Practice Issue
What is the nursing practice issue you have identified related to the topic you have chosen?
The issue is associated with the effectiveness of caregiver-mediated practice for improving patient outcomes.
Fully describe the scope of the practice issue
The scope of the practice issue is concerned with caregivers’ capabilities to train their patients to improve their health outcomes and provide them with resources to perform exercises independently.
What is the practice area?
- Clinical
- Education
How was the practice issue identified?
- Safety/risk management concerns
- Unsatisfactory patient outcomes
- Significant financial concerns
- Clinical practice issue is a concern
Describe the rationale for your checked selections
The checked points are considered to be applicable to the systematic review because of a variety of reasons. For instance, inefficient recovery from stroke presents significant safety and risk management concerns because when patients do not receive the required support, their quality of life after stroke is expected to decrease (Huo, Hashim, Yong, Su, & Qu, 2016). Subsequently, the decreased quality of life leads to unsatisfactory patient outcomes and significant financial concerns for patients and healthcare facilities. Also, clinical practice issues were of concern for the researchers since procedures of caregiver-mediated exercises differ among practitioners from different clinical settings and even countries.
What evidence must be gathered?
- Literature search
- Guidelines
- Expert Opinion
- Patient Preferences
- Standards (Regulatory, professional, community)
Describe the rationale for your checked selections
All categories of evidence selected above must be gathered because all of them can guide the practice of caregivers in helping patients recover from a stroke. First, a literature search will reveal whether the identified intervention has been effective previously. Second, guidelines and regulatory standards will dictate the rules that professionals should follow when providing guided exercises to patients. Third, expert opinions will provide recommendations on how caregivers could provide quality care to patients recovering from a stroke. Fourth, patient preferences should also be considered during evaluations since their needs can vary depending on the level of their well-being as well as the expectations from practice.
Evidence Summary
Describe the practice problem in your own words with reference to the identified population, setting, and magnitude of the problem in measurable terms
The practice problem is associated with the burden of conducting exercises guided by a healthcare specialist for people who have experienced a stroke. This problem is significant because patients recovering from stroke want to improve the quality of their lives through gradual changes and enhancements that will not cause harm to their health that has been weakened by heart-related problems.
Identify the objectives of the article
Determining whether caregiver-mediated exercises could improve the outcomes of patients with stroke and identifying whether caregiver burden could influence such outcomes. Both long- and short-term effects of caregiver-mediated exercises were set to be evaluated with the help of the systematic review.
Provide a statement of the questions being addressed in the paper and how these relate to your practice issue
Can caregiver-mediated exercises improve “functional ability and health-related quality of life in people with stroke, and determine the effect on caregiver burden?” (Vloothuis et al., 2016, p. 7). The question relates to the practice issue because it aims to study the capabilities of health care professionals when providing appropriate support to patients whose health has been undermined by adverse health problems of a variety of types.
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes
The intervention relates to increasing the intensity of training for patients with a stroke under the governance of occupational or physical therapists.
Summarize the main findings by the authors of your systematic review, including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)
The researchers found that caregiver-mediated exercises could positively influence patients’ quality of life and standing balance as a result of the intervention (short-term results). With regards to the long times after the intervention, no significant effects of caregiver-mediated exercises were identified. Despite the fact that these findings do not show any strong evidence, it can be concluded that caregiver-mediated exercises could be a “promising form of therapeutic care to support the usual practice” (Vloothuis et al., 2016, p. 9). In the context of the PICO question, the long-term results of the study are especially important since future research has a timeline of three months. Therefore, the fact that the researchers found little evidence to support the use of caregiver-mediated exercises.
Outline evidence-based solutions that you will consider for your project
Since it was found that directly after the proposed intervention, patients showed significant improvements in their standing balance and quality of life, the solution of caregiver-mediated exercises can be viable for short-term practice. For a future project, it is worth considering the role that caregivers can play in helping patients recover from health conditions that have an adverse impact on the quality of life. Apart from recovering from a stroke, caregiver-mediated exercises can also be applied to patients who have experienced a car crash or have undergone a serious surgery; in addition, similar exercises can be used for assessing patients’ conditions for possible risks and likelihoods of readmissions, which is the focus of the project.
Discuss any limitations to the studies that you believe impact your ability to utilize the research in your project
The research was limited by insufficient evidence (data from less than ten trials) to prove whether caregiver-mediated exercises could improve the health outcomes of patients after stroke. The quality of evidence in the systematic review was low to moderate, which suggests that the findings should be considered with caution. With regards to bias, the researchers reported publication bias when it comes to the inclusion of relevant studies for review; for instance, the majority of studies used in the meta-analysis were targeted at upper extremity functioning, which downgraded the level of evidence. It is also important to mention that there were some potential biases in the process of review because, in some countries, caregiver-mediated exercises are more necessary than in others. Since the use of such therapeutic exercises varies in different countries, there also could be differences in the scope of practice among practitioners. These limitations are important to consider in a future project, especially when it comes to the quality of evidence for identifying how adult patients can be protected from risks for readmissions.
References
Huo, K., Hashim, S. I., Yong, K. L. Y., Su, H., & Qu, Q.-M. (2016). Impact and risk factors of post-stroke bone fracture. World Journal of Experimental Medicine, 6(1), 1-8.
Vloothuis, J., Mulder, M., Veerbeek, J., Konijnenbelt, M., Visser-Meily, J., Ket, J., … van Wegen, E. (2016). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database of Systematic Reviews, 12, 1-66.