NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Clinic Question

In patients age 25 – 65 with congestive heart failure, how effective is weekly patient contact and comprehensive education, compared to the standardized discharge plan 2 – 4 weeks follow up, in lowering readmissions rates for reoccurrence of symptoms, within 30 days of hospital discharge?

Summary of the Articles that Support the Critical Question

Even though guideline have been improved heart failure continues to have a high hospital readmission rate. Heart failure care transition and hospital readmissions have been at the top of the list for discussions of health policies, for some time now. The retrospective analysis of >11 million Medicare receivers discovered that roughly 20% of heart failure patients were readmitted within 30 days of hospital discharge (Leavitt, 2020).  Penalties for continue heart failure 30-day hospital readmission through the Hospital Readmissions Reduction Program, have been the push behind improving discharge policies and procedures (Horne, 2020).  Unfortunately, this push for change has said to resulted in patient safety concerns and worsening of patient’s health. Well-organized and effective procedures are recommended for transitional care of heart failure patients. The goal is to reduce 30 hospital readmissions. The patients will require education surrounding self-care and disease management. The groups that receive the intervention had a decrease in 30 hospital readmissions when compared to the controlled groups.

Explanation of the Critical Question

The problem is increased hospital readmission rates among 25 – 65-year-old heart failure patients. The effectiveness of weekly patient contact and a comprehensive education discharge plan will be analyzed and compared to patients receiving the standard 2 – 4-week discharge follow up. 30-day readmission rates for heart failure exacerbation will be compared.

The Value of Addressing Heart Failure Admission Rate

Reducing monetary expenses and refining patient outcomes are the key quality goals of today. Evidence based

NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes
NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

practices give the opportunity to decrease the cost of heart failure 30 day readmissions. Studies have shown some improvement with heart failure discharge outcomes, however more research is needed. Successful transition to home post discharge for heart failure patients will take the patient and family to be involved. Managing care independently is the goal. The discharge plan will require comprehensive education on healthy diet, self-monitoring, increased activity, adequate medication regimen, close contact with health care provider. These materials are included in standard discharge planning, however some patient have a difficult time comprehending health care and understanding medical terms. The value in addressing heart failure readmission rates is providing help to those struggling with managing heart failure.

Quality Improvement Initiative

This would be a great quality improvement initiative. Heart failure patient are at risk for mortality.
Almost .33% of heart failure patient die within 1 year of diagnosis (Sawan, 2018).  Even with the advancement in therapy and heart failure monitoring device therapy, heart failure continues to be accountable for 9 deaths as the leading or contributing cause (Sawan, 2018). Quality improvement in heart failure treatment have been made, however there is lots more work to be done. Motivating the healthcare systems to improve heart patient’s outcomes may require additional incentives. Quality Improvement initiatives will uncover the key factors in improving the problems related to heart failure readmission rates.


Horne, Benjamin D; Roberts, Colleen A; Rasmusson, Kismet D; Buckway, Jason; Alharethi, Rami. (2020). Risk score–guided multidisciplinary team-based Care for Heart Failure Inpatients is associated with lower 30-day readmission and lower 30-day mortality. The American Heart Journal; Philadelphia Vol. 219, (Jan 2020): 78-88.

Sawan Jalnapurkar; Zhao, Xin; Heidenreich, Paul A; Bhatt, Deepak L; Smith, Eric E. (2018). A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get with The Guidelines-Heart Failure.  The American Heart Journal; Philadelphia Vol. 200

Leavitt, Mary Ann; Hain, Debra J; Keller, Kathryn B; Newman, David. (2020). Testing the Effect of a Home Health Heart Failure Intervention on Hospital Readmissions, Heart Failure Knowledge, Self-Care, and Quality of Life. Journal of Gerontological Nursing; Thorofare Vol. 46, Iss. 2, (Feb 2020): 32-40. DOI:10.3928/00989134-20191118-01

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The framework of a critical practice problem with measurable outcomes requires evidence in its structure. There are methods in place to assist with its delivery. The intent of this entry is to explain a practice problem and the summarization of two related articles.

It has been found that the inflammatory process of lymph nodes of the breast post COVID vaccination yields false positive mammograms in females. Therefore, females are urged to delay mammograms 4-6 weeks post vaccination to aid in the reduction of this activity, causing untimely delays in evaluation. Can a patient reduce the inflammatory process through nutrition? Defining the problem precisely and succinctly is important because all subsequent actions and decisions build on the clarity and accuracy of the problem (Gray et al., 2021; 2021).  This EBP question is a foreground question, yielding specific knowledge and generally compare two or more specific interventions (Gray et al., 2021). Presenting the practice problem to stakeholders must be concise.

The development of the question as defined by PICO is female veterans, nutrition, inflammation reduction, and reduced inflammation for prompt mammogram evaluation.  Breast-imaging radiologists have noticed that underarm lymph nodes can be larger than usual after getting a COVID-19 vaccine, on the same side where the vaccine was administered (States News Service, 2021). This article addresses the timing of mammograms. Reports suggest that a negative outcome of COVID-19 patients is strongly associated with an excessive production of pro-inflammatory cytokines, called “cytokine storm” (Medina-Quero et al., 2020). This article breaks down the inflammatory process. Both articles present a robust problem statement and utilizes defined strategies in its problem presentation, utilizing input from diverse healthcare professionals.

Presenting a practice problem to stakeholders must be crisp and one that has a recurring issue potential. The development of the question must be vigorous and well defined. Development of an interdisciplinary team is required for proper delivery.



Gray, J. R., Grove, S. K., & Sutherland, S. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Saunders Elsevier.

Medina-Quero, K., Barreto-Rodriguez, O., Mendez-Rodriguez, V., Sanchez-Moncivais, A., Buendia-Roldan, I., & Chavez-Galan, L. (2020). SARS-COV-2 infection: Understanding the immune system abnormalities to get an adequate diagnosis. BJBMS, 1–12.

States News Service. (2021, March 10). COVID-19 Story tip: Guidelines for timing of mammograms and receiving a COVID-19 vaccine.