NURS FPX9100 Assessment 6 Project Charter
NURS FPX9100 Assessment 6 Project Charter
NURS FPX9100 Assessment 6 Project Charter: COPD, which stands for Chronic Obstructive Pulmonary Disease, requires effective therapy to control the exacerbations and other symptoms. The current practices at the practicum site do not provide sufficient knowledge pertaining to COPD management, such as inadequate nutritional knowledge, delay in timely follow-ups, and failure to identify care needs. Patients receiving care from the hospital are not educated about smoking cessation and other lifestyle modifications to manage diseases. Patients do not have access to appropriate emergency services, and they have to experience longer wait times. The proposed practice problem of COPD is significant for the organization as it has implications for the quality of patient care, financial stability, and overall organizational performance. Currently, in the hospital, there is not any disease management program or specialized care services available for COPD patients.
The gap or opportunity for change was identified by the increasing number of COPD cases and readmissions attributed to inadequate home management of the condition. Patients lack awareness of COPD management techniques, including dietary considerations and other therapies, leading to readmissions. This gap has contributed to the development of a comprehensive COPD management plan that will assist patients seeking specialized care.
NURS FPX9100 Assessment 6 Project Charter
A study by Amritphale et al. (2021) evaluated the US Nationwide Readmission Database (NRD) to sample COPD readmissions in the 30-days. It was concluded that an estimated 10.5% of the patients encountered an unplanned 30-day readmission, the most significant in the elderly population. The major aetiologies were co-morbidities, including diabetes mellitus and inadequate management at home. According to American Lung Association (2020), healthcare providers and COPD clinics must educate patients on nutritional guidelines to improve breathing and reduce complications that can result in hospitalization. A systematic review by Tarazona-Santabalbina et al. (2023) found that malnutrition is common in COPD patients and is associated with poor outcomes, including increased hospitalizations and mortality. For COPD, the major healthcare costs were attributed to inpatient services, accounting for 28.8% of the expenses, followed closely by prescription medications, which accounted for 28.5% of the costs (Nurmagambetov, 2022).
The desired condition requires implementing cost-effective care services to reduce COPD expenditures and improve patient outcomes. The effective strategies of nutritional interventions and telehealth to reduce unplanned readmissions will improve the outcomes and provide higher-value care. Therefore, care providers and staff must educate patients admitted to the hospital on nutritional modification and arrange timely follow-ups through telehealth. Like NURS FPX9100 Assessment 6 Project Charter
Gap-Analysis tool: RCA (Root Cause Analysis)
|Evidence to Support the Need
The proposed intervention for COPD management includes the use of telehealth and nutritional modifications. Several studies support the implementation of non-pharmacological interventions, including telemonitoring to guide patients on breathing exercises, medication adherence, and dietary counseling. Telemonitoring was associated with fewer acute exacerbations in patients with COPD (Andersen et al., 2023).
In a systematic review and meta-analysis conducted by Hanlon et al. (2023), the efficacy of nutritional interventions for COPD patients was assessed. The study concluded that these interventions, encompassing dietary counseling and supplementation, have the potential to enhance lung function, decrease exacerbations, and improve the overall quality of life. A study by Scoditti et al. (2019) found that COPD patients often have inadequate dietary intake, including low intake of fruits and vegetables, which can contribute to malnutrition and poor outcomes. It was evaluated that patients need to increase their protein intake and limit starchy and simple carbohydrates to improve their nutritional status.
A systematic review revealed that under HRRP policies, the national 30-day all-cause readmission rate for acute exacerbations of COPD (AECOPD) is approximately 20%. These findings underscore the importance of implementing interventions to reduce COPD readmissions in hospital settings. The proposed intervention of a comprehensive care plan, which includes telehealth and nutritional interventions, aligns with these findings (Njoku et al., 2020).
|For the staff caring for in-patients diagnosed with COPD (P), how do nutritional and telehealth interventions (I) compare to standard care/ current practices affect lung function values and reduced readmission rate (O) over ten weeks (T)?
|The project aims to improve staff education on nutritional modifications and telehealth interventions for ameliorating COPD outcomes pertaining to improved lung functioning and quality of life.
The goals of the project are mentioned below.
NURS FPX9100 Assessment 6 Project Charter
|Identify the key stakeholders for your project. Think of key stakeholders (internal and external). This might include patients/clients, families, community leaders and organizations, health agencies, systems within the organization etc. List between 3-4 potential stakeholder members
|Initials or fictitious name
|Title, Role or Affiliation.
|Connection to the project.
|Potential impact (how affected).
|Contribution to the project.
|Barriers or anticipated challenges if any
Healthcare providers and staff
(Dr Johnson, Nurse Anne, and Respiratory Therapist Lee)
|They will be responsible for implementing the interventions and providing care to patients with COPD.
|Staff and providers are directly associated with this project as the project aims to enhance staff education on COPD management.
|They will impact the project by achieving the objectives of lowering readmission rates and raising staff compliance with nutritional therapies and telehealth activities.
|Through this education program, healthcare providers and staff will contribute to implementing project interventions and enhancing their knowledge and skills.
|They may face challenges in implementing the new technologies and resistance from patients in accepting lifestyle modifications.
|A Member of Health agencies and organizations
(American Lung Association)
|They will provide funding, resources, and support for the project.
|They are connected with the project as they will assist in raising awareness about this quality improvement project.
|They will help disseminate information about the project to a broader audience.
|The member can contribute to the project activities, such as attending meetings, providing input, and sharing their expertise and insights to redesign the project.
|Limited resources and competing priorities can be identified as barriers for them.
|These companies will assist patients and providers in reducing healthcare costs associated with COPD management and readmissions.
|They will provide information and knowledge about the programs and policies that provide telehealth and nutritional guidance for COPD.
|The insurance companies will be affected by the project’s goals of reducing readmission rates will lower healthcare costs. And it will enhance their financial stability and profitability by reducing their expenses.
|Insurance companies can support cost-reduction efforts and provide necessary resources.
|Competing priorities can be challenging.
|Liam and Mary Smith
|COPD Patient and his caregiver( NURS FPX9100 Assessment 6 Project Charter)
|They are connected with the project for the successful evaluation of the intervention.
|They are the primary beneficiaries of the project and will be directly impacted by the interventions proposed.
|Patients and their families can actively participate in interventions, provide feedback, and raise awareness.
|Barriers pertaining to limited knowledge to use telehealth technology can interfere with the project.
(Ms. Erica, COPD care specialist)
Ms Erica is selected for the team leader role in this project because she has specialized knowledge and experience in COPD management. She can provide expert guidance and leadership in developing and implementing the interventions proposed in the project charter, such as nutritional counselling and telehealth services.
She has essential skills and knowledge in project management and leadership. As a COPD care specialist, she can better lead the project due to her emotional intelligence and can make fair decisions in task distribution and team management. She has performed in healthcare for the last five years and belongs to the Hispanic community, and she is aware of the diversity principles. Therefore, she can address ethical practices, diversity, equity, and inclusion in team leadership. She can provide education and training to staff on COPD management, which can improve staff knowledge and compliance with nutritional interventions, as she has experience in interdisciplinary collaboration.
Ms Erica will utilize a collaborative and transformational leadership approach for this project, which will be beneficial in achieving the project’s goals and improving COPD management at the practicum site.
Collaborative leadership will be essential in communicating with other professionals, such as nutritionists, respiratory care specialists, nurses, and other members involved in the project. Nieuwboer et al. (2018) also supported the implementation of collaborative leadership in clinical decision-making to provide integrated care.
Transformational leadership is also suitable for this project, as it aims to enhance COPD outcomes through interventions like nutritional counselling and telehealth services. By creating and effectively communicating a vision for the future, they can inspire and motivate team members to work towards achieving the project’s goals. A study by Nnate et al. (2021) implemented a transformational leadership approach for shared decision-making in a respiratory unit. The authors concluded that to enhance positive patient outcomes for COPD, it is preliminary to implement a multidisciplinary approach with effective change management principles.
NURS FPX9100 Assessment 6 Project Charter
These two approaches are selected due to their significant relation with intervention. By combining transformational leadership, which inspires and motivates team members towards project goals, with collaborative leadership, which fosters teamwork and collaboration, the project leader can cultivate a culture of innovation, collaboration, and teamwork.
As a staff nurse, I have encountered several challenges regarding collaboration due to cultural barriers. Sometimes, insufficient knowledge about cultural practices can hinder the process of communication. Therefore, professionals and leaders must be aware of cultural competency. If the project requires innovation and creativity, the leader may need to take a more transformational approach to inspire and motivate team members to develop or come up with new ideas. However, when the project is confronted with a tight deadline, the leader may opt to employ a more directive leadership approach. This approach allows the leader to provide clear instructions, closely monitor progress, and ensure that the team remains focused and meets the deadline effectively.
Identify 4-6 team members (initials or fictitious name), department or affiliation and credentials or qualifications. Think about how a diverse set of individuals (demographics, disciplines, experiences, knowledge) will add to the team!
Describe each team member’s title, department or affiliation, qualifications/credentials and the rationale for inclusion and how the person contributes to the project’s success.
|Department or Affiliation
|Credentials or Qualifications
|Rationale for selection/Contribution to the project
|Experience in nutritional counselling for patients with COPD
MS in nutritional sciences and dietetics.
Experience in respiratory diseases management through diet
|She can provide expertise in nutritional counselling for patients with COPD and help develop evidence-based guidelines for the staff. She can also provide training sessions for staff to ensure effective implementation and adherence to the care plan.
|Lungs and respiratory care unit
|Bachelor of Health Science in Respiratory Care
|The rationale for including Jade is his expertise in respiratory care; he can help develop a comprehensive care plan for patients with COPD. He can also provide training sessions for staff on respiratory care techniques and help monitor patient progress. He can educate staff about respiratory breathing practices, which can be easily guided through telehealth.
|Respiratory unit supervisor
|BSN and MSN in clinal nursing
She can provide effective leadership and guidance to the team, ensuring that the project aligns with the organization’s goals and objectives. Additionally, she can actively monitor the progress toward achieving the project’s goals.
She can contribute to remote patient monitoring through telehealth, emphasizing the importance of collaborative teamwork to ensure the successful implementation of telehealth.
|High school diploma or GED, as well as a minimum of one year of relevant experience in respiratory care.
She can provide support to the team by assisting with patient care and monitoring patient progress.
She can also provide feedback to the team on the effectiveness of the interventions and help identify areas for improvement.
Communication Plan: NURS FPX9100 Assessment 6 Project Charter
|Develop a communication plan for each person associated with the Project Charter, e.g., Executive Sponsor, Stakeholders, Team Leader, Team members.
|Purpose of communication (Inform, share, engage, solicit information?).
|Frequency and timing of communication. (How often, specific stages of project?)
|Method of communication (consider audience, method, culture, language, inclusion).
|Who is responsible for the communication to this member? (Why is it important who delivers the message?)
|Potential challenges/ barriers or assets with communication (barriers, language, culture, different disciplines, best practices (cite the literature 1-2 sources as needed).
|Erica-Team Leader (COPD care specialist)
The team leader’s communication purpose would be to ensure that all team members are on the same page by engaging every team member.
The team leader would need to share updates on the project’s progress, provide guidance and support to team members, and solicit feedback and input from the team.
|The team leader will maintain regular communication with team members on a weekly basis to keep everyone informed about the project’s progress.
|The team leader will consider the culture and language when communicating with team members. The leader will promote a transparent culture. Communication methods will include email and weekly in-person meetings. The team leader will ensure that communication is inclusive and accessible to all team members.
The team leader holds the responsibility of communicating with all team members.
The team leader plays a vital role in delivering messages and ensuring understanding among team members.
|The team leader may encounter challenges in communication, such as language barriers and cultural differences within the team. The team leader should prioritize clear, concise, and inclusive communication to address these challenges. Utilizing translation services or cultural mediators can help ensure that all team members understand the message (Wang et al., 2019). Adopting best practices like active listening and asking questions is essential for the project success (Akmal et al., 2020).
The Registered Dietitian’s goal in communicating with the team is to educate and include them in nutritional recommendations for COPD.
The registered dietitian would have to communicate authentic and evidence-based nutritional advice, conduct training sessions for personnel, and get input from the group.
Regular communication between the Registered Dietitian and team members is essential to inform everyone about the project’s progress.
The RD will communicate with the team on a daily basis to make necessary modifications to the plan and to communicate on the implementation stage on the project.
To educate the staff on nutritional modification and telehealth, the dietitian will regularly communicate with staff through one-hour teaching sessions (PowerPoint presentation) at the practice site.
The dietitians will also resolve the queries of the staff regarding nutritional modification or knowledge gaps associated with them.
|Apart from communicating with the team member, the Registered Dietitian will also have additional responsibilities for communicating with other team members regarding nutritional modifications and conducting training sessions for staff.
|Language differences between team members may hinder effective communication and understanding of nutritional concepts.
It is necessary for nurses to avoid jargon and other complicated terminologies in the teaching session.
Bullock et al. (2019) also explained that the use of medical jargon can hinder the process of communication.
The purpose of communication for the Respiratory Therapist would be to inform members of respiratory care techniques for COPD through telehealth.
The respiratory therapist will share evidence-based respiratory care guidelines, provide staff training sessions, and solicit team feedback and input.
The therapist will educate the staff daily on respiratory care and management through breathing exercises and maintaining a current balance of medications.
They will also evaluate the patients weekly to get their feedback on lifestyle changes.
They will have weekly updates and specific communication at key stages, including the project’s initiation, implementation phase, and completion.
The respiratory therapists will tailor the communication to meet each audience member’s needs and knowledge levels, ensuring that information is effectively conveyed.
The preferred method of communication will be video conferencing with team members and other stakeholders. The respiratory therapist can incorporate PowerPoint presentations or simulation methods in their communication approach (Marker et al., 2019).
The team leader is responsible for communication with the therapist.
It is important to deliver messages on respiratory care techniques.
|Respiratory Therapists may encounter challenges in communicating during the staff education project on the use of telehealth. These challenges include language barriers, cultural differences, and diverse disciplinary perspectives. To address these challenges, respiratory therapists can utilize best practices such as communication, using patient-friendly language, and promoting collaborative interdisciplinary education. These practices contribute to enhanced teamwork and improved patient outcomes in COPD care (Jonas et al., 2019).
Intervention and Measurement: NURS FPX9100 Assessment 6 Project Charter
The project incorporates two main interventions for staff education, telehealth, and nutritional modifications, which align with the existing literature on non-pharmacological interventions for COPD management. Research by Janjua et al. (2021) used standard Cochrane methodological procedures to evaluate the effect of telehealth interventions on COPD outcomes. The research found that multi‐component interventions related to remote patient monitoring are likely to result in fewer re-admission to hospitals with COPD exacerbations. According to Fomengia (2019), staff education on telehealth and other advanced technologies for COPD care can improve the self-management of COPD in patients. The study focused on evidence-based educational packets for staff and patients, which include the use of smart apps and other exercise therapies at home for enhanced lung functioning. Literature has also supported the use of nutritional interventions by staff to improve the quality of life for COPD patients. A nutritionally augmented multi-dimensional intervention which includes a nutrition plan with daily protein requirements and food supplements can improve the individual functional capacity and COPD symptoms (Hegelund et al., 2023)
According to American Lung Association (2019), it is recommended to use telehealth to provide remote monitoring and guidance on breathing exercises, medication adherence, and dietary counseling.
The telehealth intervention involves guiding patients through breathing exercises, medication adherence, and remote monitoring using video conferencing or phone calls, with implementation led by the Respiratory Therapist and Nurse Technician. The nutritional modification intervention entails providing evidence-based dietary guidelines to COPD patients, with the Registered Dietitian responsible for conducting training sessions for staff and ensuring effective implementation.
The project’s logical progression stems from the literature synthesis supporting non-pharmacological interventions, leading to the practice recommendation for a comprehensive care plan and culminating in the proposed project intervention of staff education and implementation to enhance COPD outcomes in a hospital setting.
For this see the appendix
Improvement Model / Framework
The Chronic Care Model (CCM), which consists of six critical elements, can be a valuable tool for the COPD improvement project. The elements of self-management support, delivery system design, decision support, clinical information systems, community resources, and healthcare organization are all aligned with the project’s goals and objectives (Rose & O’Connor, 2021).
To improve care delivery and support patient care, the project proposes a telehealth intervention that aligns with the CCM’s delivery system design and clinical information system elements. Similarly, a nutritional modification intervention aligns with the CCM’s self-management support and community resources elements, seeking to empower patients in managing their condition and providing access to community resources for their care.
By employing the CCM, the project can adopt a comprehensive approach to chronic disease management. It addresses key
aspects of care, encourages patient self-management, and promotes the use of available community resources. This
framework offers a structured and cohesive approach that aligns with the proposed interventions and supports the goal of
improving COPD management and outcomes.
The rationale for choosing the Chronic Care Model for the COPD project is that it aligns well with the goals and objectives of
improving COPD management and outcomes. COPD is a chronic condition that requires long-term, integrated care involving
various healthcare providers. The CCM emphasizes on patient and staff engagement, self-management support, and collaborative care. Additionally, the CCM recognizes the importance of community resources and healthcare system support in delivering effective care. This aligns with the project’s aim of implementing telehealth and nutritional modification interventions, which involve collaboration among care providers and hospital staff to provide high-quality care.
By adopting the Chronic Care Model, the project can leverage its evidence-based strategies and interventions to enhance care delivery improve patient outcomes, and promote sustainability in COPD management. The framework provides a
a structured and holistic approach that addresses the multifaceted nature of COPD and ensures a patient-centered and
coordinated care experience.
|Metric (What is being measured to determine success):
|Outcome Measure (What is the desired outcome in measurable terms):
|Process Measure (Are you doing the right things to get to the outcome? Are the steps in the process leading to the planned outcome?):
|Balancing Measure (Are the changes being made causing problems in other areas?):
|Reduction in the number of re-admissions due to COPD poor management
|Increased staff knowledge regarding the effective management of COPD as staff compliance will improve the nutritional and telehealth interventions
|Staff and care providers percentage who attend training sessions on nutritional modifications and telehealth interventions
As the project aims to reduce hospital readmissions due to COPD then, the balancing measure would be an increase in the ED room visits for COPD exacerbations
Increase in staff workload due to daily training sessions.
|Data Collection & Management
|Develop a plan for the collection, management, and stewardship of the data you will collect for your Project Charter.
|The data pertaining to COPD readmissions, no ED visits due to COPD exacerbations, and other health complications will be collected. Data regarding staff knowledge of COPD management will also be collected through patient satisfaction scores with care.
|The nursing staff responsible for in-patient care will collect the data, and outpatient data regarding telehealth effectiveness will be gathered by other ancillary staff.
The data will be collected at regular intervals of one week following the staff training and education.
Over the period of ten weeks, in the first week, the data will be identified which needs to be collected, particularly for COPD outcomes. The data will be managed in the second and third weeks, and staff training sessions will be upheld. After training for 4 weeks, the staff will implement the intervention.
The results will be compared with the previous data and outcome measures in the last week.
And the final report will be prepared.
|The hospital’s electronic health record (HER) system will be utilized to store data pertaining to patient and staff outcomes.
Specific measures for protecting the data from unauthorized access or disclosure will be the implementation of encrypted or password-protected (Fillmore et al., 2023)
Only authorized staff and team members will have access to the data.
|When obtaining and analyzing data, it is crucial to take factors linked to diversity, equality, and inclusion into consideration in order to make sure the project is inclusive and equitable. To do this, the data must be stratified by gender, race, ethnicity, and socioeconomic level. The project team will create targeted interventions to address these disparities by identifying potential differences in health outcomes. For instance, in a study on managing COPD, researchers discovered that women and vulnerable groups are frequently underrepresented in clinical trials, which can result in differences in results and treatment (Zatloukal et al., 2020).
Describe the psychometric properties (reliability and validity) of any instruments, tools, surveys, or questionnaires used; status of permission to use instruments. If the instrument is not public, permission to use the instrument is attached as an appendix.
|SWOT Analysis and Business for Project
|Think about how this project benefits the target population, the organization, and those served. Complete the SWOT Analysis.
|The CMW Clinic has a strong reputation in the community for providing high-quality healthcare services. The clinic has a dedicated staff that is committed to improving patient outcomes. The project has the clinic’s leadership team’s support, which will help ensure its success. The project will provide valuable education and resources to care providers and patients, which will improve their knowledge and skills related to COPD management.
|The clinic could encounter difficulties when it comes to carrying out the project due to limited resources, such as insufficient funding and staff time. Furthermore, there might be some staff members who are hesitant to embrace change, which could impede the project’s overall success. Additionally, patients might be unwilling to participate in the project or might fail to avail themselves of the benefits of technology due to the limited availability of internet services.
|The project has the potential to improve patient outcomes and reduce healthcare costs associated with COPD management. The project can help to position the clinic as a leader in COPD management and telehealth services in the community. The project can also help to improve staff knowledge and skills related to COPD management, which can have a positive impact on patient care.
|There may be increased competition from other healthcare providers in the community offering similar services. COVID restrictions can also impact the implementation process. Poor quality of care can also impact the project’s success. Another potential risk is the staff’s inability to fully implement the project initiatives and put the training into practice.
Akmal, A., Foote, J., Podgorodnichenko, N., Greatbanks, R., & Gauld, R. (2020). Understanding resistance in lean implementation in healthcare environments: An institutional logics perspective. Production Planning & Control, 1–15. https://doi.org/10.1080/09537287.2020.1823510
American Lung Association. (2019). Chronic Obstructive Pulmonary Disease (COPD) | American Lung Association | American Lung Association. Lung.org. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd
American Lung Association. (2020, April 1). Nutrition and COPD | American Lung Association. Www.lung.org. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/nutrition
Amritphale, A., Fonarow, G. C., Amritphale, N., Omar, B., & Crook, E. D. (2021). All-cause unplanned readmissions in the United States. Insights from the nationwide readmission database. Internal Medicine Journal. https://doi.org/10.1111/imj.15581
Andersen, F. D., Trolle, C., Pedersen, A. R., Køpfli, M. L., Børgesen, S., Jensen, M. S., & Hyldgaard, C. (2023). Effect of telemonitoring on readmissions for acute exacerbation of chronic obstructive pulmonary disease: A randomized clinical trial. Journal of Telemedicine and Telecare, 1357633X2211502. https://doi.org/10.1177/1357633×221150279
Bullock, O. M., Colón Amill, D., Shulman, H. C., & Dixon, G. N. (2019). Jargon as a barrier to effective science communication: Evidence from metacognition. Public Understanding of Science, 28(7), 845–853. https://doi.org/10.1177/0963662519865687
Fillmore, A. R., McKinley, C. D., & Tallman, E. F. (2023). Managing privacy, confidentiality, and risk: towards trust. Health Information Exchange, 131–147. https://doi.org/10.1016/b978-0-323-90802-3.00030-7
Fomengia, Y. (2019). Staff education on chronic obstructive pulmonary disease self-management using teach-back. Walden Dissertations and Doctoral Studies. https://scholarworks.waldenu.edu/dissertations/7000/
Hanlon, P., Guo, X., McGhee, E., Lewsey, J., McAllister, D., & Mair, F. S. (2023). Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD. NPJ Primary Care Respiratory Medicine, 33(1), 1. https://doi.org/10.1038/s41533-022-00324-5
Hegelund, M. H., Ritz, C., Nielsen, T. L., Olsen, M. F., Søborg, C., Braagaard, L., Mølgaard, C., Krogh-Madsen, R., Lindegaard, B., & Faurholt-Jepsen, D. (2023). Multidimensional individualized nutritional therapy for individuals with severe chronic obstructive pulmonary disease: Study protocol for a registry-based randomized controlled trial. Trials, 24(1). https://doi.org/10.1186/s13063-023-07099-1
Janjua, S., Carter, D., Threapleton, C., Prigmore, S., & Disler, R. (2021). Telehealth interventions: Remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013196.pub2
Jonas, C. E., Durning, S. J., Zebrowski, C., & Cimino, F. (2019). An interdisciplinary, multi-institution telehealth course for third-year medical students. Academic Medicine, 94(6), 833–837. https://doi.org/10.1097/acm.0000000000002701
Ma, Y., Peng, Y., Chen, P., Nie, N., & Chen, Y. (2019). Assessment of COPD-related knowledge among internal medicine nurses: A cross-sectional study. International Journal of Chronic Obstructive Pulmonary Disease, Volume 14, 2917–2925. https://doi.org/10.2147/copd.s232055
Marker, S., Mohr, M., & Østergaard, D. (2019). Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: An interview study. BMC Medical Education, 19(1). https://doi.org/10.1186/s12909-018-1447-0
Nieuwboer, M. S., van der Sande, R., van der Marck, M. A., Olde Rikkert, M. G. M., & Perry, M. (2018). Clinical leadership and integrated primary care: A systematic literature review. European Journal of General Practice, 25(1), 7–18. https://doi.org/10.1080/13814788.2018.1515907
Njoku, C. M., Alqahtani, J. S., Wimmer, B. C., Peterson, G. M., Kinsman, L., Hurst, J. R., & Bereznicki, B. J. (2020). Risk factors and associated outcomes of hospital readmission in COPD: A systematic review. Respiratory Medicine, 173, 105988. https://doi.org/10.1016/j.rmed.2020.105988
Nnate, D. A., Barber, D., & Abaraogu, U. O. (2021). Discharge plan to promote patient safety and shared decision making by a multidisciplinary team of healthcare professionals in a respiratory unit. Nursing Reports, 11(3), 590–599. https://doi.org/10.3390/nursrep11030056
Nurmagambetov, T. A. (2022). How much does the United States spend on respiratory diseases? American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.202209-1696ed
Rose, E. K., & O’Connor, J. (2021). “Addressing advance care planning in patients with COPD.” Chest, 161(3). https://doi.org/10.1016/j.chest.2021.10.037
Scoditti, E., Massaro, M., Garbarino, S., & Toraldo, D. M. (2019). Role of diet in chronic obstructive pulmonary disease prevention and treatment. Nutrients, 11(6), 1357. https://doi.org/10.3390/nu11061357
Tarazona-Santabalbina, F. J., Naval, E., De la Cámara-de Las Heras, J. M., Cunha-Pérez, C., & Viña, J. (2023). Is frailty diagnosis important in patients with COPD? A narrative review of the literature. International Journal of Environmental Research and Public Health, 20(3). https://doi.org/10.3390/ijerph20031678
Wang, J., Cheng, G. H. ‐L., Chen, T., & Leung, K. (2019). Team creativity/innovation in culturally diverse teams: A meta‐analysis. Journal of Organizational Behavior, 40(6), 693–708. https://doi.org/10.1002/job.2362
Zatloukal, J., Brat, K., Neumannova, K., Volakova, E., Hejduk, K., Kocova, E., Kudela, O., Kopecky, M., Plutinsky, M., & Koblizek, V. (2020). Chronic obstructive pulmonary disease – diagnosis and management of stable disease; A personalized approach to care, using the treatable traits concept based on clinical phenotypes. position paper of the czech pneumatological and Physiological Society. Biomedical Papers, 164(4), 325–356. https://doi.org/10.5507/bp.2020.056