Prepare a 350-word draft of a clinical problem that you would like to use for your Research project. There should be an introduction to the problem (as to why it is a problem) that is documented with literature, a clear problem statement (one declarative sentence that begins with “The problem is…”, and a purpose to your project. Post this as your Initial response. (Essential I-IX).

Discussion Rubric attached, Research project attached and Master Essential.


This week the focus is the trustworthiness of qualitative research and validity.  The term trustworthiness of qualitative research can sometimes be interpreted as a detrimental factor in qualitative research because it based on opinions and experiences rather than on numbers on quantifiable data. Validity represents that the research findings represent the truth about the phenomenon being studied. Therefore, is extremely important in quantitative research. Please make sure to study both concepts by reading the chapters assigned and reading articles that contain those terms.  This week objectives are to demonstrate understanding of the above concepts as they relate to nursing research. 


1.25 Point

1 Point

0.75 Point



Weight 25.00%

100 %

3 Posts

80 %

2 Posts

60 %

1 Post

0 %

0 Posts

Quality of information

Weight 25.00%

100 %

Information is clear and relates to topic

80 %

Information is somewhat clear and might relate to topic

60 %

Information has little relation to topic and is not clearly displayed

0 %

Information is not clear and it does not relate to topic


Weight 25.00%

100 %

Provides relevant resources using APA guidelines

80 %

Provides relevant resources without APA guidelines

60 %

Limited on the resources provided with major errors in APA

0 %

Does not provide any resources

Critical Thinking

Weight 25.00%

100 %

Enhances the critical thinking process through premise reflection

80 %

Enhances the critical thinking process without premise reflection

60 %

Does enhance the critical thinking process in a very limited manner

0 %

Does not enhance the critical thinking process


The Essentials of Master’s Education in Nursing

March 21, 2011


Introduction 3

Master’s Education in Nursing and Areas of Practice 5
Context for Nursing Practice 6
Master’s Nursing Education Curriculum 7

The Essentials of Master’s Education in Nursing
I. Background for Practice from Sciences and Humanities 9

II. Organizational and Systems Leadership 11

III. Quality Improvement and Safety 13

IV. Translating and Integrating Scholarship into Practice 15

V. Informatics and Healthcare Technologies 17

VI. Health Policy and Advocacy 20

VII. Interprofessional Collaboration for Improving Patient

and Population Health Outcomes 22

VIII. Clinical Prevention and Population Health for

Improving Health 24

IX. Master’s-Level Nursing Practice 26

Clinical/Practice Learning Expectations for Master’s Programs 29

Summary 31

Glossary 31


References 40

Appendix A: Task Force on the Essentials of Master’s Education in Nursing 49

Appendix B: Participants who attended Stakeholder Meetings 50

Appendix C: Schools of Nursing that Participated in the Regional Meetings

or Provided Feedback 52

Appendix D: Professional Organizations that Participated in the Regional
Meetings or Provided Feedback 63

Appendix E: Healthcare Systems that Participated in the Regional Meetings 64


The Essentials of Master’s Education in Nursing
March 21, 2011

The Essentials of Master’s Education in Nursing reflect the profession’s continuing call for
imagination, transformative thinking, and evolutionary change in graduate education. The
extraordinary explosion of knowledge, expanding technologies, increasing diversity, and global
health challenges produce a dynamic environment for nursing and amplify nursing’s critical
contributions to health care. Master’s education prepares nurses for flexible leadership and
critical action within complex, changing systems, including health, educational, and
organizational systems. Master’s education equips nurses with valuable knowledge and skills to
lead change, promote health, and elevate care in various roles and settings. Synergy with these
Essentials, current and future healthcare reform legislation, and the action-oriented
recommendations of the Initiative on the Future of Nursing (IOM, 2010) highlights the value and
transforming potential of the nursing profession.

These Essentials are core for all master’s programs in nursing and provide the necessary
curricular elements and framework, regardless of focus, major, or intended



Challenges in Transitional Care

Florida National University

Robert Alonso

May 21, 2019

Introduction to the Problem

Increasing cases of patient readmissions as soon as they are discharged from hospitals have been on the rise thus indicating existing challenges in the provision of transitional care. Transitional care refers to the provision of continuous treatment to the patients as they move from one health care facility to the next or from the health facilities to their homes. According to a study conducted by Ortiz in 2015, it was established that “35.6% of hospital re-admissions within 30 days of discharge are of elderly patients aged 75-84” (Ortiz, 2019). These statistics indicate existing disparities in the provision of transitional care thus resulting in the worsened conditions of the patients as soon as they go home. Ortiz nonetheless establishes that most caregivers admit to not having adequate knowledge and experience on how to deal with the patients as soon as they are discharged from hospitals (Ortiz, 2019). In most cases, elderly patients suffering from acute conditions tend to be the most vulnerable and easily fall ill once transitional care is missing. Further according to Storm, “A majority of the deaths involving elderly patients in home-based and community-based care were as a result of lack of additional transitional care” (Storm et. al., 2014). Similar results are echoed by Ye et. al., (2016), where in China policies were introduced in 2012, hindering the provision of transitional care to patients by the nurses, and as a result the practice saw at least 33% of the elderly patients decline in their overall well-being and functioning once left under the care of their caregivers. Therefore, such statistics indicate that home-based care is often marked by a lack of professional monitoring and also the transition from a medical setting to a home setting often results in medication mix-up which negatively imposes on the health of the elderly patients.

Clearly Identify the Problem

Transitional care is marked by a lack of specialized nursing interventions which results to the high rates of hospital readmissions especially among the elderly patients suffering from acute conditions. Also, there lacks clear communication during the handing off of the patients to the caregivers, hence resulting in increased confusion on the part of the care givers on how to take care of the patients which results in their worsening conditions (Morphet et. al., 2014). Additionally, a majority of the caregivers are not adequately trained on how to provide primary care to their patients and hence when left in their care, their condition does not get



Challenges in Transitional Care

Institutional Affiliation

Student Name

Brief Literature Review

The provision of quality transitional care is significant to all patients since it helps to ascertain that the care needs of the patients are fulfilled once they transition across different care settings. According to McDonagh& Kelly (2010), challenges associated with transitional care result in adverse negative outcomes such as higher healthcare costs, unnecessary hospital readmission rates, reduced life quality and satisfaction levels of the patient as well as increased burden on the caregivers. Coleman and Berenson (2004) note that hospital readmission rates have increased by 37% especially among elderly patients with stroke conditions. Coleman and Berenson (2004) further add that the problem is projected to worsen with the expected population increase of older adults. A number of studies have established that adverse events take place within transitional care and that elderly patients with complex care needs tend to be at higher risks. Additionally, Allen et. al. (2014) maintains that at least 49% of patients experience at least one instance of distance-related medical errors or adverse events during the transitional care period. Some of these events have been reported to be preventable and that their severity could be reduced through the use of earlier corrective actions as they are often brought up by issues like diagnostic test follow-up errors, falls, infections and drug mix-ups(Toles et. al., 2016). The severity of these events may result in permanent disability or in some cases death. At least 50% of the patients experiencing such adverse conditions end up requiring extra health-care services hence increased hospital readmission rates. LaMantia et. al., (2010) notes that the existence of such transitional care problems are brought about by ineffective and poor communication and inconsistencies in the exchange of patient information among the health care providers. In overall, therefore, the literature proposes that there is need to conduct additional research on transitional care in a bid to increase understanding on how the quality of transitional care, especially for the elderly patients, can be enhanced.

Methodology and Design of the Study

The study on transition care covers the hospital admission of patients all the way to their being discharged to their homes under the care of their caregivers. Hence the methodology of the study will include the participant observation study on the admission and discharge transition process. Such



Phase 4-Results

Institutional Affiliation

Student Name

Project Results

The project aimed to identify the main challenges facing transitional care, to determine the impact of unspecialized nursing on transitional care, and to identify the importance of specialized nursing in the provision of transitional care. The results of the study identified five significant challenges facing the quality of the provision of transitional care to the elderly patients all of which were inclusive of the failed roles played by different parties among them the nursing personnel, the caregivers as well as the patients.


From the study, it was identified that a majority of the elderly patients had caregivers which hindered the provision of transitional care. Nonetheless, the patients with caregivers echoed that they played an essential role in their transitional care, for example by providing essential information to the nurses on the patient’s health and also by providing adequate self-care to the patients during both the admission and the discharge process. However, despite their significant role, the caregivers were required to consult with the health care personnel during the admission and patient discharge transitions in order to acquire more information on their patient’s health condition, medications, and surgical operation among others (Allen et. al., 2014). The study identified that in most cases, the caregivers were neither informed nor prepared about the patient’s discharge process, often questioning the nurses on whether their patients were entirely ready to be discharged. Additionally, the study identified that the caregivers placed high expectations on the nurses and the health care personnel, where the caregivers expected the health care personnel to offer adequate care to the patients until they were fully recovered and often the caregivers were not prepared to extend any transitional care services to their patients.

Patient Characteristics

From the study, it was evident that upon admission a majority of the patients suffered from various chronic conditions as well as other minor diagnoses among them pain, nausea, fatigue, diarrhea, hearing loss, walking problems among others. However, upon admission, most of the patients only presented characteristics of the main chronic conditions while ignoring the symptoms associated with the minor diagnoses. As a result, such patients were not prioritized during the admission process, forcing them to wait longer in the emergency department. These resulted in the development of symptoms like increased confusion, dizziness, anxiety, tir



Phase 3-Implementation

Institutional Affiliation

Student Name

Owing to the increasing rates of hospital readmissions arising from poor transitional care it is essential to implement a program that will see to it that the current challenges facing transitional care are addressed and that there is an increase in specialized nursing to help foster the provision of transitional care. Currently, the health care committee has proposed a number of interventions that need to be implemented by the project manager to see the improvement of transition care, especially in relation to dealing with elderly patients (Morphet et. al., 2014). Some of these interventions that have been proven to result in the reduction of patient readmission rates among them patient needs assessment, patient education, medication reconciliation, timely outpatient appointment as well as the provision of telephone follow-up services (Morphet et. al., 2014).It is essential that once the patients are discharged from hospitals that they continue to receive enhanced communication, medication safety and that their caregivers receive advanced care planning and training on how to best manage the associated common medical conditions (Ortiz, 2019). As a result of the currently proposed interventions, the project aims to target the challenges on transition care by defining the role of home-based services, the significance of caregiver support, community partnerships and the importance of new transitional care personnel (Ortiz, 2019). The project manager has gone as far as proposing the time frame that it will take to see the realization of the effects of the project, a practical budget as well as the resources and tools that will be used in the project to see the successful realization of the transitional care program.

The Time Frame of the Project



Ascertaining the current state of Transitional Care in Hospitals (Patients Admissions, Level of Communication and Coordination among the Nurses, Level of Interaction between the Healthcare providers and the Nurses)

6 months

Ascertaining the Level of Nursing Expertise in Hospitals (Level of Education and Expertise of the Nurses)

6 Months

Making Home Visits to the Patients to Ascertain the Level of Expertise of the Caregivers

6 Months

Consolidation of the Collected Results

6 Months

The e