Tag: Clinical-Nursing

NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

Fundamental Nursing Lessons Learnt from a Difficult Situation in Practice: Carper’s Pattern’s of Knowing in Nursing

The Practical Situation Experienced

Nursing is about promoting health, preventing illness, and restoring hope. However, there are situations in which a nurse can find themselves almost helpless with regard to all the three above. A case in point is the prospect of having to reassure a patient with terminal illness by giving them hope yet you know very well that they may not have long to live. Even more daunting is the task requiring you as the nurse to convince the patient and her relatives that they will benefit from hospice care. This is the situation I once found myself in. I was faced with this situation of a 37 year-old who had advanced ovarian cancer with a very poor prognosis. It was obvious that what she needed most in her…

Week 2 Assignment: Reflective Essay

Guidelines with Scoring Rubric

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Purpose

Nursing knowledge is classified in a variety of ways, one of which is Carper’s Patterns of Knowing (Carper, 1978).  Carper’s framework offers a lens through which the nurse can reflect upon insights acquired through empirical, ethical, personal, and aesthetic knowledge (Carper, 1978).  Through intentional reflection using Carper’s Patterns of Knowing, nurses can process experiential learning and knowledge acquired through practice.  The purpose of this assignment is to reflect upon a specific practice situation and better understand the professional knowledge and insights obtained through that experience. NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

Course Outcomes

Through this assessment, the student will meet the following Course Outcomes:

Demonstrate logical and creative thinking in the analysis and application of theory to nursing practice. (CO #1)

Examine broad theoretical concepts as foundational to advanced nursing practice roles. (CO #3)

 

Total Points Possible

This assignment is worth 100 points.

Due Date

Submit your file by 11:59 p.m. MT Sunday at the end of Week 2.

Requirements

Criteria for Content

Think of a surprising or challenging practice situation in which you felt underprepared, unprepared, or uncomfortable.

Select an important nursing issue/topic that was inherent to the identified situation.

As a method of refection, use Carper’s Patterns of Knowing to analyze the situation. In a
two- to three-page paper
address the following:

Briefly
explain the situation

Identify the nursing issue inherent in the identified situation

NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

What do you think was the underlying reason for the situation? (Esthetics)

What were your thoughts and feeling in the situation? (Personal)

What was one personal belief that impacted your actions? (Ethics)

What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

What new insights did you gain through this reflective practice opportunity?

Preparing the paper

Submission Requirements

Application: Use Microsoft Word 2013™ to create the written component of this assessment.

Length:

The paper (excluding the title page and reference page) should be
at least two but no more than three pages.

A minimum of
two (2)
scholarly literature sources must be used.

Submission: Submit your file to the Canvas course site by the due date/time indicated.

Best Practices in Preparing the Reflective Essay

The following are best practices in preparing this reflective essay.

Review directions thoroughly.

Follow assignment requirements.

Make sure all elements on the grading rubric are included.

Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scholarly writing.

Because the paper is a reflective essay, first person is acceptable for this assignment.

Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.

Ideas and information that come from scholarly literature must be cited and referenced correctly.

A minimum of
two (2)
scholarly literature sources must be used.

Abide by CCN academic integrity policy.

 

Grading Criteria

Category

Points

%

Description

Explanation of the Situation

10

10%

Provide a succinct description of a practice situation in which you felt underprepared or uncomfortable.

Nursing Issue or Concern Inherent to the Situation

15

15%

Explain the specific nursing issue or concern that was inherent to the situation and include your rationale.

 

Reflection upon the Situation using Carper’s Patterns of Knowing

 

45

50%

Analyze the situation and apply Carper’s Patterns of Knowing to discuss the following:

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

Summary of Reflection

20

20%

Provide a summary of your reflection. Include a minimum of two new insights gained through the situation you experienced. Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role.

APA Format

5

5%

Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section or topic of the paper (one deduction for each type of APA style error). Ideas and information that come from scholarly sources must be cited and referenced correctly.
Two (2) scholarly
literature references are used.

Writing Mechanics

5

5%

Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal written work as found in the 6th edition of the APA manual. For this assignment first person may be used.

Total

100

100%

A quality assignment will meet or exceed all the above requirements.

 

Grading Rubric

Assessment Criteria

Exceptional

(100%)

Outstanding or highest level of performance

Exceeds

(88%)

Very good or high level of performance

Meets

(80%)

Competent or satisfactory level of performance

Needs Improvement

(38%)

Poor or failing level of performance

Developing

(0)

Unsatisfactory level of performance

 

Content Possible Points
= 90 Points

Explanation of the Situation

 

10 Points

9 Points

8 Points

6 Points

0 Points

Presentation of information is
comprehensive and concise
and includes all of the following elements:

·         Synopsis of the practice situation

·         Discussion of how the practice situation created a feeling of being underprepared, unprepared, or uncomfortable

 

Presentation of information is
superficial
and includes all of the following elements:

 

·         Synopsis of the practice situation

·         Discussion of how the practice situation created a feeling of being underprepared, unprepared, or uncomfortable

 

Presentation of information is
minimally
demonstrated and includes all of the following elements:

·         Synopsis of the practice situation

·         Discussion of how the practice situation created a feeling of being underprepared, unprepared, or uncomfortable

 

Presentation of information in
one
of the following elements fails to meet expectations or is missing the following:

 

·         Synopsis of the practice situation

·         Discussion of how the practice situation created a feeling of being underprepared, unprepared, or uncomfortable

 

Presentation of information in
two or more
of the following elements fail to meet expectations or are missing the following:

·         Synopsis of the practice situation

·         Discussion of how the practice situation created a feeling of being underprepared, unprepared, or uncomfortable

 

Nursing Issue or Concern Inherent to the Situation

 

15 Points

13 Points

12 Points

9 Points

0 Points

Presentation of information is
comprehensive and concise
and includes
all
the following elements:

 

·         Identification of the specific nursing issue or concern which was present in this situation

·         Discussion of why the specific issue or concern is noteworthy

·         Support from the literature to validate the specific issue or concern

Presentation of information is
superficial
in places and includes
all
the following elements:

 

·         Identification of the specific nursing issue or concern which was present in this situation

·         Discussion of why the specific issue or concern is noteworthy

·         Support from the literature to validate the specific issue or concern

Presentation of information is
minimally
demonstrated and includes
all
the following elements:

·         Identification of the specific nursing issue or concern which was present in this situation

·         Discussion of why the specific issue or concern is noteworthy

·         Support from the literature to validate the specific issue or concern

Presentation of information in
one
of the following elements fails to meet expectations or is missing:

 

·         Identification of the specific nursing issue or concern which was present in this situation

·         Discussion of why the specific issue or concern is noteworthy

·         Support from the literature to validate the specific issue or concern

Presentation of information in
two or more
following elements fail to meet expectations or are missing:

·         Identification of the specific nursing issue or concern which was present in this situation

·         Discussion of why the specific issue or concern is noteworthy

·         Support from the literature to validate the specific issue or concern

Reflection upon the Situation using Carper’s Patterns of Knowing

 

45 Points

 40 Points

 36 Points

17 Points

0 Points

Presentation of information is
comprehensive and concise
and includes
all
of the following elements:

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

·         Support from the literature to validate the empirical pattern of knowing

Presentation of information is
superficial
in places and includes
all
of the following elements:

NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

 

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

·         Support from the literature to validate the empirical pattern of knowing

Presentation of information is
minimally
demonstrated and includes
all
of the following elements:

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

·         Support from the literature to validate the empirical pattern of knowing

Presentation of information in
one
of the following elements fails to meet expectations or is missing the following:

 

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

·         Support from the literature to validate the empirical pattern of knowing

Presentation of information in two or more of the following elements fail to meet expectations or are missing the following:

·         What do you think was the underlying reason for the situation? (Esthetics)

·         What were your thoughts and feeling in the situation? (Personal)

·         What was one personal belief that impacted your actions? (Ethics)

·         What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)

·         Support from the literature to validate the empirical pattern of knowing

Summary of Reflection

20 Points

 18 Points

16 Points

8 Points

0 Points

Presentation of information is
comprehensive and concise
and includes
all
of the following elements:

·         Include a minimum of two new insights gained through the situation you experienced

·         Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role

Presentation of information is
superficial
in places and includes
all
of the following elements:

 

·         Include a minimum of two new insights gained through the situation you experienced

·         Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role

Presentation of information is
minimally
demonstrated in
all
of the following elements:

 

·         Include a minimum of two new insights gained through the situation you experienced

·         Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role

Presentation of information in
one
of the following elements fails to meet expectations or is missing the following:

 

·         Include a minimum of two new insights gained through the situation you experienced

·         Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role

Presentation of information in
two or more
of the following elements fail to meet expectations or are missing the following:

·         Include a minimum of two new insights gained through the situation you experienced

·         Discuss how intentional reflective practice can add to professional knowledge in your future advanced practice nursing role

Content Subtotal ___ /90 points

Format Possible Points = 10 Points NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

APA Format

5 Points

4 Points

3 Points

2 Points

0 Points

APA guidelines, as per the 6th edition of the manual, are demonstrated for the

·         title page;

·         running head;

·         body of paper (including citations and headings); and

·         reference page.

 

One deduction for each type of APA format error.

 

0 to 1
APA error is present

APA guidelines, as per the 6th edition of the manual, are demonstrated for the

·         title page;

·         running head;

·         body of paper (including citations and headings); and

·         reference page.

 

One deduction for each type of APA format error.

2–3
APA errors are present

APA guidelines, as per the 6th edition of the manual, are demonstrated for the

·         title page;

·         running head;

·         body of paper (including citations and headings); and

·         reference page.

 

One deduction for each type of APA format error.

 

4–5
APA errors are present

APA guidelines, as per the 6th edition of the manual, are demonstrated for the

·         title page;

·         running head;

·         body of paper (including citations and headings); and

·         reference page.

 

One deduction for each type of APA format error.

 

6–7
APA errors are present

APA guidelines, as per the 6th edition of the manual, are demonstrated for the

·         title page;

·         running head;

·         body of paper (including citations and headings); and

·         reference page.

 

One deduction for each type of APA format error.

 

8 or greater
APA errors are present

References and Page Length

 

Note: Students are to use at least
two (2) scholarly re
ferences.

The paper (excluding the title page and reference page) should be at least
two but no more than three pages.

3 Point deduction

NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

Does not use at least two (2) scholarly references
and/or
falls short of or exceeds required page length.

Writing Mechanics

5 Points

4 Points

3 Points

2 Points

0 Points

1–2
errors or exceptions to the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the 6th edition of the APA manual. For this assignment, first person may be used.

 

3–4
errors or exceptions to the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the 6th edition of the APA manual. For this assignment, first person may be used.

 

5–6
errors or exceptions to the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the 6th edition of the APA manual. For this assignment, first person may be used.

 

7–8
errors or exceptions to the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the 6th edition of the APA manual. For this assignment, first person may be used.

 

9 or greater
errors
or exceptions to the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the 6th edition of the APA manual. For this assignment, first person may be used.

Format Subtotal ____/10 points

 

Total Points ____/100 points

Comments: NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

 

Fundamental Nursing Lessons Learnt from a Difficult Situation in Practice: Carper’s Pattern’s of Knowing in Nursing

The Practical Situation Experienced

Nursing is about promoting health, preventing illness, and restoring hope. However, there are situations in which a nurse can find themselves almost helpless with regard to all the three above. A case in point is the prospect of having to reassure a patient with terminal illness by giving them hope yet you know very well that they may not have long to live. Even more daunting is the task requiring you as the nurse to convince the patient and her relatives that they will benefit from hospice care. This is the situation I once found myself in. I was faced with this situation of a 37 year-old who had advanced ovarian cancer with a very poor prognosis. It was obvious that what she needed most in her last days would be round-the-clock hospice care for especially pain relief. The task, therefore, of convincing her together with her relatives to follow this route fell on me. Needless to say, I felt not only unprepared, but also uncomfortable because I knew there was no hope of her surviving for long. Yet I had to give her a reason to look forward to the next day.

The nursing issue inherent in this situation was the need for apt, caring and tactful guidance and counselling as an important role of me as the nurse in this end-of-life situation. I had to not only help the patient and her relatives make the right decision of checking into a hospice, but also give them convincing reasons why they needed to do so. This was not an easy mission to accomplish.

Reflection on the Situation Based on Carper’s Patterns of Knowing

           
Four facets of nursing knowledge have been identified as empirics or the scientific basis of nursing, esthetics or the consideration of nursing as an art, ethics or the morality in nursing, and the personal knowledge component of nursing (Carper, 1978; Schmidt et al., 2003). On empirics, therefore, I needed to be armed with evidence that hospice care indeed is beneficial for this patient and her family. This is the evidence that I needed to base my argument on in trying to convince them to accept hospice care. Quaglietti, et al. (2004) have stated that the palliative care offered in the hospice takes care of the patient’s and her family’s expectations in terms of care. They continue that nurse practitioners (NPs) are well placed to meet these expectations. On esthetics, empathy is the single most important factor in mastering the art of offering nursing care to patients (Carper, 1978). This was the underlying reason for the situation – need for empathy. Experience had taught me that to gain the patient’s trust and confidence; I as the nurse must feel genuine empathy for them. This way they will make less effort to accept any proposal such as going into hospice care. On personal knowledge, Carper (1978) identifies interpersonal interaction as the barometer with which this knowledge is measured and gained. In this scenario, my personal feeling was that I had to relate with both the patient and her relatives at a personal level by establishing a personal bond with them. In doing this, I had to first know myself and confront my own personal fears and shortcomings. Last but not least on ethics, I had to be aware that I had a moral obligation to only offer suggestions that would bring the greatest good to the patient and by extension her family (beneficence). Also, whatever suggestion or intervention that I suggested had to be devoid of the possibility of causing harm to the patient (nonmaleficence). But, most importantly, it dawned on me that I had to respect the decision of the patient and her relatives at the end (respect for autonomy) (Haswell, 2019). NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

Summary     

           
This experience was indeed rich in knowledge for me. I learnt that the four factors of nursing knowledge are present in all practical nursing situations. Thus the double insight I got was the importance of evidence-based practice decisions and the power of empathy. Intentional reflective nursing practice is therefore imperative for improved future care.

References

Carper, B.A. (1978).
Fundamental patterns of knowing in nursing
. Retrieved 8 September 2019 from
https://www.google.co.ke/url?sa=t&source=web&rct=j&url=https://pdfs.semanticscholar.org/8871/eb88fb06168bb31e20e9c54e57920e575a47.pdf&ved=2ahUKEwje0JrqscHkAhVClFwKHYXzAgsQFjAQegQICRAB&usg=AOvVaw0CEuuz-eqnIwVMqcmUI55E

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179. Doi: 10.12968/joan.2019.8.4.177

Schmidt, L.A., Nelson, D. & Godfrey, L. (2003). A clinical ladder program based on Carper’s fundamental patterns of knowing in nursing.
JONA
, 33(3), 146-152. Doi: 10.1097/00005110-200303000-00005

Quaglietti, S., Blum, L. & Ellis, V. (2004). The role of the adult nurse practitioner in palliative care.
Journal of Hospice and Palliative Nursing
, 6(4), 209-214. Doi: 10.1097/00129191-200410000-00009 NR501 Week 2 Assignment Carper’s Pattern’s of Knowing Nursing Theory Reflective Essay

Conceptual Iowa Model Example

4. In addition, create a conceptual Iowa model of the project. PICOT question. (P) For post-operative patients, (I) can standardized hourly rounding by a medical team be a better deterrent (C) compared to bed alarms or other tools that are readily available within a hospital (O) and designed to reduce patient fall risk (T) during hospitalization. With narrative Conceptual Iowa Model Example

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Conceptual Iowa Model Example

The lowa model focuses on how research is organized, conducted and used. The lowa model is relevant in this project because it will allow knowledge and triggers of falls among post-operative patients to be analysed. The model will also allow analysis of current research regarding approaches that can reduce falls in the target population such as standardized hourly rounding & bed alarms (Newell & Burnard 2016).

The first step is to select the topic and, in this case, the topic is “falls in the post-operative patients”. Evidence indicates the significant adverse health effects and economic effects associated with falls and this indicates the urgency and the need to address the issue in the organization (Newell & Burnard 2016). Conceptual Iowa Model Example.

The second step will involve team formation. The team will develop, implement and evaluate the efficacy of the project. The team members should have the relevant knowledge about the project and all interested stakeholders should be involved. The team will, therefore, consist of the Physicians, nurses, pharmacists, physical therapist, & management. The role of the management is to provide the required resources for project implementation (Berwick, 2015).

The team can then conduct a brainstorming session to identify the evidence and literature materials to guide the identification and retrieval of the evidence (Pravikoff, et al, 2015). This project will target nursing and health databases such as Cochrane, PubMed, Web of Science & Cinahl. Conceptual Iowa Model Example

The team members will assess the quality of the evidence and have the evidence graded. In addition, the evidence will be grouped if it is quantitative, mixed-method or qualitative. The evidence will then be critically appraised using tools such a CASP in order to ensure only the quality studies are included (Pravikoff, et al, 2015).

After critiquing the evidence, the team will meet in order to determine the recommendations for practice between standardized hourly rounding and bed alarms or other tools. The evidence-based practice will be selected based on the collaborative decision of all team-members after taking into consideration the relevance, practicability, efficacy, significance, and suitability of the evidence (Berwick, 2015).

The change will then be piloted, to examine if it is feasible. If the change is practical and the outcomes have been evaluated, the change will then be implemented.

During the implementation of the evidence-based practice such as the proposed project, it is important to consider and follow the organizational policies and guidelines. The team should collaborate with the management and all organizational stakeholders and act as the change champions in order to garner support for the change implementation (Nutbeam, 2018).

Evaluation of the project is important to examine the impact of the evidence into practice. Accordingly, data regarding fall rate in post-operative patients will be collected before and after the project. A comparison of the fall rate pre-project and post-project will be done to evaluate the efficacy and impact of the recommended evidence-based practice (Nutbeam, 2018). Conceptual Iowa Model Example.

References

Berwick DM (2015). Disseminating innovations in health care.
JAMA
. 289(15): 1969–75

Jähne-Raden N, Marschollek M & Wolf K. (2019). INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward.
Sensors (Basel)
. 19(5), 1017.

Mitchell M, Lavenberg J, Trotta R & Craig U. (2014). Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review.
J Nurs Adm
. 44(9), 462–472.

Newell R &, Burnard P. (2016).
Research for evidence-based practice
. Oxford: Blackwell Publishing Ltd.

Nutbeam D. (2018). Evaluating health promotion: progress, problems, and solutions.
Health Promot Int
. 13(1): 27–44

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2015). The readiness of U.S. nurses for evidence-based practice.
American Journal of Nursing
. 105(9). 40–51.

Smith P, Barret L, Rayson K & Govro K. (2015). Effectiveness of a bed alarm system to predict falls in an acute care setting.
Clinical Nursing Studies
. 3(1). Conceptual Iowa Model Example

›Applying Current Literature to Clinical Practice

›
Overview of the article

Title:

›The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta‐analysis

›Authors: Cao, P. Y., Zhao, Q. H., Xiao, M. Z., Kong, L. N., and Xiao.

›Year of publication: 2018 Applying Current Literature to Clinical Practice

›It contains a systematic review research on the effectiveness of exercise on fall prevention in nursing home residents

BUY A PLAGIARISM-FREE PAPER HERE

Nursing home residents have a high risk of falling. No conclusive evidence exists on the effectiveness of exercise on fall prevention in nursing home residents

The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents.

Presents an abstract, background, design section, data resources, review methods, results and…

 

In a 5- to 10-slide PowerPoint presentation, address the following:

Provide an overview of the article you selected.

What population is under consideration?

What was the specific intervention that was used? Is this a new intervention or one that was already used?

What were the author’s claims?

Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Support your position with evidence-based literature.

Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.

 

Applying Current Literature to Clinical Practice

 

Abstract

The presentation describes and reviews a study on the effectiveness of group psychotherapy among women who have a history of sexual harassment. The analyzed study was published in the
Journal of Clinical Nursing.
The presentation examines various factors in the study, such as the reason for selection of these women and the setting of the group therapy among others. In addition, the presentation researches features that include curative factors that can be helpful to the group under consideration. Aspects such as catharsis and instillation of hope among others in the study have been discussed in the presentation. Exclusion criteria involved in the study, which include age, history of alcohol abuse, etc. have been addressed in addition to the findings of the research. Finally, the limitations of the study are reviewed in the presentation as well as their effects on the application of the results obtained in the study.

 

Applying Current Literature to Clinical Practice

Overview

The presentation focuses on various aspect of the study in order to evaluate its findings. Information such as the type of group involved in the study and its participants is helpful to determine the validity and reliability of the study. The presentation also discusses the reasons for the group members’ selection, setting of the group, frequency of the group meetings, and their duration. Other key issues considered include the findings, curative factors that might be helpful to group members, and exclusion criteria. Finally, the limitations of the study are examined as well as their impact on the application of the findings of the research.

Introduction

Group psychotherapy is one of the most effective therapies for patients suffering from depression, anxiety, and even post traumatic disorders. Group psychotherapy involves helping people with the same problems and background. During the sessions, the selected members are treated as a group in order to enhance skills such as socializing and group cohesiveness. This presentation focuses on answering the question derived from the study, which is whether group psychotherapy among women with a history of sexual harassment proves effective and gives durable results.

 

›Applying Current Literature to Clinical Practice

›
Overview of the article

Title:

›The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta‐analysis

›Authors: Cao, P. Y., Zhao, Q. H., Xiao, M. Z., Kong, L. N., and Xiao.

›Year of publication: 2018

›It contains a systematic review research on the effectiveness of exercise on fall prevention in nursing home residents

Nursing home residents have a high risk of falling. No conclusive evidence exists on the effectiveness of exercise on fall prevention in nursing home residents Applying Current Literature to Clinical Practice

The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents.

Presents an abstract, background, design section, data resources, review methods, results and conclusion

 

›Population

Target audience

›Nursing homes

residents

The aim of this study was to determine the effectiveness of exercise on fall prevention in nursing home residents. Applying Current Literature to Clinical Practice

 

›Specific intervention

›Exercise

 

›The intervention was already in use

Exercise is a cognitive behavior therapy for nursing home residents (Schoenfelder, 2000).

It has been in use in many areas of healthcare as a form of psychotherapeutic approach

 

›
Author’s claims

›No conclusive evidence exists on exercise effectiveness on preventing of falls in home nursing

›Nursing home residents have a high risk of falling (Cao et al., 2018; KAYA et al. 2012)

The authors claims that there is limited information regarding the effectiveness of exercise in nursing homes for prevention of falls Applying Current Literature to Clinical Practice

 

›
Findings/outcomes

›Exercise did not play a role in preventing falls

›This might not translate into practice with my own clients

Translation to practice is limited by little evidence-based research regarding physical exercise in nursing homes fall prevention

Home nursing facilities employ physical exercise as a therapy to good health and improving quality of life and body strength with the aim of preventing falls and thus is expected to reduce falls among my clients (Carter, Kannus & Khan, 2001).

Physical exercise is one of the most effective interventions for fall prevention

The research employed small samples which presented low quality evidence

 

›
Limitation’s impacts

›The render the findings not generalizable

›They increases the need for further research in my practice area.

›They increase cost and time of  further research before drawing conclusions

Limitation: lack of sufficient data on exercise effectiveness on fall prevention in nursing homes

There was low heterogeneity

Use of small and low quality samples

Limited research cannot be generalized since it does not cover the entire target population

It demands further research which is costly and time consuming Applying Current Literature to Clinical Practice

 

›
References

›Cao, P. Y., Zhao, Q. H., Xiao, M. Z., Kong, L. N., & Xiao, L. (2018). The effectiveness of exercise for fall prevention in nursing home residents: A systematic review meta‐analysis.
Journal of advanced nursing
, 74(11), 2511-2522.

›KAYA, Ç. A., Kirimli, E., KALAÇA, Ç., Cifcili, S., ÜNALAN, P. C., & Kalaca, S. (2012). The incidence of falls and related factors in the elderly living in residential homes. 
Turkish Journal of Geriatrics
, 
15
(1).

›Schoenfelder, D. P. (2000). A fall prevention program for elderly individuals: exercise in long-term care settings. Journal of gerontological nursing, 26(3), 43-51.

›Carter, N. D., Kannus, P., & Khan, K. (2001). Exercise in the prevention of falls in older people. 
Sports medicine
, 
31
(6), 427-438. Applying Current Literature to Clinical Practice

›

Applying a change Model to the Implementation Plan

2. apply a change model to the implementation plan. Include the following:

3. Apply the Iowa model of E-BP, and carry your implementation through each of the stages, phases, or steps identified in the chosen model.

This is the PICOT Question for this capstone project. PICOT (P) For post-operative patients, (I) can standardized hourly rounding by a medical team be a better deterrent (C) compared to bed alarms or other tools that are readily available within a hospital (O) and designed to reduce patient fall risk (T) during hospitalization.

 

Applying the Iowa Model to the Implementation Plan

Student’s Name

Institution of Affiliation

Course Name

Date

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Selected Evidence-Based Practice Model

           
Numerous conceptual and theoretical models used in the implementation of evidence-based research findings to clinical practice in healthcare organizations exist.  In an organizational context, leadership has to decide the most recommended evidence-based changes to make and the approach of doing it. Most of these models are a representation of methodological approaches and tend to break the entire procedure into simpler and smaller steps. As supported by Nilsen (2015), the use of these models tends to increase the chances of success, a complete implementation process, improves the allocation of resources and provides an avenue of evaluating outcomes. Applying a change Model to the Implementation Plan.

The Iowa evidence-based practice model is a perfect example of such a model. This model has been used in different organization and education settings and proven effective in facilitating the implementation of evidence-based practice. For the implementation of the findings of this EBP project, the Iowa model was the preferred model to explore new strategies that could influence a reduction in falls among post-operative patients during hospitalization. This was the model of choice since it emphasizes on multidisciplinary collaboration, incorporates organizational change and utilizes inputs from the implementation team (White & Spruce, 2015).  Post-operative care involves numerous disciplines which collaborate to ensure timely and full patient recovery. Therefore, since this model is highly dependent on collaboration, it is the most reasonable choice. It is also worth mentioning the Iowa model can easily be understood and interpreted thus user-friendly (Schaffer, Sandau & Diedrick, 2013). Since it allows trial runs of a proposed evidence-based practice change before the actual implementation, the chances of failure are significantly reduced. Applying a change Model to the Implementation Plan.

Applying the Iowa Model To The Implementation Plan

The Iowa model will promote the implementation of fall reduction strategies in the surgical unit. The model’s algorithm has three decision-making points, the initial being determining if the subject should be a priority for the organization (Brown, 2014). While some subjects may be triggered by problems, others may be triggered by problems. For this healthcare organization, implementing new evidence-based fall reduction strategies is the organization’s priority which was triggered by an increase in fall incidences among post-operative patients. The falls resulted in prolonged hospital stays, poor health outcomes and significant financial loses.

The next step is the formation of a multidisciplinary team which should comprise of specific stakeholders from every discipline and any other interested stakeholder. When initiated by frontline practitioners in the surgical unit rather than the organization’s leadership, it is inarguable that the change process will be more successful (White & Spruce, 2015). In this case, the team will comprise of the nurse manager, direct patient care nurses, physiotherapist, nutritionist, nurse practitioner, and surgeon.

The team’s first assignment will be searching for evidence. Therefore, they will need to decide on the keywords to use in scientific databases regarding fall reduction strategies for post-operative patients. After collecting enough evidence, the team will have to critique and synthesize it. Therefore, should the team have inadequate skills or experience in conducting literature searches and assessing the strength of evidence found, it will be vital to ask for the assistance of someone in the organization (Nilsen, 2015). Applying a change Model to the Implementation Plan. The team will likely find guidelines, systematic reviews and pre-appraised researches that discuss fall prevention and fall-reduction strategies for different patient populations. Based on the evidence found, the team will be able to identify the potential gaps in knowledge that exist.

The next point would be deciding if the evidence found is adequate to guide evidence-based practice. Based on the team’s judgment, if the evidence found will be considered sufficient, they should progress to pilot an evidence-based change. On the other hand, in case of lack of a solid research base, the team can progress to use other types of available scientific evidence such as expert opinions and case studies. Otherwise, the implementation team may consider conducting the unavailable research.

If the implementation team progresses with the adoption of new fall-reduction strategies, the next stage is piloting the change in actual practice.  In this phase, there are six steps to follow.  The initial is determining the expected outcomes. The project aims at reducing the fall risks of post-operative patients during hospitalization through standardized hourly rounding by a medical team. Therefore, the most expected outcomes to measure will be; fall incidences, post-operative recovery duration, and length of stay (Pelt, et al., 2014). Secondly, baseline data should be obtained and the outcomes measured before the implementation of the change Applying a change Model to the Implementation Plan.

The third stage is the development of written policies and guidelines which define the new fall-reduction strategies and protocols for post-operative patients. In the surgical unit, the team can consider testing the new fall-risk reduction strategy for two weeks or one month. However, this requires that all personnel directly or indirectly involved with the care of post-operative patients are included and the expectations are well communicated. Next is evaluating the new strategy by making a comparison between the outcome measures and the baseline data that was initially obtained Applying a change Model to the Implementation Plan. This helps to establish if the new fall reduction strategy for post-operative patients (standardized hourly rounding by a medical team) positively influences fall incidences (Morgan, 2019).  Lastly, the protocols and guidelines developed should be modified based on the outcomes.

Conclusion

In today’s highly diverse healthcare environment, the significance of utilizing evidence-based practice in clinical settings to improve care outcomes cannot be overemphasized.  Nurse leaders are responsible for ensuring that quality care is provided in cost-effective ways and that the goals of care are adequately addressed. For the implementation plan of this EBP project, the Iowa EBP model that promotes quality care is the best guide to ensuring success in implementation. The model will particularly be helpful in the implementation of evidence-based strategies that would ensure a reduction in the fall risks of post-operative patients during hospitalization. Applying a change Model to the Implementation Plan

 

References

Brown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. 
Clinical Journal of Oncology Nursing
, 
18
(2).

Morgan, K. (2019). Improving Nurse Responsiveness through Advanced Call Bell Implementation & Hourly Rounding.

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. 
Implementation Science
, 
10
(1), 53.

Pelt, C. E., Anderson, A. W., Anderson, M. B., Van Dine, C., & Peters, C. L. (2014). Postoperative falls after total knee arthroplasty in patients with a femoral nerve catheter: can we reduce the incidence?. 
The Journal of arthroplasty
, 
29
(6), 1154-1157.

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. 
Journal of Advanced Nursing
, 
69
(5), 1197-1209.

White, S., & Spruce, L. (2015). Perioperative nursing leaders implement clinical practice guidelines using the Iowa Model of Evidence-Based Practice. 
AORN Journal
, 
102
(1), 50-59. Applying a change Model to the Implementation Plan.

›Applying

›

Proposed EBP Project Solution

proposed evidence‐based practice project solution. Address the following criteria:

1. Proposed Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, too costly, or there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your PICOT before continuing.

2. Organization Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.

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Expected Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the PICOT. PICOT (P) For post-operative patients, (I) can standardized hourly rounding by a medical team be a better deterrent (C) compared to bed alarms or other tools that are readily available within a hospital (O) and designed to reduce patient fall risk (T) during hospitalization.

3. Method to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations which may need to be addressed.

4. Outcome Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient‐centered quality care, efficiency of processes, environmental changes, and/or professional expertise. Proposed EBP Project Solution

 

Proposed Evidence‐Based Practice Project Solution

Student’s Name

Institution of Affiliation

Course Name

Date

 

Proposed Solution

Postoperative patients are at high risk of falls in acute care settings. The outcomes associated with falls in this patient population include disability, prolonged hospital stays, additional medical costs, loss of independence and loss of hospital revenue. Some of the most prevalent causes of falls among post-operative patients are associated with mental, physical, emotional, social and physiological symptoms of an individual (Mitchell et al., 2014). The most preferred approach to ensure a reduction in fall incidences among post-operative patients in clinical settings is through standardized hourly rounding by healthcare teams.

Standardized hourly rounding has proven to be a highly effective and proactive approach of communicating with families and patients to address their needs during hospitalization. As noted by Moorer et al., (2017), it is used in the clinical setting to promote the ability of the healthcare team members to assess the most potential risks that are likely to result to falls among post-operative patients and institute prevention measures where necessary. Standardized hourly rounding has also shown to increase patient safety, nursing efficiency and to reduce documentation (Morgan, 2019). When conducting around, the medical team should assess the 4 P’s (pain, personal needs, position, and placement).

During the rounding process, a patient’s pain level should be assessed and if need be, pain mediation administered. Members of the medical team can also address a patient’s needs such as offering assistance to use the toilet, nutrition or hydration. For patients who are wrongly positioned, medical team members can help them to get into a comfortable position. For post-operative patients who are immobile, they should be turned to ensure that the integrity of the skin is maintained. With regards to placement, an hourly rounding process would help to ensure that the patient’s most vital needs such as equipment for toileting, phone or bed alarm can easily be reached. Lastly, with regards to preventing falls, in this case, a patient or family caregiver can be asked to sound the bell alarm when the patient needs to get out of bed.

The proposed intervention has been embraced in most care settings as a quality improvement strategy that increases patient safety and the satisfaction of staff and patients. The implementation of this intervention is realistic since there’s available staff who are adequately informed on the need to deliver this intervention. Besides, the intervention is cost-effective as it will not incur any additional costs. Instead, it will help the organization to save on additional healthcare-related costs and collect more revenue.

Organization Culture

The organization purposes to provide quality surgical care for individuals suffering from both chronic and acute illnesses and uphold an environment that promotes healing as revealed in its mission, vision, goals, and objectives. It is also determined to prevent additional harm and complications to post-operative hospitalized patients through interprofessional collaboration, evidence-based research, effective leadership, and communication. Post-operative patients have numerous needs that should be addressed including spiritual, emotional, nutritional, physical, psychological, physiological and social needs. This requires intervention from different providers including a nutritionist, physiotherapist, psychologist, physician and pharmacist among others. As supported by Jacobs (2014), the adoption of a multidisciplinary team approach for standardized rounding will promote nurses ability to change specific clinical practices with the consent, input and approval of other stakeholders and all a patient’s needs will be addressed.

To promote evidence-based research, the organization has been transformed into a learning organization and has a library that is fully equipped with adequate resources. Besides, the staffs have adequate knowledge and skills in conducting literature searches, critiquing and synthesizing literature to address specific clinical problems. Therefore, integrating the proposed evidence-based solution into clinical practice will be efficient and effective. Proposed EBP Project Solution

Method to Achieve Outcomes

The outcomes to be achieved following the implementation of standardized hourly rounding by a medical team are as follows:

A significant reduction in fall incidences among post-operative patients in the surgical unit based on outcome data as compared to baseline data

Shorter hospital stays, reduced mortality and morbidity rates based on monthly mortality and morbidity data

Increased staff and patient satisfaction as evidenced by low readmission rates

Increased hospital revenue based on financial outcome and baseline financial data

Potential barriers to the achievement of the aforementioned outcomes that may hinder the implementation of the proposed solution can be categorized under individual and organizational characteristics. To ensure success, these barriers ought to be assessed and eliminated. Individual barriers: some nurses lacking the skills to locate research sources and opting to seek for information from colleagues as opposed to conducting a scientific search in scientific databases (Odias, 2015). Other stakeholders may have the skills to critique, appraise and synthesize literature but lack technology/computer skills which can, however, be addressed through training. A potential organizational barrier is the lack of adequate time to participate in the entire process since staffs in the surgical department are often engaged.

Outcome Impact

Following the implementation of standardized hourly rounding with a medical team, it is expected that the outcomes will impact the following indicators: improving patient-centered quality care since every patient’s need will be addressed separately by members of a healthcare team. Interprofessional collaboration will promote members of the medical team to acquire new knowledge and skills which enhances professional expertise.  Since the proposed solution aims at reducing the incidence of falls among post-operative patients, it is expected that it will result to shorter hospital stays, reduced medical costs and improved health outcomes which denote an improvement in the quality of care. Proposed EBP Project Solution

 

References

Jacobs, D. (2014). Evidence-Based Falls Management Program in the Nursing Home.

Mitchell, M. D., Lavenberg, J. G., Trotta, R., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic review. 
The Journal of nursing administration
, 
44
(9), 462.

Morgan, K. (2019). Improving Nurse Responsiveness through Advanced Call Bell Implementation & Hourly Rounding.

Moorer, M. B. A., Kunupakaphun, S., Delgado, E., Moody, M., Wolf, M. S. N., Moore, R. N., & Eamranond, M. D. (2017). Using appreciative inquiry as a framework to enhance the patient experience. 
Patient Experience Journal
, 
4
(3), 128-135.

Odias, M. J. B. (2015). Barriers encountered by nurses and nursing assistants that prevent purposeful rounding.

Tatevossian, A. (2017). Fall Prevention: Responder 5 Bed Connectors. Proposed EBP Project Solution

Neuman’s Systems Theory in Home Health Essay

This module has given you an overview of multiple theorists both nursing and non-nursing. Choose a theorist of your choice(The Neuman Systems Theory) and explain how it relates to nursing practice. Give an example of how this theory was applied in your own practice.

1. The Neuman Systems Theory

2. Practice- Home Health

 

Applying Neuman’s Systems Theory in Home Health

Student’s Name

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Institution

Course

 

The significance of nursing theories and conceptual models in clinical nursing practice for the growth of the nursing profession is broadly acknowledged. The theory of choice for this discussion is the systems model theory which was developed by Betty Neuman. Betty Neuman   was a counselor, a community health nurse, and professor. The theory emphasizes on the need for nurses to view a patient as an integrated and is based on the relationship of an individual to stress, how one reacts to it and the dynamic reconstitution factors (Jukes & Spencer, 2016). Hence, for an individual’s well-being and balance, the theory affirms that a person is interdependent and inter-relational due to stressful situations that result to associated socio-cultural, psychological, environmental and physiological effects (de Almeida et al., 2018).  In this case, a nurse’s role is to retain the stability of this system.

Betty Neuman’s system model can be reformulated and applied in home-health practice to ensure that clients can meet the activities of daily life by providing daily assistance while at home as opposed to long-term or residential care centers. These services can be provided through three prevention levels: primary, secondary and tertiary levels.  Primary prevention should focus on safeguarding and strengthening the flexible line of defense especially for seniors, adults and pediatric patients in recovery after staying in hospital to prevent unnecessary admissions (Landers et al., 2016). This can be achieved through disease education and vaccination. Secondary prevention ought to strengthen resistance lines, reduce reaction and increase factors of resistance. Secondary prevention can be attained through wound care, disease management, and pain management. Lastly, tertiary prevention should aim at readapting and stabilizing the return to wellness after treatment. It may include activities in occupational therapy, physical therapy, and speech therapy. Neuman’s Systems Theory in Home Health Essay.

References

de Almeida, N. G., de Oliveira, M. R., Guedes, M. V. C., da Silva, L. D. F., de Freitas, M. C., Torres, R. A. M., & de Melo Fialho, A. V. (2018). Betty Neuman Systems Model: Analysis according to Meleis.

Jukes, M., & Spencer, P. (2016). Neuman’s Systems Model. 
Nursing times
, 
112
(27), 20-23. Neuman’s Systems Theory in Home Health Essay

Landers, S., Madigan, E., Leff, B., Rosati, R. J., McCann, B. A., Hornbake, R., & Lee, T. (2016). The future of home health care: a strategic framework for optimizing value. 
Home health care management & practice
, 
28
(4), 262-278.

Narrative research support for proposed project / problem

3- two

Write a narrative of 750‐1,000 words that presents the research support for the projects problem and proposed solution.

Problem Statement: Reduction of Fall Rates for Post-Operative Patients

Make sure to do the following:

1. Include a description of the search method (e.g., databases, keywords, criteria for inclusion and exclusion, and number of studies that fit your criteria).

2. Summarize all of the research studies used as evidence. The essential components of each study need to be described so that readers can evaluate its scientific merit, including study strengths and limitations.

3. Incorporate a description of the validity of the internal and external research. Narrative research support for proposed project / problem

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It is essential to make sure that the research support for the proposed solution is sufficient, compelling, relevant, and from peer‐reviewed professional journal articles.

These are the references used in assignment 2

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics. Health Care Management Review. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization. Nagoya Journal of Medical Science. 80(3), 341–349.

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano. Enfermagem. 22(2), 262–268. Narrative research support for proposed project / problem

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study. Revista Latino-Americano Enfermagem. 25(2904).

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40. BioMed central Cancer. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk for falls in patients in the postoperative period. Cogitare Enferm. 20(1), 29–37.

 

Reduction of Fall Rates for Post-Operative Patients

Description of the Search Method

A comprehensive bibliographic search was performed using various electronic databases such as PubMed, Wiley library databases, EbscoHost, Web of science, Google Scholar and CINAHL. The purpose of performing bibliographic search was to locate the relevant and quality research articles to be used in the study topic. Reference lists of the retrieved research articles were also analyzed and any article in the list that was found to have met the inclusion criteria of this study was searched. In addition, to conduct the search, the PICO was broken down into difference terms as indicated below:

In post-operative patients (P), what are the evidence-based practice nursing interventions (I), when compared to no interventions (C), that can reduce the fall rate (O)?

The keywords used during the search included fall rates, fall prevention, patient falls, nursing interventions, and safety and inpatient falls.

The inclusion criteria include peer-reviewed research studies; studies published between 2014-2019; studies investigating fall rates among inpatients; and studies published in English language.

Summary of Research Studies used as Evidence

According to Mata et al (2017) falls sustained during hospitalization results to increased length of hospital stay, complications and even increment of the healthcare costs. Luzia et al (2014) further explains that falls in inpatients can result to trauma of fractures that further reduce the quality of life and the ability of the patient to perform activities of daily living. Vitor et al, (2015) explains that the inpatients are unfamiliar with the hospital setting and this increases the probability of the patients sustaining falls. The reason is that the hospital setting is completely different with the home setting where facilities like toilet and bathrooms are located in completely different locations, as well as electricity switches; this can lead to confusing among post-operative patients and thus increase their risk for falls and the subsequent injuries.

Shida et al, (2015) opines that post-operative patients normally try to achieve their mobility and regain independence in order to be able to return to performing the normal activities of daily living. post-operative period is also characterized with pain which hinders the patient in so many aspects such as walking properly. This shows that surgeries increase the risk of fall for the patients because of the associated physical weakness. This is the reason post-operative patients are at an increased risk for falls. Everhart et al (2014) further explain that patient fall in healthcare setting represent a major patient safety concern.  Kobayash et al (2018) majority of patients undergoing surgeries need special circumstances that enable them to adapt to the perioperative period in order to reduce the risk of fall.  This is supported by Victor et al (2014) who exlians that patients in hospitals especially those within the postoperative during are predisposed to a number of complications and one of the complications is the risk for falls. Accordingly, falls rate among the common adverse incidents that occur among the inpatients.

Everhart et al (2014) conducted longitudinal study in an acute care hospital while Kobayash et al (2018) prospectively used a database within the institution’s incident reporting system. Luzia et al (2014) conducted a cross-sectional study with a sample of 174 patients. The data collection was done using a computerized nursing care prescriptions system and then statistical data analysis was done. Mata et al (2017) used quantitative and cross-sectional method and used 257 adult patients. The data collection was done utilizing sociodemographic and clinical questionnaire. Shida et al (2014) used the QoR-40 and questionnaire to assess the patients’ postoperative recovery. Vitor, et al (2015) used a quantitative approach to perform a descriptive cross-section study. Narrative research support for proposed project / problem

Validity of the Internal and External Research

The validity of the studies that were selected to be used in this proposal was addressed using different kinds of validity that include convergent validity, face validity, and content validity. According to Dini et al., 2014) these are the key elements used to assure quality in research. Reliability was achieved by examining the consistency of the studies. Various tools used to text the consistency included instruments like Cronbach’s alpha and KMO Bartlett’s test (Dini et al., 2014). However, in some studies the author developed own tools to collect the data while other authors used data collection tools that reliability and validity has been validated. Finally, rigor of the research ensured the validity of the research. This was achieved by performing a wide literature review to locate all available relevant studies and research on the study topic. Tools such as McMaster appraisal checklists and CASP were also used to rate all the articles included in this study to further ensure their quality (Dini et al., 2014).

 

References

Dini, A.P., Alves, D.F.D.S., Oliveira, H.C. and Guirardello, E.D.B., 2014. Validity and reliability of a pediatric patient classification instrument. 
Revista latino-americana de enfermagem
, 
22
(4), pp.598-603.

Everhart D, Jessica S, Duncan P, Hall A, Neff D & Shorr R. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics.
Health Care Manage Rev
. 39(4), 352–360. Narrative research support for proposed project / problem

Kobayashi K, Kei A, Yuko I, Yusuke S, Nagao Y, & Shiro I. (2018). Characteristics of falls in orthopedic patients during hospitalization.
Nagoya J Med Sci
. 80(3), 341–349.

Luzia M, Victor G & Lucena F. (2014). Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients. Rev.
Latino-Am. Enfermagem
. 22(2), 262–268.

Mata L. Cissa A, Gabrielle P & Moraes T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study.
Rev Lat Am Enfermagem
. 25(2904). Narrative research support for proposed project / problem

Shida D, Wakamatsu K, Tanaka Y, Yoshimura A, Kawaguchi M, Miyamoto S, et al. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40.
BMC Cancer
. 15(799), 1–6.

Vitor A, Moura L, Fernandes L, Botarelli FR, Araújo J & Vitorino I. (2015). Risk for falls in patients in the postoperative period.
Cogitare Enferm
. 20(1), 29–37.

Research articles evaluation summary table

3 -1

To begin, work through the reference list that was created in the ”Section B: Problem Description” assignment in Topic 2. Appraise each resource using the ”Rapid Critical Appraisal Checklists,” available in the textbook appendix. The specific checklist you use will be determined by the type of evidence within the resource.

Then, develop a research table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the ”Evaluation Table Template,” available in the textbook appendix. Use the ”Evaluation Table Template” as an adaptable template. Research articles evaluation summary table.

Problem Statement: Reduction of Fall Rates for Post-Operative Patients

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TEXT BOOK

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Walters Kluwer.

These are the references used in assignment 2

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics. Health Care Management Review. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization. Nagoya Journal of Medical Science. 80(3), 341–349.

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano. Enfermagem. 22(2), 262–268.

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study. Revista Latino-Americano Enfermagem. 25(2904).

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40. BioMed central Cancer. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk for falls in patients in the postoperative period. Cogitare Enferm. 20(1), 29–37.

 

Summary Table

Name

Institution

Date

 

 

Summary Table

Author (Year)

Title

Aim

Design

Sample, number of participants

Level of evidence

Findings

Everhart et al (2014)

Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics

To establish if hospitals can be classified into fall rate trajectory groups & to determine the characteristics of the nurses and healthcare organizations allied to hospital fall rate trajectory groups.

4-month longitudinal study

Research articles evaluation summary table

1,529 hospitals

 

U.S. acute care general hospitals taking part in the National Database for Nursing Quality Indicators

Level 4

Magnet hospitals lower rates of falls

Hospitals did not change their fall performance over time

There is a relationship between nurse staffing and the rate of falls

Kobayashi et al (2018)

Characteristics of falls in orthopedic patients during hospitalization

 

To establish characteristics over five years of cases of fall in orthopedic patient

Prospective study

Prospective analysis of 212,617 inpatients

Assessment of fall risk,

research articles evaluation summary table

Level 2

Fall rate is high in orthopedic patients, irrespective of a low risk management score. Therefore, it is important to ensure frequent assessments at short intervals and fall risk assessments for hospitalized orthopedic patients

Luzia et al (2014)

Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients

 

To determine the incidence of diagnosis of falls in the adult patients admitted within surgical and clinical wards in order to classify the clinical profile and identify the risk factors associated with risk for falls

A cross-sectional study

174 patients

University hospital in Brazil, with 795 beds

 

Data collection was done using on-line hospital records and computerized nursing care prescriptions system and statistical analysis was done

Level 5

The risk for falls of the inpatients in surgical and clinical wards was found to be low in the researched organizations. The patients at higher risk of falls included older adults, men, surgical patients, and patients with cardiovascular diseases and neurological disorders. The risk factors for diagnosis of risk for falls included impaired mobility, increased age, neurological changes, and vulnerability associated with impaired health and medical procedures

Mata et al (2017)

Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study

To examine factors linked with the risk of fall in patients undergoing surgical procedures

A quantitate cross-sectional study

Hospital in state of Minas Gerais, Brazil

257 adult inpatients

Data collection done using sociodemographic and clinical questionnaire, the Morse Fall Scale, and the Quality of Recovery Score

Descriptive statistical analysis and multinomial logistic regression used to perform data analysis

Level 5

Factors associated with the risk of fall in adults in the postoperative hospital stay include age, surgical recovery, diabetes, cancer, and systemic arterial hypertension

Shida et al (2015)

The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40

To examine if early discharge from the hospital after surgery is compatible with a better outcome from according to the perspective of the patients

A cross-sectional study

research articles evaluation summary table

Tokyo Bokutoh Metropolitan in Hospital Tokyo Bokutoh Metropolitan Hospital

Data collected using QoR-40, a recovery-specific and patient-rated questionnaire

Level 5

Surgical procedures affect the quality of life of patients and this included mobility. Therefore, patients should not be discharged early after surgery to lower the risk associated with early hospital discharge post-operative

 

Vitor et al (2015)

Risk for falls in patients in the postoperative period

To determine and identify the factors associated with a diagnosis of risk for falls & the major risk factors in patients recovering after surgical procedures with a university hospital

A descriptive cross-sectional study, using a quantitative approach

Public tertiary teaching hospital located in the municipality of Natal/ Rio Grande do Norte, Brazil

Sample included patients in the postoperative period, admitted within the clinical surgical units of the hospital.

Sample size: 80 patients.

Level 5

Risk for falls ND found in 69 patients (86.25% of the sample)

There is a significant relationship between the surgical procedure (postoperative condition) and the elevated susceptibility of the person the risk of falls. The risk for falls during the postoperative period was attributable to syncope, weakness, and loss of balance

Anemia is a predisposing factor for falls

Narcotic and/or opioid medications used during hospitalization can be attributed to the increased risk for falls

 

 

 

 

References

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics.
Health Care Management Review
. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization.
Nagoya Journal of Medical Science
. 80(3), 341–349.

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano.
Enfermagem
. 22(2), 262–268. research articles evaluation summary table

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study.
Revista Latino-Americano Enfermagem.
25(2904).

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015).

The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40.
BioMed central Cancer
. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk

for falls in patients in the postoperative period.
Cogitare Enferm
. 20(1), 29–37. research articles evaluation summary table

How to Reduce fall rates in post-operative patients Capstone proposal

Capstone proposal on how to reduce fall rates in post-operative patients on the surgical unit

The proposed problem description for your EBP project, should address the following:

My capstone proposal

BUY A PLAGIARISM-FREE PAPER HERE

How to reduce fall rates for post-operative patients in the surgical unit

1)Describe the background of the problem. Tell the story of the issue and why it deserves attention.

2)Identify the stakeholders/change agents. Who, or what organizations, are concerned, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc

3) State the purpose and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus. Measurements need to be taken before and after the evidence‐based practice is introduced to identify the expected changes.

4) Provide supportive rationale that the problem or issue is an important one for nursing to resolve using relevant professional literature sources.

5)Develop an initial reference list to assure that there is adequate literature to support your evidence‐based practice project. Follow the ”Steps to an Efficient Search to Answer a Clinical Question” box in chapter 3 of the textbook. Use ”NUR‐699 Search Method Example” to assist you.

6) The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ) and others may be used when you are gathering statistics to provide the rationale for the problem. How to Reduce fall rates in post-operative patients Capstone proposal

 

Capstone Proposal

Name

Institution

Date

Capstone Proposal on how to Reduce Fall Rates in Post-Operative Patients on the Surgical Unit

Background of the Problem

Falls and their ensuing injuries significantly impact the physical, social and mental health of patients within a healthcare organization (Wildes et al, 2015). The length of the hospital stay of patients who sustain fall can extend for almost 13 days, and the incidence of such events can increase healthcare costs by about 61 percent (Mata et al, 2017). According to Luzia et al (2014) falls of hospitalized patients can lead to fracture or trauma that cause a reduction in activities of daily living. Sometimes the falls can be fatal. Accordingly, fall prevention is an important element of nursing care during patients’ hospital stay.

Patients are not normally familiar with the hospital environment and this increases the risk of falls. The arrangement of wards differs since light switches are located at different locations, and so are other facilities such as bathroom and the toilet; this can confuse post-operative patients and increase the risk of such patients falling and sustaining injuries (Vitor et al, 2015).

Surgical recovery is the time in which patients strive to regain their independence and as a result, achieve their return to activities of daily living. However, the surgical procedure increases the risk of fall for post-operative patients due to the weak physical state associated with the illness, and the subsequent surgery (Shida et al, 2015). Therefore, post-operative patients are weaker and can sustain falls afterward.

Therefore, there indicates the need to implement strategies to reduce fall rates for post-operative patients in the surgical unit.

The Stakeholders/Change Agents

Registered nurses

Unit manager

Physicians

Orthopedic specialists

Nurse champions

Pharmacy representative

Risk management department

Patients

American Nurses Association

National Database of Nursing Quality Indicators (ANA–NDNQI)

The Purpose and Project Objectives

The specific aim of the proposed project is to attain a 50% decrease of the overall fall incidents per 1000 patient days in the surgical unit and to lengthen days between falls to an average of 30 days within six months. The objective of the program is thus to establish a culture of safety in the surgical unity by decreasing fall events within the unit. Fall events among post-operative patients can lead to patient injury, patient mortality, reduce the functional mobility of the patient, increase the hospital length of stay, as well as raise the healthcare cost (Kobayashi et al, 2018).

The proposed project also aims to prevent patient harm and injury that results from fall incidents using a sustainable fall prevention program. In addition, the proposed project aims to engage the organizational staff members to drive a culture of safety through improved communication and also identify lessons from each fall incident. Finally, the project aims to decrease the cost for fall with injury as well as lower exposure to lawsuits, and improve the unit’s and hospital’s public image (Everhart et al, 2014). Basically, the proposed project can significantly impact the safety and quality of care in the surgical unit and the hospital at large. How to Reduce fall rates in post-operative patients Capstone proposal

The proposed model to guide the surgical unit in reducing the fall rate is the Kotter change model. The model will help in identifying the driving and restraining forces during the fall reduction process. Using the Kotter change model, the hospital leadership will be informed about the urgency and the significance of the fall reduction project and request for aid to support and facilitate the implementation of the proposed project (Vitor et al, 2015).

The project’s efficacy will be measured by measuring the percentage of the fall rate per 1000 patient days pre-project and post-project. The other measurement will involve measuring the number of days between falls for the patients sustaining falls within the surgical unit. Data about fall events within the surgical unit will be collected and entered into the system as falls happen for six months. This will assist in establishing baseline data regarding the rate of falls as well as falls with injury in the unit.  Similarly, after the end of the project’s implementation, data on the same will be collected. The baseline data and the post-project data will be analyzed and compared in order to determine the efficacy of the project and at the same time identify the key contributing factors that cause falls in the surgical unit.

Rationale that the Problem or Issue Needs to be Addressed

As aforementioned, falls are associated with poor health outcomes, increased mortality rate, loss of function, inability to perform activities of daily living, increased the length of hospital stay and increased healthcare costs (Shida et al, 2015). In addition, pre-operative patients are weaker and hence at an increased risk of sustaining falls. This is made worse by the fact that when pre-operative patients sustain falls, this may adversely affect the surgical procedure and even lead to severe injury or fatality (Mata et al, 2017). It is, therefore, the duty of clinicians to influence quality and safe care to the unit they provide care. The proposed project, therefore, aims to reduce the fall rate in the surgical unit and thus improve safety and health outcomes for the pre-operative patients.

 

 

References

Everhart D, Jessica S, Duncan P, Hall A, Neff D & Shorr R. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics.
Health Care Manage Rev
. 39(4), 352–360.

Kobayashi K, Kei A, Yuko I, Yusuke S, Nagao Y, & Shiro I. (2018). Characteristics of falls in orthopedic patients during hospitalization.
Nagoya J Med Sci
. 80(3), 341–349.

Luzia M, Victor G & Lucena F. (2014). Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients. Rev.
Latino-Am. Enfermagem
. 22(2), 262–268.

Mata L. Cissa A, Gabrielle P & Moraes T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study.
Rev Lat Am Enfermagem
. 25(2904). How to Reduce fall rates in post-operative patients Capstone proposal

Shida D, Wakamatsu K, Tanaka Y, Yoshimura A, Kawaguchi M, Miyamoto S, et al. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40.
BMC Cancer
. 15(799), 1–6.

Vitor A, Moura L, Fernandes L, Botarelli FR, Araújo J & Vitorino I. (2015). Risk for falls in patients in the postoperative period.
Cogitare Enferm
. 20(1), 29–37.

Wildes T, Dua P, Fowler SA, Miller JP, Carpenter CR, Avidan MS, et al. (2015). Systematic review of falls in older adults with cancer.
J Geriatr Oncol
. 1(6), 70–83.