NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Name

Capella university

NURS-FPX 6030 MSN Practicum and Capstone

Prof. Name

Date

Problem Statement (PICOT)

The transition of care for women during the post-partum period after pre-term birth is a critical aspect of maternal and neonatal healthcare. In these crucial times, proper management of hospital resources is mandated to ensure the well-being of both mothers and pre-term infants. Without appropriate and strategic management of limited hospital resources, chances are to experience negative implications for mothers, infants, and hospital organizations. Nurse-led programs on care transitions are instrumental in educating and supporting mothers in managing the unique needs of pre-term infants Green et al., (2020).

Therefore, this assessment delves to address this PICOT question as a problem statement: In pregnant women with a history of preterm birth (Population), how does strategic management of a nurse-led transitional care program during the postpartum period (Intervention), as compared to standard management practices in routine care (Comparison), influence the efficiency of hospital resource management (Outcome) within a 12-month follow-up period (Time)? With the help of this PICOT question, the last step is to develop an intervention to manage the hospital resources efficiently through nurse-led care transition programs for the subject under the PICOT study.

Need Assessment

The project aims to address the need for implementing nurse-led transitional care programs during the post-partum period, specifically after preterm birth, to improve efficiency in hospital resource management. Addressing this concern is essential as efficient hospital resource management is necessary for providing high-quality healthcare services. Without comprehensive transitional care, there is a risk of increased hospital readmission rates, resulting in the reutilization of resources for unplanned hospital visits and additional strain on healthcare facilities (Weber et al., 2020).

Moreover, standard care practices do not address the emotional and mental health of mothers who have experienced preterm birth. This widened gap in maternal mental health support can contribute to increased stress and anxiety (Mutua et al., 2020). The mothers, after giving birth to pre-term babies, require discharge training, and approximately 20% of extremely preterm infants require specialized care at home (Molina et al., 2019).

This calls for effective care transitions led by nurses to ensure the mothers acquire adequate knowledge of premature infant care at home and prevent frequent hospital readmission rates. With a practical transition care approach, such as nurse-led transitional care programs, the patient’s medical, psychosocial, and overall health needs can be appropriately addressed (Liss et al., 2019). The assumption on which this analysis is based is that nurse-led care transitions guide the mothers on their self-care management along with infant healthcare needs. The educational care transition by nurses can improve the quality of care for mothers and infants and potentially reduce hospital readmission rates. Moreover, nurse-led care transition programs can allocate hospitals’ valuable resources efficiently as they know what to do and how to educate patients according to their health needs (Mileski et al., 2020). 

Population and Setting

The target population for this quality improvement project includes women who have experienced preterm birth and their preterm infants during the post-partum period. It is imperative to address the identified need within this population for several factors. Pre-term infants are the ones who are vulnerable and require specialized care due to their underdeveloped physiological systems (Molina et al., 2019). By transitioning to strategic care during the post-partum period, nurse-led programs can ensure optimal health outcomes for these infants, including their growth and development, and preventing complications.

On the other hand, the mothers who have given birth to pre-term babies undergo physical and emotional challenges. This requires adequate post-partum care to monitor and address their specific health concerns, such as postpartum complications and mental health support (Ma et al., 2021). This project targets hospital settings where pregnant mothers give birth to pre-term infants. Addressing the identified need within this setting ensures that infants receive appropriate and timely care with nurse-led care transition programs in the Neonatal Intensive Care Unit (NICU). Moreover, healthcare resources can be better allocated and utilized by addressing this concern in the hospital setting (Mileski et al., 2020). 

Quality Improvement Method

Plan, Do, Study, and Act (PDSA) is the quality improvement method selected to address this need to improve hospital resource management by the nurse-led care transition programs. In this method, nurse-led care transitions will be planned for women who have experienced preterm birth in hospitals. The planning will include delegating roles and responsibilities of nursing staff involved in this process and establishing protocols for maintaining interprofessional communication and collaboration (Htay et al., 2021). The next step will include implementing this plan on a pilot basis, such as for a few patients or units. Moreover, the nurses will be trained to perform care transition procedures by strictly adhering to these protocols (Brummett, 2021).

The implementation will be closely monitored to identify challenges and issues. In the next phase of the ‘Study,’ the data will be analyzed to assess the impact of this program on healthcare resource efficiency by monitoring hospital readmission rates, patient satisfaction rates, and other methods, such as soliciting feedback from healthcare professionals and mothers of infants. Based on these findings, adjustments are made, and the program can be scaled up to expansion. This method for quality improvement can help optimize healthcare resources by seeking evidence from reduced length of hospital stays and efficient use of healthcare resources within the hospital (Swanson et al., 2022). 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

The potential challenges that are identified while working on the need to manage hospital resources efficiently while providing nurse-led care transition to the target population include resistance to change due to established routine care practices, poor interprofessional collaboration and communication, lack of adequate patient engagement due to cultural differences or emotional stress and logistical challenges for collecting accurate data (Torrens et al., 2020).

Intervention Overview

The implementation of the nurse-led care transition programs can be successful by adopting specific interventions that fit best to the target population of mothers post-partum after giving birth to infants in the hospital. The intervention includes nurse-led care transition programs for post-partum support. By conducting nurse-led transitional care workshops or programs, nurses can be well-trained to perform care transition processes in post-partum care and to communicate effectively with other healthcare professionals such as gynecologists, pediatricians, pharmacists, etc. (Rush et al., 2019). These programs must focus on these practices to promote efficient use of healthcare resources in care for pre-term infants and their mothers in the post-partum period. This approach is well-suited for the target population within the healthcare setup as it provides hands-on experience for nurses to work with the target population.

Moreover, it addresses the need for efficient use of healthcare resources by delivering sufficient knowledge to mothers with pre-term infants postpartum. The weaknesses identified in the intervention are the appropriate need for resources to organize workshops on addressing identified needs, ongoing reinforcement, and support leading to risk of confidentiality breaches of protected health information (Torrens et al., 2020).

Comparison of Approaches

The interprofessional alternative to address the project’s need is interprofessional team training and collaboration involved in providing care for mothers in their post-partum after giving birth to pre-term infants. Training and collaborative meetings will be held in this approach to promote effective post-partum care to mothers and timely interventions for preterm infants. These meetings will teach teamwork, shared meetings, and care coordination in their deeper roots, ultimately addressing the need to improve healthcare organizational resources (Walker et al., 2019). However, this approach requires dedicated time for training sessions, potentially impacting regular clinical schedules. Healthcare professionals can face challenges in time management due to complex working schedules and can miss meetings. Moreover, the team members can resist changed workflows, necessitating effective change management strategies (Torrens et al., 2020).

Initial Outcome Draft

The primary outcome of the suggested quality improvement project is to facilitate the efficiency of hospital resource management by implementing nurse-led care transition programs. This outcome will optimize available hospital resources by effectively using them, preventing the waste of limited resources and avoiding over-use due to unnecessary hospital stays. Ultimately, the resources can be allocated effectively to meet the specific needs of patients, including the mothers in post-partum and their preterm infants (Bartsch et al., 2020).

Moreover, with reduced hospital readmission rates and unnecessary resource utilization, hospitals can achieve financial efficiencies while maintaining high-quality care through nurse-led care transition programs. The criteria to evaluate the successful accomplishment of this outcome include analyzing dashboard metrics such as hospital readmission rates, patient surveys of the target population on satisfaction, financial stability or efficiencies’ estimation, and improved quality of care to all patients through effective resource allocation (Bartsch et al., 2020).

Time Estimate

The rough time frame for developing and implementing the proposed intervention, i.e., a nurse-led care transition program via workshops, will be 10 to 12 months. This timeline will be divided into a development phase of 3-6 months, a pilot testing phase (6-9 months), refinement (3-6 months), and scaling up (9-12 months). In the development phase, a literature review on nurse-led transition care programs will be performed, and evidence-based practices will be identified to ensure efficient resource utilization.

This will be followed by implementation and data analysis in the next three months of pilot testing. Here, the program’s feasibility, acceptability, and influence on resource efficiency will be estimated. In the refinement phase of three months, pilot study data will be analyzed to gather feedback from healthcare professionals, mothers, and related families. Moreover, the project will be refined for future improvement plans. Lastly, this program will be expanded to other departments to improve resource management and efficiency.

The participants will be trained in this phase and monitor the program’s impact on a broad scale, considering variations in patient population and care settings. Furthermore, ongoing evaluation will be conducted through ongoing data collection and analysis. While the time frame is specific, the areas of uncertainty lie in the process. For instance, external factors such as changes in healthcare policies or the introduction of new technologies can influence the program’s success. Moreover, the uncertainties about existing digital infrastructure and accessibility can also impact the implementation. The program’s long-term sustainability and impact on healthcare resource efficiency depend on external factors and have many uncertainties requiring monitoring and continuous evaluation.

 Literature Review

 The literature review validates the need for addressing the improvement in resource efficiency of healthcare resources by implementing nurse-led care programs for mothers in post-partum after giving birth to pre-term babies. The literature review suggests and supports the significance and demand for efficient use of hospital resources. In an evidence-based article by Ann et al. (2019), the power of nurses to improve the efficiency of hospital resources and create opportunities for nurses to impact healthcare quality positively is discussed.

The authors state that healthcare resources are scarce in number, and by harnessing the power of nurses to use these limited resources efficiently, healthcare can be improved, and costs to organizations can be reduced. In another study by Anwar and Abdullah (2021), hospital resources, including human resources, and their impact on organizational performance are highlighted. The study shows that efficient management of hospital resources through decentralization can improve the efficiency of organizational performance.

Similarly, the comparison of advanced nurse-led care with usual care is conducted in an evidence-based study along with its efficacy. The study also evaluated its impact on costs and critical care environments such as NICU. This approach reduced costs and wait times, efficiently using available healthcare resources (Htay & Whitehead, 2021). Another study by Li et al. (2021) evaluated the effects of nurse-led transitional care on healthcare utilization, particularly for patients who have experienced heart failure. The results showed that hospital readmission risks were reduced along with shortening hospital stay length. Ultimately, healthcare resources were efficiently and equitably utilized.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

The evidence-based systemic review study by Mileski et al. (2020) improved the understanding of the nurse’s role in alleviating patient hospitalization risks and improving their health outcomes. The study showed that the valuable contribution of nurse practitioners resulted in decreased extra hospitalization and enhanced access to healthcare by adequate education and guidance. This resulted in a better allocation of resources and improved healthcare access to other patients. The article by (Mizukawa et al., 2019) studied the effectiveness of nurse-led collaborative management through telemonitoring domains. It was evaluated that this approach improved psychosocial status and prevented hospital readmissions. The prevented hospital readmission highlights the hospital’s better and more effective resource utilization. 

Another resource by Morkisch et al. (2020) suggests that implementing the care transition models by integrating interprofessional intervention can reduce rehospitalization rates in geriatric patients. This is done by implementing nurses’ appropriate and adequate contribution to education and self-management promotion. Moreover, reducing hospital readmission rates without increasing costs shows effective management of hospital resources. The article by Green et al. (2020) reviews the transition process of preterm babies. The authors suggest that pre-term babies require the intensive participation of nurses in transition to meet the unique needs of their health condition. Moreover, nurses’ roles also support maternal mental health during the care transition.

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

This will improve healthcare outcomes for babies and mothers, with the secondary outcome of locating limited healthcare resources appropriately. The resource by Ma et al. (2021) shares the caregivers’ experiences on the care transition of pre-term babies to guide nurses on their required role of smoothing the care transition process for the target population and improving their care transition while mediating the healthcare resources effectively. These needs include intensive care after discharge to prevent infections and complications, tackling the emotional needs of mothers, and negative psychological pressure. According to Spall et al. (2019), with the help of nurse-led interventions, patient-centered transitional care services did not significantly improve the quality-of-care transition effectively in patients with heart failure. 

 This evidence supports the implementation of nurse-led care transition programs to improve the efficiency of healthcare resources in hospitals for mothers in their post-partum with pre-term babies. These pieces of evidence are evaluated based on CRAAP criteria of Currency, Relevance, Accuracy, Authority, and Purpose (Muis et al., 2022). All resources are current and published within the last five years. Moreover, the articles are relevant to the identified need for efficient healthcare resource management. The articles are accurate and substantiated by references. The authors are relevant to nursing and healthcare to improve healthcare resources (Muis et al., 2022).

Evaluation and Synthesis of Relevant Health Policies

The American Nurses Association (ANA) policies on care coordination and care transition help address the identified need to improve healthcare resources and efficiency by implementing nurse-led care transitions. The ANA policy on care coordination in the transition process guides them on performing patient-centered care transitions to facilitate smooth care transitions (ANA, 2023). Moreover, it guides nurses on communication transitions during nursing care transitions. It ensures patients like mothers with preterm babies during transition procedures acquire adequate education on post-transition care at home (Figueiredo & Potra, 2019).

These health policies guide nurses on the correct procedure of care coordination during care transitions and help them ensure the hospital readmission rates are prevented and healthcare resources are effectively managed  (Htay & Whitehead, 2021).

Conclusion

In conclusion, this quality improvement project addresses the identified need for managing healthcare resources efficiently. This is done by implementing nurse-led care transition programs such as workshops and mobile health applications. This is further discussed by highlighting a time frame and literature review. Lastly, ANA health policies on care coordination and transition can effectively guide nurses in performing care transition for this targeted population in healthcare settings. 

 References

ANA. (2023, December 21). Care coordination and the essential role of nurses | American Nurses Association (ANA). ANA. https://www.nursingworld.org/practice-policy/health-policy/care-coordination/ 

Ann, C. K., Tracey, M., & Yvonne, S. (2019). Affordable care: Harnessing the power of nurses – proquest. Www.proquest.com. https://search.proquest.com/openview/e725593146ca4406b5812a2fa6721948/1?pq-origsite=gscholar&cbl=43860 

Anwar, G., & Abdullah, N. N. (2021, January 15). The impact of human resource management practice on organizational performance. Papers.ssrn.com. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3824689 

Bartsch, S. M., Ferguson, M. C., McKinnell, J. A., O’Shea, K. J., Wedlock, P. T., Siegmund, S. S., & Lee, B. Y. (2020). The potential health care costs and resource use associated with COVID-19 in the United States. Health Affairs, 39(6), 10.1377/hlthaff. https://doi.org/10.1377/hlthaff.2020.00426 

Brummett, A. (2021). Improving quality and efficiency of postpartum hospital patient education delivery. Thescholarship.ecu.edu. https://thescholarship.ecu.edu/handle/10342/9325 

Cui, X., Zhou, X., Ma, L., Sun, T.-W., Bishop, L., Gardiner, F., & Wang, L. (2019). A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: A randomized and controlled trial in China. Rural and Remote Health, 19(2). https://doi.org/10.22605/rrh5270 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Figueiredo, A. R., & Potra, T. S. (2019). Effective communication transitions in nursing care: A scoping review. Annals of Medicine, 51(sup1), 201–201. https://doi.org/10.1080/07853890.2018.1560159 

Green, J., Fowler, C., Petty, J., & Whiting, L. (2020). The transition home of extremely premature babies: An integrative review. Journal of Neonatal Nursing, 27(1). https://doi.org/10.1016/j.jnn.2020.09.011 

Htay, M., & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. International Journal of Nursing Studies Advances, 3(3), 100034. https://doi.org/10.1016/j.ijnsa.2021.100034 

Li, M., Li, Y., Meng, Q., Li, Y., Tian, X., Liu, R., & Fang, J. (2021). Effects of nurse-led transitional care interventions for patients with heart failure on healthcare utilization: A meta-analysis of randomized controlled trials. PLOS ONE, 16(12), e0261300. https://doi.org/10.1371/journal.pone.0261300 

Liss, D. T., Ackermann, R. T., Cooper, A., Finch, E., Hurt, C., Lancki, N., Rogers, A., Sheth, A., Teter, C., & Schaeffer, C. (2019). Effects of a transitional care practice for a vulnerable population: A pragmatic, randomized comparative effectiveness trial. Journal of General Internal Medicine, 34(9), 1758–1765. https://doi.org/10.1007/s11606-019-05078-4 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Ma, R. H., Zhang, Q., Ni, Z. H., & Lv, H. T. (2021). Transitional care experiences of caregivers of preterm infants hospitalized in a neonatal intensive care unit: A qualitative descriptive study. Nursing Open, 8(6). https://doi.org/10.1002/nop2.899 

Mileski, M., Pannu, U., Payne, B., Sterling, E., & McClay, R. (2020). The impact of nurse practitioners on hospitalizations and discharges from long-term nursing facilities: A systematic review. Healthcare, 8(2), 114. https://doi.org/10.3390/healthcare8020114 

Mizukawa, M., Moriyama, M., Yamamoto, H., Rahman, M. M., Naka, M., Kitagawa, T., Kobayashi, S., Oda, N., Yasunobu, Y., Tomiyama, M., Morishima, N., Matsuda, K., & Kihara, Y. (2019). Nurse-led collaborative management using telemonitoring improves quality of life and prevention of rehospitalization in patients with heart failure. International Heart Journal, 60(6), 1293–1302. https://doi.org/10.1536/ihj.19-313 

Molina, J. G., Medina, I. M. F., Sola, C. F., Padilla, J. M. H., Lasserrotte, M. del M. J., & Rodríguez, M. del M. L. (2019). Experiences of mothers of extremely preterm infants after hospital discharge. Journal of Pediatric Nursing, 45, e2–e8. https://doi.org/10.1016/j.pedn.2018.12.003 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Morkisch, N., Upegui-Arango, L. D., Cardona, M. I., van den Heuvel, D., Rimmele, M., Sieber, C. C., & Freiberger, E. (2020). Components of the Transitional Care Model (TCM) to reduce readmission in geriatric patients: A systematic review. BMC Geriatrics, 20(1), 1–18. https://doi.org/10.1186/s12877-020-01747-w 

Muis, K. R., Denton, C., & Dubé, A. (2022). Identifying CRAAP on the internet: A source evaluation intervention. Advances in Social Sciences Research Journal, 9(7), 239–265. 

Mutua, J., Kigamwa, P., Ng’ang’a, P., Tele, A., & Kumar, M. (2020). A comparative study of postpartum anxiety and depression in mothers with pre-term births in Kenya. Journal of Affective Disorders Reports, 2, 100043. https://doi.org/10.1016/j.jadr.2020.100043 

Spall, H. G. C., Lee, S. F., Xie, F., Oz, U. E., Perez, R., Mitoff, P. R., Maingi, M., Tjandrawidjaja, M. C., Heffernan, M., Zia, M. I., Porepa, L., Panju, M., Thabane, L., Graham, I. D., Haynes, R. B., Haughton, D., Simek, K. D., Ko, D. T., & Connolly, S. J. (2019). Effect of patient-centered transitional care services on clinical outcomes in patients hospitalized for heart failure. JAMA, 321(8), 753. https://doi.org/10.1001/jama.2019.0710 

Swanson, N. M., Elgersma, K. M., McKechnie, A. C., McPherson, P. L., Bergeron, M. J., Sommerness, S. A., Friedrich, C., & Spatz, D. L. (2022). Encourage, assess, transition (EAT) A quality improvement project implementing a direct breastfeeding protocol for preterm hospitalized infants. Advances in Neonatal Care, 23(2), 107–119. https://doi.org/10.1097/anc.0000000000001037 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., Bottone, H., Polson, R., & Maxwell, M. (2020). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. International Journal of Nursing Studies, 104(104), 103443. https://doi.org/10.1016/j.ijnurstu.2019.103443 

Walker, R., Olander, E. K., Hill, B., Willey, S., & Skouteris, H. (2019). Weight management across pregnancy and postpartum care: The need for interprofessional education and collaboration. Nurse Education in Practice, 41, 102651. https://doi.org/10.1016/j.nepr.2019.102651 

Weber, L. A. F., Lima, M. A. D. da S., & Marques Acosta, A. (2020). Quality of care transition and its association with hospital readmission. Aquichan, 19(4), 1–11. https://doi.org/10.5294/aqui.2019.19.4.5