The facility at which I am employed is located on a Native American Reservation in North Central Montana. There is a high rate of enrolled members who are diagnosed with diabetes, many of which are further classified as uncontrolled and have multiple complications. I work in the Diabetes Management Department as the Diabetes Educator, Diabetes Nurse, and the Diabetic Foot Care Specialist. The patient safety problem that I have identified involves an increase in the number of patients diagnosed with diabetes who were presenting to the clinic with different types of chief complaints related to their feet. Some of those diagnoses included in-growing toenails, onychomycosis, macerations, ulcerations, fissures, corns, and callosities. Many of those patients also had musculoskeletal diagnoses such as hammertoe, claw toe, early-stage Charcot Foot, prominent metatarsal heads, and Taylor’s bunions. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
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The Research and The Potential Cause
Indian Health Services (IHS) (2020) state as many as 10 – 20% of native American patients diagnosed with diabetes who attend a scheduled diabetes exam will have an acute problem related to foot care such as infection, toenail overgrowth, and callosities that needs immediate treatment. The authors continue to state that it is essential to inspect the feet of the diabetic patient at each exam visit because there may also be other factors that increase the risk of injuries such as peripheral arterial disease and sensory neuropathy (IHS, 2020).
Using the Electronic Health Record system, a report was generated to determine which patients diagnosed with any form of diabetes were due for an annual foot exam (had not had a documented foot exam in the past eleven months) and which of those patients also had a full diabetes examination scheduled. In 2018, 35% of the diabetic population of the reservation had a complex foot examination completed. In 2019, only 19% of the diabetic population had a diabetic foot exam documented. After careful review and comparison, it was noted that the patients who attended the scheduled full diabetes examinations were not always receiving the annual foot examination from the nurses or the providers. The nurses should have been removing the shoes of those patients with diabetes and performing a foot exam with 10-g monofilament plus one other sensory test, such as vibratory perception with a tuning fork. This exam was not being completed and was leading to poor outcomes.
More Research
Realizing that this facility cannot be the first facility to experience this challenge, further research was conducted to determine what evidence-based practice guidelines might have been established recently through studies that proved effective in increasing the number of diabetic foot exams. Vanderbilt University Medical Center conducted a study to improve foot exam completions by implementing posters for rooms and developing a template for charting that proved successful (Agency for Healthcare and Research Quality, 2014). The Centers for Disease Control and Prevention (CDC) (2017) reports that in 2016 over 82% of adults who are also diagnosed with diabetes in Montana have had an annual foot exam completed.
Change in Practice
The importance of annual foot exams for patients diagnosed with diabetes and the gathered data was shared with the appropriate leaders at the facility. After two weeks of collaboration, a few steps were implemented to help ensure the patients were educated, the nurses were trained and supported, and the patient outcomes were improved. Some of the critical elements of change included the following: NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem
- A Diabetic Foot Exam Template was developed to help facilitate accurate and efficient documenting
- Each of the nurses in the clinic participated in education related to foot exams and are provided additional education quarterly to help them learn about what may be abnormal and interventions to take.
- Each exam room is stocked with 10-g monofilament (sensory testing) and a tuning fork (for vibratory perception testing)
- Each exam room and every nursing station has a graphic hanging that shows how to perform the sensory testing.
- Each of the 22 exam rooms has a sign hung that states, “Do You Have Diabetes? We would LOVE to see your feet” Please make sure your nurse takes off your shoes!”
- The Foot Care Nurse reviews upcoming appointments and orchestrates daily huddles with providers and nurses
Impact on Patient Outcomes
To date, the changes implemented have been positive, not only for the patient outcomes but also for nurse-provider communications. At this point, I have not run updated reports to get exact numbers but have noticed differences in patient care as well as responses from patients during patient interactions. The impacts on patients and processes are as follows:
- Fewer patients are presenting to Urgent Care for chief complaint related to their feet, i.e., “sore on the toe,” “infected in-grown.”
- Increased number of patients scheduling appointments for routine foot care
- Increased number of patients receiving Annual foot exam from nurse or provider during an office visit.
- Nurses and providers are calling Foot Care Nurse more often with questions, for specific patient education, to schedule appointments for patients while they are with the patient.
The Research Question and Why
How often do nurses perform foot exams on patients diagnosed with diabetes at Rocky Boy Health Center?
To answer this question and to increase the number of foot exams performed, a quantitative methodology will be used. There is a distinct correlation in the variables; the nurse and the patient diagnosed with diabetes and foot exams. The information is easily gathered from the facility’s database. The data has been collected and compared to state and national indicators. Research has been conducted and evidence-based guidelines reviewed concerning improving nurse compliance with conducting foot exams. New processes have been established at the facility, and patient outcomes are improving. Continued monitoring and measuring are needed before I can say with certainty that these new implementations have been a real success.
References
Agency for Healthcare and Research Quality (2014). Toolkit for implementing the chronic care
model in an academic environment: Diabetes foot exam. Retrieved July 13, 2020 from <https://www.ahrq.gov/prevention/curriculum/chroniccaremodel/chronic3a3.html
Centers for Disease Control and Prevention, 2017. U.S. Diabetes surveillance system: Foot
exams by state. Retrieved July 13, 2020 from <https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
Indian Health Services (2020). Foot care: Diabetes standards of care & clinical practice
resources. Retrieved 12 July 2020, from https://www.ihs.gov/diabetes/clinician-resources/soc/foot-care1/
Discussion: Choosing the Type of Research for a Research Problem
How do you choose the type of research to conduct to address a research problem? What information should you keep in mind to ensure that your research process will adequately address your research problem?
Understanding the different types of research is a critical skill for the nurse researcher and nursing professional. As a current nursing professional, consider how understanding the different types of research may be conducive to achieving a particular mission in your health care setting, such as developing an intervention to address a quality or patient safety problem. This knowledge can also be a step toward assuming a nursing leadership position. As a critical component of your nursing toolkit, differentiating between the types of research is a fundamental step toward enacting change through the process of research. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
For this Discussion, please review the following:
- Think about clinical practice problems you have seen in health care that compromise patient safety and health outcomes. For example, nursing-sensitive indicators reflect high-priority practice problems, which are described in the article by Martinez, Battaglia, Start, Mastal, and Matlock (2015).
- Choose one of the clinical practice problems you have seen in your current or past job in a health care setting. Consider the possible causes of this problem and how you think it is, or was, affecting patient outcomes.
- Some patient safety problems are solved by making changes in clinical practice. For example, decreasing catheter-associated urinary tract infections in hospitalized patients often requires changes in clinical practice such as better adherence to preventive measures when catheters are inserted (e.g., use of disposable gloves, maintaining sterile fields, cleansing urethral meatus). For the problem you identified, what specific change in practice do you think is needed?
- When a practice change is implemented, it is important to verify whether or not the change has improved patient outcomes. One way to determine this is by conducting research. One of the first steps in the research process involves developing a research question that will later serve as the foundation for your study. Using information from Chapter 5 in your textbook and the handout on developing research questions, think about a research question and about the effectiveness of the practice change you proposed in improving patient outcomes.
- Another step in the research process involves identifying which type of research could be conducted to best answer your research question. In Chapter 5 of your textbook you will find a list of different types of research in the first column in Table 5-2, and Table 5-3. You can learn more about these different types of research in both Chapter 2 and the Glossary in your textbook. To locate even more information, you can also use an Internet search engine for more in-depth descriptions and examples. After learning more about the different types of research, think about which one you think is best for determining how well the clinical practice change you identified will improve patient outcomes. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
By Day 3
Post a description of how you would address the following:
Part 1: Patient Safety Problem
Describe the patient safety problem you identified, its causes, and the impact you think it has on patient outcomes. For this problem, describe a specific change in practice that could help improve patient outcomes.
Part 2: Research on Patient Safety Problem
Develop a research question that tests the effectiveness of your practice change in the improvement of one or more patient outcomes. What type of research would you use to answer this question? Describe the reasons why you think this is the best approach and why you would not use the other three types of research.
Note: Post a three paragraph (at least 350 words) response. Be sure to use evidence, in-text citations, and essay-level writing skills, including the use of transitional material and organizational frames. Use the writing resources to develop your post.
By Day 7
Read two or more of your colleagues’ postings from the Discussion question.
Respond to two or more of your colleagues with a comment that asks for clarification, provides support for, or contributes additional information. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
Post a Discussion entry on 3 different days of the week. See the Rubric for more information.
Does an increase in nursing knowledge regarding correct blood transfusion techniques improve patient outcomes?
Utilizing blood and blood parts is a standard restorative methodology in emergency clinics. Medical caretakers have an essential job in a sheltered blood transfusion. Hence, medical caretakers must have adequate information on circumstances, sum, and techniques for utilizing blood parts, conceivable symptoms, and vital consideration. Blood is valuable, particularly in sparing the lives of patients. Blood segments are costly, and their planning is restricted. In this way, they ought to be expertly chosen and utilized for patients by all means. The point of blood and blood segments transfusion in clinical medicines is to give reasonable and safe blood items to accomplish the best clinical results (KAREN K. GIULIANO & JANE HENDRICKS, 2017).
Notwithstanding its first job in sparing lives, blood transfusion is related with dangers. Committing errors in blood transfusion and lacking control of patients who get blood during the transfusion are among the reasons for death for such patients. Since there is no subbing item for human blood, the requirement for blood transfusion is proceeding. Over half of patients hospitalized in acute consideration units and a half to 70% of patients in particular and orthopedic wards need a blood transfusion. (KAREN K. GIULIANO & JANE HENDRICKS, 2017). NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
Yearly reports in Britain show serious dangers of blood transfusion, for example, disregard in the distinguishing proof of blood classification and its parts, wrong ID of patients, and disregard in controlling patients during transfusion as essential drivers of mix-ups. In this manner, thinking about the strict requirement for blood and blood segments, alongside restricted sources and constrained chance of setting up each blood item. It is significant to attempt by all ways to expand the information on the clinical workforce and giving the necessary instruction to diminish the utilization of complete blood and to utilize only the segments vital for patients’ wellbeing to lessen blood waste and transfusion confusion. Studies indicated that medical caretakers and nursing understudies do not have adequate data and right execution appropriate to the significance of the issue. Medical caretakers misplay a colossal job, logical and safe use of blood and its segments. If they can do it effectively, the likelihood of the frequency of blood transfusion dangers will decrease to a base. The progressions in innovation have made a situation that makes persistent consideration progressively productive and accommodating for the patient.The adjustments in preparing, human services setting, developing duties, nursing society, and patient consideration have spared countless lives and helped it become the regarded field that it is today (KAREN K. GIULIANO & JANE HENDRICKS, 2017).
References
KAREN K. GIULIANO, P. R., & JANE HENDRICKS, B. R. (2017). Current Nursing Knowledge. Inadvertent Perioperative, 1-12.
The Problem
I work in a busy emergency department at a regional medical center in rural Mississippi. I’ve noticed throughout working here that we seem to have a lot of patients returning to the ER with the same complaint as previous visits. Many times, this is because the patient did not adhere to the prescribed medications at discharge. The problem I want to focus on lies in the number of recently discharged patients that return to the ER with the same complaint who did not get their prescriptions filled versus those who utilized hospital-based Med-to-Bed services. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.
Change in Practice
Currently, a patient is asked during triage what pharmacy they use. This is an excellent opportunity to offer Med-to-Bed services to patients. By making the patient aware of the service early, the pharmacy tech (already housed in the ER) can meet with the patient and get their insurance verification (if any) complete, so when the provider has a disposition and medication prescriptions, it will be a quicker process to get the medications in the hands of the patient before discharge.
The Research Question
Do patients that utilize hospital-based Med-to-Bed services have fewer return visits to the ER for the same complaint?
I believe this question falls into quasi-experimental research and experimental research (Gray, J., Grove, S., Sutherland, S. 2016, p. 87) because it studies single aspects of the cause and effect relationships between medication adherence and return visits. Working in coordination with the pharmacy, I could track current Med-2-Bed utilization versus total ER visits. I will work with my ER director to have the Med-2-Bed education given at triage and see if the number of service utilization increases over three months. I can have an additional report ran to see if there is a decrease in ER revisits for the same complaint. I read about one such study that showed a reduction in 30-day hospital readmissions from 10.3% to 8.7% and a decrease in ER revisits from 18.2% to 11.9% (Conliffe et al., 2019).
References
Conliffe, B., VanOpdorp, J., Weant, K., VanArsdale, V., Wiedmar, J., & Morgan, J. (2019). Impact of an advanced pharmacy practice experience student-run “Meds 2 beds” and discarge counseling program on quality of care.. Hospital Parmacyp, 54(5), 314–322.
R., G. J., Grove Phd Rn Anp-bc Gnp-bc, Susan K., & Suzanne, S. (2016). Burns and grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence(8th ed.). Saunders. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem