NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I
Students must formulate an evidence-based and financially feasible strategic plan for their change proposal. Development of a written plan requires an assessment of the organization’s culture, stakeholders, potential challenges, barriers, and obstacles to the implementation of the change proposal. In this topic, students will develop their understanding of cultural aspects related to the organizational environment.
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I Objectives:
- Assess the organization and community for key stakeholders.
- Assess the culture of the organization for potential challenges in incorporating the nursing practice intervention.
- Create a strategic plan defining how the nursing practice intervention would be implemented in the capstone project change proposal.
- Integrate reflective practice into the practicum reflective journal.
- Demonstrate interprofessional collaboration throughout the creation of the capstone project change proposal.
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NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I Tasks
Practice Experience Conference (Mid-Conference)
Students are required to initiate a mid-conference that will occur during Topic 5, using the “Practice Experience Conference Form (Mid-Conference)” resource. This conference is intended for the student, preceptor, and faculty to discuss progress toward meeting the learning goals and course objectives contained in the Individual Success Plan (ISP).
Progress toward completing the written capstone project will also be discussed, including faculty recommendations for project development. Student progress will be documented on the Clinical Evaluation Tool (CET), which is submitted in LoudCloud prior to the conference.
The CET will be discussed during the mid-conference and graded in LoudCloud by the faculty after the mid-conference. If the student receives an “Unacceptable” or “Below Expectations” in any category, the student will remediate for that category of the CET.
Midterm Evaluation of Student
The preceptor will perform a midterm evaluation with the faculty. The preceptor will input the evaluation content into the Lopes Activity Tracker. The student will upload the evaluation into LoudCloud after meeting with the preceptor to discuss the midterm evaluation.
Students must meet all clinical expectations of the course, earn a passing grade on all benchmark assignments, and successfully complete remediation (if necessary) in order to receive a passing grade in the NRS-493 course.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Clinical Practice Experience Remediation
Students who are not making appropriate progress on their capstone project and receive an “Unacceptable” or “Below Expectations” on the CET will be required to complete remediation activities. Required remediation activities are listed on the “NRS-493: Clinical Experience Remediation” document. The required activities must be submitted in LoudCloud upon their completion by the end of Topic 7. All required remediation activities will be reviewed and approved by the faculty.
Professional Capstone and Practicum Reflective Journal
Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.
This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).
In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below. In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.
- New practice approaches
- Interprofessional collaboration
- Health care delivery and clinical systems
- Ethical considerations in health care
- Practices of culturally sensitive care
- Ensuring the integrity of human dignity in the care of all patients
- Population health concerns
- The role of technology in improving health care outcomes
- Health policy
- Leadership and economic models
- Health disparities
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Capstone Project Change Proposal Sample Student Work
Background
Falls are a reoccurring and expensive issue in healthcare. According to the Centers for Disease Control and Prevention, each year $50 billion is spent as a result of non-injury falls, and $754 million is spent as a result of fatal falls (CDC, 2020). It is crucial for healthcare facilities to take the appropriate and necessary measures in hopes of minimizing these occurrences.
The topic of falls is one that should concern all healthcare workers, as each and every one plays a role in prevention. Many facilities have fall policies and procedures in place that focus solely on a single fall contributing factor. The current literature, however, suggests that the most effective way to prevent falls is through the implementation of multifactorial fall prevention intervention.
This paper will discuss the effectiveness of multifactorial fall prevention interventions and provide some examples of these interventions.
Problem Statement
Falls are accompanied with a significant financial cost, as well as physical and psychological costs to the patient. Falls can lead to fractures, loss of independence, increased length of stays, quality of life changes, and even death to the patient (Wallis, A., 2021). When asked, staff members have also reported feeling helpless and frustrated about their inability to control falls (Vlaeyen, E., 2017).
There are numerous and varying causes of falls, therefore the efforts to prevent falls should also vary. Falls can occur as a result of improper or lack of use of mobility aids, changes in mentation or coordination, weakness, impaired vision, side effects of medication, and/or chronic diseases. A decrease in frequency of falls would result in a decrease in fall related injuries, costs and deaths, improved patient outcomes and safety, improved quality of life, and decrease in length of patient stays.
Due to the above, there is a dire need to promote increased fall prevention practices in healthcare. The use of multifactorial fall approaches is identified by the Joint Commission as a evidence-based tool (Arrah, 2020).
Purpose of Change Proposal
The purpose of this change proposal project is to decrease the frequency of falls through the implementation of multifactorial fall prevention interventions, specifically for patients residing either short-term or long-term in long-term care facilities.
This change proposal aims at implementing various fall prevention interventions on a patient specific basis. By identifying the patient specific fall risk and implementing prevention measures based on that patient’s risk factors patient safety is being promoted for each individual.
PICOT Question
The PICOT question being focused on in this capstone project is as follow: For residents at Crossroads Care Center in Sun Prairie, WI (P) does the use of multifactorial fall risk interventions (I) reduce the future risk of falls (C) compared to single fall risk interventions (O)?
Literature Search
In order to discover relevant literature, the writer first identified reliable databases to search for said literature. The databases utilized in this paper were found through the Grand Canyon University (GCU) library website resources. The databases chosen from the GCU library were EBSCOhost, CINAHL, and PubMed. Another database utilized was Google Scholar.
These databases were searched using combinations of the keywords “fall interventions”, “long-term care facility”, “eldery or geriatric”, and “multifactorial or multicomponent or multi-interventional”. The search excluded articles that did not fit the criteria of being peer-reviewed and published within the last five years.
Evaluation of Literature
All of the articles chosen for this project were related to the PICOT question above, as well as peer-reviewed and published within the last five years. The research questions in the articles were all centered around multifactorial fall preventions interventions, but the specific focus of each article chosen varied.
The focuses include the effectiveness, costs and benefits, barriers and facilitators, and the long-term effects of multifactorial fall prevention. Two of the articles focused more specifically on the number of falls and reducing this number, while one article focused on the use of patient safety agreements in combination with other interventions to form a multifactorial fall prevention program.
The sample populations identified in each of the articles also large variability. The populations include residents in nursing homes and or long-term care facilities or rehabilitation units in the Netherlands, large southeastern metropolitan areas, Wisconsin, North Caroline, Virginia, Maryland and Texas, Quebec, Ontario and other mid-size Canadian cities, and New South Wales.
Another group of articles focuses specifically on those 65 years or older in an acute hospital setting, in Europe, North America, Oceania, and Asia, and one study includes the study of over 19,000 older adults living in the community.
Change Theory
The nursing change theory identified and chosen by the writer in this proposal project is the nudge theory. Instead of steps, the nudge theory identifies seven principles. These principles include defining changes, consider employee point of view, provide evidence to show the best options, present change as a choice, listen to employee feedback, limit options, solidify change with short-term wins.
This change theory is the most effective for this change proposal because it educates those effected by the practice change with the evidence that supports the change, as well as gives them an opportunity to provide their feedback, voice their concerns and ask questions. This also allows the management that is implementing he proposal to make any needed changes based on that feedback prior to fulling implementing the change.
Implementation Plan and Outcome Measures
The change proposal will be presented to the department heads and upon approval will be implemented beginning with current residents that have endured a fall within the last month, and further extending to any new admissions. These residents will be evaluated using a Morse fall risk scale. Based on this result, specific fall risk factors will be determined and fall prevention interventions will be implemented to prevent future falls.
Each individual fall prevent plan will include medication review and a form of physical activity a minimum of 3 times a week. This physical activity may include physical and/or occupational therapy, independent or accompanied walking for leisure, or facility organized activities. Facility organized activities may include chair exercise, bowling, balloon volleyball, ping-pong, and pool noodle strength training.
Other interventions may include patient safety agreements, low bed, placement near nurses’ station, non-slid socks, education of patient, staff, and or family, increased frequency of rounding, and proper instruction of use of mobility aids. The outcomes of the change would be assessed by comparing the number of falls in the facility before and after the change, as well as the number of falls per specific resident in a month time period before and after the change.
Use of Evidence-Based Practice in Implementation
There are countless evidence-based studies based on falls, with many of those studies identifying that the use of multicomponent is effective in preventing and/or decreasing the occurrences of falls, as well as decreasing fall related costs overtime. In evaluation of the articles there was multiple common themes.
Each of the articles concluded that the use of multifactorial fall prevention interventions were effective at either preventing and reducing falls or decreasing fall related costs. In relation to the specific interventions identified, exercise and medication review were identified in six of eight articles. Therefore, each patient that is identified as a high fall risk, or that has a history of falls, must have both of these interventions initiated.
Potential Barrier
As with all change, there is the potential for some barriers to arise. Some potential barriers include determination from management that a change is not indicated or noncompliance from staff or residents. Although a need for new procedure in order to decrease the frequency of falls has been identified by the Director of Nursing for Crossroads Care Center, this does not ultimately determine that the department heads will identify this change project as the desired new procedure.
If approved and implemented by management, staff and/or residents may be noncompliant with the new practice. A change in practice my cause resistance from either of the above. It is the goal that since staff are being included in the implementation through the nudge change theory that they will be compliant. The residents, however, are mostly elderly and may not be willing to following the changes.
Conclusion
Falls in healthcare are financially, physically, and psychologically costly. Falls can increase cost, lengthen stays, cause injury, and even death. Not all falls are preventable, but it is the responsibility of the nurses and other healthcare workers to take the necessary steps to control factors that may lead to falls. Through the implementation of multifactorial fall prevention intervention protocol, staff have the ability to prevent falls as a result of varying causes.
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I Resources
- Arrah L Bargmann, BSN, RN, Stacey M Brundrett, MSN, RN, AGCNS-BC, Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety, Military Medicine, Volume 185, Issue Supplement_2, May-June 2020, Pages 28–34, https://doi.org/10.1093/milmed/usz411
- Cost of Older Adult Falls. (2020, July 9). Centers for Disease Control and Prevention. https://www.cdc.gov/falls/data/fall-cost.html
- Jackson, Karen. (2016). Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention. Journal of Nursing Education and Practice. 6. 10.5430/jnep.v6n6p84.
- Hopewell S, Copsey B, Nicolson P, et alMultifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participantsBritish Journal of Sports Medicine 2020;54:1340-1350.
- Lee, S. H., & Yu, S. (2020). Effectiveness of multifactorial interventions in preventing falls among older adults in the community: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES, 106. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2020.103564
- Ma, C. L. K., & Morrissey, R. A. (2020). Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward. Australian Journal of Rural Health, 28(4), 408–https://doi-org.lopes.idm.oclc.org/10.1111/ajr.12646
- Panneman, M. J. M., Sterke, C. S., Eilering, M. J., Blatter, B. M., Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of multifactorial falls prevention in nursing homes in the Netherlands. Experimental Gerontology, 143. https://doi-org.lopes.idm.oclc.org/10.1016/j.exger.2020.111173
- Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., Dobbels, F., & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International Journal of Nursing Studies, 70, 110–121. https://doi- org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2017.02.002
- Wallis, A., Aggar, C., & Massey, D. (2021). Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review. Collegian. https://doi- org.lopes.idm.oclc.org/10.1016/j.colegn.2021.05.003
NRS-493 Professional Capstone and Practicum Reflective Journal Rubric
| Course Code | Class Code | Assignment Title | Total Points | ||||||
| NRS-493 | NRS-493-O502 | Professional Capstone and Practicum Reflective Journal | 0.01 | ||||||
| Criteria | Percentage | 1: Unsatisfactory (0.00%) | 2: Less Than Satisfactory (75.00%) | 3: Satisfactory (79.00%) | 4: Good (89.00%) | 5: Excellent (100.00%) | Comments | Points Earned | |
| Group 1 | 100.0% | ||||||||
| New Practice Approaches | 8.0% | New practice approaches are not present. | New practice approaches are present, but they are incomplete or otherwise lacking in required detail. | New practice approaches are present. Some minor details or elements are missing, but the omissions do not impede understanding. | New practice approaches are present and complete. The submission provides the basic information required. | New practice approaches are present, complete, and incorporate additional relevant details and critical thinking to engage the reader. | |||
| Interprofessional Collaboration (C4.3) | 8.0% | Interprofessional collaboration information is not present. | Interprofessional collaboration information is present, but it is incomplete or otherwise lacking in required detail. | Interprofessional collaboration information is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Interprofessional collaboration information is present and complete. The submission provides the basic information required. | Interprofessional collaboration information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Health Care Delivery and Clinical Systems | 8.0% | Health care delivery and clinical systems information is not present. | Health care delivery and clinical systems information is present, but it is incomplete or otherwise lacking in required detail. | Health care delivery and clinical systems information is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Health care delivery and clinical systems information is present and complete. The submission provides the basic information required. | Health care delivery and clinical systems information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Ethical Considerations In Health Care (C2.3) | 8.0% | Information regarding ethical considerations in health care is not present. | Information regarding ethical considerations in health care is present, but it is incomplete or otherwise lacking in required detail. | Information regarding ethical considerations in health care is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information regarding ethical considerations in health care is present and complete. The submission provides the basic information required. | Information regarding ethical considerations in health care is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Practice of Culturally Sensitive Care (C5.3) | 8.0% | Information regarding the practice of culturally sensitive care is not present. | Information regarding the practice of culturally sensitive care is present, but it is incomplete or otherwise lacking in required detail. | Information regarding the practice of culturally sensitive care is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information regarding the practice of culturally sensitive care is present and complete. The submission provides the basic information required. | Information regarding the practice of culturally sensitive care is present and complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Preservation of Integrity of Human Dignity in the Care of All Patients (C5.4) | 8.0% | Information regarding the preservation of integrity and human dignity in the care of all patients is not present. | Information regarding the preservation of integrity and human dignity in the care of all patients is present, but it is incomplete or otherwise lacking in required detail. | Information regarding the preservation of integrity and human dignity in the care of all patients is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete. The submission provides the basic information required. | Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Population Health Concerns | 8.0% | Information regarding population health concerns is not present. | Information regarding population health concerns is present, but it is incomplete or otherwise lacking in required detail. | Information regarding population health concerns is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information regarding population health concerns is present and complete. The submission provides the basic information required. | Information regarding population health concerns is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Role of Technology in Improving Health Care Outcomes (C4.1) | 8.0% | Information on the role of technology in improving health care outcomes is not present. | Information on the role of technology in improving health care outcomes is present, but it is incomplete or otherwise lacking in required detail. | Information on the role of technology in improving health care outcomes is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information on the role of technology in improving health care outcomes is present and complete. The submission provides the basic information required. | Information on the role of technology in improving health care outcomes is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Health Policy | 8.0% | Health policy information is not present. | Health policy information is present, but it is incomplete or otherwise lacking in required detail. | Health policy information is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Health policy information is present and complete. The submission provides the basic information required. | Health policy information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Leadership and Economic Models | 8.0% | Information on leadership and economic models is not present. | Information on leadership and economic models is present, but it is incomplete or otherwise lacking in required detail. | Information on leadership and economic models is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Information on leadership and economic models is present and complete. The submission provides the basic information required. | Information on leadership and economic models is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Health Disparities | 8.0% | Information on health disparities is not present. | Information on health disparities is present, but it is incomplete or otherwise lacking in required detail. | Information on health disparities is present Some minor details or elements are missing, but the omissions do not impede understanding. | Information on health disparities is present and complete. The submission provides the basic information required. | Information on health disparities is present, complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Outline of Overall Personal Discovery | 8.0% | Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is not present. | Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present, but it is incomplete or otherwise lacking in required detail. | Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present. Some minor details or elements are missing, but the omissions do not impede understanding. | Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete. The submission provides the basic information required. | Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete, and incorporates additional relevant details and critical thinking to engage the reader. | |||
| Mechanics of Writing (includes spelling, punctuation, grammar, language use) | 4.0% | 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), sentence structure, or word choice are present. | Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. | Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. | Writer is clearly in command of standard, written, academic English. | |||
| Total Weightage | 100% |
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Strategic Plan Summary
- Write a 150-250 word strategic plan defining how the nursing practice intervention will be implemented in the capstone project change proposal.
- APA style is not required, but solid academic writing is expected.
- You are not required to submit this assignment to LopesWrite.
Lopes Activity Tracker Submission
Document your clinical practice hours using the Lopes Activity Tracker (LAT) in your student portal. Once you have opened the app, click on the link for your class to record your hours. Clinical practice hours should be documented and submitted within 48 hours of the clinical experience. After the hours have been submitted, the preceptor will verify the hours, which are then reviewed by the faculty.
Download the electronic summary of your practicum experience from the Lopes Activity Tracker. Save the file and submit it though the assignment dropbox for faculty approval.
This report is to be submitted in every topic.
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I Topic 5 DQ 1
Stakeholder support is necessary for a successful project implementation. Consider your internal stakeholders, such as the facility, unit, or health care setting where the change proposal is being considered, and your external stakeholders, like an individual or group outside the health care setting. Why is their support necessary to the success of your change proposal, and how you will go about securing that support?
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I
Topic 5 DQ 2
Technology is integral to successful implementation in many projects, through either support or integration or both. Name at least one technology that could improve the implementation process and the outcomes of your capstone project change proposal. Do you plan to use this technology? If not, what are the barriers that prevent its use?
NRS-493 Topic 5 Capstone Project Change Proposal Implementation Plan I
Study Materials
Inside Looking In or Inside Looking Out? How Leaders Shape Cultures Equipped for Evidence-Based Practice
Read “‘Inside Looking In’ or ‘Inside Looking Out’? How Leaders Shape Cultures Equipped for Evidence-Based Practice,” by Halm, from American Journal of Critical Care (2010).
Defining What Evidence Is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight From Clinical Nurses
Read “Defining What Evidence Is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight From Clinical Nurses,” by Jeffs, Beswick, Lo, Campbell, Ferris, and Sidani, from Applied Nursing Research (2013).
Best Practice in Nursing: A Concept Analysis
Read “Best Practice in Nursing: A Concept Analysis,” by Nelson, from International Journal of Nursing Studies (2014).
Research at the Bedside: It Makes a Difference
Read “Research at the Bedside: It Makes a Difference,” by Bridges, from American Journal of Critical Care (2015).
Evidence-Based Practice (EBP)
Read “Evidence-Based Practice (EBP),” by Samonte and Vallente, from Salem Press Encyclopedia (2015), for specific information on developing a literature review.