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Chapter 5: Implications in Practice and Conclusions

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Implications in Practice and Conclusions

As stated earlier, chest pains have been a great global problem, especially in America.

However, the main challenge that people patients face is the length of stay in the emergency

department because of the lack of better methods to aid in helping or diagnosing patients

suffering from the same. Due to this inefficiency, a chest pain pathway tool should be introduced

to help reduce patients' time in the emergency departments, cut costs, and reduce other risks such

as infections.

Apart from describing the importance of chest pathway tools and they should be

implemented, this chapter also summarizes the whole project, determines findings and interprets

them, interpret strengths and limitations, implications, recommendations, plan for dissemination,

and a conclusion.

5.1. Summary of the project

This section covers the previous four chapters of the project, from the introduction to the

study in chapter one to the analysis of data in chapter four. In the introductory part of the study,

the main challenge which the inefficiency caused by the lack of better tools, which leads to a lot

of wasted time, a length of stay in the emergency department, and a waste of money. A new

method was also introduced, and its benefits were explained. This was followed by illustrating

the background of the project. Organizational needs were also assessed as reasons why quality

improvement was necessary. Still, in chapter one, a SWOT analysis was done to determine the

method's viability.

In the second chapter, a lot was also discussed, which included a lot of scientific

underpinnings such as literature search strategy, synthesis of the literature, evidence-based

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practice question, Validation of the HEART Pathway Tool, theoretical framework, the change

model, Integration of the Christian Worldview, and chapter summary. The third chapter was all

about project design and methodology. Some things discussed included the purpose, project

planning and procedure, potential bias, and mitigation. Regarding business, almost all project

processes encountered prejudices from quantitative methodology, sampling methods, etc. There

are also ethical considerations in this chapter and, lastly, the chapter summary.

Major findings

At the end of this research work, there were many findings that the researcher came up

with about the previous topic. After conducting a test on a sample of 145in the comparative

group and 158 in the implementation group, the results showed a big difference when a health

facility uses its standard methods and the HEART pathway tool. When a t-test was to help

analyze data, it was discovered that the device could help reduce admission time from a

comparative time of 58.61 minutes to an implementation time of 48.21 minutes.

The project yielded statistical significance (p = 0.025) and clinical significance as

evidenced by a 10.8 mean minute reduction in the admission time (formula) for the number of

recorded referrals between the comparative and implementation groups and was both statistically

and clinically significant. Clinical significance was further noted.

Interpretation of Findings

Based on these findings, the translation of Frisoli et al.’s using the Emergency Nurses

Association’s Clinical Practice Guideline: Intimate Partner Violence may impact this

population. Recommendations include sustaining the project at the site and disseminating the

results. The results from the tests achieve statistical significance and conform to a few related
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articles relating to the same. According to the tests, it was noted that the HEART Pathway

protocol could classify more than 20% of patients with acute chest pains for early discharge

without compromising the safety and accuracy of diagnoses.

According to Mahler et al. (2015), when a similar procedure was done with an

almost identical sample size. The results we practically the same. It was discovered in both these

tests that the HEART Pathway tool can help reduce patients' stay in the emergency departments

by 20% in terms of days, therefore, enabling them for early discharge, which comes with many

benefits. Based on this journal and the test this study contacted, it is evident that it is an

important tool because of its efficiency. In both trials, it was discovered that patients did not have

adverse cardiac events for the 30 days of diagnosis.

However, it should be noted that almost all findings discovered by a research

study apply in any setting, but QI (Quality Improvement) findings may only apply to a particular

environment or population. The findings interpretation bias is the maturation bias which occurs

when the pre-intervention and intervention groups are significantly different (Handley et al.,

2018). The bias might result in the LOS being different because of sample variance rather than

the HEART pathway tool. The difference in the samples may result due to age gaps and different

confounding factors, which may occur at different levels in the intervention and control groups.

Some of the confounding factors that may impact the two groups include the occurrence of other

conditions which might result in longer hospital stays. The bias will be mitigated by ensuring

that the patients in the pre-intervention and intervention groups have similar characteristics.
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Strengths and Limitations

There are a lot of strengths and limitations to this study, as elaborated above in previous

chapters. The health facility has a ratio of one-to-five staffing, meaning the patients have enough

doctors and nurses to attend to them. This helps in making sure patients' needs are adhered to

precisely and are attended to efficiently. On the doctors' side, this is a good ratio to make sure

there is no burnout among staff. With enough health work, there is a mixture of skills and

experience.

The introduction of evidence-based practice culture was already established. This made it

easy for them to accept QI changes and the HEART pathway tool. Another important strength is

that the management was positive about the implementation and supported it fully. Like any

company, they needed an improvement that would yield more. The introduction of the HEART

pathway tool was a nice idea since it was to reduce patient length of stay and costs. Full

management support accelerated the pace at which the project was handled to make it completed

quicker and more efficiently.

Implications

After a research study is done and there are findings, it is always important to discuss

how the findings will impact the world. Research may be helpful to policymakers, other future

researchers, or even the layperson. Research may be important to the researcher and his or her

colleagues or, for this instance, fellow students, but it can also be important to other generations

to come if well preserved. This section will cover both theoretical implications as well as nursing

practice implications.
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Theoretical implications

Dorothea Orem’s self-care deficit theory and John Kotter’s eight-step change model

provided the scientific underpinnings of the project. Orem’s self-care deficit nursing theory will

be applied to support the need to evaluate ED patients with chest pain to determine whether they

have major adverse cardiac events, resulting in an accurate assessment providing an opportunity

for timely management associated with a decrease in LOS.

According to this theory which mainly deals with major factors such as nursing, humans,

environment, health, and self-care, it is very important to consider patients and their conditions

before and after treatment. It was, however, of great importance that all these factors were

considered while conducting research and during tests. As stated earlier, many patients suffered

after treatment hence the need for a permanent solution that could help. While considering this

theory, many healthcare facilities should ensure that self-care is also considered, which is very

helpful for patients after treatment. There is no need to rethink a new nursing theory; this one is

sufficient.

Nursing Practice Implications

Based on this study, four types of nursing implications are studied, i.e., medication-

related, treatment-related, procedure-related, and patient education-related. For medication-

related implications, all involved nurses and doctors were keen on monitoring patient responses

to the HEART pathway tool. They also ensured that patients were given the best medication

while under treatment. For treatment-related implications, they were also responsible for

ensuring they treated patients correctly, which involved selecting the right procedure.
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Another important part was the procedure-related nurse implications. In this case, nurses

ensured that all the procedures were performed correctly. This also involved selecting the right

procedure and properly following it (Brown, 2022). Lastly, the nursing patient education-related

implications involved educating patients on their conditions. It also included instructions on how

they should handle themselves out there, the diet, the environment, and how to take medications

correctly.

Recommendations

This study suggests complementarily implementing the HEART protocols with other

guideline adherent tests, and decision aids faster patient disposition potentially. The second

recommendation includes the proposed evidence-based practice change is adopting the HEART

pathway tool.

Recommendations for Future Projects and Researchers

Future researchers can compare other protocols, such as the Manchester acute coronary

syndromes, with HEART Pathway. Also, Future researchers could focus on the modified Heart

score and high-sensitivity troponins. A need for additional studies in academic and community

hospitals, specifically in the ED, was recommended.

There are also other factors that future researchers should factor in before starting their

research work and during research work. Funding is very crucial during any project

implementation. Therefore, they should source enough funding before embarking on the project

so that it runs smoothly along the way. With enough money, the project can be implemented

swiftly without pause. It is also important to ensure enough time allocation for the project. Some

projects take a long while others take a few weeks.

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Other factors to consider include the environment and government policies. It is always

good to ensure that everything is okay and that the projects can run smoothly without issues with

the authority. There is, however, a need to conduct future research because the current one was

not done as perfectly as required because of a lack of funds and enough time. Lastly, for future

research, samples should be picked randomly from different cities to make sure many races are

represented. This way, clearer and most effective results will be obtained. These results,

combined with efficient HEART Pathway tools that would have been produced in the future, will

make treatment easier.

Recommendations for Sustainability

Several sustainability recommendations must be followed or adhered to. In this case, the

most important tool to walk with is a sustainability plan, like a guide. It is a roadmap that guides

organizations to achieve their long-term goals. The content of this plan includes the strategies,

activities, and partners involved in the project. A plan is very important since it directs the

organization on what to do considering all the steps listed, what to put in place regarding

resources, and whom to involve at what stage.

A sustainability plan can be modified to suit the company's needs or the nature of the

project. The plan can work at the unit, organization, state, and national levels because of the

authority involved and the support needed. It also depends on the company size.

Plan for Dissemination

The study project was carried out at Stony Brook Southampton Hospital in America

because it was the closest hospital for the researcher. With this in mind, many local people

within the area will have the advantage of viewing the test results in person and getting a copy of

the study. Since this process needs a bigger audience, a video version of the test process shall be
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produced and sold online, from sampling to results analysis. Lastly, people who need help

getting a hard copy can buy a soft copy online.

Conclusion and Contributions to the Profession of Nursing Practice

This study will tremendously help society and the nursing community in several ways.

Other hospitals and nurses specializing in this field can always use these materials to enrich

themselves with the knowledge from the tests and research.

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References

Brown, M. (2022). What is a Nursing Implication: Meaning & Examples. Nursing Troop.

https://nursingtroop.com/what-is-a-nursing-implication-meaning-examples/

Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018). Selecting and

improving quasi-experimental designs in effectiveness and implementation

research. Annual Review of Public Health, pp. 39, 5–25. https://doi.org/10.1146/annurev-

publhealth-040617-014128

Mahler, S. A., Riley, R. F., Hiestand, B. C., Russell, G. B., Hoekstra, J. W., Lefebvre, C. W.,

Nicks, B. A., Cline, D. M., Askew, K. L., Elliott, S. B., Herrington, D. M., Burke, G. L., &

Miller, C. D. (2015). The heart pathway randomized trial. Circulation: Cardiovascular

Quality and Outcomes, 8(2), 195–203. https://doi.org/10.1161/circoutcomes.114.001384

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