Introduction
Among the chosen population of patients aged 50 or older, one of the most widespread problems is the high amount of readmissions due to insufficient risk assessment before discharge. In the previous paper, the issue was identified as follows: how can patient outcomes be improved with the employment of caregiver-mediated practice? This paper aims to develop a nursing-focused plan, comprising the use of the ACE Star model, collecting and summarizing evidence from scholarly literature and practice guidelines, and translating these findings into an action plan.
Change Model Overview
First of all, it is essential to overview the ACE Star model, which is used to synthesize the knowledge employed in various aspects of evidence-based practice (EBP) processes (Fisher, Cusack, Cox, Feigenbaum, & Wallen, 2016). It is apparent that a method that is based on evidence and research can be significantly more efficient; however, its implementation is still insufficient because nurses “often rely on tradition or intuitive processes as a rationale for interventions” (Fisher et al., 2016, p. 1). ACE Star model represents a framework for the inclusion of evidence into practice, which is implemented through five primary stages: “knowledge discovery, evidence summary, translation into practice recommendations, integration into practice, and evaluation” (“ACE Star model of knowledge transformation,” 2018, para. 2).
Define the Scope of the EBP
Regarding the practice issue, it should be observed that patients aged 50 and older often fail to improve their quality of life due to insufficient caregiver-mediated training after the stroke. It is a considerable problem because further readmissions impose additional expenses for the clinical facilities regarding financial and human resources. Also, elderly stroke patients are subjects to higher bone fracture risk, having “a 2 to 4-fold increased risk of hip fractures” (Huo, Hashim, Yong, Su, & Qu, 2016, p. 2). These facts constitute the scope of the problem, which is the capability of caregivers to improve the health outcomes of their patients.
Stakeholders
Further, it is essential to determine principal stakeholders of the evidence-based practice in the clinical practice area. Since I am in the position of the project’s leader, it is appropriate that my role would be a stroke care coordinator (Asplund, Sukhova, Wester, & Stegmayr, 2015). Other stakeholders have to take subordinate positions. It is important to appoint an assistant coordinator, who would share a part of the coordinator’s responsibilities. The rest of the team comprises three or four advanced practice nurses and a pharmacist.
Determine Responsibility of Team Members
The distribution of responsibilities between the members of the project team has to be discussed. First of all, the coordinator’s role requires the overall control and assessment of the practice’s outcomes. To reduce the number of routine operations in the scope of the team’s leader, an assistant coordinator will perform them. Nurses will be in charge of direct caregiving and training processes with patients. A pharmacist will be responsible for the appropriate counseling in the questions of medication reconciliation and adherence (Condon, Lycan, Duncan, & Bushnell, 2016).
Evidence
The Evidence Summary from the previous paper includes two articles: the research by Vloothuis et al. (2016), and the analysis by Huo et al. (2016). After conducting the external search for evidence, the three additional studies were identified. The articles by Asplund et al. (2015) and Condon et al. (2016) represent profound evidence-based research, and the article by Fisher et al. (2016) can be considered the quality improvement data. The strength of this literature research lies in the inclusion of various peer-reviewed materials, which have significant implementations for practice.
Summarize the Evidence
One of the key interventions which were identified in the Evidence Summary is to provide intensive training guidance for stroke patients by nurse practitioners (Vloothuis et al., 2016). Also, as it is stated by Huo et al. (2016), “the post-treatment effect of bone loss is prevented by adding an antiresorptive drug after stopping teriparatide” (p. 6). It is evident from the research by Asplund et al. (2015) that community hospitals have fewer barriers to organize efficient stroke care units. Condon et al. (2016) state that nurse practitioner-led stroke care significantly decreases the number of readmissions in the long run. Finally, Fisher et al. (2016) observe the importance of the inclusion of evidence into practice processes.
Develop Recommendations for Change Based on Evidence
In general, it should be stated that the conducted literature research allows proposing several recommendations for practice. Nurses are advised to improve their quality of training since it has a significant impact on health outcomes. The following section will propose a plan for more details.
Translation
Action Plan
Since it is important to assess the efficiency of the stroke care unit in the long-term, the timeline for the project implementation is set to a minimum of three months. Within this time scope, it is planned to implement the following steps: (1) to develop sustainable, evidence-based competencies of patient training among nurses, (2) to employ caregiver-mediated exercises, and (3) to provide discharged patients with follow-up calls (Fisher et al., 2016; Vloothuis et al., 2016; Condon et al., 2016).
Process, Outcomes Evaluation, and Reporting
The principal desired outcome is the reduction of patients’ readmissions. Additionally, the development of evidence-based practice skills among nurse practitioners is another goal. The first goal will be measured by the comparison of registered readmissions in the chosen time scope, and the improvement of EBP competencies could be measured by self-assessment questionnaires and interviews. The coordinator will collect the required information into one report that will be presented to the key stakeholders by the end of the project implementation period.
Identify Next Steps
It is possible to observe that the positive results of the project implementation would indicate the opportunity to implement it on a larger scale. For example, it is evident that the approach under discussion is also applicable to patients who undergone serious surgeries or survived a car crash. For the implementation to become permanent, it is essential to sustain the change and implement competency-based education (Fisher et al., 2016).
Disseminate Findings
As it was already mentioned, to communicate the research findings within the organization, a report should be composed, and it is also possible to hold a meeting with the stakeholders. To inform those who might be concerned, it is appropriate to convert the research in the form of a scholarly article. Additionally, a lecture on a thematic conference is suitable.
Conclusion
The key aspects of the problem are the patients’ insufficient knowledge of post-discharge care guidelines and the lack of follow-up. Based on the evidence from the scholarly literature, the following solution could be proposed: to increase the intensity of training for patients with a stroke under the guidance of health practitioners (Vloothuis et al., 2016). The ACE Star model’s five stages were implemented to develop a comprehensive change proposal: discovery research and evidence summary stages were discussed in the previous study, and this paper translated evidence summary to guidelines and integrated practice, which are enhanced by the identified means of outcomes measuring.
References
ACE Star model of knowledge transformation. (2018). Web.
Asplund, K., Sukhova, M., Wester, P., & Stegmayr, B. (2015). Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals. Stroke, 46(3), 806-812.
Condon, C., Lycan, S., Duncan, P., & Bushnell, C. (2016). Reducing readmissions after stroke with a structured nurse practitioner/registered nurse transitional stroke program.
Fisher, C., Cusack, G., Cox, K., Feigenbaum, K., & Wallen, G. R. (2016). Developing competency to sustain evidence-based practice.
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.