Gap Identification in Nursing Practice

Topic: Nursing
Words: 655 Pages: 2


Identifying gaps in practice is an opportunity for an AGNP to influence the quality of care improvement and apply skills obtained during the education. Indeed, my site, East Orange General Hospital Clinic, provides multiple groups of beneficiaries with various services and working with my preceptor enabled me to analyze if the issues exist and require specific attention. I discovered the growing number of follow-up appointments missed, mainly by the impoverished population representatives. The lack of attendance is a problem because it causes patient conditions’ worsen, additional financial burden, and decreases the effectiveness of the prior treatment (Williamson et al., 2021). This paper aims to discuss the activities to influence how patients perceive the follow-up appointments in East Orange General Hospital Clinic and the ways to increase their returns.

Identifying The Problem

The problem was primarily noticed by my preceptor, who stated that the number of skipped follow-up appointments increased, influencing the overall quality of services the East Orange General Hospital Clinic provides. Indeed, checking the records revealed that more than 25 patients did not attend the additional visit, and most of them represent the impoverished population. We identified the problem that requires to be addressed through specific activities; I can work on resolving it during my practicum experience. The lack of attendance might occur due to clients’ inability to make time for it, afford the visit due to the insurance and transportation costs (Arpey et al., 2017). It is crucial to identify the problem in terms of the practicum site to develop the workable addressing strategy, and my preceptor recommended exploring why the clients refuse to return.

Accessing and Appraising The Evidence

My practicum experience includes working with the impoverished population, the representatives who skip follow-up appointments most frequently; thus, I can apply evidence-based tactics to address the identified gap. It is crucial to explore the reasons for the identified problem’s occurrence in East Orange General Hospital Clinic and analyze the gathered information from the perspective of the current practices. Evidence-based practice enables practitioners to combine their observations, clinical records, and scholarly literature to develop activities for improvement (Stannard, 2021). Scientific research suggests that the lack of education, wrong priorities, social vulnerability, and expenses are principal causes of missed appointments (Williamson et al., 2021). Studying the patients’ profiles revealed that the possible reasons they did not return to their doctors are forgetfulness, language barrier, and insufficient funds.

Applying and Evaluating The Change To Practice

Based on the evidence about why impoverished patients of my practicum site do not return to their physicians for the follow-up appointments, multiple activities can address the practice gap. The consequences of missing a follow-up must be clearly explained to make a client understand that the procedure is worth prioritizing and spending money on. Clinical office managers’ activities can include reminders for patients with severe or chronic conditions to avoid forgetting about their visit. Evaluating the change is necessary for further improvement, and it can be performed through additional feedback from physicians and patients gathering and statistical measurement of skipped follow-up visits (Hickey & Giardino, 2021). The clients’ motivation to attend their doctors must be increased as the practitioners apply enhanced communicational strategies and make additional calls (White et al., 2021). As an AGNP, I have an opportunity to track the changes and discuss them with NPs and physicians to evaluate if they find the evidence-based tools workable and offer more changes to address the gap in practice.


My practicum site works with diverse populations, and the identified problem is related to the impoverished who frequently do not return to their follow-up appointments. The evidence revealed that forgetfulness, language barrier, insufficient funds for transformation, lack of education, and understanding of follow-ups’ importance are the main reasons for skipping a visit. The activities to improve the practices are based on physicians’ motivational communication and officers’ reminding. The effectiveness can be evaluated through statistical analysis and patient and provider feedback.


Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017). How socioeconomic status affects patient perceptions of health care: a qualitative study. Journal of Primary Care & Community Health, 8(3), 169-175. Web.

Hickey, J. V., & Giardino, E. R. (Eds.). (2021). Evaluation of quality in health care for DNPs (3rd ed.). Springer Publishing.

Stannard, D. (2021). Problem identification: The first step in evidence-based practice. AORN Journal, 113(4), 377-378. Web.

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2021). Translation of evidence into nursing and healthcare (3rd ed.). Springer Publishing Company.

Williamson, A. E., McQueenie, R., Ellis, D. A., McConnachie, A., & Wilson, P. (2021). ‘Missingness’ in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study. PloS One, 16(6), e0253163. Web.

Nursing Ethical and Legal Issues in a Car Accident Case
Florence Nightingale’s Nursing Theory