Benchmark-Capstone Project Change Proposal Essay

Benchmark-Capstone Project Change Proposal Essay

Benchmark-Capstone Project Change Proposal Essay

Close to 2.5 million individuals in the US are affected by pressure injuries annually (Padula et al., 2018).  However, despite the existence of evidence-based preventive recommendations, there has long been a pressure injury issue in the clinical setting. There are different causes of the inadequacy of the pressure injury prevention. The expense of treating these avoidable pressure injuries is currently over 60,000 dollars per individual, according to some estimates (Padula et al., 2018). As a result of failure to take prompt action, the patient’s life quality will be impaired, and the medical costs will rise as a result of the development of pressure injury during the hospitalization. The focus of this project is to reduce the incidences of the pressure injuries among the older patients admitted in the hospital.

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Background

Patient safety in the clinical environment is one of the major focuses of nursing practice, and therefore, stakeholders should ensure that any threats to patient safety are eliminated.  One of the strategies used in such aspects includes quality improvement and diseases prevention, such as preventing the onset and progression of pressure ulcers (Magny et al., 2017).  One of the most common clinical problems that need to be remediated for quality improvement is pressure injuries. Lowering the occurrence of pressure ulcers in hospitalized older patients requires medical professionals to adhere to the Evidence-Based Practices (EBP) and be aware of the implications of not following the skin evaluation standards. Pressure injuries are typically linked with a shortage of staff expertise, a large workload, personnel problems, and insufficient resources, all of which relate to the prompt detection and prevention of pressure injuries.

Clinical Problem Statement

Pressure injuries entail one of the most common clinical problems, especially among the inpatients having reduced mobility. The clinical problem has various adverse impacts, such as longer hospital stays, increased hospital spending, and possible legal issues. Therefore, various interventions such as pressure-relieving equipment have been used to reduce the incidence of the same (Jeddou et al., 2017).  However, the problem still persists, and therefore, there is a need for better interventions.

Purpose of the Change Proposal In Relation To Providing Patient Care in the Changing Health Care System

The adverse impacts of pressure injury on patients have triggered a host of research efforts to help in its prevention and management. The proposed evidence-based intervention proposed is a nurse-led screening to timeously detect pressure injury development. This screening involves identifying individuals exposed to acquiring pressure ulcers and visiting them frequently to assess their skin condition and take necessary measures (Gefen, 2018). This intervention has the potential of controlling pressure injury development as nurses can focus more on the individuals at higher risks, as revealed through screening.

PICOT Question

Among the elderly patients admitted to the surgical unit, what is the efficacy of the nurse-led pressure injury development early detection evaluation compared to normal pressure injury screening on the development of pressure injuries within eight weeks?

Literature Search Strategy Employed

Various research and medical databases were useful in obtaining the relevant articles reviewed. Google Scholar, Cochrane database of systematic reviews, Ovid, CINAHL, and Medline were all instrumental in obtaining articles relevant to the PICOT. Keywords such as pressure injuries, pressure ulcers, bedsores, early detection, screening, and elderly were used in obtaining the relevant articles. The articles were then restricted to the ones published in the last five years.

Evaluation of Literature

The search strategy employed yielded various relevant articles, which are then reviewed in this section. Hekmatpou et al.(2018) performed research using a research question, “what is the impact of using Aloe Vera gel in preventing pressure injuries among individuals admitted in the orthopedic wards?”The intervention used in the study was nurse-led skincare, where the nurses applied Aloe Vera gel on the heel, sacrum, and areas around the hip two times a day to deter the development of the condition. From the analysis, the use of pure Aloe Vera showed a statistically significant difference from the control group, which means that the nursing intervention can be used to effectively prevent pressure ulcers development among patients.

El-Saidy et al. (2019) evaluated the impact of bony prominence protectors and skincare on pressure ulcer development among patients with reduced mobility. The nurse-led intervention used in the study was an application of bony prominence protectors and skincare. Some of the instruments used in the study include a structured questionnaire, pressure ulcer scale for healing, and Glasgow coma scale. The researchers observed that there was lower pressure ulcer risk upon the implementation of the intervention since they saw a substantial statistical difference between the pre and post-test for both the pressure ulcer healing and Braden scale scores.

Recently, Babamohamadi et al. (2019) undertook a study exploring the impact of the peppermint gel on preventing pressure sores among individuals in the neurosurgical intensive care units who get admitted with head trauma. The main intervention used was the application of peppermint gel for two weeks three times a day. One of the instruments used in the study is the Braden scale. The research showed that the applying peppermint gel is efficacious in preventing pressure injuries. For instance, while the pressure ulcer incidence rate among the intervention group was 22.8%, a considerably higher figure of 77% was observed in the control groups. The study also revealed that the sacrum was the most common area for pressure ulcer development.

Another relevant study was conducted by Barakat-Johnson et al. (2019) focused on exploring and understanding the nursing staff experience with pressure injury. Various themes included; the presence of ethical challenges when a nurse cannot render quality care, clarifying organizational triumphs, aim, and focus, the importance of skill and knowledge, and the management of competing requirements in a clinical setting. Jackson et al. (2017) study aimed to offer a deeper insight into the pressure injuries associated with pain using narration among home-dwelling patients. Among the study’s key findings are that pain resulting from pressure ulcers adversely impacts sleep, mobility, and daily living. The participants described the pain as, in most cases, out of control and poorly understood. The main themes from the study include; a highly insurmountable situation, an uncertain future, the need to do away with the pain, and poorly controlled pain.

Fulbrook et al. (2019) explored the nurses’ knowledge of pressure injuries and identify knowledge gaps for implementation of practice improving educational strategies. The analysis revealed unsatisfactory levels of knowledge among the nurses, with the nurses scoring lowest in wound description. Internet information such as reading guidelines on preventing pressure ulcers was associated with higher scores.

Lovegrove et al. (2018) also carried out a study was to identify and describe the prescription offered by nurses on pressure ulcer prevention strategies after risk assessment. The other aim was examining the correlation between intervention prescription and the risk level. There was a relationship between the risk of pressure ulcers and the prescription of preventative intervention. In addition, the preventative intervention prescription was not sufficient leading to higher chances of patients developing pressure ulcers and that nurses prescribe interventions relative to the identified risk.

Applicable Change or Nursing Theory Utilized

Change or nursing theories form an important of evidence-based practice and quality improvement implementation as they give a framework upon which such implementations are based and offer theoretical underpinnings for change management (Hidayat et al., 2020). A change theory would be appropriate since this project aims at early detection pressure injury development as compared to the normal pressure injuries care in the clinical setting. Therefore, this project seeks to change the normal clinical practice of clinical pressure injury detection to earl screening for the possible development of pressure ulcers.

The proposed change theory is Kurt Lewin’s change theory. The theorist argues that change is inevitable and, therefore, should be managed for optimum gains. This theory has three stages of change management, unfreeze, change and refreeze (Fulmer & Mezey, 2019). Through the theory’s concepts can be key in helping nurses transition from an old practice into the new and desired practice of early detection of pressure ulcer development. The change phase of the theory implies that the staff develops new feelings and ideas, which can then act as a springboard to the new required practice change. Finally, the unfreezing stage comes in with a consolidation of the desired practice change as a standard.

The change phase of the theory involves transitioning into a new state with a change applied to make the phase. During this phase, the nurses start to learn the desired new norms, practice, and thinking. This stage may have several barriers and enhancers. Among the enhancers are effective communication, support from the leadership, and sufficient time for every stakeholder to get used to the implemented change (Fulmer & Mezey, 2019). Therefore, the stakeholders have to be reminded of their duties and the reasons, need, and importance of the proposed change. Finally, the project will get to the refreezing phase. During this stage, the new strategies for early detection of the development of pressure ulcers will be integrated into the organization’s normal routine or practice to be a new standard of practice. During this time, one of the most vital targets is to restrain the staff from going back to the former ways of thinking and carrying out activities regarding pressure injuries management, hence ensuring that the introduced change forms part of the people’s culture.

Proposed Implementation Plan with Outcome Measures

The implementation plan is key in making the proposed change a success. An effective implementation plan brings together different aspects of the project to enable a seamless implementation that focuses on achieving the set goals. This project will be accomplished in a clinical setting with a major focus on elderly patients. The particular target will be elderly patients who have reduced mobility due to their condition, hence more prone to developing pressure ulcers as they may spend more time sleeping on the bed or sitting down more than walking or standing. Approval for the implementation of the project will be sought from the hospital.

Part of the implementation plan is the implementation timeline. Timeline enables the implementers to monitor the progress of the project and ensure that it remains on course to be completed within the required period (Melnyk & Fineout-Overholt, 2019). Therefore, the proposed timeline for the project is eight weeks. The outcome measures are key in measuring the impact or effectiveness of the project. One of the outcome measures of this project is improved knowledge among the nursing staff regarding timeous screening for early detection of the development of pressure ulcers. The next is the acquisition of skills regarding screening for pressure ulcers.  Another outcome measure is the reduced incidences of pressure ulcer development among the elderly patients admitted at the facility.

How Evidence-based Practice Was Used in Creating Intervention Plan

Coming up with or formulating an intervention plan requires a researcher to consider several factors (Melnyk & Fineout-Overholt, 2019). One of such factors that led to the creation of the intervention plan is evidence-based practice. A comprehensive literature review and evidence evaluation was undertaken to explore evidence-based practice supporting the management of pressure injuries. From the literature search and evaluation, it was noted that some of the most effective intervention strategies are nurse-led strategies. For example, nurse-led screening for the development of pressure ulcers, nurse efforts to frequently turn the patients sleeping on the bed, and nursing interventions of applying various skin care products, among others, are some of the most used interventions. Therefore, the intervention plan formulated was considered to be nurse-based and nurse-led.

Plan for Intervention Evaluation

One of the most crucial phases in implementing an evidence-based practice project is the evaluation phase. Evaluation represents the last step and is instrumental in helping the project leaders get an idea of the magnitude of the impact of the implemented intervention as deduced from the outcomes (Fulmer & Mezey, 2019). Again evaluation is also key in the assessment of how effective the implemented methods were. Therefore, the project will be evaluated after implementation, where the collected data will be compared to the baseline data. For instance, the incidences of pressure injury development will be determined after the implementation of the proposed change. The data will then be compared to the baseline data. Such a comparison will be key in determining the impact of the intervention.

Expected Barriers and Solution Proposals

Implementation of a proposed change or project usually faces various barriers. It is imperative to identify these barriers and formulate a plan to mitigate them as they may change from one setting to the next (Melnyk & Fineout-Overholt, 2019). One of the potential barriers is the organization’s reluctance to offer adequate support to the proposed project since the management and the leadership may develop cold feet towards the project and, therefore, fail to give the required support. One solution to this problem is to try as much as possible to align the project’s objectives to the organizational goals, vision and mission. Such an alignment can be key in making the leaders focus more on the project. The other possible barrier is resistance by the nursing staff to the proposed change. Such a resistance to change can derail the implementation process. Various efforts will be employed to overcome the barrier, for instance, employing strategies to obtain their buy-in. The other strategies include actively involving the staff and encouraging open communication to help them feel valued and part of the project.

Conclusion

Pressure ulcers have adverse impacts on patients and should be prevented and carefully managed. In most cases, pressure injuries may be prevented. Patients perceived to be at risk for pressure injury development should have their underlying risk factors checked. This capstone proposal change seeks to explore the prevention and management of pressure ulcers among elderly patients in surgical settings. The nurses need to promote the patient’s mobility and do patient skin assessments regularly, and the need for hospitals to offer adequate resources and leadership for better management and prevention.

References

Babamohamadi, H., Ansari, Z., Nobahar, M., & Mirmohammadkhani, M. (2019). The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind, randomized controlled trial. Complementary therapies in medicine, 47, 102223. https://doi.org/10.1016/j.ctim.2019.102223.

Barakat-Johnson, M., Lai, M., Wand, T., & White, K. (2019). A qualitative study of the thoughts and experiences of hospital nurses providing pressure injury prevention and management. Collegian, 26(1), 95-102. https://doi.org/10.1016/j.colegn.2018.04.005

El-Saidy, T. M. K., & Aboshehata, O. K. (2019). Effect of Skin Care and Bony Prominence Protectors on Pressure Ulcers among Hospitalized Bedridden Patients. American Journal of Nursing, 7(6), 912-921. DOI:10.12691/ajnr-7-6-2.

Fulbrook, P., Lawrence, P., & Miles, S. (2019). Australian nurses’ knowledge of pressure injury prevention and management: a cross-sectional survey. Journal of Wound, Ostomy, and Continence Nursing, 46(2), 106. https://dx.doi.org/10.1097%2FWON.0000000000000508.

Fulmer, T., & Mezey, M. (2019). The NICHE Theory of Change: The Power of Convening and Evidence 4. NICHE: Nurses Improving Care for Healthsystem Elders, 39.

Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: a randomized, triple-blind clinical trial. BMC complementary and alternative medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2.

Hidayat, A. T., Hariyati, R. T. S. H. S., & Muhaeriwati, T. M. (2020). Applicability of Lewin’s Change Management Model for Optimization Management Function in Nursing Delegation between Head Nurse and Team Leader: A Mini Project in Jakarta Military Hospital. International Journal of Nursing and Health Services (IJNHS), 3(4), 471-478. https://doi.org/10.35654/ijnhs.v3i4.68.

Gefen, A. (2018). The future of pressure ulcer prevention is here: detecting and targeting inflammation early. EWMA J, 19(2), 7-13. https://ewma.org/fileadmin/user_upload/EWMA.org/EWMA_Journal/articles_previous_issues/Gefen_A.pdf.

Jackson, D., Durrant, L., Bishop, E., Walthall, H., Betteridge, R., Gardner, S., … & Usher, K. (2017). Pain associated with pressure injury: A qualitative study of community‐based, home‐dwelling individuals. Journal of advanced nursing, 73(12), 3061-3069. https://doi.org/10.1111/jan.13370.

Jeddou, B., Khalfallah, M., Jarraya, D., Jarraya, H., Ouahchi, Z., Nouira, R., & Dziri, C. (2017). Prevalence and risk factors of pressure ulcers in a Tunisian hospital. La Tunisie medicale, 95(7), 494-499. https://pubmed.ncbi.nlm.nih.gov/29694654/

Lovegrove, J., Fulbrook, P., & Miles, S. (2018). Prescription of pressure injury preventative interventions following risk assessment: An exploratory, descriptive study. International wound journal, 15(6), 985-992. https://doi.org/10.1111/iwj.12965.

Magny, E., Vallet, H., Cohen-Bittan, J., Raux, M., Meziere, A., Verny, M., … & Boddaert, J. (2017). Pressure ulcers are associated with 6-month mortality in elderly patients with hip fractures managed in orthogeriatric care pathway. Archives of osteoporosis, 12(1), 1-6. https://doi.org/10.1007/s11657-017-0365-9.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Wolters Kluwer.

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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.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
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.