GCU NRS-493 Topic 8 Written Capstone Change Project

Instructions

Students will synthesize the components developed in prior topics to formulate a written evidence-based account of the capstone project. Additionally, the student will integrate the following into the written evidence-based account: a plan for evaluating the nursing intervention, a change or nursing theory, and a discussion on how potential barriers will be overcome.

Objectives:

Produce a written comprehensive evidence-based capstone project change proposal using components developed in prior topics of the course.

  • Integrate a plan for evaluating the nursing intervention in the written comprehensive evidence-based capstone project change proposal.
  • Integrate a change or nursing theory into the written comprehensive evidence-based capstone project change proposal.
  • Identify potential barriers to the implementation of the change proposal.
  • Integrate how the identified potential barriers will be overcome.
  • Integrate reflective practice into the practicum reflective journal.
  • Demonstrate interprofessional collaboration during the creation of the capstone project change proposal.

Tasks

Benchmark – Capstone Project Change Proposal

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

  • Background
  • Clinical problem statement.
  • Purpose of the change proposal in relation to providing patient care in the changing health care system.
  • PICOT question.
  • Literature search strategy employed.
  • Evaluation of the literature.
  • Applicable change or nursing theory utilized.
  • Proposed implementation plan with outcome measures.
  • Discussion of how evidence-based practice was used in creating the intervention plan.
  • Plan for evaluating the proposed nursing intervention.
  • Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
  • Appendix section, if tables, graphs, surveys, educational materials, etc. are created.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1: Exemplify professionalism in diverse health care settings.

2.2: Comprehend nursing concepts and health theories.

3.2: Implement patient care decisions based on evidence-based practice

Lopes Activity Tracker

Document your clinical practice hours using the Lopes Activity Tracker (LAT) in your student portal. Once you have opened the app, click on the link for your class to record your hours. Clinical practice hours should be documented and submitted within 48 hours of the clinical experience. After the hours have been submitted, the preceptor will verify the hours, which are then reviewed by the faculty.

Download the electronic summary of your practicum experience from the Lopes Activity Tracker. Save the file and submit it though the assignment dropbox for faculty approval.

This report is to be submitted in every topic.

Topic 8 DQ 1

Based on how you will evaluate your EBP project, which independent and dependent variables do you need to collect? Why?

Topic 8 DQ 2

Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?

Topic 8 DQ 2 Sample Approach

When researching EBP to implement or develop, it is essential to consider its statistical and clinical significance. “Measures of statistical significance quantify the probability of a study’s results being due to chance. Clinical significance, on the other hand, refers to the magnitude of the actual treatment effect, which will determine whether the results of the trial are likely to impact current medical practice” (Ranganathan, 2015).

The P-value used to measure statistical significance “is the probability that the study results are due to chance rather than real treatment effect” (Ranganathan, 2015).

According to Prasad (2019), “conventionally, P < 0.05 has been termed “statistically significant,” but often what is statistically significant is not always clinically important, and what is statistically nonsignificant may be a case of an unwarranted claim of “no difference.”

Based on the above definition and comparison, it is essential for nurses to “check whether statistically significant results are also clinically important. What is clinical importance? “Clinical importance is a matter of judgment based on the magnitude of effects and the balance between benefits versus risks, costs, and inconvenience” (Prasad, 2019).

“The clinical significance of a result is dependent on its implications on existing practice-treatment effect size being one of the most important factors that drive treatment decisions” (Ranganathan, 2015).

The importance of clinical significance applied in our project would be the change it represents for the lives of the Hispanic community members and its relative cost-effectiveness and ease of implementation. Also, the number of individuals within the Hispanic community that can be reached directly and indirectly could enhance a health behavior change impacting the health outcomes in the community members represented by fewer COVID-19 infections, hospitalizations, and deaths.

References

Capstone Project Change Proposal Sample Paper

Background

Falls are a reoccurring and expensive issue in healthcare. According to the Centers for Disease Control and Prevention, each year, $50 billion is spent as a result of non-injury falls, and $754 million is spent as a result of fatal falls (CDC, 2020). Healthcare facilities must take the appropriate and necessary measures in hopes of minimizing these occurrences. The topic of falls is one that should concern all healthcare workers, as everyone plays a role in prevention.

Many facilities have fall policies and procedures focusing solely on a single fall contributing factor. The current literature, however, suggests that the most effective way to prevent falls is through the implementation of multifactorial fall prevention intervention. This paper will discuss the effectiveness of multifactorial fall prevention interventions and provide some examples of these interventions.

Problem Statement

Falls are accompanied by significant financial costs, as well as physical and psychological costs to the patient. Falls can lead to fractures, loss of independence, increased length of stays, quality of life changes, and even death to the patient (Wallis, A., 2021). When asked, staff members have also reported feeling helpless and frustrated about their inability to control falls (Vlaeyen, E., 2017). 

There are numerous and varying causes of falls, therefore, the efforts to prevent falls should also vary. Falls can occur due to improper or lack of use of mobility aids, changes in mentation or coordination, weakness, impaired vision, side effects of medication, and/or chronic diseases.

A decrease in the frequency of falls would result in a decrease in fall-related injuries, costs and deaths, improved patient outcomes and safety, improved quality of life, and a decrease in the length of patient stays. Due to the above, there is a dire need to promote increased fall prevention practices in healthcare. The use of multifactorial fall approaches is identified by the Joint Commission as an evidence-based tool (Arrah, 2020).

Purpose Of Change Proposal

This change proposal project aims to decrease the frequency of falls by implementing multifactorial fall prevention interventions, specifically for patients residing either short-term or long-term in long-term care facilities. This change proposal aims at implementing various fall prevention interventions on a patient-specific basis. Identifying the patient’s fall risk and implementing prevention measures based on that patient’s risk factors, patient safety is being promoted for each individual.

PICOT Question

The PICOT question being focused on in this capstone project is as follows: For residents at Crossroads Care Center in Sun Prairie, WI (P), does the use of multifactorial fall risk interventions (I) reduce the future risk of falls (C) compared to single fall risk interventions (O)?

Literature Search

In order to discover relevant literature, the writer first identified reliable databases to search for said literature. The databases utilized in this paper were found through the Grand Canyon University (GCU) library website resources. The databases chosen from the GCU library were EBSCOhost, CINAHL, and PubMed. Another database utilized is

Google Scholar. These databases were searched using combinations of the keywords “fall interventions,” “long-term care facility,” “elderly or geriatric,” and “multifactorial or multicomponent or multi-interventional.” The search excluded articles that did not fit the criteria of being peer-reviewed and published within the last five years.

Evaluation Of Literature

All of the articles chosen for this project were related to the PICOT question above, as well as peer-reviewed and published within the last five years. The research questions in the articles were all centered around multifactorial fall prevention interventions, but each article’s specific focus varied. The focuses include the effectiveness, costs and benefits, barriers and facilitators, and the long-term effects of multifactorial fall prevention. 

Two of the articles focused more specifically on the number of falls and reducing this number. In contrast, one article focused on using patient safety agreements in combination with other interventions to form a multifactorial fall prevention program.

The sample populations identified in each of the articles also showed large variability. The populations include residents in nursing homes and or long-term care facilities or rehabilitation units in the Netherlands, large southeastern metropolitan areas, Wisconsin, North Caroline, Virginia, Maryland and Texas, Quebec, Ontario and other mid-size Canadian cities, and New South Wales. Another group of articles focuses specifically on those 65 years or older in an acute hospital setting in Europe, North America, Oceania, and Asia, and one study includes the study of over 19,000 older adults living in the community.

Change Theory

The nursing change theory identified and chosen by the writer in this proposal project is the nudge theory. Instead of steps, the nudge theory identifies seven principles. These principles include defining changes, considering employee points of view, providing evidence to show the best options, presenting change as a choice, listening to employee feedback, limiting options, and solidifying change with short-term wins. This change theory is the most effective for this change proposal because it educates those affected by the practice change with the evidence that supports the change and gives them an opportunity to provide feedback, voice their concerns and ask questions. This also allows the management implementing the proposal to make any needed changes based on that feedback before fully implementing the change.

Implementation Plan And Outcome Measures

The change proposal will be presented to the department heads and upon approval, will be implemented, beginning with current residents that have endured a fall within the last month and further extending to any new admissions. These residents will be evaluated using a Morse fall risk scale. Based on this result, specific fall risk factors will be determined and fall prevention interventions will be implemented to prevent future falls. 

Each individual fall prevention plan will include medication review and a form of physical activity a minimum of 3 times a week. This physical activity may consist of physical and/or occupational therapy, independent or accompanied walking for leisure, or facility organized activities.

Facility organized activities may include chair exercise, bowling, balloon volleyball, ping-pong, and pool noodle strength training. Other interventions may include patient safety agreements, low bed, placement near nurses’ stations, non-skid socks, education of patients, staff, and/or family, increased rounding frequency, and proper instruction on mobility aids. 

The outcomes of the change would be assessed by comparing the number of falls in the facility before and after the change, as well as the number of falls per specific resident in a month’s time period before and after the change.

Use Of Evidence-Based Practice In Implementation

There are countless evidence-based studies based on falls, with many of those studies identifying that the use of multicomponent is effective in preventing and/or decreasing the occurrences of falls, as well as decreasing fall-related costs over time. In the evaluation of the articles, there were multiple common themes. 

Each of the articles concluded that multifactorial fall prevention interventions were effective at either preventing and reducing falls or decreasing fall-related costs. In relation to the specific interventions identified, exercise and medication review were identified in six of eight articles. Therefore, each patient identified as a high fall risk or with a history of falls must have both of these interventions initiated.

Potential Barrier

As with all change, there is the potential for some barriers to arise. Some potential barriers include the determination from management that a change is not indicated or noncompliance from staff or residents. Although a need for new procedures to decrease the frequency of falls has been identified by the Director of Nursing for Crossroads Care Center, this does not ultimately determine that the department heads will identify this change project as the desired new procedure.

If approved and implemented by management, staff and/or residents may be non-compliant with the new practice. A change in practice may cause resistance from either of the above. Since staff are being included in the implementation through the nudge change theory, it is the goal that they will be compliant. The residents, however, are mostly elderly and may not be willing to follow the changes.

Conclusion

Falls in healthcare are financially, physically, and psychologically costly. Falls can increase cost, lengthen stays, cause injury, and even death. Not all falls are preventable, but it is the responsibility of the nurses and other healthcare workers to take the necessary steps to control factors that may lead to falls. Through the implementation of a multifactorial fall prevention intervention protocol, staff have the ability to prevent falls as a result of varying causes.

References

  • Jackson, Karen. (2016). Improving nursing home falls management program by enhancing the standard of care with collaborative care multi-interventional protocol focused on fall prevention. Journal of Nursing Education and Practice. 6. 10.5430/jnep.v6n6p84.
  • Hopewell S, Copsey B, Nicolson P, et al. Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants. British Journal of Sports Medicine 2020;54:1340-1350.
  • Lee, S. H., & Yu, S. (2020). Effectiveness of multifactorial interventions in preventing falls among older adults in the community: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES, 106. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2020.103564
  • Ma, C. L. K., & Morrissey, R. A. (2020). Reducing falls through the implementation of a multicomponent intervention in a rural mixed rehabilitation ward. Australian Journal of Rural Health, 28(4), 408. https://doi-org.lopes.idm.oclc.org/10.1111/ajr.12646
  • Panneman, M. J. M., Sterke, C. S., Eilering, M. J., Blatter, B. M., Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of multifactorial falls prevention in nursing homes in the Netherlands. Experimental Gerontology, 143. https://doi-org.lopes.idm.oclc.org/10.1016/j.exger.2020.111173
  • Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., Dobbels, F., & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International Journal of Nursing Studies, 70, 110–121. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2017.02.002