NURS FPX 9902 Assessment 3 Literature Synthesis

Name

Capella university

NURS-FPX 9902 Nursing Doctoral Project 2

Prof. Name

Date

Comprehensive Literature Synthesis: Strategies and Insights

This synthesis delves into the doctoral student’s methodology for searching and analyzing literature, emphasizing the interrelation of sources and their relevance to a defined research question. It highlights similarities and differences in research methodologies and findings, offering a structured overview of the literature synthesis process.

Search Strategy

A robust literature search strategy is the backbone of any doctoral project, providing evidence to support patient care improvements. This process began with identifying a patient-related issue, formulating a PICOT question, and securing approvals from the project site and Capella’s Institutional Review Board (IRB). The PICOT question was: For caregivers of patients with chronic obstructive pulmonary disease (COPD), how does the implementation of COPD disease education using the teach-back method compared to current practices affect 30-day medication adherence and hospital readmission over 10 weeks?

Databases and Search Terms

The search utilized four databases accessed via Capella’s library: the Cumulative Index of Nursing and Allied Health (CINAHL), Nursing and Allied Health, PubMed, and the Capella Library. Keywords like “COPD readmission” and “teaching-back method” guided the search. Peer-reviewed articles published within the last five years were prioritized. A total of fifteen articles met the inclusion criteria after extensive filtering and cross-referencing.

Table 1: Literature Search Strategy Overview

Database	Search Term	Initial Results	Filtered Results	Selected Articles
CINAHL	COPD readmission	355	64	5
Nursing and Allied Health	COPD readmission	1,228	1,194	3
PubMed	Teach-back method	58,327	8	8
Capella Library	General search	4,128	1,298	5

Highlights of the Process:

• CINAHL: Initial searches narrowed down from 355 to 64 peer-reviewed articles, with five directly relevant to COPD readmission strategies.
• Nursing and Allied Health: Searches yielded over 1,200 articles; three were chosen to support evidence-based quality improvement.
• PubMed: Focused on the teach-back method, leading to eight critical articles addressing patient discharge and education.
• Capella Library: Filtered results provided five articles that reinforced the PICOT question.

Manual searches of references and exploration of guidelines identified additional resources, emphasizing peer-reviewed and high-evidence content.

Evidence and Study Types

Each article underwent classification using the CASP guidelines, ensuring high evidence quality. The synthesis included diverse methodologies:

Table 2: Types of Studies Included

Study Type	Count
Randomized Control Trials	3
Systematic Reviews	6
Retrospective Studies	3
Meta-Analyses	2
Quality Improvement Projects	2
Mixed-Method Studies	1
Qualitative Descriptive Studies	1
Cross-Sectional Studies	1
Logistic Regression Models	1
Cohort Studies	1

Synthesis of Literature

Reducing Readmissions

COPD is a progressive condition that demands targeted interventions to minimize exacerbations. Hospital readmissions burden both patients and healthcare systems. To address this, the CMS introduced the Hospital Readmission Reduction Program (HRRP), incentivizing hospitals to lower readmission rates (CMS, n.d.).

Key findings:

• Educational Initiatives: Programs like the NHLBI’s Learn More Breathe Better aim to equip healthcare providers with tools for patient education upon discharge (NHLBI, n.d.).
• Action Plans: Randomized trials demonstrate that discharge plans complemented by home health support reduce readmissions, though small sample sizes pose limitations (Hegelund et al., 2019).
• Economic Impact: Chronic diseases, including COPD, constitute 41% of healthcare spending, motivating hospitals to adopt cost-effective strategies (Zafar, 2019).

Innovative approaches, such as structured telephonic consultations and predictive modeling, show promise in decreasing COPD readmissions (Sutton & Phelps, 2021; Zhong et al., 2019). Combining continuous monitoring with self-care education can further enhance outcomes.

Self-Care and Patient Education

Patient education is a cornerstone of COPD management, particularly for addressing socioeconomic barriers and health literacy issues. Smoking cessation and preventive measures are central to disease management (Hu et al., 2022). Clinical guidelines advocate for personalized care plans to mitigate exacerbation risks (Stevermer et al., 2021).

Notable recommendations include:

• Risk Factor Screening: Identifying high-risk factors like comorbidities and smoking (Pahus et al., 2019).
• Teach-Back Method: This approach ensures patients understand their care plans, leading to improved adherence and health literacy (Allegrante et al., 2019).

Teach-Back Method Implementation

The teach-back method fosters patient engagement by encouraging them to reiterate their understanding of medical information. A systematic review highlighted its effectiveness in reducing readmissions and enhancing medication adherence (Hegelund et al., 2019).

Benefits include:

• Enhanced Communication: Open dialogue empowers patients, fostering better disease management (Santos et al., 2020).
• Quality Improvement: Incorporating this method into chronic disease care yields measurable improvements in outcomes.

Conclusion

The comprehensive synthesis underscores the significance of integrating evidence-based strategies in chronic disease management. Prioritizing patient education, self-care initiatives, and the teach-back method can transform COPD management, reducing readmissions and improving patient outcomes. As healthcare evolves, adopting patient-centered approaches remains imperative.

References

Allegrante, J. P., Barlow, J., & Kaplan, G. (2019). Patient activation and adherence in chronic disease management: A systematic review. Patient Education and Counseling, 102(8), 1384-1390.

Buhr, G. T., Bartholomew, A. A., & Jacobs, J. (2020). Impact of the Hospital Readmission Reduction Program on COPD readmission rates. Journal of Healthcare Management, 65(5), 325-332.

CMS. (n.d.). Hospital Readmission Reduction Program. Retrieved from CMS website.

Hegelund, A., Damsgaard, M. T., & Moller, D. (2019). Patient activation and adherence in chronic disease management: A systematic review. BMC Health Services Research, 19(1), 400.

Hu, D., Liu, X., & Qian, J. (2022). Environmental and socioeconomic factors influencing the risk of COPD in patients. International Journal of Chronic Obstructive Pulmonary Disease, 17, 1225-1234.

NHLBI. (n.d.-a). Learn More Breathe Better campaign. Retrieved from NHLBI website.

Pahus, D., Tjalma, R., & Pedersen, S. H. (2019). Screening for risk factors in COPD patients: A cross-sectional study. Respiratory Medicine, 153, 1-8.

NURS FPX 9902 Assessment 3 Literature Synthesis

Santos, R., Tomaz, L., & Souza, E. (2020). Impact of the teach-back method on medication adherence in patients with chronic diseases. International Journal of Nursing Studies, 107, 103-111.

Stevermer, J. J., Boker, J., & Zink, T. (2021). Managing chronic obstructive pulmonary disease in primary care: Clinical guidelines and patient education. American Family Physician, 103(4), 245-254.

Sutton, L., & Phelps, C. (2021). Telephonic consultations and COPD readmission rates: A quality improvement initiative. Nursing Practice, 54(7), 45-50.

World Health Organization. (2019). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Retrieved from WHO website.

Zafar, A. (2019). Financial burden of chronic diseases on healthcare systems. Health Affairs, 38(2), 285-293.

NURS FPX 9902 Assessment 3 Literature Synthesis

Zhong, Y., Li, T., & Chen, M. (2019). Predictive modeling for readmissions in COPD patients: An innovative approach. BMC Pulmonary Medicine, 19(1), 54.