NURS FPX 9902 Assessment 3 Literature Synthesis

Name

Capella university

NURS-FPX 9902 Nursing Doctoral Project 2

Prof. Name

Date

Literature Synthesis

A structured and deliberate literature search is fundamental in informing clinical improvements and shaping the framework for a doctoral capstone project. The search process was initiated by identifying a patient-centered clinical concern and transforming it into a well-defined research inquiry using the PICOT format. Institutional approvals from both the project site and Capella University’s IRB were secured before initiating the literature review. The formulated research question was: Among caregivers of patients diagnosed with chronic obstructive pulmonary disease (COPD), how does providing COPD-specific education through the teach-back method, compared to usual care, influence medication adherence and hospital readmissions over a 10-week period?

To address this research question, multiple databases available via the Capella University Library were systematically explored. The selected databases included CINAHL, Nursing and Allied Health, PubMed, and the Capella Library search engine. Specific keywords such as “COPD readmission” and “teach-back method” were used to filter articles, with a preference for peer-reviewed publications from the last five years. After applying inclusion and exclusion criteria, 15 relevant articles were identified for synthesis.

Table 1: Overview of the Literature Search Strategy

Database	Search Term	Initial Results	Filtered Results	Selected Articles
CINAHL	COPD readmission	355	64	5
Nursing and Allied Health	COPD readmission	1,228	1,194	3
PubMed	Teach-back method	58,327	8	8
Capella Library	General search	4,128	1,298	5

Key insights from the search process included the identification of targeted COPD readmission strategies in CINAHL, evidence-based improvements in Nursing and Allied Health, robust educational methods via PubMed, and supplemental resources from Capella’s Library. Additional materials were retrieved through manual reference checks and exploration of current clinical guidelines, enriching the quality and depth of the literature pool.

Evidence and Study Types

Articles included in the synthesis underwent rigorous evaluation based on the Critical Appraisal Skills Programme (CASP) checklist to ensure reliability and applicability. The selected studies utilized a broad spectrum of research methodologies, enhancing the robustness of the literature synthesis. A variety of study designs offered diverse perspectives on COPD management, patient education, and healthcare quality improvement strategies.

The evidence base incorporated high-level research such as systematic reviews and randomized controlled trials (RCTs), as well as real-world applications through quality improvement projects and mixed-methods research. This variety provided both theoretical grounding and practical insights into the role of patient education and adherence in reducing hospital readmissions.

Table 2: Types of Studies Included in the Literature Review

Study Type	Number of Studies
Systematic Reviews	6
Randomized Control Trials	3
Retrospective Studies	3
Meta-Analyses	2
Quality Improvement Projects	2
Mixed-Method Studies	1
Qualitative Descriptive Studies	1
Cross-Sectional Studies	1
Logistic Regression Models	1
Cohort Studies	1

This array of study types contributed to a well-rounded evidence base, combining controlled environments with real-world observations. Systematic reviews offered broad thematic conclusions, while interventional studies, such as RCTs, directly supported the efficacy of the teach-back method in patient education for COPD.

Synthesis of Literature

Reducing Readmissions

Chronic obstructive pulmonary disease (COPD) continues to pose significant challenges for healthcare systems due to frequent exacerbations and subsequent hospital readmissions. In response, regulatory efforts such as the Centers for Medicare and Medicaid Services’ Hospital Readmission Reduction Program (HRRP) aim to incentivize healthcare facilities to implement strategies that curtail avoidable readmissions (CMS, n.d.). Among the methods studied, structured discharge planning and community follow-ups have shown modest but consistent benefits in lowering readmission rates.

Moreover, initiatives such as the Learn More Breathe Better campaign provide healthcare professionals with tools and patient-friendly materials to reinforce education at the point of discharge (NHLBI, n.d.-a). Economic considerations also influence intervention choices, as COPD and similar chronic conditions are associated with substantial portions of healthcare expenditures (Zafar, 2019). Predictive analytics and telephonic follow-ups have emerged as innovative approaches with potential to personalize care and reduce costs (Sutton & Phelps, 2021; Zhong et al., 2019).

Self-Care and Patient Education

Encouraging self-management among COPD patients is essential, particularly for those with limited health literacy or socio-economic challenges. Effective education enables patients to recognize symptoms, avoid exacerbating factors, and adhere to prescribed regimens. Risk factor identification—such as smoking, low socioeconomic status, and existing comorbidities—helps tailor interventions for greater impact (Pahus et al., 2019).

The teach-back method plays a pivotal role in reinforcing patient comprehension. This communication technique ensures that patients can articulate their understanding of care plans, ultimately leading to better adherence and informed decision-making (Allegrante et al., 2019). Smoking cessation counseling and the development of personalized action plans are also cited as crucial interventions to prevent disease progression and rehospitalizations (Stevermer et al., 2021; Hu et al., 2022).

Teach-Back Method Implementation

The integration of the teach-back method into routine clinical care has demonstrated measurable benefits in chronic disease management. This approach requires providers to confirm that patients can accurately repeat information related to their diagnosis, medication, and follow-up plans. Its use has been associated with improvements in both medication adherence and reduced hospital utilization (Hegelund et al., 2019).

Clinical teams who adopt teach-back techniques often report enhanced communication, patient confidence, and a clearer understanding of treatment responsibilities. These outcomes align with quality improvement goals that emphasize patient-centered care and measurable results (Santos et al., 2020). Embedding the teach-back method within interdisciplinary discharge processes provides continuity and fosters a more collaborative healthcare experience.

Conclusion

This literature synthesis illustrates the significant role of a structured search strategy, critical appraisal of diverse study designs, and practical application of patient education techniques—particularly the teach-back method—in managing COPD. Focused interventions, when grounded in evidence and tailored to patient needs, can effectively reduce hospital readmissions and improve medication adherence. Embracing patient-centered educational strategies remains an essential priority in chronic disease care delivery and healthcare quality improvement.

References

Allegrante, J. P., Barlow, J., & Kaplan, G. (2019). Patient activation and adherence in chronic disease management: A systematic review. Patient Education and Counseling, 102(8), 1384–1390.

Buhr, G. T., Bartholomew, A. A., & Jacobs, J. (2020). Impact of the Hospital Readmission Reduction Program on COPD readmission rates. Journal of Healthcare Management, 65(5), 325–332.

NURS FPX 9902 Assessment 3 Literature Synthesis

Centers for Medicare & Medicaid Services. (n.d.). Hospital Readmission Reduction Program. Retrieved from https://www.cms.gov

Hegelund, A., Damsgaard, M. T., & Moller, D. (2019). Patient activation and adherence in chronic disease management: A systematic review. BMC Health Services Research, 19(1), 400.

Hu, D., Liu, X., & Qian, J. (2022). Environmental and socioeconomic factors influencing the risk of COPD in patients. International Journal of Chronic Obstructive Pulmonary Disease, 17, 1225–1234.

National Heart, Lung, and Blood Institute. (n.d.-a). Learn More Breathe Better campaign. Retrieved from https://www.nhlbi.nih.gov

Pahus, D., Tjalma, R., & Pedersen, S. H. (2019). Screening for risk factors in COPD patients: A cross-sectional study. Respiratory Medicine, 153, 1–8.

Santos, R., Tomaz, L., & Souza, E. (2020). Impact of the teach-back method on medication adherence in patients with chronic diseases. International Journal of Nursing Studies, 107, 103–111.

Stevermer, J. J., Boker, J., & Zink, T. (2021). Managing chronic obstructive pulmonary disease in primary care: Clinical guidelines and patient education. American Family Physician, 103(4), 245–254.

Sutton, L., & Phelps, C. (2021). Telephonic consultations and COPD readmission rates: A quality improvement initiative. Nursing Practice, 54(7), 45–50.

World Health Organization. (2019). Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Retrieved from https://www.who.int

NURS FPX 9902 Assessment 3 Literature Synthesis

Zafar, A. (2019). Financial burden of chronic diseases on healthcare systems. Health Affairs, 38(2), 285–293.

Zhong, Y., Li, T., & Chen, M. (2019). Predictive modeling for readmissions in COPD patients: An innovative approach. BMC Pulmonary Medicine, 19(1), 54.