Respond 

As a reminder to those who may have not read my posts in the past six weeks, my PICOT question is: In patients with CHF, would a scheduled education program with booklet versus just education handouts decrease 30 day hospital admissions over a 3 month period?” Heart failure readmission rates cause the Center for Medicare and Medicaid Services to now give hefty penalties to organizations within thirty days so there is currently a tremendous amount of research surrounding this topic. There are two major research studies that really follow the PET model that I am aiming for with this study. My goal is to have approximately 60 test subjects from my primary care practice who fall within the categories of having a low ejection fraction, diagnosed with heart failure, and who do not have severe comorbidities including other systems. I will split this group into a control group and an intervention group. The control group will receive a three-month educational program and booklet while the other will receive the standardized care that has been used in the office.

            The PDSA model was created by Edward Deming and is a great way to implement change and improve quality of care. The PDSA stands for Plan, Do, Act, and Study (Donnelly & Kirk, 2015). The key through the literature research review was that patients’ who had better education about their disease process, diet, exercise, lifestyle modifications, medications, and treatment plan, ultimately had better outcomes than those who are simply receiving the standardized care. Through review of quantitative and qualitative research literature, it was evident that the influence and key tools to self-management precluded better patient outcomes, lower readmission rates, decrease in length of stay in the hospital, and improved quality of life. Using the PDSA model, I will outline my plan and figure out the ultimate goal of this process. This PICOT question would require planning who will be doing the education session, who will create the booklet, how we will fund this project, and how to select as well as the selection process for our test subjects (as well as informed consent). This also includes the approval of an ethics committee for this research in order to protect the test subjects. The “Do” would be to start the research program by following the two groups and providing the education and reference channels to the patients as see fit. It is important to document throughout the course of this research in order to gain the most information possible. The “Study” would be at the conclusion of the three-month period when all the finalized data is collected and analyzed. This is where the researcher would see if their predicaments were correct and how they related to the research literature. The final step is “Act” and this will involve assessing the overall cycle and looking where to make changes to being the next PDSA cycle. In a world of health care where it is constantly changing and evolving, it is important that processes are being assessed in order to change and improve. Following the three-month process of education, intervention, and data collection, it is really important to focus on what worked during the process, what didn’t, and what changes can be made to reach the goal of healthier and happier patients.

            One article I found had a very similar PICOT and used a PET method that seemed very relevant to my PDSA. It used a similar number of subjects and also slipt them into groups over a three month period. It had very positive results in a sense that the patients who were in the intervention group were very satisfied with their quality of life and managed to stay out of the hospital. As nurses and a future nurse practitioner, isn’t that what our goal of all this EBP is for – to improve patient outcomes? I think to truly take my study one step further would be to also perform a qualitative study and take a closer look at their perception of the education, self-management, and possibly ways to improve my program.

Alireza, A., Tahereh, N., & Mansoureh, A. (2018). Effect of the self-management education program on the quality of life in people with chronic heart failure: A randomized controlled trial. Electronic Physician, 10(7), 7028-7037. doi:10.19082/7028

Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Education For Primary Care: An Official Publication Of The Association Of Course Organisers, National Association Of GP Tutors, World Organisation Of Family Doctors, 26(4), 279–281. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.

            oclc.org/login.aspx?direct=true&db=mdc&AN=26253069&site=ehost-live&scope=site

Transcultural Perspectives in the care of Older Adults.

Review the attached PowerPoint presentation.  Once done, read the following clinical case below and answer the questions;

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age. Diet is a key factor in controlling blood glucose levels and preventing serious cardiac, renal, peripheral vascular, and retinal complications such as heart attacks, renal failure, limb amputations, and blindness.

An Indian Health Service (IHS) nurse visits a patient in her mobile home, located on an Arizona Indian reservation. The patient is a 72-year-old, obese, female Pima Indian with a blood glucose level of 280. She is at risk for serious complications of type 2, or non–insulin-dependent, diabetes mellitus. With type 2 diabetes, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain a normal blood glucose level. The patient lives with her adult daughter, two grandchildren, and five great-grandchildren. The nurse’s goals are to use culturally appropriate diet education to repattern the patient’s eating habits for the purpose of reducing the blood glucose level to normal (between 70 and 110 mg/dL); promoting steady sustained weight loss (5 pounds per week); encouraging increased exercise and activity. The nurse also asks the patient to participate in group sessions at the Pima Community Center focused on healthy food preparation and eating a balanced meal. If you were a nurse who just began doing home health care on the Pima Reservation, how would you learn about the specific cultural beliefs and practices related to nutrition and diet for this patient as a member of the Pima Indian Nation, versus stereotypes about the diet of Native Americans in general? Given that the patient’s family doesn’t own a vehicle, how will you encourage her to shop for healthy foods, prepare them, and actively participate in weight loss and exercise programs held free of charge at the Pima Community Center? How would you assess the patient’s eating habits, for example, type of food, method of preparation, amount eaten, etc.? Each of the patient’s children, grandchildren, and great-grandchildren is obese. How would you involve the patient’s family in the plan of care and motive them to lose weight as well?

800 WORD COUNT

3 CITATIONS WITH REFERENCES

**Research current healthcare financing concerns prevalent in the United States.

**observed and/or that your healthcare organization currently experiences.

**Consider how these concerns relate to fundamental issues of economics, such as “price,” “supply vs. demand,” “scarcity of resources,” or “needs and wants.”

**Consider how these concerns relate to the healthcare product or service solution you have proposed for your organization

I want 1500 words with proper understanding