See attached phase 1 and phase 2
Phase 3 of the research project is the implementation phase. The implementation phase will be written in the future state as we will not be implementing the actual project. This phase focuses on providing steps by steps instructions on how the program will be implemented, a table describing the time frame of the project, if there is any budget that needs to be taking into account, and any resources or statistically tools required. The length of this paper should be around 5-6 pages.Please pay very close attention to your APA 6th edition formatting, grammar, intext citations, and references. If necessary, consult the University’s Writing Center for additional assistance.Running Head: OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Factors that Limit Effective Discharge Planning for Chronically ill Patients in ICU
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 02/302020
1
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Table of Contents
Introduction ……………………………………………………………………………………………………………….. 3
Statement of the Problem …………………………………………………………………………………………….. 4
Purpose of the Study …………………………………………………………………………………………………… 4
Approach …………………………………………………………………………………………………………………… 4
Research Question ……………………………………………………………………………………………………… 5
Expected Outcomes ……………………………………………………………………………………………………. 5
Significance of the Study …………………………………………………………………………………………….. 5
Methodology ……………………………………………………………………………………………………………… 6
Research Design……………………………………………………………………………………………………… 6
Sample Population and Sampling Method ………………………………………………………………….. 6
Data Collection ………………………………………………………………………………………………………. 6
Data Analysis …………………………………………………………………………………………………………. 6
References …………………………………………………………………………………………………………………. 8
2
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Introduction
According to Naylor et al. (2011), the goal of transitional care is to prevent
hospitalizations and health complications of chronically ill patients when they leave hospital
settings. It is a process that requires a comprehensive home-follow-up and discharge
planning. Effective discharge planning is meant to link the treatment that a patient receives at
the hospital and the post-discharge care that the patient receives from the community
(Shepperd et al., 2013). When patients arrive at the hospital, nurses should: i)
comprehensively assess the health status of the patient, ii) develop comprehensive care plans
for every patient using evidence-based guidelines, and in collaboration with other health
professionals and the families of the patients, and iii) daily visit and asses the patient and start
working on a care plan upon discharge. When a patient gets discharged from the hospital, a
nurse should visit the patient periodically at home or schedule phone calls with the patient.
Numerous studies such as Behzadian and Kapelan (2015), Mazloum et al. (2016), and
Kisely et al. (2017) .indicate that patient satisfaction and health outcomes increase with
effective discharge planning, while other studies indicate that it reduces readmission rates and
the length of stay at the hospital. Discharge nursing is an essential component in nursing
because it has significant impacts on how the family copes when chronically ill patients leave
the hospital. Discharge planning follows the following steps: i) identifying patients that will
need help with discharge planning, ii) working together with the patient’s family and other
healthcare professionals in planning the discharge, iii) recommending continued care options,
or referring the patient to services or programs that meet their preferences and needs, and iv)
encouraging and supporting the patients and their families during the care periods. But
despite the importance of discharge planning, Wong et al. (2011) argues that most hospitals
discharge their patients without proper panning. This research will explore the experiences
3
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
that nurses face during discharge planning with the aim of identifying the obstacles to
effective and comprehensive discharge planning.
Statement of the Problem
Many studies have revealed that most hospitals discharge their patients with
inadequate information, poor instruction, poor communication, insufficient planning, and
poor coordination between and among healthcare teams. Whenever discharging patients,
hospitals should ensure that comprehensive discharge plans are developed for each and every
patient, depending on the uniqueness of their cases (Raven et al., (2011). And since nurses
are always in contact with the patients and their families, they have a role to play in ensuring
that each patient and a comprehensive discharge plan before leaving the hospital. But as
many studies indicate, most healthcare providers do not release their patients from hospitals
with comprehensive discharge plans.
Purpose of the Study
The purpose of the study will be to explore the factors that hinder nurses’ ability to
develop comprehensive discharge plans for chronically ill patients effectively. The researcher
hopes that the findings of the study will be used by nurses and other health professionals in
overcoming the challenges to effective discharge planning of patients in ICU.
Approach
The researcher will approach the research both bibliographically and empirically.
Bibliographic research will involve a review of the literature on similar topics in order to
understand the investigations of other experts as contained in the relevant literature.
Empirical research will allow the researcher to challenge, extend, and verify the hypothesis.
Empirical research will involve the collection of data from selected participants; collected
data will then be analyzed and conclusions made.
4
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Research Question
This study will aim at answering the following research question:
1. What are the Factors that Limit Effective Discharge Planning for Chronically ill
Patients in ICU
Expected Outcomes
Through this research, the research expects to gain insight and identify the factors that
hinder nurses’ abilities to develop an effective discharge plan for chronically ill patients in
ICU. The researcher will explore the experiences and views of different nurses and hopes that
the participants will help identify those factors and how they can be controlled. The
researcher envisions that the findings of the research will be used as the basis for
improvements in regard to patient discharge planning, thus relaxing heightened anxiety levels
of families related to their patients being discharged from hospital. Evidence-based discharge
planning could also be used to manage time and to improve job satisfaction on nurses
working in ICU.
Significance of the Study
With the right information, healthcare professions – nurses included – can be able to
develop comprehensive discharge plans tailored towards the needs of individual patients. It is
expected that this research will reveal the factors that hinder effective discharge planning and
propose strategies that can be employed by a health professional in overcoming those
obstacles. If nurses and other health professions can arm themselves with the right
information, skills, and attitude, their efficiency also increases, eventually translating to
increased health outcomes and satisfied patients.
5
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Methodology
Research Design
The findings of this study will be based on the views of nurses in ICU, and on
information obtained from relevant literature reviews. Therefore, the researcher will use a
qualitative design because of its suitability in exploring the behaviors and thoughts of people
individually and when in groups.
Sample Population and Sampling Method
The participants in this study will be 15 INC nurses within the XYZ area. A small
sample population will be chosen for this study due to time and financial constraints.
Purposive sampling will be used in selecting participants because it is the only way the
researcher will be sure that the chosen participants (nurses) have knowledge of the topic
under investigation (Etikan et. al., 2016). Only registered nurses with at least two years of
experience will be used in the study. Student nurses of nurses with less than two years of
experience will be excluded.
Data Collection
The researcher will collect data using in-depth interviews, which will be guided by
prompts and opening questions from the researcher. This will allow the researcher to develop
his own views. As opposed to structured questions, Prompts prevent the research from
forcing participants into certain lines of thought; they allow participants to speak of their
experiences using their own words (Pietkiewicz et al., 2014).
Data Analysis
Thematic content analysis will be used because it will allow the researcher to identify
main elements and recurring themes from collected data. Recorded interviews will first be
transcribed by the researcher. Transcription is a time-consuming exercise, but it will allow
the researcher to be immersed in the collected data. Transcribed data will be stored
6
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
electronically as word documents, followed by transcripts coding. To maintain the anonymity
of participants, pseudonyms will be used instead of their names. The researcher will then
analyze the data using SPSS and then summaries and conclusions made. To guarantee the
authenticity of the findings, an independent researcher will be asked to review the data and
validate it.
7
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
References
Behzadian, K., & Kapelan, Z. (2015). Advantages of integrated and sustainability-based
assessment for metabolism based strategic planning of urban water systems. Science
of the total environment, 527, 220-231.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Kisely, S., Wyder, M., Dietrich, J., Robinson, G., Siskind, D., & Crompton, D. (2017).
Motivational aftercare planning to better care: applying the principles of advanced
directives and motivational interviewing to discharge planning for people with mental
illness. International journal of mental health nursing, 26(1), 41-48.
Mazloum, S. R., Heidari-Gorji, M. A., Bidgoli-Gholkhatmi, M., & Agayei, N. (2016).
Effectiveness of discharge-planning on physical quality of life of patients with
ischemic heart disease. International Journal of Applied and Basic Medical Research,
6(2), 129.
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The
importance of transitional care in achieving health reform. Health affairs, 30(4), 746754.
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative
phenomenological analysis in qualitative research psychology. Psychological journal,
20(1), 7-14.
Raven, M. C., Doran, K. M., Kostrowski, S., Gillespie, C. C., & Elbel, B. D. (2011). An
intervention to improve care and reduce costs for high-risk patients with frequent
hospital admissions: a pilot study. BMC health services research, 11(1), 270.
8
OBSTACLES TO EFFECTIVE DISCHARGE PLANNING
Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L.
(2013). Discharge planning from hospital to home. Cochrane database of systematic
reviews, (1).
Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C., Chan, F. W., Wong, F. Y., & Yeoh,
E. K. (2011). Barriers to effective discharge planning: a qualitative study investigating
the perspectives of frontline healthcare professionals. BMC health services research,
11(1), 242.
9
Running head: QUALITATIVE RESEARCH PROJECT PHASE TWO
Qualitative Research Project Phase Two
Student’s Name: Yaniel Lopez
Curse: NGR 5110 Nursing Research
Date: 02/13/2020
1
QUALITATIVE RESEARCH PROJECT PHASE TWO
Literature Review
Effective discharge planning is one that has been presumed to be a significant aspect
especially when discharging chronically ill patients, particularly in the intensive care units.
According to (McMartin, 2013), discharge planning is denoted as the procedure or process which
is initiated during admission in the hospital and during discharge. Naylor et al. (2011), asserts
that the transition care should be carried out effectively since it can help in curtailing healthcare
complications and hospitalizations after discharge. The primary aim of effective discharge
planning is to help in enhancing the care of the patients after they have been discharged from the
hospital. According to (McMartin, 2013), people who have chronic or critical conditions tend to
experience alterations in their health status. Through effective discharge planning, the health care
providers can obtain the chance of limiting the rates of hospitalizations after discharge since
effective discharge planning is accompanied by appropriate interventions, follow-ups, and
support services. A review conducted by (McMartin, 2013) affirmed that discharge planning
helps in declining hospital readmissions. In his review, (McMartin, 2013) also found out that
effective discharge planning can help in reducing the length of initial hospital stay. The reviewer
further denotes that during transitions in the health care settings, mistakes tend to emerge and can
result in medication errors. As well, transitions have the potential of increasing hospitalizations
hence the need for discharge planning in the health care settings. The author further affirms that
communication and planning before the discharge events are crucial aspects in making the aspect
of discharge planning more effective. Through discharge planning, the patients are provided with
the chance of communicating with their providers on how they can effectively manage their
chronic conditions.
2
QUALITATIVE RESEARCH PROJECT PHASE TWO
Wong et al in (2011) researched to examine the barriers that deter effective discharge
planning. Through the qualitative study (Wong et al,2011) found out that it is imperative to
develop comprehensive systems and ensure that the roles of the staff individuals are clearly
defined to promote effective discharge planning. According to (Wong et al,2011) a systematic
approach should be incepted to help in developing the discharge planning structure and offer
quality care to patients. Accordingly, the discharge planning process should be policy-driven and
that both coordination and communication should be incorporated to help in enhancing the
effectiveness of the discharge process. Researchers further affirm that the process of discharging
patients is complex and challenging hence the need to incept measures for addressing the
challenges. Research by (Wong et al, 2011) found out that hospital discharge policies, review of
performance, capacity planning and stakeholders’ cooperation and engagement are critical
aspects for the inception of an effective discharge process in the health care settings.
An integrative research study by (Peltonen et al, 2015) sought to explore the
organizational aspects that result in or trigger the discharge delays and admission delays in the
intensive care units. According to the study, the researchers found out that both discharge and
admission delay in the intensive care units might result in adverse events and may increase the
costs of providing care to the patients. The review concluded that there is a need to carry out indepth research to ascertain the factors that result in a delay in discharge planning and admission.
From the review of literature, it is imperative to ascertain there is a gap in the study since
previous researchers have not expounded on the aspects or factors that deter effective discharge
planning for patients who are chronically ill in the intensive care units. The identification of the
factors that impact on effective discharge planning would help the health care providers to
3
QUALITATIVE RESEARCH PROJECT PHASE TWO
ascertain the measures that should be undertaken to deal with the situation and ensure that the
methods of discharging the patients are effective.
Methodology and Design of the Study
The design of the study is the qualitative design involving the use of the interviews as the
data collection instruments. The primary rationale for deploying the use of the interviews as the
data collection instrument is that the interviews provide the chance for the researcher to carry out
an in-depth exploration of the views and perceptions of the participants regarding the topic of
study. The qualitative design is also an effective method of exploring the ideologies and
behaviors of people regarding a particular aspect (Suri, 2011). The embracement of the
qualitative design of the study would help in carrying out in-depth exploration and obtaining
information from the nurses that would help in ascertaining the factors that limit the
effectiveness of discharge planning for chronically ill patients in the intensive care units. The
study employs the use of 15 participants who are nurses in the INC within the area. The inclusion
criterion for the participants of the study is that the nurses chosen for the study should have
experience of more than two years of experience in the area of specialization and they should be
registered nurses. The exclusion criterion for the participants of the study is that the participants
or respondents of the study should be excluded if they experience in the area of specialization is
less than two years.
Sampling Methodology
The sampling methodology for qualitative research under discussion is the purposive
sampling technique. Purposive sampling is used to denote the technique in which the selected
4
QUALITATIVE RESEARCH PROJECT PHASE TWO
individuals or participants for the study have in-depth knowledge and experience in the topic of
interest. As well, in purposive sampling, the participants of the study have the willingness or
desire to participate in the study. It is heeded that in purposive sampling the participants or
respondents of the study should have the potential of communicating their ideologies and
experiences reflectively and expressively (Suri, 2011). One of the advantages of using purposive
sampling in the research under evaluation is that purposive sampling helps in obtaining the
participants with the required characteristics or attributes (Suri, 2011).As well, the information
obtained from the participants obtained through purposive sampling has a low margin of error
since the data or information is obtained from the respondents with knowledge in a particular
topic. For the study to evaluate the factors that limit effective discharge planning for ICU
patients under critical conditions, the use of purposive sampling is advantageous since the
researcher will obtain information from the relevant response. Ideally, the nurses in the study
provide health care services in the Intensive care units and therefore the information obtained
from the participants is validated. Therefore, the use of purposive sampling is appropriate for the
particular study.
Necessary Tools that will be incorporated in the Paper
One of the tools that will be incorporated in the paper is the interview sheet which will
include the questions or the inquiries that will be asked to the participants. As well, the consent
form will be included since it will seek to inform the participants on the role of the study. The
participants will be informed that their information will be used for research only. As well, the
data recording tools will also be prevalent since the information obtained from the participants
will e recorded and stored.
5
QUALITATIVE RESEARCH PROJECT PHASE TWO
Flow Charts in the Paper
The paper will contain various charts that will be meaningful to the researcher as they
will help in validating the research study. One of the charts that will be used in the paper is the
one showing the exclusion and inclusion criterion for the participants of the study. As well, the
charts showing the results of the study will also be incorporated into the paper. The chart below
depicts the flow chart for the inclusion and exclusion criteria for the participants of the study.
The chart showing the results of the study will also be included. As well, the analyzed data will
also be depicted in form of charts to demonstrate on how the researcher arrived at the conclusion
of the study.
.Table 1: Exclusion and Inclusion Criteria
Inclusion Criterion
Exclusion Criterion
Registered nurse
Less than two years of experience in the area
of specialization.
Two years or more of experience in the area of
specialization
6
QUALITATIVE RESEARCH PROJECT PHASE TWO
References
McMartin, K. (2013). Discharge Planning in Chronic Conditions An Evidence-Based Analysis.
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The
importance of transitional care in achieving health reform. Health affairs, 30(4), 746-754.
Peltonen, L., McCallum, L., Siirala, E., Haataja, M., Lundgrén-Laine, H., Salanterä, S., & Lin, F.
(2015). An Integrative Literature Review of Organisational Factors Associated with
Admission and Discharge Delays in Critical Care. Biomed Research International, 2015,
1-12. doi: 10.1155/2015/868653
Suri, H. (2011). Purposeful Sampling in Qualitative Research Synthesis. Qualitative Research
Journal, 11(2), 63-75. doi: 10.3316/qrj1102063
Wong, E., Yam, C., Cheung, A., Leung, M., Chan, F., Wong, F., & Yeoh, E. (2011). Barriers to
effective discharge planning: a qualitative study investigating the perspectives of
frontline healthcare professionals. BMC Health Services Research, 11(1). doi:
10.1186/1472-6963-11-242
7

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