Developing an Evaluation Plan
This section discusses how the proposed solution (education and follow-up) will be monitored and evaluated to assess its effectiveness in reducing congestive heart failure (CHF) readmission rates in geriatric patients. The section will also detail the variables that will be assessed when evaluating project outcomes.
Available literature demonstrates that “each aim of a project requires a metric that will determine if it has been attained” (Hain & Kear, 2015, p. 19). Owing to the fact the main aim of the proposed solution is to reduce CHF readmission rates in geriatric patients through education and follow-up, it is important to develop an evaluation plan with capacity to quantitatively measure the project’s outcome variables and assess how they are being met (Saunders, 2015). Additionally, since the main outcome is the reduction of CHF readmission rates, there must be prior data of readmission rates in geriatric patients to provide an enabling framework for comparison with post-intervention data.
Based on these observations, prior patient admission, discharge and readmission information will form the baseline data that will then be compared with post-intervention readmission data to identify any changes in CHF readmission rates within 90 days of discharge. A post-intervention reduction in CHF readmission rates will be viewed as a direct result of the solution to educate geriatric patients on CHF self-care and enhance their efficacy through focused post-discharge follow-up sessions. To reinforce these findings, a post-intervention survey will be conducted with selected patients to assess how the implemented solution has been able to influence their attitudes and perceptions regarding CHF self-care and management.
Many nurses in acute care settings develop negative attitudes related to their work due to heavy workloads and dissatisfaction with existing organizational and patient issues. Indeed, it is evident that high patient readmission rates may trigger job dissatisfaction in nurses and increase the turnover rate (Bayati et al., 2014). Similarly, research is consistent that inadequate staffing and low job satisfaction can obstruct nurses’ efforts to undertake the processes of care needed to reduce the rate of hospital readmissions (McHugh, Berez, & Small, 2013). A secondary aim of the proposed solution, therefore, is to reduce job dissatisfaction and turnover by ensuring that patients are empowered to take care of themselves through CHF education and follow-up.
To evaluate the effectiveness of the proposed solution in developing positive staff attitudes and increasing job satisfaction, a baseline survey will be undertaken prior to the implementation of the intervention to collect data on staff attitudes and contributors to job satisfaction and dissatisfaction in acute care settings. A post-intervention survey will then be undertaken using standardized questionnaires and the resulting data compared with the baseline data to identify any changes in staff attitudes and job satisfaction that could be attributed to the implemented intervention (Saunders, 2015). Here, it is important to use standardized questionnaires to ensure the instruments “are valid (actually measure what each is supposed to measure) and reliable (consistently measure every time)” (Hain & Kear, 2015, p. 19). Surveys are documented as effective evaluation tools for evidence-based projects due to their ease of administration and capacity to yield objective statistical data that can be quantitatively analyzed to determine the effectiveness of the implemented solution (Hain & Kear, 2015).
Lastly, to evaluate the effectiveness of the proposed intervention in reducing staff turnover, a human resource audit will be undertaken prior to implementing the solution to identify trends in nursing turnover in the last 12 months. The data will be compared to post-intervention human resource audits (six months and 12 months after intervention) to identify any changes in nurse turnover trends (Saunders, 2015). A post-intervention reduction in nurse turnover will be interpreted to imply that the proposed solution is effective in meeting its intended objective of reducing turnover. The justification for using human resource audits as an evaluation tool is nested in the fact that they are less costly and easy to use in filtering objective outcome data from the records (Hakkennes & Green, 2006).
Available literature underscores the importance of undertaking a proper identification of variables and exploring their interrelationships in realizing the aims and objectives of an evidence-based nursing project (Hain & Kear, 2015). Drawing from the exploration of the evaluation plan, it can be deduced that the variables that will be tested and measured (dependent variables) when evaluating project outcomes include CHF readmission rates, staff attitudes and satisfaction, staff turnover, as well as patient attitudes and perceptions. The variables that will be changed or controlled (independent variables) during the implementation of the intervention include CHF education and follow-up sessions. It is important to mention that the intended project outcomes include (1) reduction of CHF readmission rates, (2) reduction in nurse turnover, (3) development of positive staff attitudes and increased job satisfaction, and (4) realization of positive patient attitudes and perceptions regarding CHF self-care and management. Although the key variable is CHF readmission rates based on its importance in assessing whether the implemented solution has been effective in reducing patient readmission, the other variables are important in demonstrating how the solution is performing in addressing attitudinal and perceptual issues that may either aggravate or solve the problem.
Overall, this section has not only discussed the methods that will be used to evaluate the effectiveness of the proposed intervention (CHF education and follow-up), but also provided an elaborate description of independent and dependent variables that will be assessed when evaluating project outcomes. The section has also provided some justifications for using the identified methods and techniques.
Disseminating Evidence
Multicomponent strategies including informal journal clubs, seminars, open forums, and conferences will be used to disseminate evidence with the view to sharing the lessons learnt and ensuring that the intervention is replicated or applied in other clinical settings. The main knowledge delivery modes that will be used to disseminate evidence to relevant stakeholders and the larger nursing community are PowerPoint presentations and posters. After the evaluation process is completed, the project leader will arrange for interdisciplinary journal club sessions, seminars, open forums and conferences to present the findings of the project and discuss recommendations and other issues of interest arising from the implementation process. It is important to note that the main components that will disseminated in these sessions include project purpose, implementation methods, results, implications or recommendations for practice, and significance to efforts aimed at reducing CHF readmission rates in elderly patients (Melnyk & Fine-Overholt, 2015).
The selected strategies have the capacity to not only increase reach to a variety of interest groups and audiences, but also to enhance the motivation of nursing professionals to use and apply the evidence in clinical settings (Forsyth, Wright, Scherb, & Gasper, 2010). The selected modes of knowledge sharing and communication (PowerPoint presentations and posters) are easy to use, concise, and demonstrate capacity to not only summarize and translate the evidence into clearly understandable content for clinical application, but also to show how the evidence and arising recommendations could be integrated into actual practice (Forsyth et al., 2015). Additionally, these dissemination modes provide the project leader with an opportunity to share in-depth, individualized information about the project because the audience can ask questions and seek clarifications. Overall, it is clear that these dissemination strategies and modes will be effective in ensuring that the evidence arising from the project is shared with stakeholders and the broader nursing community.
References
Bayati, M., Braverman, M., Gillam, M., Mack, K.M., Ruiz, G., Smith, M.S., & Horvitz, E. (2014). Data-driven decision for reducing readmissions for heart failure: General methodology and case study. PLoS ONE, 9(10), 1-9. Web.
Forsyth, D.M., Wright, T.L., Scherb, C.A., & Gasper, P.M. (2010). Disseminating evidence-based practice projects: Poster design and evaluation. Clinical Scholars Review, 3(1), 14-21.
Hain, D.J., & Kear, T.M. (2015). Using evidence-based practice to move beyond doing things the way we have always done them. Nephrology Nursing Journal, 42(1), 11-21. Web.
Hakkennes, S., & Green, S. (2006). Measures for accessing practice change in medical practitioners. Implementation Science, 1(29), 1-11.
McHugh, M.D., Berez, J., & Small, D.S. (2013). Hospitals with higher nurse staffing had lower odds of readmission penalties than hospitals with lower staffing. Health Affairs, 32, 1740-1747.
Melnyk, B.M., & Fine-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Saunders, H. (2015). Translating knowledge into best practice care bundles: A pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice. Journal of Clinical Practice, 24, 2035-2051.