Executive Solution Overview
– 2 years ago **files (3)** – ## NRS-445-RS-ResearchCritiquePICOTGuidelines.docx – ## NRS-445-RS-T1-LiteratureEvaluationTable.docx – NRS-445Rubric-RoughDraft-ResearchCritiquesandEvidence-BasedPracticeProposal.pdf **## NRS-445-RS-ResearchCritiquePICOTGuidelines.docx** 
**NRS-445: Research Critiques and Evidence-Based Practice Change Proposal Guidelines**
Use this document to synthesize the information from your "Literature Evaluation Table" from Topic 1 into a literature review. Successful completion of this assignment requires that you use your conclusions from your literature review to propose an evidence-based practice change.
**_Introduction_**
· Introduce your nursing practice problem and discuss the purpose of your paper.
· State your updated PICOT question incorporating any feedback that you received from your instructor.
**_Method of Studies_**
· State the methods of the four articles you are comparing and describe how each method helps answer the associated research question.
**_Results of Studies/Key Findings_**
· Summarize the key findings of the four studies.
**_Outcomes Comparison_**
· What are the anticipated outcomes for your PICOT question?
· How do the outcomes of the four articles you chose compare to your anticipated outcomes?
**_Proposed Evidence-Based Practice Change_**
· What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?
· Based on this information, propose an evidence-based practice change to improve outcomes of patient care for your identified setting.
· Suggest one way to assess outcomes for the proposed practice change to determine whether or not it is effective.
**_Conclusion_**
· Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.
© 2023. Grand Canyon University. All Rights Reserved.
2
## image1.jpeg
**## NRS-445-RS-T1-LiteratureEvaluationTable.docx**
1
**NRS-445 Topic 1: Literature Evaluation Table**
**Student Name:**
**Faculty Name:**
**Background of Nursing Practice Problem (one paragraph; no more than 250 words):**
Despite available pharmacologic and non-pharmacologic interventions, patient symptoms often remain poorly managed, and patient prognosis remains poor throughout the world. As widely known, patients with HF have high rates of readmission, mainly because of episodes of worsening of the disease, thus putting a burden on the healthcare facilities and the patients. Conventional approaches to follow-up and supervision of the heart failure patients entail regular hospital check-ups, which are inconvenient, especially for the elderly patients (Krzesiński, et al 2022). New technologies like telemedicine interventions that may include monitoring of the patient’s vital signs at his/her home can be a solution to the problem by enhancing the patient’s quality of care yet minimizing cases of readmission. All these interventions ensure that patients are closely watched in real-time and more so when a particular patient’s condition worsens. However, future studies are required to support the effectiveness of such interventions for preventing readmissions and enhancing the self-management of heart failure at home (Stergiopoulos, et al 2024). The possible enhancement of the patients’ condition and reduction in the costs of treatment make the telemedicine application an important subject in the management of HF.
****References:****
**Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., Siwołowski, P., Gutknecht, P., Chrom, P., Murawski, P., Walczak, A., Szalewska, D., Banasiak, W., Ponikowski, P., & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support and remote cardiologists’ decisions in patients with heart failure (AMULET study): a randomised controlled trial. European Journal of Heart Failure, 24(3), 565–577.**
**[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358)**
**Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6.**
**[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334)**
****PICO(T) Question:** _Use the PICOT question developed in Topic 1 Discussion Question (DQ) 2 and refine it as needed._**
**| | | |**
**| — | — | — |**
**| **PICO(T) Question Template** |**
**| **P** | **Population** | In heart failure patients (P) |**
**| **I** | **Intervention** | How does home-based telemedicine use remote monitoring (I) |**
**| **C** | **Comparison** | Compared to standard care (C) |**
**| **O** | **Outcome** | Affect hospital readmission rates (O) |**
**| **T** | **Timeline**<br>_(optional)_ | Within 12 months (T) |**
**| **Intervention** |**
**| In_<br>heart failure patients_(P), how does _<br>home-based telemedicine using remote monitoring_ (I) compared to <br>standard care (C) affect _<br>hospital readmission rates_ (O) within_<br>12 months_(T)? |**
**| **Problem Statement** |**
**| It is not known if the implementation of <br>_home-based telemedicine based on remote monitoring_(I) would impact <br>changes on hospital readmission rates (O) among <br>heart failure patients (P). |**
**| | | | | |**
**| — | — | — | — | — |**
**| **Criteria** | **Article 1** | **Article 2** | **Article 3** | **Article 4** |**
**| **APA Reference**<br>Include the GCU permalink or working link used to access the article | Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., … & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support, and remote cardiologists' decisions in patients with heart failure (AMULET study): A randomized controlled trial. <br>_European Journal of Heart Failure, 24_(3), 565-577.<br> <br>[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358) | Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6. <br>[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334) | Thi Xuan Hanh Vo, Marie-Pascale Pomey, Loyda Jean Charles, Paula A. B. Ribeiro, Stéphanie Béchard, Émilie Rémillard, Shana Grigoletti, John Nguyen, Pascale Lehoux, Emmanuel Marier-Tétrault, & Francois Tournoux. (2024). Patients’ experience using an app for home remote monitoring of heart failure for a university hospital in Quebec, Canada. BMC Digital Health, 2(1), 1–12. <br>[https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4](https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4) | Jocelyn Carter, Karen Donelan, & Anne N. Thorndike. (2022). Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. Journal of Primary Care & Community Health, 13. <br>[https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672](https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672) |**
**| **Purpose/Aim of Study** | The paper assesses the effectiveness of nurse-led telecare with referral to remote consultation or the cardiologist in relation to hospital readmission as well as mortality in patients with heart failure. | The following paper aims to determine the effectiveness of telemedicine as well as telemonitoring in decreasing the rate of hospital readmissions among heart failure and COPD patients. | The paper aims to assess the positive and negative aspects of the remote telemonitoring mobile application in heart failure patients and its impact on their disease. | The research aims at describing home-based care and remote monitoring experiences of heart failure patients as well as their perceptions and attitude towards the interventions. |**
**| **Research question(s)** | Is telecare with telemedicine administered by a nurse effective in lowering hospitalization rates and cardiovascular mortality in heart failure patients? | Does telemedicine use the telemonitoring technique attenuate hospital readmissions among heart failure and COPD patients? | What is the experience of heart failure patients in using a mobile app for home remote monitoring for managing their condition? | What is the patient heart failure perception on home based care and remote monitoring? |**
**| **Design**<br>Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design. | Quantitative, randomized controlled trial. It is done randomly through selection of patients for the study and assessment of indicators such as rates and number of readmissions and number of deaths. | Quantitative, systematic review of studies. This is established based on the integration of several empirical studies that have sought to ascertain the performance of telemedicine. | Qualitative, semi-structured interviews with thematic analysis. | Qualitative, using semi-structured interviews and thematic analysis. |**
**| **Setting**<br>Where did the study take place? What type of setting: inpatient, outpatient, etc.? | Outpatient setting in multiple centers across Poland. | Various healthcare settings across multiple studies reviewed. | University hospital in Quebec, Canada. | Primary care and community health settings. |**
**| **Sample**<br>Number and characteristics of participants | It enrolled 605 patients with heart failure and left ventricular ejection fraction ≤49%. | 29 studies on the telemonitoring in heart failure and COPD, 4,326 patients. | 12 heart failure patients using TakeCare™ app for at least 3 months. | 24 heart failure patients. |**
**| **Methods**<br>Interventions/Instruments | They were given nurse led assessment with support from telemedicine. Based on the findings, hospital readmissions and mortality are two other factors that were established as outcomes of the condition. | Randomized controlled trials and cohort studies were pool for meta-analysis. | Patients should be asked questions aimed at establishing their experiences with the app. | To probe patient perspectives, in depth interviews. |**
**| **Analysis**<br>How were the collected data analyzed? | Statistical methods were used on data analysis in order to determine the readmission rates between the intervention and control groups. | Meta-analysis of the readmission rates of the considered trials, which resulted in an aggregate odds ratio for telemedicine interventions. | This paper presents thematic analysis of interview data to identify common themes in patients’ experiences. | The interview data selected for thematic analysis for key themes. |**
**| **Outcomes/key findings** of the study and implications for nursing practice<br> <br>Summary of study results | According to the findings of the study, telecare had a positive impact in doing away with cases of readmission to the hospital and cases of cardio vascular deaths meaning that telemedicine is very important in the management of chronic illnesses. | The telemedicine telemonitoring examination showed that such strategy helps to decrease the level of readmission to the hospital, and thus refutes the idea that remote care should be limited. | It was evidenced, mostly, that the patients benefited from the app interface, and the general facility achieved through the application to be connected to the healthcare team. | The work of the article is that patients were glad to have an opportunity to get more connected with their healthcare providers and manage diseases easier. |**
**| **Recommendations of the researcher** | Ideally, one should build on the current application of nurse-led telecare interventions in heart failure treatment and enhance its usage in improving more patient results and the outcome of the healthcare industry’s spending. | Integrate telemedicine and telemonitoring services in the day-to-day practice in the treatment of chronic illnesses to minimize cases of readmissions. | Increase the patient experience component and the approaches used in communiqué to thus increase optimism. | Strengthen patient knowledge concerning the application of remote monitoring technologies and adaptation into their daily schedule. |**
**| **Explain how this article supports your proposed PICO(T) question.** | This study ties into the disease area of heart failure and the effects of telemedicine interventions on readmissions; therefore, it is closely connected to the PICOT question. | This article directly supports the PICOT question by presenting significant evidence that telemedicine has a positive impact on hospital readmissions. | The presented article sheds light on the patients’ readiness to utilize remote monitoring solutions – one of the key aspects using telemedicine in the case of heart failure. | This article supports the PICOT question by providing information on patient handling with remote monitoring technologies as an important factor that determines the effects of such interventions on hospital readmission. |**
**© 2023. Grand Canyon University. All Rights Reserved.**
**11**
**NRS-445Rubric-RoughDraft-ResearchCritiquesandEvidence-BasedPracticeProposal.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrs-445rubric-roughdraft-researchcritiquesandevidence-basedpracticeproposal-pdf-10237009)
**NRS-445Rubric-RoughDraft-ResearchCritiquesandEvidence-BasedPracticeProposal.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrs-445rubric-roughdraft-researchcritiquesandevidence-basedpracticeproposal-pdf-10237009)
**## NRS-445-RS-ResearchCritiquePICOTGuidelines.docx**
**NRS-445: Research Critiques and Evidence-Based Practice Change Proposal Guidelines**
Use this document to synthesize the information from your "Literature Evaluation Table" from Topic 1 into a literature review. Successful completion of this assignment requires that you use your conclusions from your literature review to propose an evidence-based practice change.
**_Introduction_**
· Introduce your nursing practice problem and discuss the purpose of your paper.
· State your updated PICOT question incorporating any feedback that you received from your instructor.
**_Method of Studies_**
· State the methods of the four articles you are comparing and describe how each method helps answer the associated research question.
**_Results of Studies/Key Findings_**
· Summarize the key findings of the four studies.
**_Outcomes Comparison_**
· What are the anticipated outcomes for your PICOT question?
· How do the outcomes of the four articles you chose compare to your anticipated outcomes?
**_Proposed Evidence-Based Practice Change_**
· What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?
· Based on this information, propose an evidence-based practice change to improve outcomes of patient care for your identified setting.
· Suggest one way to assess outcomes for the proposed practice change to determine whether or not it is effective.
**_Conclusion_**
· Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.
© 2023. Grand Canyon University. All Rights Reserved.
2
## image1.jpeg
**## NRS-445-RS-T1-LiteratureEvaluationTable.docx**
1
**NRS-445 Topic 1: Literature Evaluation Table**
**Student Name:**
**Faculty Name:**
**Background of Nursing Practice Problem (one paragraph; no more than 250 words):**
Despite available pharmacologic and non-pharmacologic interventions, patient symptoms often remain poorly managed, and patient prognosis remains poor throughout the world. As widely known, patients with HF have high rates of readmission, mainly because of episodes of worsening of the disease, thus putting a burden on the healthcare facilities and the patients. Conventional approaches to follow-up and supervision of the heart failure patients entail regular hospital check-ups, which are inconvenient, especially for the elderly patients (Krzesiński, et al 2022). New technologies like telemedicine interventions that may include monitoring of the patient’s vital signs at his/her home can be a solution to the problem by enhancing the patient’s quality of care yet minimizing cases of readmission. All these interventions ensure that patients are closely watched in real-time and more so when a particular patient’s condition worsens. However, future studies are required to support the effectiveness of such interventions for preventing readmissions and enhancing the self-management of heart failure at home (Stergiopoulos, et al 2024). The possible enhancement of the patients’ condition and reduction in the costs of treatment make the telemedicine application an important subject in the management of HF.
****References:****
**Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., Siwołowski, P., Gutknecht, P., Chrom, P., Murawski, P., Walczak, A., Szalewska, D., Banasiak, W., Ponikowski, P., & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support and remote cardiologists’ decisions in patients with heart failure (AMULET study): a randomised controlled trial. European Journal of Heart Failure, 24(3), 565–577.**
**[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358)**
**Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6.**
**[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334)**
****PICO(T) Question:** _Use the PICOT question developed in Topic 1 Discussion Question (DQ) 2 and refine it as needed._**
**| | | |**
**| — | — | — |**
**| **PICO(T) Question Template** |**
**| **P** | **Population** | In heart failure patients (P) |**
**| **I** | **Intervention** | How does home-based telemedicine use remote monitoring (I) |**
**| **C** | **Comparison** | Compared to standard care (C) |**
**| **O** | **Outcome** | Affect hospital readmission rates (O) |**
**| **T** | **Timeline**<br>_(optional)_ | Within 12 months (T) |**
**| **Intervention** |**
**| In_<br>heart failure patients_(P), how does _<br>home-based telemedicine using remote monitoring_ (I) compared to <br>standard care (C) affect _<br>hospital readmission rates_ (O) within_<br>12 months_(T)? |**
**| **Problem Statement** |**
**| It is not known if the implementation of <br>_home-based telemedicine based on remote monitoring_(I) would impact <br>changes on hospital readmission rates (O) among <br>heart failure patients (P). |**
**| | | | | |**
**| — | — | — | — | — |**
**| **Criteria** | **Article 1** | **Article 2** | **Article 3** | **Article 4** |**
**| **APA Reference**<br>Include the GCU permalink or working link used to access the article | Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., … & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support, and remote cardiologists' decisions in patients with heart failure (AMULET study): A randomized controlled trial. <br>_European Journal of Heart Failure, 24_(3), 565-577.<br> <br>[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358) | Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6. <br>[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334) | Thi Xuan Hanh Vo, Marie-Pascale Pomey, Loyda Jean Charles, Paula A. B. Ribeiro, Stéphanie Béchard, Émilie Rémillard, Shana Grigoletti, John Nguyen, Pascale Lehoux, Emmanuel Marier-Tétrault, & Francois Tournoux. (2024). Patients’ experience using an app for home remote monitoring of heart failure for a university hospital in Quebec, Canada. BMC Digital Health, 2(1), 1–12. <br>[https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4](https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4) | Jocelyn Carter, Karen Donelan, & Anne N. Thorndike. (2022). Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. Journal of Primary Care & Community Health, 13. <br>[https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672](https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672) |**
**| **Purpose/Aim of Study** | The paper assesses the effectiveness of nurse-led telecare with referral to remote consultation or the cardiologist in relation to hospital readmission as well as mortality in patients with heart failure. | The following paper aims to determine the effectiveness of telemedicine as well as telemonitoring in decreasing the rate of hospital readmissions among heart failure and COPD patients. | The paper aims to assess the positive and negative aspects of the remote telemonitoring mobile application in heart failure patients and its impact on their disease. | The research aims at describing home-based care and remote monitoring experiences of heart failure patients as well as their perceptions and attitude towards the interventions. |**
**| **Research question(s)** | Is telecare with telemedicine administered by a nurse effective in lowering hospitalization rates and cardiovascular mortality in heart failure patients? | Does telemedicine use the telemonitoring technique attenuate hospital readmissions among heart failure and COPD patients? | What is the experience of heart failure patients in using a mobile app for home remote monitoring for managing their condition? | What is the patient heart failure perception on home based care and remote monitoring? |**
**| **Design**<br>Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design. | Quantitative, randomized controlled trial. It is done randomly through selection of patients for the study and assessment of indicators such as rates and number of readmissions and number of deaths. | Quantitative, systematic review of studies. This is established based on the integration of several empirical studies that have sought to ascertain the performance of telemedicine. | Qualitative, semi-structured interviews with thematic analysis. | Qualitative, using semi-structured interviews and thematic analysis. |**
**| **Setting**<br>Where did the study take place? What type of setting: inpatient, outpatient, etc.? | Outpatient setting in multiple centers across Poland. | Various healthcare settings across multiple studies reviewed. | University hospital in Quebec, Canada. | Primary care and community health settings. |**
**| **Sample**<br>Number and characteristics of participants | It enrolled 605 patients with heart failure and left ventricular ejection fraction ≤49%. | 29 studies on the telemonitoring in heart failure and COPD, 4,326 patients. | 12 heart failure patients using TakeCare™ app for at least 3 months. | 24 heart failure patients. |**
**| **Methods**<br>Interventions/Instruments | They were given nurse led assessment with support from telemedicine. Based on the findings, hospital readmissions and mortality are two other factors that were established as outcomes of the condition. | Randomized controlled trials and cohort studies were pool for meta-analysis. | Patients should be asked questions aimed at establishing their experiences with the app. | To probe patient perspectives, in depth interviews. |**
**| **Analysis**<br>How were the collected data analyzed? | Statistical methods were used on data analysis in order to determine the readmission rates between the intervention and control groups. | Meta-analysis of the readmission rates of the considered trials, which resulted in an aggregate odds ratio for telemedicine interventions. | This paper presents thematic analysis of interview data to identify common themes in patients’ experiences. | The interview data selected for thematic analysis for key themes. |**
**| **Outcomes/key findings** of the study and implications for nursing practice<br> <br>Summary of study results | According to the findings of the study, telecare had a positive impact in doing away with cases of readmission to the hospital and cases of cardio vascular deaths meaning that telemedicine is very important in the management of chronic illnesses. | The telemedicine telemonitoring examination showed that such strategy helps to decrease the level of readmission to the hospital, and thus refutes the idea that remote care should be limited. | It was evidenced, mostly, that the patients benefited from the app interface, and the general facility achieved through the application to be connected to the healthcare team. | The work of the article is that patients were glad to have an opportunity to get more connected with their healthcare providers and manage diseases easier. |**
**| **Recommendations of the researcher** | Ideally, one should build on the current application of nurse-led telecare interventions in heart failure treatment and enhance its usage in improving more patient results and the outcome of the healthcare industry’s spending. | Integrate telemedicine and telemonitoring services in the day-to-day practice in the treatment of chronic illnesses to minimize cases of readmissions. | Increase the patient experience component and the approaches used in communiqué to thus increase optimism. | Strengthen patient knowledge concerning the application of remote monitoring technologies and adaptation into their daily schedule. |**
**| **Explain how this article supports your proposed PICO(T) question.** | This study ties into the disease area of heart failure and the effects of telemedicine interventions on readmissions; therefore, it is closely connected to the PICOT question. | This article directly supports the PICOT question by presenting significant evidence that telemedicine has a positive impact on hospital readmissions. | The presented article sheds light on the patients’ readiness to utilize remote monitoring solutions – one of the key aspects using telemedicine in the case of heart failure. | This article supports the PICOT question by providing information on patient handling with remote monitoring technologies as an important factor that determines the effects of such interventions on hospital readmission. |**
**© 2023. Grand Canyon University. All Rights Reserved.**
**11**
**NRS-445Rubric-RoughDraft-ResearchCritiquesandEvidence-BasedPracticeProposal.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrs-445rubric-roughdraft-researchcritiquesandevidence-basedpracticeproposal-pdf-10237009)
**## NRS-445-RS-ResearchCritiquePICOTGuidelines.docx**
**NRS-445: Research Critiques and Evidence-Based Practice Change Proposal Guidelines**
Use this document to synthesize the information from your "Literature Evaluation Table" from Topic 1 into a literature review. Successful completion of this assignment requires that you use your conclusions from your literature review to propose an evidence-based practice change.
**_Introduction_**
· Introduce your nursing practice problem and discuss the purpose of your paper.
· State your updated PICOT question incorporating any feedback that you received from your instructor.
**_Method of Studies_**
· State the methods of the four articles you are comparing and describe how each method helps answer the associated research question.
**_Results of Studies/Key Findings_**
· Summarize the key findings of the four studies.
**_Outcomes Comparison_**
· What are the anticipated outcomes for your PICOT question?
· How do the outcomes of the four articles you chose compare to your anticipated outcomes?
**_Proposed Evidence-Based Practice Change_**
· What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?
· Based on this information, propose an evidence-based practice change to improve outcomes of patient care for your identified setting.
· Suggest one way to assess outcomes for the proposed practice change to determine whether or not it is effective.
**_Conclusion_**
· Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.
© 2023. Grand Canyon University. All Rights Reserved.
2
## image1.jpeg
**## NRS-445-RS-T1-LiteratureEvaluationTable.docx**
1
**NRS-445 Topic 1: Literature Evaluation Table**
**Student Name:**
**Faculty Name:**
**Background of Nursing Practice Problem (one paragraph; no more than 250 words):**
Despite available pharmacologic and non-pharmacologic interventions, patient symptoms often remain poorly managed, and patient prognosis remains poor throughout the world. As widely known, patients with HF have high rates of readmission, mainly because of episodes of worsening of the disease, thus putting a burden on the healthcare facilities and the patients. Conventional approaches to follow-up and supervision of the heart failure patients entail regular hospital check-ups, which are inconvenient, especially for the elderly patients (Krzesiński, et al 2022). New technologies like telemedicine interventions that may include monitoring of the patient’s vital signs at his/her home can be a solution to the problem by enhancing the patient’s quality of care yet minimizing cases of readmission. All these interventions ensure that patients are closely watched in real-time and more so when a particular patient’s condition worsens. However, future studies are required to support the effectiveness of such interventions for preventing readmissions and enhancing the self-management of heart failure at home (Stergiopoulos, et al 2024). The possible enhancement of the patients’ condition and reduction in the costs of treatment make the telemedicine application an important subject in the management of HF.
****References:****
**Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., Siwołowski, P., Gutknecht, P., Chrom, P., Murawski, P., Walczak, A., Szalewska, D., Banasiak, W., Ponikowski, P., & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support and remote cardiologists’ decisions in patients with heart failure (AMULET study): a randomised controlled trial. European Journal of Heart Failure, 24(3), 565–577.**
**[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358)**
**Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6.**
**[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334)**
****PICO(T) Question:** _Use the PICOT question developed in Topic 1 Discussion Question (DQ) 2 and refine it as needed._**
**| | | |**
**| — | — | — |**
**| **PICO(T) Question Template** |**
**| **P** | **Population** | In heart failure patients (P) |**
**| **I** | **Intervention** | How does home-based telemedicine use remote monitoring (I) |**
**| **C** | **Comparison** | Compared to standard care (C) |**
**| **O** | **Outcome** | Affect hospital readmission rates (O) |**
**| **T** | **Timeline**<br>_(optional)_ | Within 12 months (T) |**
**| **Intervention** |**
**| In_<br>heart failure patients_(P), how does _<br>home-based telemedicine using remote monitoring_ (I) compared to <br>standard care (C) affect _<br>hospital readmission rates_ (O) within_<br>12 months_(T)? |**
**| **Problem Statement** |**
**| It is not known if the implementation of <br>_home-based telemedicine based on remote monitoring_(I) would impact <br>changes on hospital readmission rates (O) among <br>heart failure patients (P). |**
**| | | | | |**
**| — | — | — | — | — |**
**| **Criteria** | **Article 1** | **Article 2** | **Article 3** | **Article 4** |**
**| **APA Reference**<br>Include the GCU permalink or working link used to access the article | Krzesiński, P., Jankowska, E. A., Siebert, J., Galas, A., Piotrowicz, K., Stańczyk, A., … & Gielerak, G. (2022). Effects of an outpatient intervention comprising nurse‐led non‐invasive assessments, telemedicine support, and remote cardiologists' decisions in patients with heart failure (AMULET study): A randomized controlled trial. <br>_European Journal of Heart Failure, 24_(3), 565-577.<br> <br>[https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358](https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2358) | Georgios M. Stergiopoulos, Anissa N. Elayadi, Edward S. Chen, & Panagis Galiatsatos. (2024). The effect of telemedicine employing telemonitoring instruments on readmissions of patients with heart failure and/or COPD: a systematic review. Frontiers in Digital Health, 6. <br>[https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334](https://doi-org.lopes.idm.oclc.org/10.3389/fdgth.2024.1441334) | Thi Xuan Hanh Vo, Marie-Pascale Pomey, Loyda Jean Charles, Paula A. B. Ribeiro, Stéphanie Béchard, Émilie Rémillard, Shana Grigoletti, John Nguyen, Pascale Lehoux, Emmanuel Marier-Tétrault, & Francois Tournoux. (2024). Patients’ experience using an app for home remote monitoring of heart failure for a university hospital in Quebec, Canada. BMC Digital Health, 2(1), 1–12. <br>[https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4](https://doi-org.lopes.idm.oclc.org/10.1186/s44247-024-00126-4) | Jocelyn Carter, Karen Donelan, & Anne N. Thorndike. (2022). Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. Journal of Primary Care & Community Health, 13. <br>[https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672](https://doi-org.lopes.idm.oclc.org/10.1177/21501319221133672) |**
**| **Purpose/Aim of Study** | The paper assesses the effectiveness of nurse-led telecare with referral to remote consultation or the cardiologist in relation to hospital readmission as well as mortality in patients with heart failure. | The following paper aims to determine the effectiveness of telemedicine as well as telemonitoring in decreasing the rate of hospital readmissions among heart failure and COPD patients. | The paper aims to assess the positive and negative aspects of the remote telemonitoring mobile application in heart failure patients and its impact on their disease. | The research aims at describing home-based care and remote monitoring experiences of heart failure patients as well as their perceptions and attitude towards the interventions. |**
**| **Research question(s)** | Is telecare with telemedicine administered by a nurse effective in lowering hospitalization rates and cardiovascular mortality in heart failure patients? | Does telemedicine use the telemonitoring technique attenuate hospital readmissions among heart failure and COPD patients? | What is the experience of heart failure patients in using a mobile app for home remote monitoring for managing their condition? | What is the patient heart failure perception on home based care and remote monitoring? |**
**| **Design**<br>Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design. | Quantitative, randomized controlled trial. It is done randomly through selection of patients for the study and assessment of indicators such as rates and number of readmissions and number of deaths. | Quantitative, systematic review of studies. This is established based on the integration of several empirical studies that have sought to ascertain the performance of telemedicine. | Qualitative, semi-structured interviews with thematic analysis. | Qualitative, using semi-structured interviews and thematic analysis. |**
**| **Setting**<br>Where did the study take place? What type of setting: inpatient, outpatient, etc.? | Outpatient setting in multiple centers across Poland. | Various healthcare settings across multiple studies reviewed. | University hospital in Quebec, Canada. | Primary care and community health settings. |**
**| **Sample**<br>Number and characteristics of participants | It enrolled 605 patients with heart failure and left ventricular ejection fraction ≤49%. | 29 studies on the telemonitoring in heart failure and COPD, 4,326 patients. | 12 heart failure patients using TakeCare™ app for at least 3 months. | 24 heart failure patients. |**
**| **Methods**<br>Interventions/Instruments | They were given nurse led assessment with support from telemedicine. Based on the findings, hospital readmissions and mortality are two other factors that were established as outcomes of the condition. | Randomized controlled trials and cohort studies were pool for meta-analysis. | Patients should be asked questions aimed at establishing their experiences with the app. | To probe patient perspectives, in depth interviews. |**
**| **Analysis**<br>How were the collected data analyzed? | Statistical methods were used on data analysis in order to determine the readmission rates between the intervention and control groups. | Meta-analysis of the readmission rates of the considered trials, which resulted in an aggregate odds ratio for telemedicine interventions. | This paper presents thematic analysis of interview data to identify common themes in patients’ experiences. | The interview data selected for thematic analysis for key themes. |**
**| **Outcomes/key findings** of the study and implications for nursing practice<br> <br>Summary of study results | According to the findings of the study, telecare had a positive impact in doing away with cases of readmission to the hospital and cases of cardio vascular deaths meaning that telemedicine is very important in the management of chronic illnesses. | The telemedicine telemonitoring examination showed that such strategy helps to decrease the level of readmission to the hospital, and thus refutes the idea that remote care should be limited. | It was evidenced, mostly, that the patients benefited from the app interface, and the general facility achieved through the application to be connected to the healthcare team. | The work of the article is that patients were glad to have an opportunity to get more connected with their healthcare providers and manage diseases easier. |**
**| **Recommendations of the researcher** | Ideally, one should build on the current application of nurse-led telecare interventions in heart failure treatment and enhance its usage in improving more patient results and the outcome of the healthcare industry’s spending. | Integrate telemedicine and telemonitoring services in the day-to-day practice in the treatment of chronic illnesses to minimize cases of readmissions. | Increase the patient experience component and the approaches used in communiqué to thus increase optimism. | Strengthen patient knowledge concerning the application of remote monitoring technologies and adaptation into their daily schedule. |**
**| **Explain how this article supports your proposed PICO(T) question.** | This study ties into the disease area of heart failure and the effects of telemedicine interventions on readmissions; therefore, it is closely connected to the PICOT question. | This article directly supports the PICOT question by presenting significant evidence that telemedicine has a positive impact on hospital readmissions. | The presented article sheds light on the patients’ readiness to utilize remote monitoring solutions – one of the key aspects using telemedicine in the case of heart failure. | This article supports the PICOT question by providing information on patient handling with remote monitoring technologies as an important factor that determines the effects of such interventions on hospital readmission. |**
**© 2023. Grand Canyon University. All Rights Reserved.**
**11**
**NRS-445Rubric-RoughDraft-ResearchCritiquesandEvidence-BasedPracticeProposal.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrs-445rubric-roughdraft-researchcritiquesandevidence-basedpracticeproposal-pdf-10237009)