D028 – CPE Task 1: Clinical Practice Experience Details

D028 – CPE Task 1: Clinical Practice Experience Details

Name

 Western Governors University

D028 Advanced Health Assessment for Patients and Populations

Prof. Name

Date

MSN Core Word E-Portfolio Template

Instructions for Course Completion

To successfully complete this course, students must submit the Clinical Practice Experience (CPE) Record, which includes key deliverables required for evaluation. These deliverables are accessible under the “Supporting Documents” section of the Assessment Task Overview.

Students should compile all necessary components, such as reflective writings, within this e-portfolio template during each phase of the course. Previously created documents can be inserted into this Word document using the following steps:

• Click at the desired insertion point.
• Navigate to Insert > Object, then click the dropdown arrow.
• Select Text from File.
• Choose the file to insert and double-click it.
• Repeat this process for additional documents.

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D028 Clinical Practice Experience (CPE) Schedule Table

The following suggested timeline assists students in planning their assignment completion. Students are advised to duplicate this table in their e-portfolio and update it accordingly.

Required CPE Activities (Deliverables)	Estimated Time	Anticipated Completion Date
1a. CPE schedule table	20 minutes	September 6, 2024
1b. Discussion of CMS HRRP	1 hour	September 6, 2024
1c. Discussion of selected patient:		September 6, 2024
– One Social Determinant of Health (SDOH) affecting the patient
– One intervention to prevent readmission related to SDOH	2 hours
2a. Evidence-based practices to reduce hospital readmission		September 7, 2024
– Identify one practice to prevent readmission for the patient	30 minutes
2b. Public health intervention for the patient at each practice level	1 hour	September 7, 2024
3a. Discuss five standards of Transitions of Care	1.5 hours	September 7, 2024
3b. Develop communication plan (Standard 5) for patient	1.5 hours	September 7, 2024
3c. GoReact Video and Peer Responses	1 hour	September 7, 2024
3d. Reflection Summary	45 minutes	September 7, 2024

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What Is the Hospital Readmissions Reduction Program (HRRP)?

The Hospital Readmissions Reduction Program (HRRP), launched by the Centers for Medicare & Medicaid Services (CMS), aims to decrease the frequency of hospital readmissions for certain medical conditions and surgeries following patient discharge. These include acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, coronary artery bypass graft (CABG) surgery, and elective total hip or knee arthroplasty (THA/TKA) (CMS, n.d.).

CMS issues confidential annual Hospital-Specific Reports (HSRs) to healthcare providers. These reports are invaluable for advanced practice nurses (APNs), helping them pinpoint areas requiring improvement. The reports support the customization of interventions that enhance care coordination, communication, and application of evidence-based strategies to reduce readmissions. These initiatives ultimately improve patient outcomes while reducing healthcare costs.

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Patient Case Scenario

The patient is a 55-year-old Hispanic male who experienced a myocardial infarction (MI) after symptoms including chest tightness, nausea, and shortness of breath during gardening. His medical background reveals hypertension, obesity, and hyperlipidemia. The family history is notable: his father died from an MI at age 62, and his mother has Type II diabetes, hypertension, and osteoporosis.

His lifestyle habits include eating out 6–8 times weekly at restaurants, cafeterias, or fast food outlets. He drinks coffee and soda daily and consumes 2–4 beers socially on weekends about 3–4 times per month. Physical activity is minimal, limited to a 15–20 minute walk once per week. His last primary care visit was seven months ago.

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What Are Social Determinants of Health (SDOH) and How Do They Affect the Patient?

Social determinants of health (SDOH) refer to the broad conditions in which individuals are born, grow, live, work, and age—factors that profoundly influence health outcomes (Social Determinants of Health, n.d.). For this patient, the critical SDOH domain is his neighborhood and built environment, which directly affects his access to safe, affordable, and nutritious food (Healthy People 2030, n.d.).

His frequent reliance on dining out, particularly fast food, underscores a pressing need for interventions that increase his access to healthier food choices within his community. Limited access to nutritious food can exacerbate chronic conditions and increase hospital readmission risk.

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What Intervention Can Be Implemented?

An effective intervention is arranging regular consultations with a dietary coach or nutritionist. Such professionals can work collaboratively with the patient to develop heart-healthy meal plans emphasizing portion control and practical options for dining out. Active patient involvement in meal planning enhances adherence and reduces the likelihood of hospital readmission.

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What Evidence-Based Practices Can Reduce Hospital Readmission?

For patients recovering from MI, sustaining health and preventing readmission is critical. Cardiac rehabilitation (CR) is an evidence-based practice that significantly lowers morbidity and mortality. It integrates endurance training, dietary counseling, and lifestyle changes (Grochulska, Glowinski, & Bryndal, 2021).

CR programs offer supervised exercise, stress management, and heart-healthy education. Incorporating CR into this patient’s care supports lasting behavioral changes and minimizes risks of recurrent cardiac events (American Heart Association [AHA], 2024).

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What Public Health Interventions Can Support the Patient?

Public health efforts must address the patient’s needs at multiple levels—individual, community, and systemic—as outlined in the table below:

Level	Intervention
Individual	Support scheduling regular primary care visits, medication adherence, and cardiac rehabilitation referrals.
Community	Encourage participation in heart health education programs, peer support groups, workshops, and media campaigns.
System	Advocate for policies standardizing discharge protocols for MI patients, including follow-ups and medication plans.

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What Are the Five Standards of Transitions of Care?

The American Case Management Association (ACMA) outlines five essential standards to ensure effective patient transitions and reduce hospital readmissions (ACMA, 2023):

Standard	Description
1	Identify patients at risk of poor transitions and apply targeted interventions.
2	Conduct comprehensive transition assessments for high-risk patients.
3	Ensure medication reconciliation at every care transition, including prescribed and over-the-counter drugs.
4	Develop ongoing care management plans with input from patients and caregivers, shared among healthcare providers.
5	Communicate essential care transition information promptly to all relevant stakeholders, including caregivers.

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How Should Care Transitions Be Communicated to Stakeholders?

Effective communication during care transitions is vital to preventing readmissions and supporting recovery. For the 55-year-old MI patient, key stakeholders include:

• Primary Care Provider (PCP): Should be informed about hospital discharge details, procedures (e.g., angioplasty), medication regimens, and follow-up care plans.
• Cardiologist: Needs updates on patient recovery, rehabilitation, and any treatment changes.
• Cardiac Rehabilitation Team: Must receive timely information to initiate personalized exercise and education programs and provide feedback to the care team and patient.

This communication ensures coordinated care, promotes adherence to treatment plans, and reduces readmission risk.

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Reflection

In my nursing experience within emergency care, the predominant approach has been rapid assessment and discharge—often described as “treat them and street them.” This assignment challenged me to reconsider this practice by examining the multifaceted nature of care continuity after discharge.

Using the MI patient scenario, I analyzed how medical history, social determinants, and lifestyle influence health outcomes. This reinforced the importance of integrating both social and clinical data to develop personalized care plans aimed at reducing readmission risk.

Exploring the Transitions of Care Standards highlighted the critical processes for seamless care transitions, medication safety, and stakeholder engagement. Additionally, understanding the HRRP deepened my appreciation for systemic initiatives to improve healthcare quality.

As an advanced practice nurse, I now recognize my vital role in discharge planning, patient education, care coordination, and follow-up to foster successful recovery after hospitalization.

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References

American Case Management Association. (2023). Transitions of care standards [PDF]. https://transitionsofcare.org/wp-content/uploads/2023/06/ACMA-Transitions-of-Care-Standards_Final_06132023.pdf

American Heart Association. (2024, April 24). What is cardiac rehabilitation? Cardiac Rehab. https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation

Centers for Medicare & Medicaid Services. (n.d.). Hospital readmissions reduction program (HRRP). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/hospital-readmissions-reduction-program-hrrp

D028 – CPE Task 1: Clinical Practice Experience Details

Grochulska, A., Glowinski, S., & Bryndal, A. (2021). Cardiac rehabilitation and physical performance in patients after myocardial infarction: Preliminary research. Journal of Clinical Medicine, 10(11), 2253. https://doi.org/10.3390/jcm10112253

Healthy People 2030. (n.d.). Neighborhood and built environment. https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment

Social determinants of health. (n.d.). Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health

 

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