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[ANSWERED 2023] In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course

Benchmark – Capstone Project Change Proposal

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

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

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

Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Rubric

Benchmark – Capstone Project Change Proposal

  1
Unsatisfactory 0-71%
0.00%
2
Less Than Satisfactory 72-75%
75.00%
3
Satisfactory 76-79%
79.00%
4
Good 80-89%
89.00%
5
Excellent 90-100%
100.00%
60.0 %Content  
5.0 % Background Background section is not present Benchmark Capstone Project Change Proposal Nursing Paper. Background section is present, but incomplete or otherwise lacking in required detail. Background section is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Background section is present and complete. The submission provides the basic information required. Background section is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Problem Statement Problem statement is not present. Problem statement is present, but incomplete or otherwise lacking in required detail. Problem statement is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Problem statement is present and complete. The submission provides the basic information required. Problem statement is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Change Proposal Purpose Purpose of change proposal is not present. Purpose of change proposal is present, but incomplete or otherwise lacking in required detail. Purpose of change proposal is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Purpose of change proposal is present and complete. The submission provides the basic information required. Purpose of change proposal is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % PICOT PICOT is not present. PICOT is present, but incomplete or otherwise lacking in required detail. PICOT is present. Some minor details or elements are missing but the omission(s) do not impede understanding. PICOT is present and complete. The submission provides the basic information required. PICOT is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Literature Search Strategy Literature search strategy is not present. Literature search strategy is present, but incomplete or otherwise lacking in required detail. Literature search strategy is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Literature search strategy is present and complete. The submission provides the basic information required. Literature search strategy is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Literature Evaluation Literature evaluation is not present. Literature evaluation is present, but incomplete or otherwise lacking in required detail. Literature evaluation is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Literature evaluation is present and complete. The submission provides the basic information required. Literature evaluation is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Utilization of Change or Nursing Theory (2.2) Theory utilization is not present Benchmark Capstone Project Change Proposal Nursing Paper. Theory utilization content is present, but incomplete or otherwise lacking in required detail. Theory utilization content is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Theory utilization content is present and complete. The submission provides the basic information required. Theory utilization content is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Proposed Implementation Plan with Outcome Measures (3.2) Implementation plan is not present. Implementation plan is present, but incomplete or otherwise lacking in required detail. Implementation plan is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Implementation plan is present and complete. The submission provides the basic information required. Benchmark Capstone Project Change Proposal Nursing Paper Implementation plan is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (2.3) Identification of potential barriers to plan implementation and /or discussion component is not present. Identification of potential barriers to plan implementation with a discussion component is present, but is incomplete or otherwise lacking in required detail. Identification of potential barriers to plan implementation with a discussion component is present. Some minor details or elements are missing but the omission(s) do not impede understanding. Identification of potential barriers to plan implementation with a discussion component is present and complete. The submission provides the basic information required. Identification of potential barriers to plan implementation with a discussion component is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
5.0 % Appendices Inclusive of Practice Immersion Clinical Documentation (1.2) Appendices are not present. Appendices are present, but incomplete or otherwise lacking in required detail. Appendices are present with minor elements missing that do not impede understanding Benchmark Capstone Project Change Proposal Nursing Paper. Appendices are present and complete. The submission provides the basic information required. Appendices are present, complete, and incorporates additional relevant details and critical thinking to engage the reader.
10.0 % Evidence of Revision Final paper does not demonstrate incorporation of feedback or evidence of revision on research critiques. Incorporation of research critique feedback or evidence of revision is incomplete. Incorporation of research critique feedback and evidence of revision are present. Evidence of incorporation of research critique feedback and revision is clearly provided. Evidence of incorporation of research critique feedback and revision is comprehensive and thoroughly developed.
30.0 %Organization and Effectiveness  
10.0 % Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
10.0 % Argument Logic and Construction Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Benchmark Capstone Project Change Proposal Nursing Paper Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
10.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Writer is clearly in command of standard, written, academic English.
10.0 %Format  
5.0 % Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
5.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error

Expert Answer and Explanation

Impact of Hourly Rounding on Falls Prevention

Background

Falls are one of the population health concerns. The Center for Disease Control (CDC) is a common health problem among older people aged 65 and above. The CDC reports that an older person suffers a fall every second of every day in the United States (US), making it the leading cause of injury death and injury among this age group. The CDC records that in the US, one in four older adults will fall annually, making falls a public health concern in people aged 65 and above. Each year, about 36 million falls are reported among older people leading to more than 32000 deaths. The CDC also noted that more than three million people are treated in the emergency rooms for injuries from falls. Injuries such as head injuries and broken bones are caused by one in every five falls. According to CDC, 300000 older adults age hospitalized for hip fractures every year. Fall is also experienced in healthcare facilities, especially acute care departments. Gliner et al. (2022) state that one in ten patients aged 65 and above admitted in acute care will fall. The statistics show that fall is a population health concern that should be addressed to improve the quality of life of older people. This capstone project has proposed hourly rounding as an evidence-based intervention to reduce incidences of falls in acute care departments.

Clinical Problem Statement

It is not known to what degree or if hourly rounding compared to current practice can reduce incidences of falls in the acute care department. As the name implies, hourly rounding is the practice of unlicensed assistive personnel and nurses making planned visits to patients’ rooms in inpatient care and conducting specific nursing interventions each hour (Sun et al., 2020). The objective of this practice is to improve patient outcomes proactively by addressing their needs. The problem is that it is not known if the intervention can reduce falls in the acute care department. At the capstone project site, incidences of falls were high. The organization reported an average of eight cases of falls in the acute care every day. This project aims to reduce incidences of falls using hourly rounding.

Purpose of the Change Proposal 

The purpose of this change proposal is to determine if hourly rounding can effectively reduce incidences of falls in the acute care department. Various studies have found that hourly rounding is an effective fall prevention strategy. For instance, Goldsack et al. (2015) conducted a study to explore the impact of hourly rounding on falls in a hospital unit. The authors reported that through hourly rounding, healthcare professionals could prevent falls by identifying patients at risk and providing them with the necessary care. Gliner et al. (2022) also conducted a study and found that hourly rounding reduced cases of falls in a hospital by 80%.

PICOT Question

In older adults aged 65 and above hospitalized in the acute care department, does hourly rounding reduce incidences of falls during admission time compared to no hourly rounding? This capstone project wants to understand if hourly rounding can reduce incidences of falls among adults admitted to the acute care department during admission time.

Literature Search Strategy Employed

A literature review was conducted to identify evidence-based studies that support the proposed intervention. A five-step search strategy was used to identify the literature articles for the capstone project. The first step was identifying the clinical question that guided the search. The question that was used to guide the search is the PICOT question. The second step was developing the search terms. The search terms used in the search process include falls, hourly rounding, incidences of falls, impact, and effect. The third step was connecting the search terms and using them to search for articles. The search terms were connected using the Boolean operators. The operators are AND, OR, and AND/OR. The operators helped in narrowing down the search. In step four, the databases to search were selected. Three databases were identified: CINAHL Plus with Full Text, BASE: Excerpta Medica Database, and MEDLINE through Ovid (1947 to Present). The last step was searching for articles and sorting them to remain with the needed evidence.

Evaluation of the Literature

Literature was evaluated to ensure that credible and reliable studies were used to support the proposed intervention. A literature review table was used to evaluate the selected literature sources. The first element looked at in the literature was the title of the article and publication date. Only articles published within five years and have the right title were included. The second element was the research question and purpose of the article. The research question/hypothesis and the purpose of the article must align. Only articles that met this criterion were selected. The third element looked at the methodologies of the articles. The articles included extensively explained how the study was done. The last element looked at the articles’ findings, recommendations, and if they are useful to this project.

Applicable Change or Nursing Theory Utilized

The change theory used in this project is Lewin’s change management model. According to the model, a change can be successfully implemented through three stages. The first state is unfreeze (Teguh et al., 2019). In this stage, change managers introduce the change to stakeholders. The managers should utilize the best communication methods in this stage to convince the stakeholders that the change is worth implementing. The managers should also show the stakeholders the implications of not implementing the change. The second step is change. Here, the change is implemented (Teguh et al., 2019). The change manager should ensure that the project team has the requisite knowledge and resources to implement the change. The change manager ensured that the project team needed knowledge by training them. The last step is refreeze (Teguh et al., 2019). The manager should reinforce the change in this stage and ensure that people do not backslide and return to their old ways.

Proposed Implementation Plan with Outcome Measures

Activity Timeline
The first activity is project design and approval. The project manager will design project, write a proposal, and present it before the management and other stakeholders for approval. A week
The second step is selection of project team members. After the project has been approved, the project manager will put together a team of professionals who will help in planning and implementation of the project (Shaghayeghi, 2020). A week
The third step is budgeting, identifying, and allocation of resources. Team will work together and develop a budget for the project and allocate resources. Three weeks
Assigning roles. Here roles will be assigned to project members. A day
Implementation. The project will be implemented by first training the team that will oversee the process. The nurse educator will be the head of training. Nurses will be educated on how to prevent falls. Five weeks

Proposed Outcomes

The following are the proposed capstone project outcomes. The first outcome is  the reduction of patient falls within the in-patient care settings. The second objective is to improve response times within the acute care setting, The third outcome is to enhance patient satisfaction as a result of decreased patient falls among older adults admitted within the acute care setting.

Use of Evidence-Based Practice to Create the Intervention 

The evidence-based practice was fundamental in creating the proposed intervention for this project. The research was conducted to ensure that the literature supports the proposed intervention. One of the studies that supported the use of hourly rounding to prevent falls was done by Grillo et al. (2019). The authors found that hourly rounding and fall bundles reduced incidences of falls in care facilities. Althobaiti (2019) also found that the use of hourly rounding in inpatient wards helped prevent incidences of falls. The authors noted that through hourly rounding, healthcare professionals could identify falls and prevent them. Christiansen et al. (2018) also conducted a mix-method review and found that intentional hourly rounding reduced cases of falls in a hospital facility.

Plan for Evaluation 

The project will be evaluated using an outcome-based method. This method evaluates whether a project has achieved its intended outcomes. It measures the results of the project. Through the outcome, the change manager will identify the outcomes demonstrating how the project achieved the intended outcome. Data will be collected by comparing incidences of falls before and after the intervention is implemented. Document analysis will be used to collect data that will be used in evaluating the project. The project will be evaluated four weeks after the intervention has been implemented.

Barriers and Outcomes 

One of the barriers that will impact the implementation of the project is the lack of knowledge about patients at risk of falls. Nurses might have problems identifying patients at risk of falls. The change manager will overcome this barrier by educating the nurses on falls and providing them with characteristics of patients at risk of falls. The second barrier is the lack of nursing staff to conduct hourly rounds on patients in the acute care department. A nursing shortage might prevent the nurses from conducting hourly rounds. The change manager can overcome this barrier by collaborating with other healthcare professionals. Taylor (2018) noted that fall prevention is not the responsibility of nurses only. Other care providers such as doctors, social workers, and unlicensed care assistants are also responsible for preventing falls. Collaborating with these professionals will solve the issue of the nursing shortage.

References

Althobaiti, S. W. (2019). Impact of the use of the 4Ps in hourly rounds on reductions in patient falls in wards. Journal of Contemporary Scientific Research (ISSN (Online) 2209-0142), 3(7), 1-7. https://www.jcsronline.com/wp-content/uploads/2019/09/Volume3Issue7Paper1.pdf

Center for Disease Control. (2020). Keep on your feet—preventing older adult falls. https://www.cdc.gov/injury/features/older-adult-falls/index.html

Christiansen, A., Coventry, L., Graham, R., Jacob, E., Twigg, D., & Whitehead, L. (2018). Intentional rounding in acute adult healthcare settings: A systematic mixed‐method review. Journal of Clinical Nursing, 27(9-10), 1759-1792. https://doi.org/10.1111/jocn.14370

Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient Falls, Nurse Communication, And Nurse Hourly Rounding In Acute Care: Linking Patient Experience And Outcomes. Journal of Public Health Management and Practice, 28(2), E467-E470. https://www.ingentaconnect.com/content/wk/phh/2022/00000028/00000002/art00038

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing2022, 45(2), 25-30.

Grillo, D. M., Firth, K. H., & Hatchel, K. (2019). Implementation of purposeful hourly rounds in addition to a fall bundle to prevent inpatient falls on a medical-surgical acute hospital unit. Medsurg Nursing, 28(4), 243-250. https://www.proquest.com/info/openurldocerror;jsessionid

Sun, C., Fu, C. J., O’Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding. Is there an impact on patient falls?. JONA: The Journal of Nursing Administration, 50(6), 355-362.

Taylor, R. (2018). Using and developing the evidence-base in primary healthcare. Primary Health Care 22(1), 31-36. doi:10.7748/phc2001802.22.1.31.c8g916

Teguh, A., Hariyati, R. T. S., & Muhaeriwati, T. (2019). Applicability of Lewin’s change management model for optimization management function in nursing delegation between head nurse and team leader: A mini project in Jakarta military hospital. International Journal of Nursing and Health Services (IJNHS), 2(2), 66-74.

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