Feasibility of Your Capstone Project and Importance of Communication

Now that you have identified your capstone change project, it is time to look at its feasibility.

■ What tangible and intangible resources will be needed to implement your project?

■ What improved outcomes do you anticipate will occur that could indicate the project produced a successful return on investment (ROI) of these resources?

■ How will you communicate your plan for change with key decision-makers so that they will support the allocation of the resources you are seeking?

based on the work attached milestone_1.doc

Capstone Project Milestone #1: PICO And Evidence Appraisal Worksheets PICO Worksheet

Your Name:

Date: July 13, 2016 Your Instructor’s Name:

Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project.

Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements.

Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to develop your PICO question.

Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question)

Step 3: How were the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply. Step 4: What evidence must be gathered? Everyone should have a literature search.

However, what other sources of reliable information will be helpful for your particular question?

Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed?

What is the PICO question? Does the use of proper skin hygiene andChanging positions reduces the likelihood of pressure ulcers occurring? _______________________________________________   Define each element of the question below: P– (Patient, population, or problem): Elderly patients admitted for hip surgery. I– (Intervention): Turn patients in different angles after every three hours and use the required skin hygiene measures through cleaning with soap, clean water, and cream.C– (Comparison with other treatment/current practice): Turing patients alone after every two hours.O– (Desired outcome): The two approaches will reduce the prevalence and occurrence of hospital-acquired ulcers.
What is the practice issue/problem? The issue was identified as a result of an increase in the occurrence of hospital-acquired ulcers in elderly patients who have been admitted for hip surgery.
What is the practice area?_✓ Clinical Education   Administration  Other
How was the practice issueidentified? (check all that apply) ✓_ Safety/risk management concerns Unsatisfactory patient outcomes Wide variations in practice ✓_ Significant financial concerns   Difference between hospital and community practice  ✓_ Clinical practice issue is a concern Procedure or process is a time waster  Clinical practice issue has no scientific base Other:
What evidence must be gathered? (check all that apply)
_✓ Literature search_✓ Guidelines Expert Opinion  Patient Preferences  ✓_ Clinical Expertise  ✓_ Financial Analysis ✓_ Standards (Regulatory, professional, community) Other
Search terms: The keywords that were used in searching for the information include hospital-acquired ulcers, elderly patients, skin hygiene as well as turn and position intervention
Databases to search:The databases used for the search include PubMed Health library, Cochrane, CINAHL plus since they provide evidence-based research studies.
Search Strategies: Through putting the keywords in the databases and the search with the most recent information regarding the intervention is chosen for the review of theliterature.

Evidence Appraisal Worksheet Your Name:

Date: July 13, 2016

Your Instructor’s Name:

Purpose: To find evidence to support an intervention that will change the outcomes. Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The fourth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources.

Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual.

Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source.

Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were the results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW.

Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?

Evidence Appraisal Worksheet
PICO Question: Does the use of proper skin hygiene and changing of positions reduce the likelihoods of pressure ulcers occurring?
 APA Reference for ArticleType ofStrength ofBrief
Give the APA-formatted referenceSourceResearchDescription of
for the article.*Research:Discuss theResearch
 Peer-reviewedpower of theAddress the
 *Non-researchReport if*How does the
 systematicevidence isinformation in
 review, clinicalHigh, Good,the article apply
 practiceorto the project
 guidelines,Low/Majorproblem or
 organizationalFlaw. Useproposed
 experience, orthe tools onintervention?
 expertpage*Summarize in
 opinion/case238-244 ofyour own words.
 study/literaturyour text* Include results
 e reviewand discussof the study and
  the reasonshow these
  why youresults are
   have assigned a particularlevel of quality.applicable to your project.* What is the recommendation of the source for clinicalpractice?
1Armour-Burton, T., Fields, W.,Research: peerThe strengthThe facts
 Outlaw, L., & Deleon, E. (2013). Thereviewedis on thegathered from
 Healthy Skin Project: changingarticle.groundsthis report show
 nursing practice to prevent and that thethat proper skin
 treat hospital-acquired pressure report is anhygiene
 ulcers. Critical care nurse, 33(3), investigationminimizes the
 32-39. n that wasrate of
   carried outhospital-acquire
   in Sharpd pressure
   Hospital,The outcome of
   California.the study also
   The reportproves that
   evidence isprevention
   goodmethods such
because theas skin care and
samplesupport of
used hasmultidisciplinary
enoughteams reduce
proof thatthe occurrence
theof the ulcers.
are at risk of 
2Gillespie BM, Chaboyer WP,Non-research:TheThe evidence
 McInnes E, Kent B, Whitty JA,a systematiceffectivenessgiven indicates
 Thalib L. Repositioning forreview.s of thisthat
 pressure ulcer prevention in adults. source isrepositioning is
 Cochrane Database of Systematic that it isan effective
 Reviews 2014, Issue 4. Art. No.: based onapproach.
 CD009958. DOI: severalHowever, the
 10.1002/14651858.CD009958.pu evaluatedresearchers
 b2 studies.recommend
   The quality of the proof is poorsince thethe sample size is 502 subjects.further investigation to determine what is the bestrepositioning method.
3Moore, Z., Cowman, S., & Posnett,Research: peerThe study isThe report
 J. (2013). An economic analysisreviewedeffectivesupports that
 of repositioning for thearticle.since therepositioning
 prevention of pressure ulcers. informationprevents the
 Journal of clinical nursing, obtained isoccurrence of
 22(15-16), 2354-2360. first hand.the
   the rating isd ulcers.
   high sinceThey further
   the researchrecommend that
   used ait is low on costs
   randomand proves to be
   method andeffective.
   involved a 
   control group. 
4Still, M. D., Cross, L. C., Dunlap, M.,Research:TheThe evidence
 Rencher, R., Larkins, E. R.,peer-reviewedeffectivenessgenerated
 Carpenter, D. L., … & Coopersmith,articles.s of theagrees that
 C. M. (2013). The turn team: a research isturning patients
 novel strategy for reducing in theafter every two
 pressure ulcers in the surgical researchhours is indeed
 intensive care unit. Journal of the designhelpful.
 American College of Surgeons, where aThe research
 216(3), 373-379. pointrecommends
   prevalencethat the nursing
   method waspractice should
   used in alluse aggressive
   the 507interventions to
   participants.prevent and
   Also, thereduce the
   study wasoccurrence of
   done at anhospital-acquire
   appropriated pressure
   time thatulcers.
Evidence Appraisal

A study conducted by Gillespie et al. (2014) shows that repositioning is helpful in reducing the development of the hospital-acquired pressure ulcers. Pressure ulcers develop due to the friction between the sheets and the bony joints which is caused by the weight of the human body. Therefore, it could be said that they result due to shearing and pressure to patients who are immobile and come in the form of damaged localized tissue.

He further argues that repositioning alongside other interventions will help reduce the development of the ulcers. Repositioning helps the ulcers remain in low volume and aid in the air circulation.

His review involves 502 participants, and the evidence shows that repositioning reduces the occurrence of pressure ulcers. Unfortunately, the studies under consideration failed to give sufficient information about the frequencies in which repositioning should be done.

For that reason, there should be more investigations to establish the effectiveness of the study. Nonetheless, the researchers contend that even though the frequency is not indicated, the method does not mean it is ineffective.

On the other hand, Armour-Burton et al. (2013) support the idea that healthy skin care reduces the development of the hospital-acquired ulcers. The ulcers might even result in severe conditions or even death. Therefore, having a multidisciplinary team will help in the reduction of the state.

The method used was upgrading a current evidence-based practice study where a pressure algorithm was created to foster effective management. At the same time, the collaboration of the staff education, nurse assistants, and liaison nurses was found to be useful.

The outcomes reduced from 0% to 18.92%. Therefore, the mean results attained showed that both the multidisciplinary approach and prevention strategies help in reducing the occurrence and development of the ulcers.

Also, Still et al. (2013) argue that it is necessary and useful to turn patients in the Surgical Intensive Care Unit after every two hours. This is so because it helps reduce the recurrence of the ulcers. The study further suggests that pressure ulcers are the primary cause of death in SICU patients.

The study was done on 507 SICU patients, and the assessment was taken after every two hours the entire day. Before then, the turning of patients resulted in 42 patients having pressure ulcers. Afterward, the repositioning led to 12 ulcers in 229 patients.

Therefore, the results indicated the constant turning and repositioning reduced the development of the ulcers. Similarly, the different stages of the ulcers could be prevented through this intervention.

On the other hand, Moore et al. (2013) argue that repositioning and tilting patients in a 30-degree angle reduces the development of the ulcers. The study was aimed at

assessing the prevalence of the ulcers in the elderly patients. It further evaluated the claims that repositioning was costly.The population was allocated randomly and involved the control groups. The cost-effectiveness was also measured and found out that costs in the experimental group were €206.6 with 18.5 minutes spent, and the control group was €252.1 with 24.5 minutes spent. Despite this, 88.1% of patients in the control group were free from the ulcers and the same of 99.6% was seen in the experimental group.

Therefore, the study concluded that repositioning after every three hours was sufficient when compared to the time nurses spend. In that regard, repositioning under the EPUAP/NPUAP 2009 rules is economical.


Armour-Burton, T., Fields, W., Outlaw, L., & Deleon, E. (2013). The Healthy Skin Project:

changing nursing practice to prevent and treat hospital-acquired pressure ulcers. Critical care nurse, 33(3), 32-39.

Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD009958. DOI: 10.1002/14651858.CD009958.pub2 Moore, Z., Cowman, S., & Posnett, J. (2013). An economic analysis of repositioning for the prevention of pressure ulcers. Journal of clinical nursing, 22(15-16), 2354-2360. Still, M. D., Cross, L. C., Dunlap, M., Rencher, R., Larkins, E. R., Carpenter, D. L., … & Coopersmith, C. M. (2013). The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit. Journal of the American College of Surgeons, 216(3), 373-379.