Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment

Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment
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Improving a Fall Prevention Program in a Clinical Environment

Falls are very important and preventing these falls are the most important goal and plan for every patient’s safety that encounters healthcare settings. There are many ways in preventing falls such as new trainings, new bed alarm tones and even hourly rounding. Daily improving to bedside reporting is another suggestion this field of study. Failing to increase measures in implementing change can lead to death and or longer hospitalization stays. Detecting problems early and adjusting to change will help with improvement of falls. Patients will build confidence and a trusting relationship that will help secure a solid foundation for the healthcare setting.

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Background

University of Louisville Hospital is a Level Trauma 1 Center in the state and nearby surrounding states. Admissions records over 3,000 patients a year and half of them are from outside of the county. Decreasing patients falls is the most important. In order to promote this proposition we need to set up teams that are willing to work together and communicate. University of Louisville hospital has had a total of 45 falls this year from January thru May. According to research, falls have been around for over 50 plus years. Incident reports are avoided when these happen the best thing is adverse events. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Healthcare facilities need to make sure they understand the interventions and not focus on the quantity of falls which is very important. Inpatient fall rates range from 1.7 to 25 falls per 1,000 patient days, depending on the care area, with geropsychiatric patients having the highest risk (NCBI, 2007). Falls inpatient has increased in some facilities. The facility that I am employed at fall cases have decreased through interventions and hourly rounding. Falls may never be fixed but we can all work together to decrease the chances and give the proper teachings.

Problem Statement

According to research falls have been around for over 50 plus years. Incident reports are avoided when these happen the best thing is adverse events. Falls in hospital are associated with excess financial and opportunity costs (Oxford Academic, 2008). The majority of falls in healthcare facilities are patients over 70 years of age and the youth between 18-39 years of age. Falls inpatient has increased in some facilities and this is why interventions are needed. Falls can be very costly towards everyone’s pockets and also their health. Prolonged hospital and even injuries such as fractures and death can occur if proper precautions are not in place. Liabilities can also occur which can cost the hospital more funds than actually receiving to improve better care. Consequently, various hospitals falls, prevention programs have been implemented in the last decades (BMC Health Services Research, 2006). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Fall cases have decrease over time at the facility that I am employed at and this was all through hourly rounding and building a rapport with you patients. We as a team can always help fix the issues at hand, falls may never be completely solved but they can be decreased through teamwork and dedication. Falls may never be fixed but we can all work together to decrease the chances and survival rates through proper teachings and statistical facts.

Change Proposal

In order to promote safety and prevent falls within all healthcare facilities the plan of care that promotes, reassurance, full assessment and communication. The purpose to change fall prevention strategies in our facility is to decrease falls and provide advance care through evidence based research. The proper education and research will introduce more expected outcomes. There will be some challenges and barriers that may interfere with this intervention. There will be multiple ways that this research will be used in order to be successful. Encouraging engagement and participation will affect the quality improvement process such as implementing small scale demonstrations which are less difficult to manage. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Small-scale demonstrations or small tests of change also allow you to refine the new processes, demonstrate their impact on practices and outcomes, and build increased support by stakeholders (AHRQ, 2017). It is important to understand that many changes will be made along the way and learning from these experiences will help with adding change to any obstacles that take place.

PICOT

PICOT is used to help people clarify answers for any problems they may encounter. This will be used in research and evidence based practices that can be used and implemented on a daily basis. The P in PICOT stands for the population or specific cohort that is included in the study. The I in PICOT stand for the interventions that are used for in treatments during this study. The C in PICOT stands for the comparison in the study of research. The O in PICOT stands for the objectives in the research study. The T stands for the time frame which is not always included in the Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment study.

The inpatient population such as the sick and elderly (P) for the study of prevention in falls in an inpatient setting. The intervention (I) for this study and intervention of falls is the revision of the post debriefing forms and training for bedside report along with hourly rounding. The comparison (C) in this study is to reduce the risk for falls such as hourly rounding and improved training for staff. The outcome (O) for this study is to reduce falls in an inpatient facility. The time frame (T) in this study would be decreasing of falls over a three to six month period.

Literature Search

Falls can be related to intrinsic and extrinsic factors. Intrinsic factors are disorders, mental problems anything that is preventable through health. Extrinsic factors are made up of environmental things such as spills, rugs, and cluttered areas. All falls are important and it’s even more important to understand the causes. Morse falls scale is very important and our hospital uses this scale for every patient that is admitted to the hospital. Medical errors are another way falls can occur. Nurses or even ancillary staff may forget to give a patient a call light and patient may have to use the restroom and attempt to get up and fall. Making sure that the patient has worked with physical therapy and communication has been documented and transcribed accurately. Identifying those at risk allows targeted assessment and intervention such as a review of medications and environmental modifications (BMC Medicine, 2004). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Falls can be very costly towards everyone’s pockets and also their health. Prolonged hospital and even injuries such as fractures and death can occur if proper precautions are not in place. Liabilities can also occur which can cost the hospital more funds than actually receiving to improve better care. Consequently, various hospitals falls, prevention programs have been implemented in the last decades (BMC Health Services Research, 2006). Coming up with reasoning to why a person fall is the leading answer to the problem. Every patient is different and their reasons are going to be different as well so making sure that the proper assessment is given then falls should be prevented.

Literature Evaluation

Information that was collected from journals and articles to help promote fall preventions in an inpatient facility has been very beneficial. There are so many issues that can relate to falls such as bad lightening, shoes are not flat, irregular eye exams and even clothing that’s not fitting appropriately can help with falls. Understanding the causes of falls is very important and factual. The older population tends to have a higher risk for falls then that of the youth population. Falls also occur often among older people in hospital and the sickly ill patients. Our hospital uses the Morse Falls scale to assess every patient that is admitted into our doors which is part of a detail assessment of the patient. Medical errors are another way falls can occur which is caused by either shortage of nurses, work overload or even lack of education. Nurses or even ancillary staff may have times where they may not give the patient a call light and then the patient may attempt to get up and fall which can lead to death or even broken bones. It’s also relevant that patients have worked with ancillary staff such as physical therapy and other therapies that play a role in activities of daily living. Communication is very important and vital information that has to be documented and transcribed accurately; if not, then many errors can occur. There are many suggestions such as bed alarming sounds changing and a new call light sound becoming more distinct giving that familiar sound to focus on the patient. Orienting the patient through assessments every 2-4 hours throughout shift depending on level of consciousness will help with fall preventions. Fall rates will decrease in our inpatient medical surgical and progressive care units. Focusing on post fall forms will help after the revision take place and orienting all staff new and old will help with the these goals of safety and reliability. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Coming up with reasoning to why a person fall is the leading answer to the problem. Every patient is different and their reasons are going to be different as well so making sure that the proper assessment is given then falls should be prevented.

Patient engagement is another suggestion if it’s going to prevent falls in the future. Introducing safety huddles have been suggested to reduce fall in hospitals which helps with communication and knowing each patient. Intentional rounding will help with patients that are at higher risk of falling. Falls inpatient has increased in some facilities. The facility that I am employed at fall cases have decreased through interventions and hourly rounding. Falls may never be fixed but we can all work together to decrease the chances and give the proper teachings. Falls seem to be one of the most major problems in older adults. In the United States one in three people aged 65 or more living in the community fall at least once a year (BMJ, 2006). Research and clinical programs in hospital fall prevention should pay more attention to study design and the nature of interventions (Wiley Online Library, 2015). Research will be very beneficial to the hospital and the elderly population. Collecting all information on the patient will help with eliminating falls. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Nursing Theory

Nursing theories are very important when implementing evidence base practices. There will be two change theories that will be factored in this healthcare setting. Model and role model theory has it’s concept from Piaget’s Theory of Cognitive Development. Erickson’s theory helps nurses care for their patients by recognizing each individual’s uniqueness, and focusing on the individual patient’s needs (Nursing Theory, 2016).

It is also a self-care method of nursing, which means it is based on the patient’s perceptions of the environment, and adapts based on individual stressors for that patient (Nursing Theory, 2016). Understanding the patient in order to maintain safety measures will help reach goals and also allow the patient to feel secure.

Next theory that can help with the improvement of this research will be the novice to expert theory. Patricia Benner developed a concept known as “From Novice to Expert.” This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences (Nursing Theory, 2016). She was based off of clinical experience through learning the patient over time. This Theory had five levels novice, advance beginners, competent, proficient, and expert. Different levels of skills will show the changes that need to take place in the healthcare facilities (Nursing Theory, 2016). Both theories are both beneficial in learning the patient’s cognitive skills and also building a confidence in each individual allowing them to heal and be safe. Changes are instilled in both theories and depending on the changes in the future. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Implementation

Medicines have side effects understanding these effects and communicating with your doctor along with the nurse the feelings that you are experiencing will help prevent any cases of falls. Nurse need to make sure that the call light is in reach and they give the proper teaching of what medicine they are giving their patient along with an understanding. Routine rounding is very important in the hospital which can be shared amongst the nurse and nursing assistant. Blood pressure medications are one of the most serious falls because of the dizziness that it can cause. Making sure the patient has proper footwear can also prevent falls, non skid socks and even slippers will help. Making sure the patient has a bed alarm under the patients and patients are aware of the call light being in reach. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Collecting all information on the patient will help with eliminating falls. We as nurses need to make sure that patients with the need for assistance devices need to be close to the nurse station and teachings on falls every hour when rounding. Patient that are on many prescriptions need to understand that side effects can really cause falls and that’s not good. Bring the entire team together and communicate will help with fall preventions. Making sure that a checklist is in place will help with less falls and more awareness. The Morse falls scale will help with understanding the risk of falls per patient. Making sure you understand the goal and also include everyone in the plan with an open mind will help with the benefits of the research project. Educational presentations would be presented to the healthcare and ancillary staff. This would be to help staff get a clearer perspective and also more education on fall preventions. A revision of the post fall briefing form adding more detail information will be applied to help with teamwork.

Potential Barriers

Changes brought to the surface will be one of the most difficult challenges on the units at work. This will have a big impact on the implementation strategies. Lacking structural guidelines and trainings can prevent falls from decreasing. Communication lacking between therapist and staff on each individualized patient can also prevent a change from occurring. Considering time is another barrier that can occur with falls and patient’s timing, how often they’re getting up and the time they’re falling. Physicians will not look at this situation as important as diagnosis which is another barrier that can prevent changes to occur. Interference of parents and visitors can also be a hindrance of growth within the plan of care of the patient. Some older people considered using assistive devices, such as walking frames, as a stigma, because they believe that using such aids is a sign of weakness and reflects a change in one’s self image (BMJ Open, 2015). One HCP perceived that older people normalized falls and consider them to be part of the normal ageing process. He felt that older people disregarded falls because they believed they were inevitable in old age (BMJ Open, 2015). Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment. Living situations outside of the facility is another barrier that can occur which the design of the house and the inadequate space for assistive devices. Admitting weaknesses and balance issues is another difficult task to get through, patients tend to be in denial of any issues they may be having. We as nurses and healthcare staff need to make sure that we have the knowledge and skills in managing falls in order to deliver a safe environment.

References

O., D., P., A., G., L., . . . G. (2008, October 01). Systematic review and meta-analysis of studies

using the STRATIFY tool for prediction of falls in hospital patients: How well does it work? | Age and Ageing | Oxford Academic. Retrieved from
https://academic.oup.com/ageing/article/37/6/621/40889

Section 4: Ways to Approach the Quality Improvement Process. (2015, November 16). Retrieved from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Bühler, H., Geest, S. D., & Milisen, K. (2006, June 07). Falls and consequent injuries in

hospitalized patients: Effects of an interdisciplinary falls prevention program. Retrieved from
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-69

Papaioannou, A., Parkinson, W., Cook, R., Ferko, N., Coker, E., & Adachi, J. D. (2004, January

21). Prediction of falls using a risk assessment tool in the acute care setting. Retrieved from
https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-2-1

Oliver, D. (2007, January 11). Strategies to prevent falls and fractures in hospitals and care

homes and effect of cognitive impairment: Systematic review and meta-analyses. Retrieved from
https://www.bmj.com/content/334/7584/82

Oliver, D., Hopper, A., & Seed, P. (2015, April 27). Do Hospital Fall Prevention Programs

Work? A Systematic Review. Retrieved from
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1532-5415.2000.tb03883.x

“Patricia Benner Novice to Expert – Nursing Theorist.”
Biographies of Nursing Theorists and Their Work – Nursing Theory
, 2016, nursing-theory.org/nursing-theorists/Patricia-Benner.php.

“Helen Erickson – Nursing Theorist.”
Environmental Theory – Nursing Theory
, 2016,
www.nursing-theory.org/nursing-theorists/Helen-C-Erickson.php
.

Loganathan, Annaletchumy, et al. “Barriers Faced by Healthcare Professionals When Managing Falls in Older People in Kuala Lumpur, Malaysia: a Qualitative Study.”
BMJ Open
, British Medical Journal Publishing Group, 1 Nov. 2015, bmjopen.bmj.com/content/5/11/e008460. Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Professional Capstone and Practicum

Details This is a writing-intensive course. The

professional capstone practicum project offers

students the opportunity to propose a resolution

to an issue or problem significant to nursing

practice within a clinical environment. Students

identify, design, and propose an evidence-based

solution within a health care organization with

guidance from faculty and a preceptor in the

field. The proposal must reflect synthesis and

integration of course content and professional

practice. Development of the capstone project

is guided by the baccalaureate program student

learning outcomes. Practice immersion hours: 100.

Prerequisites: NRS-430V, NRS-429VN, NRS-434VN,

NRS-427VN, NRS-433V, PHI-413V, NRS-451VN,

NRS-410V, and NRS-440VN.

Credit Hours 6.0

PreRequisites NRS-430V, NRS-429VN, NRS-434VN, NRS-427VN,

NRS-433V, PHI-413V, NRS-451VN, NRS-410V, and

NRS-440VN

coRequisites None

Course Add-Ons Additional Material

Other

Optional: Publication Manual of the American

Psychological Association

For additional information, the following is

recommended: Current version of the Publication

Manual of the American Psychological Association.

GCU has made APA templates and other resources

available within the Student Success Center as

well as in the GCU Library. However, be aware that

a more complete APA Manual can be purchased at

your own expense. To order the APA manual, please

visit the American Psychological Association.

http://apa.org

Other

The Practice Immersion Experience

Review the "The Practice Immersion

Experience" resource to familiarize yourself

with the requirements for course assignments

and programmatic course components required to

successfully complete this course and the RN-toBSN program of study.

Electronic Resource

Guidelines for Undergraduate Field Experiences

Review the Guidelines for Undergraduate Field

Experiences resource in the Student Success

Center. This material contains important

information for your clinical experience,

including evaluation guidelines, the Clinical Site

Visit Application, and the Clinical Hour Tracking

Sheet for BSN Students Capstone Project Change Proposal – Improving a Fall Prevention Program in a Clinical Environment.

Electronic Resource

Nursing and Health Sciences Research Guides

View "Nursing and Health Sciences Research

Guides," located on the Grand Canyon

University website. This is a discipline-specific

research guide to assist you with your research.

In particular, seek out the "Evidence-Based

Practice (EBP)" tab in the LibGuide for

highly specific information pertinent to the

capstone project.

http://libguides.gcu.edu/Nursing

Electronic Resource

Evaluating Websites

View "Evaluating Websites," located on

the Grand Canyon University website. This tutorial

will explain how to evaluate websites for content

that you can trust.

http://tutorials.gcumedia.com/

evaluatingWebTutorial/interactiveIndex.html

Other

Practice Immersion Clinical Tools

The attached document contains all three

required Practice Immersion Clinical Tools. The

"Practice Immersion Clinical Evaluation

Tool – Student" will be completed by the

student’s Course Mentor and the faculty at the

course conclusion. The "Practice Immersion

Clinical Evaluation Tool – Mentor" will be

completed by the student and submitted to the

course faculty at the course conclusion. The

"Practice Immersion Clinical Evaluation Tool

– Agency" will be completed by students and

validated by faculty in regards to the clinical

site, and will also be submitted to course faculty

at the course conclusion.

Electronic Resource

Qualified Mentor/Preceptor Summary Form

Review the "Qualified Mentor/Preceptor

Summary Form" resource, located in the

Student Success Center. Use the "Qualified

Mentor/Preceptor Summary Form" as part of the

Topic 1 Course Mentor Identification and Approval

Process assignment requirements.

Other

Field Experience Site Information Form

Use the "Field Experience Site Information

Form" as part of the Topic 1 Course Mentor

Identification and Approval Process assignment

requirements.

Other

Practicum Hours Requirements for Washington

Registered Nurses

If you are a registered nurse in Washington, your

practicum experience must include a minimum of 50

hours in a community health setting.

Other

NRS-490 Course Objectives

During this course, the student will: Work

constructively with patients, communities,

organizational leadership, and other change

agents to improve practice within health care

settings. Apply Healthy People 2020 principles

in nursing practice. Synthesize nursing knowledge

and concepts into an evidence-based change

proposal for an issue or problem relevant to

nursing practice and population health outcomes.

Identify resources required to implement a

clinical change in nursing practice. Communicate

information and strategies to stakeholders in

order to implement and sustain an evidence-based

change proposal. Determine reliable methods to

measure the effectiveness of an evidence-based

change proposal project in achieving the intended

outcomes.

Topics

Topic 1: Change Proposal Subject

and Purpose Identification 1

Duration: 7 days

Description:

The first step in developing an evidence-based practice change

proposal is to identify an issue or problem to address. In this topic,

students will learn what resources are required and what skills they

will need to employ in order to create and deliver a robust capstone

practicum proposal.

Objectives:

1. Identify problems, issues, and opportunities to improve patient

care, patient outcomes, and organizational procedures within a

clinical practice setting.

2. Examine a health care clinical problem or an organization issue and

its implications to nursing practice.

3. Determine evidence-based solutions that address patient-care or

clinical practice quality problems or issues.

4. Analyze health care clinical problems and organizational issues

utilizing the PICO(T) process

5. Demonstrate values consistent with the role of a nursing

professional through fundamental knowledge and advanced skills.

Topic Material:

Other

6. Individual Success Plan

Review this resource to familiarize yourself with the requirements for

the Individual Success Plan (ISP) assignment in this topic.

Website

7. Optional: GCU Library Webinar Sign Up

For additional information, the following is recommended: Review

the webinar information offered by the GCU Library. From the

"Webinars & Workshops: Webinar Calendar" page, select

the "Category" tab and scroll down to the Nursing and Health

Sciences selection. Webinar participation is optional.

Electronic Resource

8. Guidelines for Undergraduate Field Experiences

Review the Guidelines for Undergraduate Field Experiences resource

in the Student Success Center. This material contains important

information for your clinical experience, including evaluation

guidelines, the Clinical Site Visit Application, and the Clinical Hour

Tracking Sheet for BSN Students.

Electronic Resource

9. Qualified Mentor/Preceptor Summary Form

Review the "Qualified Mentor/Preceptor Summary Form"

resource, located in the Student Success Center. Use the

"Qualified Mentor/Preceptor Summary Form" as part of the

Topic 1 Course Mentor Identification and Approval Process assignment

requirements.

Other

10. Field Experience Site Information Form

Use the "Field Experience Site Information Form" as part

of the Topic 1 Professional Capstone and Practicum Documentation

assignment requirements.

Other

11. Practicum Hours Requirements for Washington Registered Nurses

If you are a registered nurse in Washington, your practicum experience

must include a minimum of 50 hours in a community health setting.

Other

12. Scholarly Activity Summary

You may use the "Scholarly Activity Summary" resource to

help guide the preparation of the Scholarly Activities assignment, due

in Topic 10.

Electronic Resource

13. Adopting Evidence-Based Practice in Clinical Decision making: Nurses’ Perceptions, Knowledge, and Barriers

Read “Adopting Evidence-Based Practice in Clinical Decision making:

Nurses’ Perceptions, Knowledge, and Barriers,” by Majid, Schubert,

Luyt, Zhang, Theng, Chang, and Mokhtar, from the Journal of the Medial

Library Association (2011).

Electronic Resource

14. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read “Nurses, Information Use, and Clinical Decision Making – the Real

World Potential for Evidence-Based Decisions in Nursing,” by Thompson,

Cullum, McCaughan, Sheldon, and Raynor, from the BMJ website (2004).

Electronic Resource

15. Evidence-Based Practice or Practice-Based Evidence: What’s in a Name?

Read "Evidence-Based Practice or Practice-Based Evidence: What’s

in a Name?" by McKeon and McKeon, from International Journal of

Athletic Therapy & Training (2015).

Electronic Resource

16. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read "Nurses, Information Use, and Clinical Decision Making – the

Real World Potential for Evidence-Based Decisions in Nursing,"

by Thompson, Cullum, McCaughan, Sheldon, and Raynor, from the BMJ

Journals website (2004).

Gradable Items Details Points Possible

Assignment Professional Capstone and Practicum

Documentation

The Professional Capstone and Practicum

course requires students to

select a course mentor. This mentor is

not a preceptor, but an

individual who will guide students as

they work to complete the

practice immersion hour requirements

for this course. Students are not

required to "shadow" their

mentor.

The course mentor should be someone who

can provide professional

development knowledge and guidance and

who possesses a genuine

interest in working with students to

further their academic goals.

Selection, approval, and retention of a

course mentor must be

completed as soon as possible at the

start of this course, as this

individual will be working with the

student on each assignment that

10.0

Gradable Items Details Points Possible

incorporates practice immersion hours.

Working with a course mentor is

mandatory.

Once a course mentor has agreed to

serve in the role, you must

complete and submit the following

required documentation so that

practice experiences can begin in a

timely manner:

Field Experience Site Information Form

Qualified

Mentor/Preceptor Summary Form Mentor’s

license,

certification, and resume/curriculum

vitae

The student is responsible for

obtaining all signatures for the

paperwork submission. Course faculty

will approve all sites and

mentors according to student learning

needs and specific course objectives.

Do not initiate new work on practiceimmersion-hour-based course

assignments until your course

instructor has approved your course

mentor.

Once a course mentor is approved,

students should contact the mentor

within 1 week of receiving the approval

notification. Students are

encouraged to make an appointment to

meet with their mentor in person

and arrange to review the NRS-490

course objectives and the Individual

Success Plan (ISP).

For more specific information on the

course mentor process and roles

and responsibilities, refer to Section

Three of the Guidelines for

Undergraduate Field Experiences

resource.

Assignment Individual Success Plan (ISP)

Planning is the key to successful

completion of this course and your

overall program of study. The

Individual Success Plan (ISP)

assignment

requires early collaboration with the

course faculty and your course

mentor. You will need to establish a

plan for successful completion of

25.0

Gradable Items Details Points Possible

(1) deliverables associated with weekly

course objectives, (2),

required practice immersion hours, and

(3) deliverables associated

with your capstone project.

Access the "Individual Success

Plan" resource in the Topic

Materials. Read the information in the

resource, including student

expectations and instructions for

completing the ISP document.

Use the "Individual Success

Plan" to develop a personal

plan for completing your practice hours

and how topic objectives will

be met. Include the number of hours you

plan to set aside to meet your goals.

A combination of 100 supervised

clinical hours in community health

and leadership areas will be obtained

through the application of the

objectives listed in the Guidelines for

Undergraduate Field

Experiences manual.

Practicum immersion experiences are

required in a community health

setting. Community-based settings

should encourage community

integration and involvement; expand

accessibility of services and

supports; promote personal preference,

strengths, dignity; and empower

people to participate in the economic

mainstream.

According to HealthyPeople.gov,

educational and community-based

programs and strategies are designed to

reach people outside of

traditional health care settings. These

settings may include schools,

worksites, health care facilities, and

communities. Community health

and leadership practice immersion can

occur in the same site and in

conjunction with the evidence-based

project in the NRS-490 course.

If you are a registered nurse in

Washington, your practicum

experience must include a minimum of 50

hours in a community health setting.

Gradable Items Details Points Possible

Students should apply concepts from

prior courses to critically

examine and improve their current

practice. Students should also

integrate scholarly readings to develop

case reports that demonstrate

increasingly complex and proficient

practice.

Consider the challenges you expect to

encounter as you continue the

practice hour and competency

requirements throughout this course.

How

might you overcome these challenges?

You can renegotiate these deliverables

with your faculty and mentor

throughout this course and update your

ISP accordingly.

Once your ISP has been developed and

accepted by your course

faculty, you will have your course

mentor sign it at the beginning of,

and upon completion of, each assignment

that incorporates practice

immersion hours. You will track all

course practice immersion hours in

the ISP.

APA format is not required, but solid

academic writing is expected.

You are not required to submit this

assignment to Turnitin.

Assignment Professional Capstone and Practicum

Reflective Journal and Scholarly

Activities

Throughout the course, students will

engage in weekly reflection and

scholarly activities. These assignments

are presented in Topic 1 to

allow students to plan ahead, and

incorporate the deliverables into

the Individual Success Plan if they so

choose.

The weekly reflective journals and

scholarly activities will not be

submitted in LoudCloud each week; a

final, culminating submission will

be due in Topic 10. No submission is

required until Topic 10.

Professional Capstone and Practicum

Reflective Journal

0.0

Gradable Items Details Points Possible

Students are required to maintain

weekly reflective narratives

throughout the course to combine into a

final, course-long reflective

journal that integrates leadership and

inquiry into current practice

as it applies to the Professional

Capstone and Practicum course. This

course-long journal assignment will be

due in Topic 10.

In each week’s entry, you should

reflect on the personal knowledge

and skills gained throughout the

Professional Capstone and Practicum

course. Your entry should address a

variable combination of the

following, dependent on the specific

practice immersion clinical

experiences you encountered that week:

New practice approaches

Intraprofessional

collaboration Health care delivery and

clinical systems

Ethical considerations in health care

Population health

concerns The role of technology in

improving health care

outcomes Health policy Leadership and

economic

models Health disparities

In the Topic 10 submission, each of the

areas should be addressed in

one or more of the weekly entries.

This reflection journal also allows

students to outline what they

have discovered about their

professional practice, personal

strengths

and weaknesses that surfaced,

additional resources and abilities that

could be introduced to a given

situation to influence optimal

outcomes, and finally, how they met

competencies and course objectives.

Scholarly Activities

Throughout the RN-to-BSN program,

students are required to

participate in scholarly activities

outside of clinical practice or

Gradable Items Details Points Possible

professional practice. Examples of

scholarly activities include

attending conferences, seminars,

journal club, grand rounds, morbidity

and mortality meetings,

interdisciplinary committees, quality

improvement committees, and any other

opportunities available at your

site, within your community, or

nationally.

You are required to post one scholarly

activity while you are in the

BSN program, which should be documented

by the end of this course. In

addition to this submission, you are

required to be involved and

contribute to interdisciplinary

initiatives on a regular basis.

In Topic 10, you will submit a summary

report of your scholarly

activity. You may use the

"Scholarly Activity Summary"

resource to help guide this assignment.

Discussion

Question

Topic 1 DQ 1

Identify two GCU Library scholarly

databases that will help you find

the best research articles to support

your EBP proposal. Discuss why

these two databases are better than

Google Scholar or a general

Internet search.

5.0

Discussion

Question

Topic 1 DQ 2

The Institute of Medicine has stated a

goal that 90% of practice be

evidence-based by 2020. According to

HealthyPeople.gov, the United

States is currently at approximately

15%. Discuss two barriers that

might hold nursing practice from

achieving this goal, and suggest ways

in which identified barriers may be

addressed.

5.0

Participation 15.0

Topic 2: Change Proposal Subject

and Purpose Identification 2

Duration: 7 days

Description:

The first step in developing an evidence-based practice change

proposal is to identify an issue or problem to address. In this topic,

students will learn what resources are required and what skills they

will need to employ in order to create and deliver a robust Capstone

practicum proposal.

Objectives:

1. Identify problems, issues, and opportunities to improve patient

care, patient outcomes, and organizational procedures within a

clinical practice setting.

2. Examine a health care clinical problem or an organization issue and

its implications to nursing practice.

3. Determine evidence-based solutions that address patient-care or

clinical practice quality problems or issues.

4. Analyze health care clinical problems and organizational issues

utilizing the PICO(T) process

5. Demonstrate values consistent with the role of a nursing

professional through fundamental knowledge and advanced skills.

Topic Material:

Other

6. Capstone Project: Developing a Question

Review "Capstone Project: Developing a Question" to assist

you in developing a Capstone Project appropriate to the course and the

RN-to-BSN overall program of study.

Other

7. Project Topic Checklist

Access the “Project Topic Checklist” resource to complete an

assignment in this topic.

Website

8. Optional: GCU Library Webinar Sign Up

For additional information, the following is recommended: Review

the webinar information offered by the GCU Library. From the

"Webinars & Workshops: Webinar Calendar" page, select

the "Category" tab and scroll down to the Nursing and Health

Sciences selection. Webinar participation is optional.

Electronic Resource

9. Adopting Evidence-Based Practice in Clinical Decision making: Nurses’ Perceptions, Knowledge, and Barriers

Read “Adopting Evidence-Based Practice in Clinical Decision making:

Nurses’ Perceptions, Knowledge, and Barriers,” by Majid, Schubert,

Luyt, Zhang, Theng, Chang, and Mokhtar, from the Journal of the Medial

Library Association (2011).

Electronic Resource

10. Nurses, Information Use, and Clinical Decision Making – the Real World Potential for Evidence-Based Decisions in

Nursing

Read “Nurses, Information Use, and Clinical Decision Making – the Real

World Potential for Evidence-Based Decisions in Nursing,” by Thompson,

Cullum, McCaughan, Sheldon, and Raynor, from the BMJ website (2004).

Gradable Items Details Points Possible

Assignment Capstone Project Topic Selection and

Approval

In collaboration with your approved

course mentor, you will identify

a specific evidence-based practice

proposal topic for the capstone

project. Consider the clinical

environment in which you are currently

working or have recently worked. The

capstone project topic can be a

clinical practice problem, an

organizational issue, a quality

improvement suggestion, a leadership

initiative, or an educational

need appropriate to your area of

interest as well as your practice

immersion (practicum) setting. Examples

of the integration of

community health, leadership, and an

EBP can be found on the

"Educational and Community-Based

Programs" page of the Healthy

People 2020 website.

Write a 500-750 word description of

your proposed capstone project

topic. Make sure to include the

following:

The problem, issue, suggestion,

initiative, or educational

need that will be the focus of the

project The setting or

context in which the problem, issue,

suggestion, initiative, or

educational need can be observed. A

description providing a

high level of detail regarding the

problem, issue, suggestion,

initiative, or educational need. Impact

of the problem,

issue, suggestion, initiative, or

educational need on the work

environment, the quality of care

provided by staff, and patient

outcomes. Significance of the problem,

issue, suggestion,

initiative, or educational need and its

implications to

nursing. A proposed solution to the

identified project

topic

50.0

Gradable Items Details Points Possible

You are required to retrieve and assess

a minimum of 8 peer-reviewed

articles. Plan your time accordingly to

complete this assignment.

Prepare this assignment according to

the guidelines found in the APA

Style Guide, located in the Student

Success Center. An abstract is not

required.

You are required to submit this

assignment to Turnitin. Please refer

to the directions in the Student

Success Center.

Assignment Topic 2 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 2 DQ 1

During your practicum, determine what

clinical problem or issue the

organization is facing. Discuss two

implications for nursing.

5.0

Discussion

Question

Topic 2 DQ 2

What is the main issue for your

organization in addressing a solution

to evidence-based nursing practice?

Discuss what might be the first

step in addressing and resolving this

issue.

5.0

Participation 15.0

Topic 3: Evidence-Based Practice

Proposal Development Plan 1

Duration: 7 days

Description:

The next step in developing an evidence-based practice proposal is to

search the literature for support and evaluate the level of evidence.

In this topic, students will learn what resources are required and

what skills they will need to employ in order to create and deliver a

Capstone Project proposal with a high level of evidence.

Objectives:

1. Evaluate evidence-based research and other appropriate resources to

inform the development of a change plan.

2. Identify strategies for logistical implementation of proposed

solutions.

3. Demonstrate the ability to evaluate levels of evidence into a

concise format.

4. Integrate evidence, clinical judgment, interprofessional

perspectives, and patient preferences in planning, implementing,

and evaluating outcomes of care.

Topic Material:

Electronic Resource

3. Science of Improvement: Steps in the PDSA Cycle

Read “Science of Improvement: Steps in the PDSA Cycle,” located on the

Institute for Healthcare Improvement website.

Website

8. Change Theory

Explore this website: Change Theory.

Website

9. Nursing Theory

Explore this website: Nursing Theory. This website provides

information on leading nursing theories.

Website

10. Nursing Theories

Explore this website: Nursing Theories. This website provides

information on leading nursing theories.

Electronic Resource

11. Asking Focused Questions

Read “Asking Focused Questions” on the Centre for Evidence-Based

Medicine website.

Electronic Resource

13. Formulating a Researchable Question: A Critical Step for Facilitating Good Clinical Research

Read “Formulating a Researchable Question: A Critical Step for

Facilitating Good Clinical Research,” by Aslam and Emmanuel, from the

National Center for Biotechnology Information website (2010).

Electronic Resource

14. Research Questions, Hypotheses and Objectives

Read “Research Questions, Hypotheses and Objectives, by Farrugia,

Petrisor, Farrokhyar, and Bhandari, from the National Center for

Biotechnology Information website (2010).

Gradable Items Details Points Possible

Assignment PICOT Statement Paper

Review the Topic Materials and the work

completed in NRS-433V to

formulate a PICOT statement for your

capstone project.

A PICOT starts with a designated

patient population in a particular

clinical area and identifies clinical

problems or issues that arise

from clinical care. The intervention

should be an independent,

specified nursing change intervention.

The intervention cannot require

a provider prescription. Include a

comparison to a patient population

not currently receiving the

intervention, and specify the timeframe

needed to implement the change process.

Formulate a PICOT statement using the

PICOT format provided in the

assigned readings. The PICOT statement

will provide a framework for

your capstone project.

In a paper of 500-750 words, clearly

identify the clinical problem

and how it can result in a positive

patient outcome.

Make sure to address the following on

the PICOT statement:

Evidence-Based Solution Nursing

Intervention

Patient Care Health Care Agency Nursing

Practice

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 Turnitin. Please refer

to the directions in the Student

Success Center.

75.0

Gradable Items Details Points Possible

Assignment Topic 3 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 3 DQ 2

Name two different methods for

evaluating evidence. Compare and

contrast these two methods.

5.0

Discussion

Question

Topic 3 DQ 1

Submit a summary of six of your

articles on the discussion board.

Discuss one strength and one weakness

to each of these six articles on

why the article may or may not provide

sufficient evidence for your

practice change.

5.0

Participation 15.0

Topic 4: Evidence-Based Practice

Proposal Development Plan 2

Duration: 7 days

Description:

The next step in developing an evidence-based practice proposal is to

search the literature for support and evaluate the level of evidence.

In this topic, students will learn what resources are required and

what skills they will need to employ in order to create and deliver a

Capstone Project proposal with a high level of evidence.

Objectives:

1. Evaluate evidence-based research and other appropriate resources to

inform the development of a change plan.

2. Identify strategies for logistical implementation of proposed

solutions.

3. Demonstrate the ability to evaluate levels of evidence into a

concise format.

4. Integrate evidence, clinical judgment, interprofessional

perspectives, and patient preferences in planning, implementing,

and evaluating outcomes of care.

Topic Material:

Electronic Resource

3. Science of Improvement: Steps in the PDSA Cycle

Review “Science of Improvement: Steps in the PDSA Cycle,” located on

the Institute for Healthcare Improvement website.

Website

8. Change Theory

Explore this website: Change Theory.

Website

9. Nursing Theory

Explore this website: Nursing Theory. This website provides

information on leading nursing theories.

Website

10. Nursing Theories

Explore this website: Nursing Theories. This website provides

information on leading nursing theories.

Electronic Resource

11. Asking Focused Questions

Review “Asking Focused Questions” on the Centre for Evidence-Based

Medicine website.

Other

12. Literature Evaluation Table

Review the "Literature Evaluation Table" resourced to assist

you in completing the Literature Evaluation Table assignment.

Electronic Resource

14. Formulating a Researchable Question: A Critical Step for Facilitating Good Clinical Research

Read “Formulating a Researchable Question: A Critical Step for

Facilitating Good Clinical Research,” by Aslam and Emmanuel, from the

National Center for Biotechnology Information website (2010).

Electronic Resource

15. Research Questions, Hypotheses and Objectives

Read “Research Questions, Hypotheses and Objectives, by Farrugia,

Petrisor, Farrokhyar, and Bhandari, from the National Center for

Biotechnology Information website (2010).

Gradable Items Details Points Possible

Assignment Literature Evaluation Table

In nursing practice, accurate

identification and application of

75.0

Gradable Items Details Points Possible

research is essential to achieving

successful outcomes. Being able to

articulate the information and

successfully summarize relevant

peer-reviewed articles in a scholarly

fashion helps to support the

student’s ability and confidence to

further develop and synthesize the

progressively more complex assignments

that constitute the components

of the course change proposal capstone

project.

For this assignment, the student will

provide a synopsis of eight

peer-reviewed articles from nursing

journals using an evaluation table

that determines the level and strength

of evidence for each of the

eight articles. The articles should be

current within the last 5 years

and closely relate to the PICOT

statement developed earlier in this

course. The articles may include

quantitative research, descriptive

analyses, longitudinal studies, or

meta-analysis articles. A

systematic review may be used to

provide background information for

the purpose or problem identified in

the proposed capstone project.

Use the "Literature Evaluation

Table" resource to complete

this assignment.

While APA style is not required for the

body of this assignment,

solid academic writing is expected, and

in-text citations and

references should be presented using

APA documentation guidelines,

which can be found in the APA Style

Guide, located in the Student

Success Center.

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 not required to submit this

assignment to Turnitin.

Assignment Topic 4 Practice Hours Completion

Statement NRS-490

0.0

Gradable Items Details Points Possible

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

Discussion

Question

Topic 4 DQ 2

Compare and contrast two change

theories, and determine which theory

makes the most sense for implementing

your specific EBP project. Why?

Has your mentor used either theory, and

to what result?

5.0

Discussion

Question

Topic 4 DQ 1

Why is understanding the health care

system at the local level

important to consider when planning an

EBP implementation? Conduct

research and solicit anecdotal evidence

from your course mentor that

you will take into consideration for

your own change project.

5.0

Participation 15.0

Topic 5: Evidence-Based Practice

Proposal Project Development and

Implementation Plan 1

Duration: 7 days

Description:

Students need to be able to process and formulate an evidence-based

and financially feasible solution to a clinical problem or issue.

Working through the element of plan development requires them to

assess and address the challenges, barriers, and other facets of

change proposal implementation in the real world. The content in

this topic will enable students to better understand the cultural

environment(s) surrounding a change project and lead them through

the steps of how to go about successful implementation of a strategic

plan. A change or nursing theory must be used to support rational for

proposed implementation plan.

Objectives:

1. Identify objectives, strategy, and measurable outcomes of the

evidence-based practice proposal.

2. List steps needed to implement each strategy in a change proposal.

3. Outline the resources needed to develop and implement a change

proposal.

4. Describe methods for obtaining necessary support from key

stakeholders.

5. Develop a plan to evaluate the effectiveness of the change proposal

project.

6. Evaluate the role of information sources and technologies impacting

the delivery of care within an adequate environment of care.

7. Develop appropriate change plans that promote health and prevent

disease.

Topic Material:

Gradable Items Details Points Possible

Assignment Topic 5 Practice Hours Completion

Statement NRS-490

Students will track their practice

hours throughout the course via

the Practice Hours Completion Statement

provided in this assignment.

Complete the following statement

in a Word document and submit the

attachment:

Practice Hours Completion Statement

NRS-490

I, (INSERT NAME), verify that I have

completed (NUMBER OF)

practice hours in association with the

goals and objectives for this

course. I also verify that all required

course approvals are in

place from my faculty and practice

mentor.

0.0

Discussion

Question

Topic 5 DQ 1

Stakeholder support is necessary for a

successful change proposal

project implementation. Consider your

internal stakeholders, such as

the facility, unit or health care

setting where the change process is

situated, and your external

stakeholders, like an individual or

group

5.0

Gradable Items Details Points Possible

outside the health care setting. Why is

their support necessary to the

success of your project, and how you

will go about securing that support?

Discussion

Question

Topic 5 DQ 2

Technology is integral to successful

implementation in many projects,

through either support or integration

or both. Name at least one

technology that could improve the

implementation process and the

outcomes of your EBP project. Do you

plan to use this technology? If

not, what are the barriers that prevent

its use?

5.0

Participation 15.0

Topic 6: Evidence-Based Practice

Proposal Project Development and

Implementation Plan 2