NURSING EBP CAPSTONE PROJECT: SAMPLE ASSIGNMENT

The paper should include the 6 steps of the EBP process that describes your proposal process and should be no more than 7 pages, not including the title page or reference list. (5-7 pages). NOTE CHANGES.
1. Introduction
2. The Spirit of Inquiry Ignited
3. The PICOT Question Formulated; In patients, older than 60 years diagnosed with heart failure (HF) (P), is an educational approach based on promoting self-care skills I) more effective than only pharmacological management (C) in reducing risk of developing co-morbidities (O) over a 4-month period (T)?
4. Search Strategy Conducted
5. Critical Appraisal of the Evidence Performed:
6. Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice (if you were to implement the change): Implementation Plan
7. Outcomes of Practice Change Evaluated (if Implementation had taken place): Evaluation Plan
8. Project Dissemination (if the implementation had taken place)
9. Conclusion

PLEASE READ CAREFULLY THE FOLLOWING INSTRUCTIONS.
I attached few support documentations for the writer to review.
1. Implementation and evaluation plan for this project is done however few recommendations were made by the faculty. Please review it and make changes as your consideration.
2. I attached a similar EBP project with the same topic and the same PICOT question. This project is from other student, I would like to have my project done the same way, but the writer CANNOT COPY, AND PASTE has to be done on their own words.
3. I attached from our text book 3 pages, EBP plan to follow and should resemble plan of the Melnyx text.

On step 5- Critical appraisal of the Evidence: Articles to analyze.

1. Eriksson, B., Wändell, P., Dahlström, U., Näsman, P., Lund, L. H., & Edner, M. (2018). Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care-and hospital care-based outpatient clinics. Scandinavian Journal of Primary health care, 36(2), 207-215..
2. Kamrani, A. A. A., Foroughan, M., Taraghi, Z., Yazdani, J., Kaldi, A. R., Ghanei, N., & Mokhtarpour, R. (2014). Self-care behaviors among elderly with chronic heart failure and related factors. Pakistan Journal of Biological Sciences, 17(11), 1161.
3. Masterson Creber, R., Patey, M., Lee, C. S., Kuan, A., Jurgens, C., & Riegel, B. (2016). Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial. Patient education and counseling, 99(2), 256-264. doi:10.1016/j.pec.2015.08.031
4. Kato, N. P., Kinugawa, K., Sano, M., Kogure, A., Sakuragi, F., Kobukata, K., . . . Kazuma, K. (2016). How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence, 10, 171-181. doi:10.2147/PPA.S100203
5. Sezgin, D., Mert, H., Ozpelit, E., & Akdeniz, B. (2017). The effect on patient outcomes of a nursing care and follow-up program for patients with heart failure: A randomized controlled trial. Int J Nurs Stud, 70, 17-26. doi:10.1016/j.ijnurstu.2017.02.013

NURSING EBP CAPSTONE PROJECT: SAMPLE ASSIGNMENT

Heart Failure in Elderly: Impact of Comorbidities and Self-care Skills in Disease Progress

Introduction

A review of the literature is conducted with the purpose of expanding the analysis of research studies and publications referring to Heart failure (HF) and its comorbidities. Heart failure is a complex clinical condition, particularly in the elderly, that usually interacts with other chronic medical conditions. HF has been established as a clinical and public health problem, associated with significant mortality, morbidity and health care costs, particularly among those over 65 years of age. (Yancy, et al., 2017). In the latter half of the 20th century, HF was single out as an emerging epidemic with a progressive increase in prevalence and hospitalizations noted especially in the elderly. HF has a high prevalence in United States, estimated to be greater than 5.8 million and it is projected that the prevalence of HF will increase 46% from 2012 to 2030. (Heidenreich, et al., 2013). Clinicians caring for patients with heart failure need to be vigilant to comorbid conditions that may complicate the care of these patients. An overwhelming majority of patients with HF are older adults with multiple chronic conditions (MCC) which play an important role in HF progression and response to treatment. (Roger, 2013).  Recent data from the Centers for Medicare & Medicaid Services shows that 55% of Medicare patients have HF have ≥5 chronic comorbidities. (Yancy, et al., 2017). The functional capacity of a HF patient, quality of life and premature mortality are linked to these comorbid conditions and how good patients manage their health.

The Spirit of Inquiry Ignited

Despite advances in medical treatment and therapeutic approaches, HF continues to have unacceptably high morbidity and mortality rates in our health system. (Riegel, Dickson & Faulkner, 2016). The magnitude, complexity and care requirements of patients affected by this disease have led to the development of different clinical practice guidelines and organizational initiatives to improve patient’s quality of life and reduce the high costs generated during HF care (Mentz, et al., 2014). But clinicians frequently ask themselves why, despite incorporating the best available research evidence about the HF management, they do not obtain the expected results. Recent studies with samples of HF patients indicate that self-care is inappropriate in patients with other comorbidities. Participation in educational self-management programs can result in better self-care behavior and patient outcomes.NURSING EBP CAPSTONE PROJECT

The PICOT Question Formulated

In patients, older than 65 years with heart failure (HF) (P), is an educational approach based on promoting self-care skills (I) more effective than only pharmacological management (C) in reducing risk of developing comorbidities (O) over a 6-month period (T)?

Search Strategy Conducted

A literature search was completed using electronic databases: MEDLINE, CINAHL, TRIP database and SU Library search. MeSH headings and text word terms were used and key words were related to heart failure, self-care and comorbidities. The search was restricted to review articles published between 2014 and 2018.

Critical Appraisal of the Evidence Performed

Evidence-based practice in nursing involves the use of best research evidence. This rapid critical appraisal (RCA) entails an evaluation of best research studies relevant to the topic being explored. There is consistent and strong evidence from randomized trials that the implementation of approaches addressing comorbidities in HF patients as well as optimal and specific HF management, including patient education, may ultimately contribute to substantial improvement of HF prognosis. In study conducted by Eriksson, Wändell, Dahlström, Näsman, Lund & Edner (2018) it was established that comorbidities are very common in outpatient settings, either primary care or hospital based, and that mortality is strongly associated with several of these conditions. Based on the results of this study, improved management of specific comorbidities (e.g. COPD) in HFpEF patients may have an even greater impact than in HFrEF.  Self-care behaviors among older people with HF are further compromised due to an increasing number of co-existing co-morbidities with additional self-care requirements as it was concluded by Kamrani, et al, (2014). Also, there is enough evidence to support that higher levels of comorbidity are associated with lower levels of self-care management (Buck, et al, 2015).   Diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease and anemia are comorbidities with a high prevalence and impact in HF. Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients, in turn, impairs self-care behaviors. (Toukhsati, Driscoll & Hare, 2015).NURSING EBP CAPSTONE PROJECT

Integrated Clinical Expertise and Evidence in decision making

Clinical expertise is essential when integrated with evidence-based practice in the decision making towards promoting the health of the patient. Applying the best evidence to our clinical decision making involves examining, critiquing, and synthesizing the available research evidence. Good clinical judgment integrates accumulated wealth of knowledge from patient care experiences as well as educational background. For this project, the evidence could be briefly summarized as follows:

• Age-related factors such as the physical and cognitive limitations of adults over 65 causes self-care to deteriorate and affect HF management.
• Practitioners in primary care settings should adopt a new perspective on treatment options for patients 65 years and older with Heart failure.
• For intervention efforts to be effective, caregiver support is important.
• The education and clinical management of patients with HF seek to optimize the patient’s health outcomes and maintain a good quality of life. Therefore, a key part in the treatment of affected patients is to promote self-management of disease and adherence to treatment.
• Efforts to strengthen self-care in patients with Heart Failure (HF) are relevant to achieve better health outcomes and improve quality of life in those affected by this condition.

Outcome Evaluated

Effects of the self-care interventions in the population of patients older than 65 years old with HF were measured by assessing the progress in the outcomes to be addressed: better control of co-morbidities, improvement of self-efficacy in HF management and better quality of life in HF patients.

• The self-care behavior was evaluated using the Self-Care of Heart Failure Index – v 6.2 (SCHFI).
• Disease‐specific quality of life was measured using Minnesota Living with Heart Failure Questionnaire (MLHFQ).
• Patient-reported outcomes (PROs), including self-care efficacy, depression, HF symptoms, and Heart failure related quality of life (HR-QoL) were evaluated at baseline and at the end of the study.

Implementation Plan

• Step 1: Formulate the Clinical Question in a format known as PICO (T).
• Step 2. Search for and select the most relevant evidence from information databases or resources most likely to answer the type of question being asked; use keywords and concepts; combine multiple search terms and Boolean connectors. One of the reviewed studies reported that patients older than 65 have a high burden of comorbidities and functional and cognitive impairments at the time they are diagnosed with HF. Also, same study disclosed that 60% of elderly with incident HF had three or more comorbidities and only 2.5% had no associated comorbid illnesses (Murad, et al., 2015). Some of these comorbidities and impairments are strongly associated with increased mortality risk.NURSING EBP CAPSTONE PROJECT
• Step 3. Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis). Implies to assess and evaluate the strengths and weaknesses of the evidence and determine a study’s reliability, validity, and applicability.

Multiple comorbidities are common in patients in heart failure and complicate HF management. Some of them could contribute to the underlying development of heart failure, others may lead to disease progression and may be associated with poor prognosis. Thus, health-related quality of life (HRQOL) is profoundly impaired in patients with HF. (Eriksson, et al., 2018). Self-care in HF patients implies that patients monitor their symptoms, adhere to their medication, diet and exercise regimens and manage symptoms by recognizing changes and responding by either adapting behaviors or by seeking appropriate assistance. Lower self-care is associated with poorer overall HRQOL, related to psychological distress, primarily depression. (Kessing, Denollet, Widdershoven & Kupper, 2017).NURSING EBP CAPSTONE PROJECT

Strategy Description

The included individual will be randomized to either the intervention group with close at home follow-up by a multidisciplinary team, or to the control group who will be receiving standard care. Participants in the study will be required to complete the Self-Care of Heart Failure Index – v 6.2 (SCHFI) at the baseline and at the end of the study to assess the acquisition and maintenance of self-care skills related to HF as well as MLHFQ. The intervention group will receive health education focused on the development of self-care skills using strategies like video conferences, webinars, telephone calls and continuous monitoring through MyHF app.

Evaluation Plan

Evaluation process entails a cycle which begins with identification of an issue followed by planning and change implementation (LoBiondo-Wood & Haber, 2017). In this EBP, the problem identified is the need for new approaches to manage HF. The change required is to reduce the impact of comorbidities in Heart Failure patients. Evaluation plan will analyze the process and outcome data and its impact in the finances, environment, staff and patient and families.NURSING EBP CAPSTONE PROJECT

• Evaluation of the structure
• Were the materials, people, and resources available for the change to occur?
• Evaluation of process: explores change implementation and delivery to the target population.
• Did the change in practice occur according to the proposed protocol?
• Evaluation of outcome: evaluates the achievements of the introduced change.
• What were the costs associated with the change?
• What has been the impact on staff, time, efficiency, and perceptions of effectiveness?
• How have patient and/or family outcomes changes?
• Were the outcomes for the project achieved? If not, why not?
• Were there other unanticipated outcomes?
• What is the likelihood of others taking up and endorsing this practice?
• How well will this new practice fit within the other existing practices?

Project Dissemination

Target audience of this EBP project are HF-patients and primary care providers. Thus, research findings will be shared with primary care providers who will most likely use this information in practice (gerontology, family practice) for the purpose of raising awareness and engage them in efforts to improve the quality of life in patients with HF. Also, it will be crucial to create a network of providers through LinkedIn and deliver a monthly Dear Colleague Letter to keep providers engaged and informed about program’s progress. MyHF app is a follow-up tool for health care professionals during clinical appointments. It has been incorporated in this project to keep patients/caregivers updated and encouraged about their self-care management. Finally, it is recommended to promote a HF patient-centered collaborative environment in primary care offices as well to evaluate results systematically. NURSING EBP CAPSTONE PROJECT

Conclusion

The magnitude, complexity and care requirements of patients affected by this disease have led to the development of different clinical practice guidelines and organizational initiatives to improve patient’s quality of life and reduce the high costs generated during HF care. The evaluation and management of the growing number of elderly patients is complicated by multi-morbid disease, polypharmacy, cognitive impairment, and functional deficits. Effective assessment of these elements and improvement in self-care skills can lead to better patient outcomes and facilitate patient-centered management. Efforts to strengthen self-care and effectively manage comorbidities in patients with Heart Failure are relevant to achieve better health outcomes and improve quality of life in those affected by this condition.NURSING EBP CAPSTONE PROJECT