Capstone Project: Milestone 1: Practice Issue and Evidence Summary Worksheet

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The problem being investigated is: how exercises, mediated by caregivers are instrumental in improving motor coordination in adult patients with stroke. The research involves Patients admitted in healthcare facilities and those at home. All patients with stroke require regular exercises to improve their motor functions and therefore, this research is relevant to every stroke patient.

Type the complete APA reference for the systematic review article you chose from the list provided.It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Vloothuis, J. D., van Wegen, E. E., Veerbeek, J. M., Konijnenbelt, M., Visser-Meily, J. M., & Kwakkel, G. (2014). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst. Rev.

Identify the objectives of the article:

The research seeks to determine: whether exercises mediated by caregivers help to improve the health of stroke patients, and the impact of this intervention on caregivers.

Provide a statement of the questions being addressed in the work and how these relateto your practice issue:

The questions being addressed include: how does performance of exercises with the help of caregivers affect the health of people living with stroke, and does these kinds of interventions have any effects on the caregivers involved?

The questions being addressed are relevant because their answers will be instrumental in evaluating whether caregiver-mediated interventions for stroke patients are effective in improving patient outcomes. Additionally, the answers will help the researchers to determine whether there will be any burdens to the caregivers.

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

The intervention involves the use of caregivers who are trained by therapists to help stroke patients perform exercises at regular intervals and with consistency. These caregivers will be used because the limited number of therapists does not allow every patient to receive their services. Regular evaluations will be done to determine whether the exercises are contributing to the improvement of physical coordination of body functions in the patients.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper.(If an optional supplemental source is also used, include a statement of relevance to it as well.)

The research concluded that exercises which are mediated by caregivers are instrumental in improving the health of people living with stroke and that the financial burden to the caregivers was not high. The research found out that body functions such as walking, standing and flexing muscles improved after interventions involving caregivers. Moreover, caregivers were not reported to have been negatively affected by their involvement in these interventions because their routines were slightly affected and they did not incur more costs.

Outline evidence-based solutions that you will consider for your project.

Some of the solutions I will consider for my project will include introduction of mobile phone applications to help stroke patients monitor their exercises and coordination of muscles and body functions during their regular exercises. Patients using these applications will be able to tell if their health and limb coordination is improved by exercises.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

Studies conducted to determine how mediated exercises are important in achieving patient outcomes have included few trials and reviews and as such, the evidence given may not be entirely objective. Interpretation of the data, therefore, should be done cautiously.

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

The topic of the research is: Effectiveness of Video Discharge Instructions in reducing Hospital Readmissions.

The systematic review used is titled: Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.(2014). Reducing hospital readmission: Current strategies and future directions. Annual Review Of Medicine, 65(1), 471-485. doi:  10.1146/annurev-med-022613-090415

The research has also used an additional source titled: Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58.

What is the nursing practice issue you have identified related to the topic you have chosen?

There has been an increase in hospital readmissions in healthcare and one of the reasons for this phenomenon is how discharge instructions are administered to patients before they leave health facilities.

Fully describe the scope of the practice issue:

The research is limited to addressing issues related to how patients admitted in cardiac units of health facilities receive their discharge instructions. Particularly, the study observes that the most common means of instruction are verbal and written, and it seeks to observe the effectiveness of giving discharge instructions through video.

What is the practice area?

___ Clinical

__ ✔ Education

___ Administration

___ Other (List):

How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns

_ ✔ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

Increase in readmission rates of patients led to the realization that the mode of delivering discharge instructions was not satisfactory or was not effective. It was observed that when instructions were given through verbal and written means, the patients were more likely to be readmitted in healthcare facilities. This means that patient outcomes were not satisfactorily realized when these instruction methods were used.

What evidence must be gathered? (check all that apply)

__ ✔ Literature search

___ Guidelines

___ Expert Opinion

__ ✔ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections:

Relevant literature on the how verbal as well as written discharge instructions can be supplemented by video instruction should be consulted to ensure that patient outcomes are achieved in a satisfactory manner. This literature will include: studies conducted by researchers as well as systematic reviews.

The study will also be informed by opinions of patients because they are best placed to determine whether discharge instructions given to them are well understood when offered through verbal, written or video channels.