Problem Statement
Patients with COPD are exposed to an array of threats even after the treatment process is completed (Cruz, Brooks, & Marques, 2014). Because of the nature of the disease, the propensity toward health problems such as flair-ups, and the subsequent need for another hospitalization, it is crucial to introduce the tools that allow monitoring the well-being of the target demographic even after they are released from a hospital (Hall, Champion, & Tori, 2016).
The specified approach is expected to help reduce the possibility of hospital readmission to a minimum (Cruz et al., 2014). Furthermore, the proposed solution to managing the needs of COPD patients is believed to contribute to a significant increase in the overall quality of their lives (Cruz et al., 2014). Therefore, the goal of this research project is to explore the opportunities for improving patient outcomes in the population with COPD by using the data collected by a home health nurse.
Evidence Supporting Proposal
There are strong reasons to believe that the use of the data supplied by a home health nurse as opposed to using the traditional transition procedures will allow for a significant rise in the quality of patient outcomes, in general, and a massive drop in the rates of patient readmission. According to the latest studies, a home health nurse is capable of identifying the threats that are unique to the environment in which a patient lives (Hall et al., 2016). As a result, opportunities for reducing the threat of recidivism among COPD patients and the subsequent readmission thereof to a hospital are reduced significantly.
Furthermore, the adoption of the specified approach opens a plethora of opportunities for patient education and the development of the ability to identify risks and avoid them accordingly among members of the target population (Hall et al., 2016). Bourbeau et al. (2016) assert that the adoption of the information management framework for meeting the needs of COPD patients that involves the use of a home nurse’s services gives patients a chance to develop “sustainable self-management skills and behaviors” (p. 1448).
The specified change in patients’ behaviors is likely to lead to the following promotion of active patient education, as well as the development of a stronger bond between nurses and COPD patients (Moriyama, Takeshita, Haruta, Hattori, & Ezenwaka, 2015). For instance, COPD patients will receive an opportunity to develop a better understanding of the nature of their disease, as well as the factors that trigger rapid deterioration of their health and aggravation of their condition (Moriyama et al., 2015).
An overview of the existing studies also indicates that the information provided by a home nurse when offering support to COPD patients who have been released from a hospital helps determine the factors that lead to an impressive increase in patients’ quality of life. The fact that the specified approach also implies a massive drop in hospital expenses should also be regarded as an important improvement. At this point, one must note that the issue of cost management within a hospital setting often implies addressing a complicated ethical dilemma. Particularly, the balance between meeting all patients’ needs to the best possible extent and the need to regulate the hospital’s financial processes by reducing expenses is very difficult to reach (Hall et al., 2016).
The use of a home nurse’s services, in turn, allows retaining a significant amount of financial resources by saving on the use of the hospital equipment, inventory, human resources, etc. (Hall et al., 2016). At the same time, the services of a home nurse allow keeping the overall quality of nursing assistance offered to the target population at the required high level (Hall et al., 2016). Thus, the proposed solution is likely to lead to a massive rise in the number of patient outcomes.
Review of Evidence-Based Research
Review # 1
Title: “Study protocol: improving the transition of care from a non-network hospital back to the patient’s medical home” (Ayele et al., 2017)
Is this a quantitative or qualitative research article?
The study uses a qualitative approach toward exploring opportunities for COPD patient’s transition.
What are the problem and purposes of the research article?
The article is aimed at determining the efficacy of the existing COPD patient transition techniques.
What are the hypotheses a research questions/objectives of the study?
The research suggests that using a transition coordinator allows enhancing the process.
What were instruments and/or other measurement strategies used in data collection?
Interviews and field notes were used to gather the information.
Was the information provided regarding the reliability and validity of the measurement instruments?
The authors provide support for the use of the chosen assessment technique.
What procedures are used for data collection?
Surveys and interviews were utilized.
Where they appropriate to the design and hypothesis?
Interviews served as the means of obtaining extensive information, while surveys helped specify it.
Review #2
Title: “An international randomized study of a home-based self-management program for severe COPD: The COMET” (Bourbeau et al., 2016)
Is this a quantitative or qualitative research article?
The article included a quantitative analysis of data.
What are the problem and purposes of the research article?
The effects of the “home-based multicomponent COPD self-management program” (Bourbeau et al., 2016, p. 1447) are explored.
What are the hypotheses a research questions/objectives of the study?
It is assumed that the COMET program will help improve COPD patients’ outcomes.
What were instruments and/or other measurement strategies used in data collection?
An electronic health data system is used to gather the data.
Was the information provided regarding the reliability and validity of the measurement instruments?
The authors prove that their study is reliable by choosing an appropriate design.
What procedures are used for data collection?
Analysis of electronic health records (EHR) is used.
Where they appropriate to the design and hypothesis?
Seeing that a quantitative analysis had to be carried out, the specified data can be deemed acceptable.
Review #3
Title: “Home telemonitoring in COPD: A systematic review of methodologies and patients’ adherence” (Cruz, Brooks, & Marques, 2014)
Is this a quantitative or qualitative research article?
The article is quantitative.
What are the problem and purposes of the research article?
The effect of outreach nurse’s services using home telephoning on COPD patients is studied.
What are the hypotheses a research questions/objectives of the study?
The article assumes that home telephoning can improve patient outcomes.
What were instruments and/or other measurement strategies used in data collection?
Telemonitoring methodology data was used in the research.
Was the information provided regarding the reliability and validity of the measurement instruments?
The information might have included subjective data.
What procedures are used for data collection?
Interviews via phone are used.
Where they appropriate to the design and hypothesis?
Since home monitoring is the focus of the research, the suggested tools seem legitimate.
Review #4
Title: “Effects of a 6‐month nurse‐led self‐management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy” (Moriyama et al., 21015)
Is this a quantitative or qualitative research article?
Since the outcomes of the study can be regarded as analytical, the design can be defined as quantitative.
What are the problem and purposes of the research article?
The authors strive to scrutinize the effects of a home-nurse-based intervention on COPD patients.
What are the hypotheses a research questions/objectives of the study?
The key research question is what outcomes the use of a home nurse’s services has on COPD patients.
What were instruments and/or other measurement strategies used in data collection?
Primarily phone interviews were used.
Was the information provided regarding the reliability and validity of the measurement instruments?
The data can be regarded as trustworthy, though some of it might be a bit subjective.
What procedures are used for data collection?
Face-to-face interviewers by phone are used in the study.
Where they appropriate to the design and hypothesis?
The data for the quantitative study was gathered mostly through interviews, which might not be the best way of receiving quantitative information.
Review #5
Title: “Home oxygen therapy assessment for COPD patients discharged from hospital: Respiratory NP Model of Care” (Hall, Champion, & Tori, 2016).
Is this a quantitative or qualitative research article?
The research is quantitative.
What are the problem and purposes of the research article?
The effects of outreach care programs are analyzed in the study.
What are the hypotheses a research questions/objectives of the study?
The authors claim that the use of outreach care programs allows for improving patient education and outcomes.
What were instruments and/or other measurement strategies used in data collection?
Outcome measures (e.g., mortality rates) were used.
Was the information provided regarding the reliability and validity of the measurement instruments?
The authors supported the use of the instrument as a time-tested one.
What procedures are used for data collection?
Patients’ records were analyzed.
Where they appropriate to the design and hypothesis?
The methods aligned with the quantitative nature of the study.
Review #6
Title: “A41 The Spectrum COPD care: From identification to policy: A Chronic Obstructive Pulmonary Disease (COPD) service integrating community and hospital services can improve patient care and reduce hospital stays” (Apps et al., 2016)
Is this a quantitative or qualitative research article?
The article is quantitative.
What are the problem and purposes of the research article?
The authors seek to introduce a policy aimed at meeting the needs of COPD patients.
What are the hypotheses a research questions/objectives of the study?
The authors seek to find out the combination of services that COPD outpatients require.
What were instruments and/or other measurement strategies used in data collection?
Audits were used to obtain the data.
Was the information provided regarding the reliability and validity of the measurement instruments?
Mukherjee et al. (20167) substantiate the use of measurement tools.
What procedures are used for data collection?
Mukherjee et al. (2016) utilized audits.
Where they appropriate to the design and hypothesis?
Seeing that audits allowed obtaining concise quantitative data, the tool aligns with the goals of the research.
Theoretical Framework for Evidence-Based Proposal
To study the effects of the identified strategy on the levels of well-being among COPD outpatients, one will have to utilize the Ideal Transition of Care (ITC) (Ayele et al., 2017). The specified approach allows locating ten crucial domains for assessing the changes in COPD patients’ well-being, as well as define the process of assessing the degree of risk to which they are exposed on a regular basis outside of the hospital environment (Apps et al., 2016). The provided framework serves as the tool for a smooth transfer of the target population from the hospital setting to their home environment (Hall et al., 2016).
It is also remarkable that the suggested approach helps implement a seamless transition of care from one setting to another. In other words, patients will not experience any discomfort, nor will they have to adjust to a rapidly changing environment after the transfer (Apps et al., 2016). Quite the contrary, the framework offers a smooth transition from a hospital to a patients’ home due to a careful analysis of the external and internal factors that may possibly hinder the recovery process or cause the development of recidivism in COPD patients (Hall et al., 2016).
The fact that the suggested approach also incorporates the principles of patient education, and the following self-management of needs aligns with the principles of the intervention based on the use of a home nurse’s services (Apps et al., 2016). The identified change is supported by the provision of extensive opportunities for contacting the hospital and nurses to receive appropriate services, should any arise, Furthermore, the focus on the consistent communication between a nurse and a patient and the use of the latest tools for keeping the dialogue unceasing need to be mentioned as the advantages of the ITC framework (Hall et al., 2016).
Project Proposal Guidelines
Seeing that two approaches toward managing the needs of COPD patients will have to be compared, it will be necessary to utilize a technique based on quantitative analysis. Particularly, the experimental setting of a randomized controlled trial should be deemed as the environment in which the study should be carried out. By splitting the participants into Group A (i.e., the one where the services of a home nurse will be offered) and Group B (i.e., a control group, where the traditional set of tools will be used to monitor patients’ well-being after being released from the hospital), one will be able to compare the outcomes successfully.
The student’s t-test will be utilized to determine changes in the levels of well-being in Group A and the control group. The resulting evidence will be viewed as the foundation for determining the effects of a strategy based on the services of a home nurse. To collect the data, one will have to consider using a survey. The questions will be aimed at determining the degree to which the exposure to external threats and the avoidance thereof is addressed by the strategies under analysis.
The sample will consist of 120 people. All of the participants will be recruited from a local healthcare organization. The inclusion criteria are the presence of COPD as the main diagnosis, age between 30 and 60, and a recent release from a hospital after a COPD-related intervention. The adoption of the convenience sampling technique may be viewed as a possibility of introducing bias into the research. Indeed, the specified tool may lead to certain underrepresenting members of the target demographic. Nevertheless, the outcomes of the analysis will point to the degree to which the strategy based on a home nurse’s services will affect the development of positive outcomes and the prevention of risks.
Projected Timeline
References
Apps, M., Mukherjee, D., Abbas, S., Minter, J., Whitfield, J., Field, S.,… Ateli, L. (2016). A41 the spectrum COPD care: From identification to policy: A Chronic Obstructive Pulmonary Disease (COPD) service integrating community and hospital services can improve patient care and reduce hospital stays. American Journal of Respiratory and Critical Care Medicine, 193, 1.
Ayele, R. A., Lawrence, E., McCreight, M., Fehling, K., Peterson, J., Glasgow, R. E.,… & Battaglia, C. (2017). Study protocol: improving the transition of care from a non-network hospital back to the patient’s medical home. BMC Health Services Research, 17(1), 123. Web.
Bourbeau, J., Casan, P., Tognella, S., Haidl, P., Texereau, J. B., & Kessler, R. (2016). An international randomized study of a home-based self-management program for severe COPD: The COMET. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1447-1451. Web.
Cruz, J., Brooks, D., & Marques, A. (2014). Home telemonitoring in COPD: A systematic review of methodologies and patients’ adherence. International Journal of Medical Informatics, 83(4), 249-263. Web.
Hall, T., Champion, R., & Tori, K. (2016). Home oxygen therapy assessment for COPD patients discharged from hospital: Respiratory NP Model of Care. Australian Journal of Advanced Nursing (Online), 33(4), 17-25.
Moriyama, M., Takeshita, Y., Haruta, Y., Hattori, N., & Ezenwaka, C. E. (2015). Effects of a 6‐month nurse‐led self‐management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy. Rehabilitation Nursing, 40(1), 40-51. Web.