Research on Nursing Knowledge in Practice

Summary of Two Articles

1: Quantitative Study

Hospital Readmission Performance and Patterns of Readmission: Retrospective Cohort Study of Medicare Admissions

Problem Statement

The problem that is addressed by Dharmarajan, Hsieh, Lin et al. (2013) in their quantitative study is that too little is known regarding the relationship between hospital rates of readmission and the diagnoses and timing of readmissions. By better understanding this relationship, the researchers hypothesize that more effective approaches to lower readmission rates may be deduced.

Statement of Purpose

The researchers identify their objective within the study in the following terms: “To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions” (Dharmaraian et al., 2013, p. 1).

Research Question(s)/Hypothesis

The research questions that the researchers pose are two-fold: 1) Does the spectrum of readmission diagnoses and median time to readmission varied by categorization of performance and, if so, 2) do they varied for better and worse performers in a consistent manner for all three conditions?

The hypothesis for that study was that high performing hospitals with the lowest 30 day readmission rates would have proportionately fewer readmissions across all diagnoses and time periods after discharge.

Study Methods

A retrospective cohort study was used to answer the research questions. Participants were patients aged 65 and older who had been readmitted within one month of hospital admission for heart failure, acute myocardial infarction or pneumonia between the years of 2007 and 2009. Categorization of readmission diagnoses and timing was done by using the Centers for Medicare and Medicaid Services condition categories.

Key Findings

In the one month following the initial admission, the researchers found that hospitals with varying 30 day readmission rates had similar distribution of readmissions with respect to the diagnoses and timing. High performing hospitals with low 30 day risk of readmission rates were found to “maintain a similar pattern of readmission diagnoses and timing as lower performing institutions” (Dharmaraian et al., 2013, p. 4). The study shows that “hospitals might best achieve low 30 day readmission rates by using general strategies or capacities that apply broadly across potential readmission diagnoses and time periods after discharge” (Dharmaraian et al., 2013, p. 4).

Reference

Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I. et al. (2013).

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. BMJ, 347, f6571.

2: Qualitative Study

Nursing Staff’s Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries in an Adult Acute Surgical Inpatient Care Setting

Problem Statement

Patients suffer falls from having their beds at inappropriate heights. The researchers show that it is important for nurses to communicate to patients the need to keep bed level settings at their lowest so as to prevent. However, it is unclear among the literature as to whether nurses are actually aware of this need. Thus, there is a current gap in the literature regarding nurses’ awareness of proper bed height settings for patient. This qualitative study aimed to address that gap.

Statement of Purpose

The purpose of this study as identified by the researchers was: “to explore nursing staff\\\\\\\'s awareness of the importance of keeping patient beds in the lowest position to prevent falls and fall injuries in adult acute inpatient care settings” (Tzeng, Yin, Anderson & Prakash, 2012, p. 272).

Research Question(s)

The research question that this study sought to answer was: “Are nursing staff aware of the importance of keeping patient beds in the lowest position to prevent falls and fall injuries?” (Tzeng et al., 2012, p. 272).

Method

The interview method was used to obtain data for this study. The researchers obtained “preexisting interview data to answer the research question. The pre-existing interview data were from semi-structured interviews, which were conducted with nursing staff in a 52-bed adult acute inpatient surgical unit with medical overflow in a community hospital located in Michigan. The semi-structured interview data were from an interdisciplinary collaborative pilot project that tested the usefulness of the bed height alert system from September 2010 to April 2011” (Tzeng et al., 2012, p. 272). Interviews were conducted in 2011. 18 RNs and 13 PCAs were interviewed for the study. Themes were developed from patients responses to determine whether nurses had demonstrated awareness of proper bed height for patients by communicating the best setting level to the patient.