The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change
The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change to address your identified nurse practice problem.
Using the “Literature Evaluation Table” assignment in Topic 1, and accompanying faculty feedback, you will synthesize the information created for your PICOT question into a literature review and evidence-based proposal.
In a 1,500-1,750-word paper, provide an overview that illustrates the research related to your particular PICOT question.
Use the following components from the “Literature Evaluation Table” to complete the assignment:
- Identified practice problem
- Two qualitative peer-reviewed research articles
- Two quantitative peer-reviewed research articles
Use the “Research Critiques and Evidence-Based Practice Proposal Guidelines” document to organize your paper.
You are required to cite a minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Sample Expert Answer
Literature Review and Evidence-Based Practice Proposal
Asthma is one of the most common chronic diseases affecting children, and it continues to be a major cause of hospitalizations worldwide. Many children experience frequent exacerbations that require emergency visits or readmissions. Caregivers often struggle to manage asthma effectively after hospital discharge, which increases the risk of early readmission. The nursing practice problem identified here is the high rate of 30-day hospital readmissions among children with asthma due to inadequate caregiver education and poor self-management support.
The purpose of this paper is to review the existing research evidence on the effectiveness of nurse-led asthma self-management education programs compared to usual discharge instructions. This will help to propose an evidence-based practice change that can improve patient outcomes. The updated PICOT question guiding this review is: In caregivers of children with asthma (P), how does a nurse-led self-management education program (I) compared to usual discharge instructions (C) affect 30-day hospital readmission rates (O) within one-month post-discharge (T)?
Method of Studies
The four selected articles used different research designs to study asthma education interventions. The first article by Kassa et al. (2022) used a qualitative study design. The researchers conducted interviews with children, caregivers, and healthcare providers in Ethiopia to explore their perceptions of asthma and barriers to management. This method helped to answer the research question by providing rich insights into why families struggle with asthma care and why adherence to medication and follow-up is low. Qualitative data highlighted the social, emotional, and cultural factors that impact asthma management.
The second article by Ng et al. (2021) used a quantitative randomized controlled trial. This trial compared a web-based asthma education at home taught by a nurse with the usual care. The researchers tested the program’s effectiveness in terms of caregiver knowledge, attitudes, practices, and hospital readmissions of the children due to randomization and statistical testing. This approach was a good source of evidence concerning the causality between the intervention and better outcomes.
Radhakrishnan et al. (2022) used a mixed-methods design in the third article. It compared face-to-face and virtual asthma education through surveys on the amount of data and interviews on the comments of the qualitative data. In this way, the researchers could consider measurable outcomes like knowledge and confidence, as well as the experiences and preferences of participants. Using a combination of the two, the research provided a more complete view of the effectiveness of virtual and in-person education to families. In the fourth article by Thach et al. (2024), the study was a quantitative retrospective study.
The authors studied the medical histories of 262 children in France who were subjected to various concentrations of asthma education. They compared the results of those with structured, unstructured, and those with minimal education. This approach was used to identify the effectiveness of organized asthma education in real-world situations, reducing hospitalizations and enhancing disease management. Together, these four methods, qualitative interviews, randomized controlled trial, mixed-methods evaluation, and retrospective chart review cover different angles of the problem. They examine barriers, test interventions, compare delivery formats, and evaluate long-term outcomes.
Results of Studies / Key Findings
The four studies provide important findings related to asthma education and management. Kassa et al. (2022) found that caregivers had low biomedical knowledge about asthma. Many caregivers had misconceptions about inhaled corticosteroids and worried about side effects. They also reported poor access to medications, high emotional burdens, and difficulty following long-term management plans. Healthcare providers in the study agreed that a lack of structured education contributed to poor adherence. These findings suggest that improving caregiver education and providing culturally appropriate support are necessary to improve outcomes.
Ng et al. (2021) reported that the nurse-led web-based program significantly improved caregivers’ knowledge, attitudes, and practices. Children whose caregivers participated in the program had fewer unscheduled hospital visits and readmissions. The program also reduced children’s anxiety about inhaler use and improved family confidence in managing asthma. The findings showed that structured, nurse-led education could address the gaps highlighted in Kassa’s study.
Radhakrishnan et al. (2022) found that both in-person and virtual education improved caregiver and patient knowledge and confidence. Interestingly, most families preferred virtual sessions because they were convenient, safe, and easy to attend. Caregivers reported feeling more supported through regular communication with asthma educators. This study shows that delivery format can be flexible as long as the education is structured and nurse-led.
Thach et al. (2024) demonstrated that structured education improved treatment adherence, use of action plans, and knowledge about asthma. Structured education resulted in fewer hospitalizations and fewer emergency visits among children with minimal or no structured education. These results support the relevance of nurse-led education programs in enhancing outcomes.
Outcomes Comparison
The answer to the PICOT question is expected to be that a self-management education program led by nurses will reduce 30-day readmission rates in children with asthma compared to standard discharge instructions. The central concept is that organized education enhances the level of knowledge among caregivers, pharmaceutical compliance, and trust in patients’ self-management, which reduces the likelihood of a relapse that would need hospital treatment.
Kassa et al. (2022) noted that the lack of knowledge and myths about inhalers and the emotional stress predispose caregivers to poor asthma management, which results in readmissions. Such results demonstrate why the family of children with asthma should not be provided with typical discharge instructions that tend to be short and unsystematic. Instead, a more structured approach to nurses is required to enhance results.
Ng et al. (2021) presented quantitative results of a web-based nurse-led education program that decreased the number of unscheduled hospital visits and readmission rates among children. Radhakrishnan et al. (2022) further augmented that virtual and in-person asthma education enhanced caregiver confidence and knowledge, and that virtual programs enhanced the convenience and accessibility of the programs to the family.
In real-world situations, Thach et al. (2024) established that organized education would lessen hospitalizations relative to trivial or unorganized education. Taken together, these studies show that structured nurse-led education is consistently associated with improved patient and caregiver outcomes. All four studies therefore support the anticipated outcome: nurse-led self-management education programs are more effective than usual discharge instructions in reducing short-term readmissions.
Proposed Evidence-Based Practice Change
There is a clear connection between the PICOT question, the selected research articles, and the nursing practice problem. The main problem identified is that children with asthma continue to experience high 30-day hospital readmission rates. This problem often results from caregivers’ limited knowledge, lack of confidence, and minimal guidance after discharge. The reviewed studies consistently show that nurse-led structured education, whether delivered online, in-person, or within a hospital setting can significantly improve outcomes.
When caregivers receive targeted support, they gain better understanding of asthma management, feel more confident using medications, and become more consistent in following treatment plans. This evidence highlights that unstructured discharge instructions alone are not effective enough to prevent hospital readmissions in children with asthma.
Based on these findings, the proposed practice change is the development and implementation of a nurse-led self-management education program for caregivers of children with asthma. This program would begin at discharge and include several structured components. Nurses would provide demonstrations of correct inhaler technique, create personalized asthma action plans with families, and review strategies for adherence to prescribed medications.
Moreover, the caregivers would be provided with instructions on how to recognize and deal with the triggers of asthma attacks and symptoms, and how to react to the early signs of exacerbations. Virtual follow-up support would be provided upon the completion of the education to support the learning and make caregivers feel supported once they return home. This system would eliminate the existing use of short-term and unstructured discharge instructions.
It is necessary to measure the effectiveness of such a change of practice because it is required to identify how patient outcomes will change. Monitoring 30-day readmission rates pre- and post-program implementation would be one of the primary outcome measures. If the rates are lower, it would indicate that the intervention is working. To add further evidence, caregiver knowledge and confidence levels could be assessed through short surveys administered at discharge and during follow-up. This combination of quantitative hospital readmission data and qualitative caregiver feedback would provide a comprehensive evaluation of the program’s effectiveness. Such an approach ensures the proposed change is not only evidence-based but also responsive to the practical needs of caregivers and children
Conclusion
In summary, the evidence strongly supports implementing a nurse-led self-management education program for caregivers of children with asthma as a way to address the persistent problem of high 30-day hospital readmission rates. The reviewed studies consistently demonstrated that inadequate caregiver knowledge and misconceptions contribute to poor asthma control, while structured, nurse-led education, whether web-based, in-person, or within a hospital setting, improves knowledge, medication adherence, confidence, and overall management skills.
Unlike brief or unstructured discharge instructions, structured education empowers caregivers with practical tools such as correct inhaler technique, individualized asthma action plans, and ongoing follow-up support. Together, these interventions directly reduce unscheduled visits, emergency room use, and hospital readmissions. The proposed practice change aligns closely with the PICOT question by addressing both the short-term outcome of readmissions and the long-term goal of improving asthma self-management.
Monitoring 30-day readmission rates, paired with caregiver surveys, provides an effective way to evaluate program success. Ultimately, adopting this evidence-based practice can enhance patient outcomes, reduce healthcare burdens, and strengthen nursing’s role in chronic disease management.
References
Jones, R., Turner, B., Perera, P., Hiscock, H., & Chen, K. (2022). Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: A multi-site qualitative study. The Journal of Asthma: official journal of the Association for the Care of Asthma, 59(10), 1973–1980. https://doi.org/10.1080/02770903.2021.1984528
Kassa, E., Kebede, R. A., & Habte, B. M. (2022). Perceptions towards childhood asthma and barriers to its management among patients, caregivers and healthcare providers: a qualitative study from Ethiopia. BMC Pulmonary Medicine, 22(1), 184. https://doi.org/10.1186/s12890-022-01984-2
Ng, J. S. K., Chau, J. P. C., Chan, A. W. K., Lui, J. K. C., & Cheng, J. W. C. H. (2021). A nurse-led web-based home asthma education program for children and their families: A randomized controlled trial. Journal of Pediatric Nursing, 59(1), 158–163. https://doi.org/10.1016/j.pedn.2021.04.014
Thach, C., Lafont, C., Epaud, R., Tahiri, K., Sauvage, F., Sagorin, V., Sérabian, V., & Delestrain, C. (2024). Effectiveness of pediatric asthma education program in the context of a general hospital in France: A retrospective real-life study. Heliyon, 10(15), e35356. https://doi.org/10.1016/j.heliyon.2024.e35356
