest Importance to Specialty Track

The research of EBP interest is of importance to the FNP specialty track because new approaches and interventions to reduce unplanned healthcare due to chronic disease and illnesses is needed.  The FNP specialty track will promote an advancement in advance knowledge, allowing the future FNP to use evidence- based practices to guide decisions in the practice setting.  As a FNP, advance knowledge can be used to create interventions that can introduce ways to improve health and ensure consistency in treatment within the rural communities.  For example, encouraging patients to use technology to gain increase education about diagnoses and interventions to prevent further health complications. The recipe for moving toward health in rural, underserved areas will need to include a focus of innovation and outcomes using evidence-based practice and technology (Brainard, et, al., 2016).  This will assist the rural communities with an improved state of health, decreasing mortality, morbidity, improving healthcare cost, and lowering the rates of unplanned healthcare.

PICO

In the rural population (P) does health education, early diagnosis, and health care programs (I) compared to deploying health resources geographically (C) reduce the incidence of unplanned healthcare (O)?

Reference

Brainard, J.S., Ford, J.A., Steel,

Evidence-Based Practice Interest from NR500

In NR 500 the Evidence-Based Practice (EBP) interest that was chosen was research of healthcare interventions and how it can lower the rates of unplanned healthcare in the rural population.  The use of emergency and unplanned care in rural communities have long been increasing.  Unplanned care is defined as the use of healthcare to include all care sought without an advance appointment, such as visits to emergency rooms, unscheduled hospital admissions, and drop-in clinics (Brainard, et, al., 2016).  Patients in the rural areas seek unplanned healthcare due to their decreased involvement with health prevention programs, low socioeconomic statuses, decreased health education, delayed diagnosis of diseases, and decreased support from caregivers who assist with chronic illnesses (Brainard, et. al., 2016).

Specialty Track and Evidence-Based Interest from NR500

The FNP specialty track will assist with obtaining advance knowledge that can be used to educate patients in the rural population about ways to improve their health. The quality of health in rural areas suffers due to the lack of exposure to proper healthcare, which includes health education, preventative programs, and confusion about the proper healthcare regimen (Brainard, et, al., 2016). This area of specialty will allow research of evidence-based practices that will be the driving force for many quality improvement initiatives, creation of standardized practices, and development of new or improved healthcare policies (Brainard, et. al, 2016).  Compared to the urban population, patients in the rural population seek care that is in the chronic states instead of the initial occurrence of symptoms.  This is due in part to their low socioeconomic status and less health education.  As a FNP who plans to provide care in rural areas, the opportunity to initiate care, education, and provide preventative measures is great.  Evidence-based information can be given to patients in the rural population in order to prevent unplanned healthcare.  The use of interventions to improve the populations’ health status can be the main focus of healthcare.  For example, the encouragement of self-care, compliance, symptom management, and the adoption of health related behaviors can be key to the prevention of unplanned healthcare.

NR500 Evidence-Based Interest

My area of EBP interest will remain the same.  As a FNP, the focus will be to utilize advance studies and guidelines into practice.  These interventions will decrease health disparities and reduce the incidence of unplanned healthcare for the rural population, along with the improvement of healthcare cost.  With the planned format of health education and preventative measures, patients can become more familiar with their required medical regimen, thus a reduction of unplanned healthcare can occur.

Evidence-Based Interest Importance to Specialty Track

The research of EBP interest is of importance to the FNP specialty track because new approaches and interventions to reduce unplanned healthcare due to chronic disease and illnesses is needed.  The FNP specialty track will promote an advancement in advance knowledge, allowing the future FNP to use evidence- based practices to guide decisions in the practice setting.  As a FNP, advance knowledge can be used to create interventions that can introduce ways to improve health and ensure consistency in treatment within the rural communities.  For example, encouraging patients to use technology to gain increase education about diagnoses and interventions to prevent further health complications. The recipe for moving toward health in rural, underserved areas will need to include a focus of innovation and outcomes using evidence-based practice and technology (Brainard, et, al., 2016).  This will assist the rural communities with an improved state of health, decreasing mortality, morbidity, improving healthcare cost, and lowering the rates of unplanned healthcare.

PICO

In the rural population (P) does health education, early diagnosis, and health care programs (I) compared to deploying health resources geographically (C) reduce the incidence of unplanned healthcare (O)?

Reference

Brainard, J.S., Ford, J.A., Steel, N. & Jones, A.P. (2016).  A systemic review of health service interventions to reduce use of unplanned healthcare in rural areas.  Journal of Evaluations in Clinical practice, 22(2), 145-155.  doi: 10.111/jep.12470

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N. & Jones, A.P. (2016).  A systemic review of health service interventions to reduce use of unplanned healthcare in rural areas.  Journal of Evaluations in Clinical practice, 22(2), 145-155.  doi: 10.111/jep.12470

Evidence based practice is a concise problem-solving approach to clinical practice that incorporates the best evidence from scholarly studies, patient outcomes and preferences, and a clinician’s expertise in making decisions about a patient’s care. The impact of evidence-based practice (EBP) has echoed across nursing practice, education, and science. The call for evidence-based quality improvement and healthcare transformation underscores the need for redesigning care that is effective, safe, and efficient.” (Stephens, 2013). EBP simply translates evidence into practice.

My professional track of choice is Family Nurse Practitioner.

 My area of interest in NR 500 was simply Hospice Care. In the hospice setting nurse practitioners are vital in determining a patients ongoing need for the medicare hospice benefit. Medicare requires that once a hospice patient has been on service for six months, their needs have to be reassessed and they must be recertified to continue receiving services. The NP goes out to the patient’s home or care facility to perform face-to-face assessments. This assessment provides the Hospice Director/Physician with the information needed to certify the patient’s hospice appropriateness. The Nurse Practitioner attestation process includes; reviewing the patient’s electronic medical record, communicating with the patient’s case manager, consulting with facility staff (long-term care facility patients), and doing a head-to-toe assessment of the client. The Nurse Practitioner is looking for specific markers of decline according to the specific hospice diagnosis/diagnoses. These markers may present as weight loss, decreased appetite and increased pain for example.

NR 505 Week 1: Identification of Area of Interest Discussion

The National Consensus of Quality Palliative Care states that “Evidence-based practice has the potential to improve the quality of care and enhance clinical judgment in serious and life-threatening illness. Hospice and palliative nurses must know how to obtain, interpret, and integrate the best available research evidence with patient data and clinical assessment.” (2013). The example of why the Hospice Nurse Practitioner is an indispensable discipline within the hospice team I will give is simply, the Nurse Practitioner is the physician’s eyes and ears in the community setting. A Decision making regarding the hospice patient’s eligibility to receive hospice benefits lies in the NPs research and assessment. He/ She is the primary link between the field nurse, physician and Medicare.

I have modified my area of interest to be focused on addressing the underuse and misuse of hospice and palliative care in the chronically ill aging community. The National Academy of Medicine authored a report in 2014 titled Dying in America: Improving Quality and Honoring Individual preferences. In this report, several barriers to the provision of high-quality care for patients electing palliative or hospice care were identified. These roadblocks include; unavailability to disadvantaged groups, a mismatch between what patients and families need and the services that are available, inadequate numbers and education of palliative care employees, and a fragmented care system that is driven by “perverse financial incentives” (2014).

 I would prefer to focus less on the actual activity of Hospice Attestations performed by the Hospice Nurse Practitioner (as stated in NR500) to the responsibility of the advanced degree nurse, as a clinician, to provide the community with the information needed for informed decision making regarding end-of-life care. I chose the aging population, because that is the sector of the local community that I currently care for. Nurse Practitioners play an integral role in research and implementation of care in the community in which he/she serves as an effort to maximize healthcare in that area. 

PICOT: In community dwelling residents age 65 or older, with a chronic medical condition, does having an advanced care planning discussion with a healthcare provider increase the likelihood that a patient and/or their designated primary caregiver will be comfortable making an informed decision in the election of palliative or hospice care services?

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. 3rd ed. Pittsburgh, PA: National Consensus Project; 2013. The National Academy of Medicine; Committee on Approaching Death: Addressing Key End-of-Life Issues. (2014, September 17). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Retrieved May 5, 2018, from https://www.nap.edu/catalog/18748/dying-in-america-improving-quality-and-honoring-individual-preferences-near

n a quantitative study, standardized questionnaires or experiments are used to collect numeric data. “Quantitative research is conducted in a more structured environment that often allows for control over study variables, environment, and research questions. Quantitative research may be used to determine relationships between variables and outcomes” (Rutberg & Bouikidis, 2018). My research focus for this eight weeks is comparing two groups both with acute pain but one group would get narcotic medication while the other group would get non-narcotic medication.

Then both groups would be evaluated and assessed an hour after the medication was given. The scenario describes a quantitative research project. There is a control group and an experimental group. For this project, it could go either way meaning either the non-narcotic group or the narcotic group could be either the control or experimental group. Though the feelings and thoughts of individuals with acute pain are important to the research, because they will be rating their pain afterwards, there are ways to measure pain levels. Often times, patients report a pain scale of 10/10 and all vitals are WNL, they are relaxed and no guarding or grimacing are present. In this case, what the person is saying and the physical observations and data do not correlate. 

 Resources: 

Rutberg, S., & Bouikidis, C. D. (2018). Exploring the evidence. Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-213 

In examining the heart transplant population, we are looking at a relatively small percentage of the population.  For this reason, it would be difficult to proceed with significant quantitative research as the limited number of possible participants most likely does not allow for a large enough data set.  In general though, qualitative data seems to be a more appropriate type of research for the population.  

NR 505 Week 1: Identification of Area of Interest Discussion

Research for this population would include some demographic data, such as type of heart failure, age of onset, and race/ethnicity, but would have a great deal to do with the experiences of participants, such as their understanding of their disease and of the education they receive concerning the process before, during, and after transplant.  Research could also include the psychosocial aspects of the experience of the patients, which would be difficult to quantify in this type of population.  In my experience with the transplant population, a support system can impact transplant patients at every stage of the transplant process.  Though each patient’s process is incredibly personal and specific to them, there are generalized guidelines, results, and complications that occur relatively commonly and frequently, just as with all areas of medicine.  

This dialogue regarding healthcare disparities in rural areas is amazing! I too am from a rural area in Alabama.  It seems many of us are battling the same issues in our communities.  Many of our residents do not seek care until their issue is at a critical point.  Many do not have a primary care provider.  They use the emergency department for primary care.  Their visits usually resulted in an inpatient stay.  One of the things our facility did to combat the rate of readmissions and poor followup was the implementation of the IMPACT (Impacting Patients Across The Care Transition) Program. The program’s primary focus was on those individuals with CORE diagnoses eg. CHF, Afib, COPD etc.  However, as the admit nurse, I was also at liberty to include those individuals identified as high probability of readmission and/or poor hospital follow-up.

  I would perform education from admission through discharge.  At discharge, I would schedule a follow-up appointment within 48-72 hours of discharge.  And, I would follow-up via phone call within 24-48 hours of the discharge date.  I also provided my contact information for questions and concerns after discharge.  After implementing the IMPACT Program, our readmission rates decreased by 50% in six months time.  And, our patient compliance with discharge follow-up increased significantly. But, it required diligence on our part with discharge phone calls and assuring patients that we were available for questions and concerns even after discharge! Another, thing that really had an impact on our compliance was the inclusion of family in the patient’s care plan.  Some family members were unaware of the severity of their loved one’s health conditions. 

This week we begin our discussion by writing about our area of interest.  In NR500, I chose to focus on the issue of language barriers in healthcare.  My specialty track for my studies is of the Family Nurse 
Practitioner.  This area of interest is consistent with my selected program track because it involves patient care.  I feel I should keep this area of interest because it is one that I have had personal experience with both as a patient and as a nurse.  English was my second language growing up so I have known what it can be like not having the ability to communicate properly to others.  The importance of language barriers is a growing issue that can produce negative health outcomes for patients.  Failure to communicate properly the seriousness of risk can have negative consequences: patients may fail to comply with instructions or elect not to have potentially life-saving treatment. (Meuter, Gallois, Segalowitz, Ryder, & Hocking, 2015).  It is vital for healthcare workers and nursing leaders to be aware of this issue to provide adequate care for their patients.  As an FNP, I must be mindful of any language barrier that may be present and take steps to ensure the proper treatment and education has been given.  I think if I had to change my area of interest or research it may be directed towards the opioid epidemic in healthcare today.  This area is also another issue that I have had experiences with and it is an area that interests me greatly.  As an emergency room nurse, I get to treat many patients battling addiction and I enjoy this topic of care.  For the PICo question regarding this issue, I thought it best to ask a simple question regarding the effect of using a qualified interpreter in healthcare.  PICo question- “Does using a qualified language interpreter have a positive effect on patient satisfaction and healthcare outcomes for patients experiencing a language barrier?  I look forward to reading other ideas and areas of interest in class.

thank you

jazi

References

Meuter, R. K., Gallois, C., Segalowitz, N.S., Ryder, A.G., & Hocking, J. (2015). Overcoming language barriers in healtcare: A protocol investigating safe and effective communication when patients or clinicians use a second language. BMC Services Research, 15371. Doi:1186/s12913-015-1024-8