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Neuman Systems Model

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Utilizing Neuman’s Systems Model as the framework, a random assignment, comparative experimental research design is proposed. Implementation of PR for COPD patients to optimize their health in a disease state would represent a tertiary level of practice intervention per Neuman’s Systems Model. The concepts being explored include, the comparison effect of a nurse led home-based PR program verses a nurse-led primary care office based PR program verse no PR program for patients who have had an acute hospital discharge within the past 15 days. The variables to be measured include hospital readmission for a period of one year after completion of the PR program or 10 weeks post enrollment, lung function defined by the measurement of …show more content…

Several studies, including two systematic reviews noted in Table 1, provide evidence that PR has an impact on reducing hospital admissions, as well as improving patient lung capacity and quality of life (QOL). While these studies have all shown some type of positive outcome, referral patterns from primary care providers remains low (Johnston & Grimmer-Somers, 2010). Holland and Hill (2011), also identify that program access and availability are also issues that hinder patient participation. Four of the studies noted in Table 1 include evaluation of nurse-led programs which provide positive outcomes The nurse-led program example were performed in both home-based and hospital-based programs, but no literature was found on nurse led PR programs that were based in primary care offices. As stated above, the focus of this research will be the comparison of two nurse-led PR programs which contain the same structure and education, one program in the patient home setting, the other conducted in the primary care office that will receive services within 15 days of a hospital discharge for a COPD exacerbation. A control group will consist of COPD patients with the same criteria, but the will not receive PR post discharge. The hypothesis of this study is, the implementation of structured nurse-led PR programs initiated within 15 days of a hospital discharge for COPD patients, will decrease hospital readmissions for a minimum of a year, as well as increasing lung function and QOL, while filling a service gap in the Northeastern and Central Pennsylvania

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