NURS 8211 Week 11 Final Data Report Example

Six Months of Teach-Back Data From One Heart Failure Unit: A Final Data Report in SQUIRE Form, With a Skill-by-Skill Readiness Reflection

Student Name

College of Nursing, Walden University

NURS 8211: Data Collection and Analysis for Evidence-Based Practice

Instructor Name

Month Day, Year

Six Months of Teach-Back Data From One Heart Failure Unit: A Final Data Report in SQUIRE Form, With a Skill-by-Skill Readiness Reflection

Introduction

Problem. Adults with heart failure are among the patients most often readmitted within a month of discharge (Jencks et al., 2009). On a composite 28-bed heart failure unit, structured teach-back was adopted two years ago for discharge teaching, but its delivery and effects had never been measured locally.

Available knowledge. A systematic review found that teach-back improved knowledge, adherence and self-management in chronic disease across many studies, with less consistent effects on readmission (Ha Dinh et al., 2016).

Rationale. The unit's practice rested on evidence from elsewhere. Measuring delivery, understanding and readmission locally was needed to know whether the practice was working as intended on this unit.

Specific aim. Within six months of a relaunch, to reach a sustained shift, by run chart rules, in the weekly proportion of eligible discharges with complete teach-back responses, with weekly values above 75%, and to describe changes in patients' ability to state three self-care rules and in 30-day all-cause readmission.

This report follows the SQUIRE 2.0 guidelines for reporting quality improvement work, which ask authors to explain why the work was started, what was done, how its effects were examined, what was found and what it means (Ogrinc et al., 2016). All data are illustrative and were constructed for the course; they describe no real unit or patient.

Methods

Context. The unit discharges about 36 eligible adults home each month. Many evening discharges are handled by float and agency nurses.

Intervention. The relaunch added required fields in the discharge navigator where the nurse records what the patient says back about weighing, fluids and warning signs, with codes for correct first time, correct after re-teaching and not correct. From week 9, a two-minute huddle at the start of evening shifts reminded float nurses of the fields.

Study of the intervention. Delivery was studied with a weekly run chart over 26 weeks. Readmission was studied with a monthly run chart and p-chart over twelve baseline and six post-relaunch months. Documentation was validated by charge nurse observation of ten discharges each month.

Measures. Structure: nurse skills validation and tool availability. Process: complete teach-back responses recorded; observed teach-back. Outcomes: patients stating all three rules at discharge; 30-day all-cause readmission including outside hospitals found through the regional exchange. Balancing: minutes from discharge order to departure.

Analysis. Run chart rules for shifts, trends and runs were applied (Perla et al., 2011). Descriptive statistics were matched to each measure's level of measurement.

Ethical considerations. The organization's review process designated the work as quality improvement. Only the minimum necessary data were extracted, identifiers were replaced with project codes and patient-level data stayed within the organization.

Results

Across six months, 214 eligible discharges occurred. By the end of the period, 94% of unit nurses had completed skills validation.

Complete teach-back responses rose after the evening huddle began. In weeks 1 to 8, weekly values were mostly between 55% and 75%. From week 15 to week 25, eleven consecutive weeks were above the 78% median, meeting the shift rule. The aim was met in the final twelve weeks. Observation agreed with documentation in 52 of 60 discharges.

Among 206 discharges with a recorded response on the weight rule, 64% were correct the first time, 27% correct after re-teaching and 9% not correct at discharge.

Readmission averaged 22% at baseline and 18% after the relaunch. No post-relaunch month fell outside the p-chart limits, and five of six months fell below the baseline median, one short of a shift.

Patients typically left 142 minutes after the discharge order (median), with an interquartile range of 96 to 215 minutes, and did not show a signal of change over the period.

Discussion

Summary. Documented delivery of teach-back improved and was largely confirmed by observation. Most patients could state the weight rule by discharge. Readmission was lower on average but showed no signal of change.

Interpretation. The delivery finding fits the unit's experience that evening discharges by float nurses were the weak point, and a targeted huddle appeared to help. The readmission finding is consistent with the review evidence, in which effects on knowledge and self-management were more consistent than effects on readmission. The relaunch also followed an unusually high stretch of readmissions, so some decline would be expected through regression to the mean (Barnett et al., 2005).

Limitations. The design had no comparison unit. A clinic booking change in the same quarter could affect readmission. Readmissions at hospitals outside the exchange were missed. Monthly numbers are small, so the p-chart limits are wide. Delivery was more likely to be complete for some patients than others, so comparisons between patients with and without complete teach-back were not used.

Conclusions. The unit can say that teach-back is now delivered and documented more consistently and that most patients leave able to state a key self-care rule. It cannot yet say that teach-back has reduced readmissions. The unit council approved continuing the practice and adding a phone check about a week after discharge, when patients are asked to restate the rules, as a faster outcome measure.

Readiness Reflection: My Present Data Skills

The course asked me to rate my readiness for the analytic work of a DNP project. Table 1 rates each skill and names the evidence behind the rating.

Table 1

Self-Rated Analytic Readiness by Skill

The pattern is that I am ready in structured tasks and still developing where judgment about what the data cannot show is required.

What I Will Do Differently

The skill I most need to strengthen is restraint. My instinct, as my first draft showed, is to reach for the strongest sentence the numbers will seem to support. The course showed me that a small, single-unit dataset is a tool for learning, not for proof. In my DNP project, I will write the limitations section before the results section, so that every result is read against its limits from the start, and I will ask a colleague outside the project to challenge each claim before it goes to a committee.

References

Barnett, A. G., van der Pols, J. C., & Dobson, A. J. (2005). Regression to the mean: What it is and how to deal with it. International Journal of Epidemiology, 34(1), 215-220. https://doi.org/10.1093/ije/dyh299

Ha Dinh, T. T., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 14(1), 210-247. https://doi.org/10.11124/jbisrir-2016-2296

Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360(14), 1418-1428. https://doi.org/10.1056/NEJMsa0803563

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895