Sandra Kolk Ferris State University COHP 450 PICO PRESENTATION Sandra Kolk Ferris State University COHP 450

To begin… Types of Research Design PICO Question Amongst hospital patients, what does the effect of support and advocacy from professional staff have on patient outcomes versus no support or advocacy? Qualitative- descriptive and observable data including opinions Quantitative- facts, numbers and measurable data

Searching… Search Engines Search Words Results

Rationale Why Important? Advocacy in nursing Emotional support Discharge planning Emotional support important when the patient is in your care. Important to understand the needs of your patient and build rapport and trust Important to communicate the needs of the patient to the next caregiver whether it be that they are being discharged to their home or to another healthcare professional.

Article 1: Stroke Discharge advocacy to reduce 30-day readmission rates Evaluate Theory Study Design Method Findings Comparative design study titled… Purpose- acute care settings held financially responsible for readmission rates higher than national averages under the patient protection act and affordable health care act The thought for the study: Readmissions often associated with gaps in follow up care Sample- 2 neuroscience units and 700 beds in an academic medical center Compared readmission rates and ED visits before, during, and after the implementation of a revised DC process including better advocacy Results showed 9.39%- 3.24% readmin a 16.36% - 12.08% ED

Article 2: Mothers’ experiences of labor support: Exploration of qualitative research Evaluate Theory Study Design Method Findings Qualitative review study Look at womens perception of labor support by professional caregivers CINAHL and Healthstar searching words: labor support, labor, delivery Commonalities of findings sorted into 4 groups Physical comfort Emotional support Informatioal support Advocacy Limitations: variety of cultural settings that limit generalizability

Ethical Considerations What is ethics in research? For this research Cultural considerations Informed consent For the women and labor: cultural considerations as well as informed consent. Cultural sensitivities when implementing research results that may not be generalizable to an entire population For the Stroke and advocacy article, informed consent is also an ethical consideration, althought there is no identifiying data used

Strength/Quality Type of research Dates Feasibility Qualitative studies bring descriptive, observable data which is important for EBP, however it lacks facts and statistics Stated- limited number of qualitative studies to compare results 1990-2001…not as accurate Stroke advocacy- data is recent and thorough and the Journal and publisher are well known… Lippincott is a very common publisher for nursing books

Credibility/Contribution Education References Authors have good credientials in both articles Including DNP and PhD References

Relevance Communication of results Implications for change Individual level Professional level Generalizability Labor- communicated at individual level for quality of care, opinions used for quality improvement Advocacy results- facts and numbers communicatd at professional level policy improvement Generalizability- good for stroke article, results can be used for a large population Labor- cultural barrier, not generalizable, limited research

Nursing Implications Advocate Follow-up Supports Advocacy and its importance Potential to contribute to EBP to change professional policies and require follow up care and ensure proper management after discharge to reduce readmissions and hospital costs Labor study- qualitative information to consider when working as an OB nurse to improve your quality of care and better understand the needs of your patients

Potential Barriers $$$ Judgements Time Lack of credibility In my personal experience, cost. Everything is billable so when you spend extra time with a patient for follow up care you arent able to bill for that Need to look past that and realize the benefits it has on the patient as well as long term cost benefits- if they return and we are paid,…lose money No time to do the extra follow up Lack of credibility to implement these research findings

Additional PICO questions Amongst the elderly, does having Medicare versus having another insurance increase hospital readmission rates? Amongst hospitals, does nursing advocacy versus no nursing advocacy for patients increase hospital costs?

Conclusion r/t PICO question and based on my results, advocacy and support from nursing staff does improve patient outcomes. However, more research may be needed to implement as EBP in the healthcare setting

REFERENCES Bowers, B. B. (2002, April). Mothers' Experiences of Labor Support: Exploration of Qualitative Research. JOGNN, 31(6). Poston, K. M., Dumas, B. P., & Edlund, B. J. (2013, December 6). Outcomes of a Quality Improvement Project Implementing Stroke Discharge Advocacy to Reduce 30-Day Readmission Rates. Journal of Nursing Care Quality, 29(3), 237-244. Thank you