NURS 3740 Quiz 4 Intro to EBP and Research; Home Health

home health education and certification

-According to the Home Health Nursing Scope and Standards, a baccalaureate degree in nursing is the appropriate and preferred educational preparation. -Roles for nurses in home health: care management, care coordination, education, advocacy, administration, supervision, and quality improvement -Other roles: provision of skilled nursing services and coordinating care for a variety of clients -APRNs are now employed in some home health agencies. -RNs may specialize in these fields and receive special certifications through the ANCC after successful completion of certification exams

major process steps - individual level of EBP

-Asking clinical questions which can be answered with research evidence (ASK) -Searching for and retrieving relevant evidence (ACQUIRE) -Appraising and synthesizing the evidence (APPRAISE) -Integrating the evidence with clinical expertise, patient preferences, and local context (APPLY) -Assessing the effectiveness of the decision, intervention, or advice (ANALYZE & ADJUST)

Current/future trends for nursing research

-Continued focus on evidence-based practice - Expanded local research in health care settings - Strengthening of interdisciplinary collaboration - Expanded dissemination of research findings - Increasing the visibility of nursing research - Increased focus on cultural issues and health disparities - Shared decision-making

home health recipients

-Elderly, infants, children of all ages, adolescents, young & middle-aged adults -Clients of diverse ethnicities, cultures, beliefs, & ages are cared for in their homes. ( All recipients usually must have some form of insurance coverage such as Medicare, Medicaid, or Private Insurance- some agencies may take a small % of uninsured/indigent clients)

Nursing research agenda (NINR)

-HIV Infection Prevention and Care - Long-term care of older adults - Symptom management of pain/se of chemotherapy - End of life care - Cardiovascular risk reduction - Diabetes ( control/coping- adolescents) - Transitional care models - Health Disparities - Use of new technologies - Living with chronic illness

barriers to EBP

-Lack of perceived value for research and EBP -Lack of time -Lack of knowledge and skills for finding, assessing, interpreting, and applying current best evidence -Difficulty in directed reading of EBP literature- process and findings -Didactic and hands on development sessions must be combined or skill set will be lost. -Lack of informatics skills

Nursing research explanation

-Nursing research clarifies relationships among phenomena and identifies the reasons why certain events occur. -Nursing research promotes an understanding of relationships between variables. It answers the question WHY? -There is quite a bit of knowledge about the action of variables both independently and in association with others. -Inferences are drawn from data that explain the relationships between 2 variables. It is about relationships and causes. Examples: 1. What is the relationship between DM and Coronary Heart Disease? 2. What is the relationship between Anxiety and AMI?

nursing research prediction

-Nursing research involves estimating and anticipating the outcomes in a particular situation. -Nursing research allows us to identify and link risks to possible screening methods to identify illness. -Nursing research provides further knowledge related to the independent causal variable. -Nursing research usually has a study hypothesis- calculated guesses that can be supported by theory and previous research. It is related to cause and effect based on theory.

categories of home health agencies

-Official/public- 13% (receive tax revenue & are operated by state, county, city, or other local units such as health departments: may include well-child clinics, immunizations, health education programs, & home health visits for preventive health care) -Visiting Nurse Associations (VNA)- 5%- (freestanding, voluntary, non-profit organizations) -Private/voluntary- 6%- (non-profit home health agencies receiving funding from donations/endowments) -Combination- 0.3%- ( have characteristics of both governmental & voluntary agencies) -Hospital-based- 12%- ( home health agencies associated with hospitals) -Proprietary- 62%- ( free-standing, for-profit agencies required to pay taxes- dominate industry)

historical trends of home health nursing

-Originated with formal caregivers in the 19th century, which evolved into visiting nurse associations §-Home health movement expanded rapidly with over 71 agencies prior to 1900 and 600 agencies by 1909. -1965- Medicare & Medicaid legislation included home health benefits which resulted in significant changes for the U.S.

nursing research activities

-Participating in a journal club- nurses meeting to discuss and critique nursing research articles -Solving clinical problems and making clinical decisions based on rigorous research -Collaborating in the development of an idea for a clinical study -Reviewing a proposed research plan with respect to feasibility in a clinical study -Recruiting potential study participants -Collecting research information- distributing questionnaires to patients -Giving clients advice about participation in studies -Discussing the implications and relevance of research findings with clients

Trends in home health

-Telehealth -EHRs/PHRs -Informatics

home health skilled nursing services

-Wound care- post/op incisional care, wound vacs for complicated wounds, JP drains, etc. -Catheterizations- suprapubic/ indwelling catheters -IV Therapy- antibiotics the most common -PICC lines- maintenance care/ sterile dressing changes -TPN -Chronic disease management- such as Diabetes, HF, & COPD programs -Medication management & education -Ostomy care & teaching

elements of EBP

-best research evidence -clinical expertise -patient needs and values

Scope of Nursing Research

-clinical research - acute/chronic illnesses or conditions, behavioral changes and interventions, and response to compelling health concerns (health disparities and vulnerable groups such as minorities, infants, youth, and older adults) -health systems and outcomes research-examine/evaluate both clinical services and systematic structures in which those services are delivered; it explores appropriate balance of personnel to provide effective and efficient care while controlling costs of health care -nursing education-use of rigorous research strategies in the assessment of the teaching-learning process and outcomes at all levels of nursing education essential to baccalaureate and graduate education

EBP

-emphasizes the identification of best available research evidence and integrating it with other factors. Decisions based on customs, ritual, and authority are de-emphasized.

Nursing research provides

-explanation -prediction -control

facts about hospice

-helps people who are terminally ill live comfortably. -isn't only for people with cancer. -The focus is on comfort (palliative care), not on curing an illness. -A specially trained team of professionals and caregivers provide care for the "whole person," including physical, emotional, social, and spiritual needs. -Services typically include physical care, counseling, drugs, equipment, and supplies for the terminal illness and related conditions. -Care is generally given in the home. -Family caregivers can get support.

nursing research control

-is manipulating a situation as to achieve a particular outcome -we control or manipulate variables related to phenomena to see if there is a change in another intervention. ( Uses control and treatment groups)

goals of nursing research

-to develop an empirical body of knowledge for a discipline or profession such as nursing -to develop and refine knowledge nurses can use to improve clinical practice -to generate knowledge regarding nursing education, nursing administration, health care services, and nursing roles -to provide high quality learning experiences for nursing students. Nurses can develop and refine the best methods for teaching nursing students through research

Healthy People 2020 goals guiding research

-to help individuals of all ages to increase life expectancy and improve their quality of life; eliminating health disparities among different segments of the population in the U.S.

research process

1. Literature review 2. Research problem and purpose 3.Study framework 4.Research objectives, questions, or hypothesis 5.Study variables 6.Assumptions 7.Limitations 8.Research design 9.Population and sample 10.Methods of measurement 11.Data collection 12.Data analysis 13.Research outcomes

research

An understanding of _______________ can improve the depth and breadth of every nurse's professional practice

patient needs and values

EBP incorporates the needs and values of the patients. Clinical encounters include patients' values, personalities, concerns, expectations, and cultural beliefs.

clinical questions

EBP is a means of answering ________________________ regarding all aspects of clinical practice

quality, cost effective

EBP provides __________________________ outcomes for families, patients, health care providers, and the health care system

How long can a patient receive hospice?

Hospice care is for people with a life expectancy of 6 months or less (if the illness runs its normal course). If a client lives longer than 6 months, her or she can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that they are terminally ill. Hospice care is given in benefit periods. A client can get hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. At the start of the first 90-day benefit period, a client's hospice doctor and regular doctor must certify that he or she is terminally ill (with a life expectancy of 6 months or less).

hospice services covered medicare benefit

Hospice care is usually given in the client's home, but it also may be covered in a hospice inpatient facility. Depending on the client's terminal illness and related conditions, the plan of care the hospice team creates can include any or all of these services: ■ Physician services ■ Nursing care ■ Medical equipment (like wheelchairs or walkers) ■ Medical supplies (like bandages and catheters) ■ Prescription drugs ■ Hospice aide and homemaker services ■ Physical and occupational therapy ■ Speech-language pathology services ■ Social worker services ■ Dietary counseling ■ Grief and loss counseling for you and your family ■ Short-term inpatient care (for pain and symptom management) ■ Short-term respite care ■ Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

hospice medicare benefit eligibility

If a client has Medicare Part A (Hospital Insurance) AND meets all of these conditions, he/she can get hospice care: ■ Client's hospice doctor and regular doctor certify that a client is terminally ill (expected to live 6 months or less). ■ A client accepts palliative care (for comfort) instead of care to cure an illness. ■ A client signs a statement choosing hospice care instead of other Medicare-covered treatments for a terminal illness and related conditions. Note: Only a client's hospice doctor and regular doctor can certify terminal illness and a 6 months or less life expectancy.

nursing education research

New strategies for recruiting and retaining well-educated nurses is critical to maintaining and enhancing the nation's health. These strategies must be developed and tested by nursing researchers. New models of nursing education are needed in the preparation of nurses for faculty and research positions earlier in their careers. Historically, there has been a lack of funding and recognition for this type of research.

respite care

The hospice benefit does allow for inpatient respite care that is occasional and up to 5 days and nights. This ensures that caregivers are given some relief and are able to have some time to relax and enjoy some time away from their loved one, knowing that the loved one is in good hands with another provider of care. This helps to prevent caregiver strain which is important when caring for a terminally ill loved one.

nursing research

a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice.

home health nursing

a specialty area of nursing practice that promotes optimal health and well being for patients, their families, and caregivers within their homes and communities

Oasis D assessments

are required at admission, recertification, transfer to inpatient facility, resumption of care after inpatient hospitalization, & upon discharge from home health)

best research evidence

empirical knowledge generated from the synthesis of quality study findings to address a practice problem

balanced budget act

in 1997 this law changed the home health payment from fee-for-service model to prospective payment based on a standardized assessment conducted on the admission visit in home health.

hospice

is a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families.

OASIS - D

is an assessment tool used to collect data for Medicare and Medicaid patients, 18 years and older, receiving skilled services, with the exception of patients receiving services for pre- or postnatal conditions. Those receiving only personal care, homemaker, or chore services are excluded since these are not considered skilled services. The assessment data collected is then transmitted to CMS and determines payment for services to be rendered to clients.

science of nursing

is growing rapidly and nurse scholars are committed to the constant progression of new knowledge

evidence based practice

is the integration of best research evidence with clinical expertise and patient values

American Nurses Credentialing Center (ANCC)

is the largest and most prestigious credentialing organization -developed a magnet program to acknowledge health care organizations providing very high quality nursing care and reputation of the nursing profession

palliative care

is the part of hospice care that focuses on helping people who are terminally ill and their families maintain their quality of life. If a client is terminally ill, ______________ can address his or her physical, intellectual, emotional, social, and spiritual needs. ______________ supports the client's independence, access to information, and ability to make choices about health care.

major priority for nursing research

is understanding health disparities and test strategies for their resolution

clinical research

nurse researchers study ways to assist individuals and groups as they respond to health/illness experiences and address the behavioral and social aspects of quality of life and illness

Health systems and outcomes research

nursing research explores ways that organizations and delivery of health care influence the quality, cost, and experiences of patients and their families. The demand for nursing researchers has increased due to the increase in indigent population, lack of adequate health insurance for many, problems with access to healthcare, need for containment of costs and development of quality care

to address issues in society and health care

nursing research must be relevant to health and illness situations, be rigorous scientifically, and be easily translatable into practice and health policy

Institute of medicine 2002

people who are uninsured lacking access to health care (health disparities)

IOM 2003 report on Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare

racial and ethnic minorities tend to receive lower quality of healthcare despite socioeconomic level or insurance coverage status

organizations achieving magnet status

sustain a practice environment where nursing research and evidence based practice are integrated into the delivery of nursing care and the framework for nursing administration decision making

Nursing research

systematic inquiry that uses disciplined methods to answer questions and solve problems

clinical expertise

the knowledge and skills of the health care professional providing care which depends on the years of clinical experience, current knowledge of the research and clinical literature, and educational preparation

Sigma Theta Tau def of EBP

the process of shared decision-making between practitioner, patient, and others significant to them based on research evidence, the patient's experiences and preferences, clinical expertise, or know-how, and other available robust sources of information

producers of nursing research

those nurses who actively participate in generating evidence by doing research.

Nursing research consumers

those who read research reports or research summaries for relevant findings that might affect their practice. Evidence-based practice depends on well-informed _____________________________

research

to search again or examine carefully

home health

•A holistic approach to nursing •Aims to empower patients/families/caregivers to achieve highest level of physical, functional, spiritual, and psychosocial health •Provides services to all ages, culture, and at all stages of health and illness (may include end of life) •Can include generalists, clinical nurse specialists, & nurse practitioners •Provides diverse services to patients with many different diagnoses and disease entities

Home health nursing essentials

•Positive attitude •Excellent communication skills •Critical thinking skills •Effective care coordination skills •Knowledge of community resources •Knowledge and skills regarding medications, treatments, documentation, and equipment •Flexibility in job •Autonomy •Sound judgement