NURS8114 Framing A Practice Problem As Critical Question With Measurable Outcomes Essay

NURS8114 Framing A Practice Problem As Critical Question With Measurable Outcomes Essay

NURS8114 Framing A Practice Problem As Critical Question With Measurable Outcomes Essay

Week 7

One of the major focuses of the healthcare setting is to ensure that patients are safe and that the services offered to them are of good standard and quality. However, there are usually numerous challenges that threaten the safety of patients and the quality of service. As such, various strategies such as quality improvement and evidence-based practice projects (Balakrishnan, et al., 2019). The clinical issue. Therefore, this discussion focuses on a practice problem. In addressing the problem, various articles will be summarized, and an explanation of the critical question and the value of addressing it will all be explored.

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The identified practice problem for this discussion is nurse burnout. Nurses play a critical role in patient care as, through collaboration with other healthcare professionals, they ensure that the patients have better outcomes. Nurse burnout occurs when there is an emotional, physical, and mental exhaustion resulting from work-connected stressors such as strain resulting from offering care to patients having poor outcomes, the pressure coming from the need to make quick decisions, and long hours of work (Kelly et al., 2021). Nurses experiencing burnout may begin by feeling detached and disengaged. Nurse burnout affects both the nurses and the patients. While it may lead to feelings of depression, hopelessness, and cynicism among nurses, the problem can result in lower quality of patient care. Nurses in such a state are likely to cause medical errors that endanger patients’ safety and life and may lead to death. Nurse burnout has also been shown to lead to other various undesirable situations such as increased staff turnover. High staff turnover has negative financial impacts on the organization (Kelly et al., 2021). In addition, nurse burnout has been associated with increased mortality.

The adverse impacts of nurse burnout imply that there is a need to come up with more robust strategies to address the situation. Indeed, the issue has attracted the attention of various stakeholders and researchers. While some researchers have focused on the possible causes of nurse burnout in the clinical setting, others have explored various ways of preventing, identifying, and managing nurse burnout. The implication is that today, various strategies of preventing and managing nurse burnout exist.

In one of such reports, Carthon et al., 2021, recently conducted research that aimed at examining the connection between patient satisfaction and nurse burnout. They also explored the connection between the outcomes and the work environment. These researchers performed a cross-sectional analysis of close to five hundred hospitals and found out that up to fifty percent of healthcare facilities that experienced high rates of nurse burnout also had poor work conditions and environment, a combination that led to reduced patient satisfaction (Carthon et al., 2021). Therefore, these writers suggest that for improved patient outcomes and lowered cases of nurse burnout, healthcare facilities need to invest in the work environments to improve them.

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Wei et al., 2017 also conducted a study with the aim of evaluating whether an active intervention can lower nurse burnout and improve their performance in the emergency department. The study had both the intervention and the control group. Whereas the control group received ordinary management, the intervention group had both the ordinary management couples with comprehensive management. Upon analysis of the results, they noted that all the applied comprehensive management substantially led to decreased depersonalization and emotional exhaustion. The authors, therefore, indicated that integrating active intervention and comprehensive management is key.


Balakrishnan, K., Brenner, M. J., Gosbee, J. W., & Schmalbach, C. E. (2019). Patient safety/quality improvement primer, part II: prevention of harm through root cause analysis and action (RCA2). Otolaryngology–Head and Neck Surgery161(6), 911-921.

Carthon, J. M. B., Hatfield, L., Brom, H., Houton, M., Kelly-Hellyer, E., Schlak, A., & Aiken, L. H. (2021). System-level improvements in work environments lead to lower nurse burnout and higher patient satisfaction. Journal of nursing care quality36(1), 7-13. Doi: 10.1097/NCQ.0000000000000475.

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing outlook69(1), 96-102.

Wei, R., Ji, H., Li, J., & Zhang, L. (2017). Active intervention can decrease burnout in ED nurses. Journal of emergency nursing43(2), 145-149.

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Discussion:Framing a Practice Problem as a Critical Question With Measurable Outcomes
Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

To prepare:
Identify the practice problem as the focus of your Discussion post. You may use the same practice problem from earlier weeks or a different one.
Review the chapter on practice questions in the Dang and Dearholt text and the Week 7 Media. With guidance from the Learning Resources, cast your practice problem as a critical question.
Search the Walden Library for 2–3 scholarly articles that address your critical question.
Analyze the articles to identify evidence that would guide quality improvement.
Return to the stakeholders that were the audience for your Module 3 Assignment. Identify the specific quality improvement component in the evidence. Then consider how you would present it to that set of stakeholders to secure agreement and action.
With these thoughts in mind …

By Day 3 of Week 7
Post a brief explanation of your critical question. Then, summarize the 2–3 articles you identified that address your critical question. Using the same language you would use with stakeholders, explain the critical question and the value of addressing it as a quality improvement initiative. Be specific. Cite the scholarly articles and other resources to support your post.


D. Harris – Main Question Post

The practice problem for this discussion post is discharge planning. Discharge planning is a process that requires identifying and preparing for a patient’s anticipated health care needs after they leave the hospital. The stakeholders in discharge planning can be as complex as discharge planning; however, the key stakeholders for this specified practice problem will include the patient and family, care team members, like nurses, social workers, therapist, leadership team, and finally, the informatics team.

The portion of discharge planning that is the problem is identifying a patient’s anticipated health care needs—specifically, a patient’s social determinants of health (SDH). The practice problem was revealed through retrospective reviews of clinical records. The reviews demonstrated that multiple patient’s social determinants of health (SDH) sections in the discharge planning assessment were left blank. Questions arose when it was noted that the record section was blank. Does the multidisciplinary team know what social determinants of health (SDH are? Then, does the multidisciplinary team understand the implications of social determinants of health (SDH) on discharge planning and readmissions? Finally, how do we get the case management and nursing team to complete the SDH assessment without causing a burden?

Evidence-based practice can be considered in the context of three forms, quality improvement, research, and evidence-based (Dang, 2021). Based on the questions presented, this practice problem will likely best be solved using the quality improvement and evidence-based practice inquiries forms. In particular, quality improvement, because a gap in performance, practice, or process was noted, the SDH assessments were blank (Dang, 2021). On the other hand, evidence-based practice, there is likely a gap in knowledge of the best available evidence from the team regarding SDH impact (Dang, 2021). Therefore, in speaking with stakeholders, the first initiatives should be geared toward education on SDH.

The education will include what SDH are and how for example, recognition and consideration of SDH are critical to enhancing health equity and supporting positive patient outcomes (Hudson, 2021). Many stakeholders are aware that when patients have positive outcomes, their unit and organization are viable, thus seeing the evidence available will likely build buy-in from the stakeholders. Furthermore, Dang (2021) reports that quality improvement produces evidence that can be applied at the unit and organizational levels.

Another article that will be shared with the stakeholders includes (Zhang et al. 2020), who found that incorporating SDH into existing predictive models is helpful to identify patients and reduce health disparities associated with vulnerable social conditions. For the stakeholders, this evidence demonstrates that Lean Principles can be used because the assessment of SDH can be embedded into the current discharge planning assessment. Therefore, creating less of a burden on the informatics team, nursing staff, and case management. Finally, the third article that will support addressing the critical questions is McNeil (2026), who offers a real-life framework to an evidence-based quality improvement project to structure the discharge planning process, including the unit nursing leadership team and the interdisciplinary discharge planning team. McNeil (2026) is valuable evidence because it will offer the stakeholders a future vision. Implementing the quality improvement project yielded positive results within three months, and the team reported satisfaction with the discharge planning process.


Danielle Harris


Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Walen, M. (Eds.). (2021). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau International.

Hudson, T. (2021). The Role of Social Determinates of Health in Discharge Practices. Nursing Clinics of North America, 56(3), 369–378.

McNeil, A. (2016). Using evidence to structure discharge planning. Nursing Management (Springhouse), 47(5), 22–23.

Zhang, Y., Zhang, Y., Sholle, E., Abedian, S., Sharko, M., Turchioe, M. R., Wu, Y., & Ancker, J. S. (2020). Assessing the impact of social determinants of health on predictive models for potentially avoidable 30-day readmission or death. PloS One, 15(6), e0235064.

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