Design for Change Proposal Nursing Assignment

Design for Change Proposal Nursing Assignment

You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.Design for Change Proposal Nursing Assignment

BUY A PLAGIARISM-FREE PAPER HERE

Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Template (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.Design for Change Proposal Nursing Assignment
The format for this proposal will be a paper following the Publication manual of APA 6 th edition.
The paper is to be four- to six-pages excluding the Title page and Reference page.
As you organize your information and evidence, include the following topics.
Introduction: Write an introduction but do not use \"Introduction\" as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.Design for Change Proposal Nursing Assignment
Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.Design for Change Proposal Nursing Assignment
Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.
Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, \"How do I know this?\" and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.Design for Change Proposal Nursing Assignment

  1. Introduction:Write an introduction but do not use "Introduction" as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
  2. Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
  3. Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
  4. Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
  5. Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.Design for Change Proposal Nursing Assignment

NR451 Milestone2 Rubric

 

Criteria Ratings Pts
This criterion is linked to a Learning Outcome Introduction

Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.)

25.0 pts

Introduction to the plan is nursing focused, and evidence-based. Potential interventions clearly identified.

22.0 pts

Introduction to the plan is missing one of the elements listed in the first column.Design for Change Proposal Nursing Assignment

20.0 pts

Introduction to the plan is missing two elements listed in the first column.

10.0 pts

Introduction lacks evidence to support need for change and/or potential solution is not evidenced-based.

0.0 pts

Introduction is missing.Design for Change Proposal Nursing Assignment

25 pts
This criterion is linked to a Learning Outcome Change Model Overview

An overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.

50.0 pts

Overview of the ACE Star model is given. Scope of problem is identified. Rationale for change is present. Stakeholders are identified. Practice area, team members and role are discussed.Design for Change Proposal Nursing Assignment

44.0 pts

All elements in the first column are included but discussion of one or more items lacks details.

40.0 pts

Overview is missing one of the elements from the first column.

19.0 pts

Overview of the ACE Star model is given. Scope of problem is not identified. Rationale for change is not present. Stakeholders are not identified. Practice area, team members and role are not discussed.

0.0 pts

Change Model Overview is missing all elements of the first column.Design for Change Proposal Nursing Assignment

50 pts
This criterion is linked to a Learning Outcome Evidence

Evidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use?

50.0 pts

Evidence summary is thoroughly provided with information of the current problem in the work setting indicating a change is needed. Design for Change Proposal Nursing Assignment Interventions discovered in Evidence Summary are used in planning for change.Design for Change Proposal Nursing Assignment

44.0 pts

Evidence summary contains all elements in the first column, however, one or more items lacks detail.

40.0 pts

Evidence is vaguely provided through information of the current problem in the work setting indicating a change is needed. Some of the interventions discovered in Evidence Summary are used in planning for change.Design for Change Proposal Nursing Assignment

19.0 pts

Evidence is provided through information of the current problem but is not convincing. Interventions discovered in Evidence Summary are not used in planning for change.Design for Change Proposal Nursing Assignment

0.0 pts

Evidence summary is not provided.

50 pts
This criterion is linked to a Learning Outcome Translation

Activities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?

50.0 pts

Activities to achieve final steps of change are fully described. Ways to translate evidence into practice are discussed (outcomes). Methods to inform staff, activities planned for plan of action and timeline are discussed.Design for Change Proposal Nursing Assignment

44.0 pts

Activities to achieve final steps of change are adequately described.

40.0 pts

Activities to achieve final steps of change are briefly described.

19.0 pts

Minimal description of the activities to achieve final steps of change.

0.0 pts

Activities for final change plan are missing. Translation of evidence into practice is missing.

50 pts
This criterion is linked to a Learning Outcome Conclusion

Clear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described.

25.0 pts

Detailed summary of main points using ACE Star model. Ways to sustain plan are thoroughly described.Design for Change Proposal Nursing Assignment

22.0 pts

Summary of main points/model is brief. Ways to sustain plan are briefly described.

20.0 pts

Summary of main points/model is vague. Ways to sustain plan are vaguely described.

10.0 pts

Summary of main points/model OR ways to sustain plan are not described.

0.0 pts

Summary is missing. There is no plan to sustain change.Design for Change Proposal Nursing Assignment

25 pts
This criterion is linked to a Learning Outcome Mechanics

APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors

25.0 pts

APA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors Design for Change Proposal Nursing Assignment

22.0 pts

Two to three errors in elements from the first column.

20.0 pts

Four to five errors in elements from the first column.

10.0 pts

Six to seven errors in elements from the first column.Design for Change Proposal Nursing Assignment

0.0 pts

More than seven errors.

25 pts
Total Points: 225Design for Change Proposal Nursing Assignment

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

For Use March 2018

 

BUY A PLAGIARISM-FREE PAPER HERE

Student Name: Brianna Craven                          Date: March 2018

Directions

  1. Refer to the guidelines for specific details on how to complete this assignment.
  2. Type your answers directly into the worksheets below.
  3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.
  4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.Design for Change Proposal Nursing Assignment

 

Practice Issue Worksheet

 

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

Topic: Interventions to improving professional adherence to guidelines for prevention of device related infections

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. Infection Control and Hospital Epidemiology35(9), 1126–1132.                http://doi.org/10.1086/677636

Design for Change Proposal Nursing Assignment

What is the nursing practice issue you have identified related to the topic you have chosen?

The practice issue that I have identified concerning my topic is whether or not the need for intense NICU infection bundles related to decreasing the incidence of ventilator-associated pneumonia, necrotizing fasciitis and CLABSI’s are recommended for the NICU population. The question I have chosen for this topic is as followed:

Will implementing new infection bundles versus not implementing new infection bundles significantly decrease acquired infections in NICU babies?Design for Change Proposal Nursing Assignment 

As a traveling Registered Nurse, I have had the pleasure to work at several different NICU’s around the United States. At the hospital that I am currently working at, a level four nicus in Tacoma, Washington, they have implemented some brand new NICU infection bundles that I have never seen before. The purpose of my capstone will be to see if the newly implanted NICU bundles have an effect on helping to decrease the incidence of infections in the NICU population.Design for Change Proposal Nursing Assignment

 

Fully describe the scope of the practice issue:
The scope of the practice issue that I have found is that in keeping tabs on some of the past hospitals that I have traveled to, I have seen that they have an above average reported CLABSI, necrotizing fasciitis, and ventilator-associated pneumonia infections. At the hospital that I am currently working at, I have noticed that regarding those three infections, there has been an overall decrease in the amount of these infections among the NICU population. Education, demonstration, and evaluation of NICU nurses during their hands-on assessment of their patients is crucial in determining whether or not the policies on infection prevention and whether or not the strict use of new infection bundles. Babies in the neonatal intensive care unit often have immature immune systems. They are exposed to many different caregivers and may have multiple blood test, IV lines, and other invasive procedures. The incidence of CLABSI reported from NICUs is consistently among the highest reported when compared to other hospital locations. Due to this factor, it is important to figure out what is the best plan of action regarding decreasing infections in this population. I will also be using the Standardized Infection Ratio (SIR) to compare the rate of central line infection/VAP/Necrotizing fasciitis Rates with other hospitals.Design for Change Proposal Nursing Assignment

 

What is the practice area?

_x__ Clinical

_x__ Education

___ Administration

___ Other (List):Design for Change Proposal Nursing Assignment

How was the practice issue identified? (check all that apply)

_x__ Safety/risk management concerns

___ Unsatisfactory patient outcomes

_x__ Wide variations in practice

___ Significant financial concerns

 

 

___ Difference between hospital and community practice

__x_ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

Safety Risk Management Concerns:Design for Change Proposal Nursing Assignment

I chose safety and risk management because critically ill infants that are cared for in the neonatal intensive care units are among the most vulnerable patient population in the hospital. NICU babies are at an increased risk for adverse outcomes related to nosocomial infections and unplanned readmission to the hospital. Nosocomial infections can affect nearly 1 in 6 very low birth weight infants (VLBW), which can double the risk of mortality and lengthen the NICU stay. Invasive equipment, such as central lines and ventilators, are a familiar source of nosocomial infection.Design for Change Proposal Nursing Assignment

Wide Variation in practice:

I chose this area because every NICU that I have worked at practices differently concerning the maintenance of CLABSI, ventilators, and feedings. I have even worked within the same hospital system, just in a separate location and saw a vast difference in how they did things compared to their partners up the road. For example, some hospitals require everybody in the room to wear a hat and mask when inserting a central line, whereas other hospitals only require the person entering the catheter of a central line to wear a hat and mask. Some hospitals are strict about suctioning an intubated baby before turning their head or repositioning, while some hospitals have no preference on which order this happens.  Some hospitals will clean an infant’s nasogastric/orogastric tube with alcohol before beginning a gavage feeding, while some hospitals don’t see it necessary.  Design for Change Proposal Nursing Assignment

Clinical practice issue is a concern:

I chose this because I believe that many hospitals are relaxed about their infection policies. I have worked in hospitals that are very strict about preventing infection in our NICU babies, and I have also worked in hospitals that hardly have a policy for infection written. Regardless of whether or not a NICU is a level IV or a level II, infection protocols should be followed consistently and concisely by all staff.Design for Change Proposal Nursing Assignment

 

 

What evidence must be gathered? (check all that apply)
_x__ Literature search

___ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

 

Describe the rationale for your checked selections:

Literature Search:

A reasonable basis of literature is fundamental regarding proving the significance of a clinical problem. A literature search is a systematic, thorough search of all types of published literature to identify a magnitude of excellent quality references relevant to a specific topic and is a fundamental element of the methodology of any research project. A Literature search is necessary to research because it can help to draw information for making sound evidence-based guidelines.Design for Change Proposal Nursing Assignment

Clinical Expertise:

Clinical expertise will need to be assessed to determine whether the newly implanted infection bundles are beneficial to our tiny patients. Evidence-based practice involves integrating the best evidence and clinical expertise.Design for Change Proposal Nursing Assignment

Guidelines:

Guidelines from organizations such as the National Women’s Newborn Service, Centers for Disease Control and the World health organization should be evaluated to determine what infection procedures are recommended in the NICU setting.

Design for Change Proposal Nursing Assignment

 

 

 

Evidence Summary Worksheet

Directions: Please type your answers directly into the worksheet.

Design for Change Proposal Nursing Assignment

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The practice problem that I have identified is whether or not the implementation of new NCU infection bundles are beneficial to our tiny NICU patients. The practice problem identified by our assigned article Interventions to improve professional adherence to guidelines for prevention of device-related infections refers to the fact that healthcare associated infections (HAI’s) are detrimental to the well-being of our patients. When infection procedures, or bundles, are not strictly followed in the NICU this can lead to patients to the subjection of acquiring device-related infections. Nosocomial infections in the NICU are a significant cause of morbidity. Premature infants are especially vulnerable since they can undergo many invasive procedures and are often times dependent on invasive devices such as feeding tubes, central lines, and ventilators. The very mechanisms that sustain life can be a reservoir for bacterial invasion, especially in those with immature immune systems. The use of Aseptic and sterile technique should always be involved when handling invasive devices in the NICU. This has been found to decrease the incidence of infection in the NICU. It would be essential to measure this outcome within a six-month time span to determine the number of babies that fall victim to infections related to invasive devices within this time frame regarding the different policies and bundles used in a particular NICU.Design for Change Proposal Nursing Assignment

 

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.Design for Change Proposal Nursing Assignment

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. Infection Control and Hospital Epidemiology35(9), 1126–1132.                http://doi.org/10.1086/677636

Identify the objectives of the article:

The objective of the study that I have chosen is to figure out quality improvement strategies to change clinical practice in improving the rate of device-related infections in the healthcare setting. The article looks at the care bundles developed by the HAI’s and suggests that bundling interventions an effective form of decreasing healthcare-associated infections. The report assesses the effectiveness of different interventions, with or without various combinations, to target healthcare professionals/healthcare organizations to improve professional adherence to infection control guidelines on device-related infection rates and also aims to measure adherence to these guidelines.Design for Change Proposal Nursing Assignment

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The matters discussed in the article deal with assessing the different interventions in targeting infection control regarding device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections Design for Change Proposal Nursing Assignment

 

 

Summarize (in your own words) the interventions the author(s) suggest improving patient outcomes.

Some of the interventions that the authors have found to be effective in preventing ventilator-associated pneumonia include elevating the head of the bed by 30 degrees; continuous suctioning when there is evidence of increased sections, not changing circuits on ventilators unless it is entirely indicative, oral care and hand hygiene. The article talked about daily sedation use, however, in the NICU we rarely use sedation unless the baby is high risk for pulling out their endotracheal tube. The questions being addressed in the article deal with assessing the different interventions in targeting infection control concerning device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections. In regards to the prevention of CLASI infections, the article has found that timely dressing changes using aseptic techniques, daily audits of central line site, chlorhexidine on the skin with the preparation of insertion of a sterile catheter, and the use of sterile barriers during catheter insertion, such as a hat, and mask.Design for Change Proposal Nursing Assignment

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)Design for Change Proposal Nursing Assignment 

The main findings of the studies showed that adherence to invasive device related bundles could help decrease the risk of nosocomial infections in this population. Many of these infection prevention practices are implemented in the newly recommended NICU bundles. The study found that there were beneficial effects regarding the use of these infection bundles up to three months, nine months, and twelve months after initiated. The study found a decrease in VAP rates between 5 and 23 cases per 1,000 ventilator days. The article highlights that for effective prevention of device-related hospital infections, it is vital to ensure that the clinical practice bundles/policies that are implemented have an evidence-based backing and target the critical risk factors for the specific indwelling medical devices in question. However, the study emphasizes that further research should be done to come to a definitive answer.Design for Change Proposal Nursing Assignment

 

Outline evidence-based solutions that you will consider for your project.

·         Whether or not suctioning an infant’s ET tube and oral secretions before repositioning decrease the incidence of VAP

·         Whether or not cleaning a nasogastric/orogastric feeding tube with alcohol for at least 15 seconds decreases the incidence of necrotizing fasciitis

·         Whether or not using a mask and hat is crucial for everybody to have one when PICC line placement has begun

·         Providing education and demonstration to NICU nurses and doctors to make sure infection bundles are properly being followed

·         Whether or not the use of aseptic/sterile technique is needed when handling invasive devices in the NICU

·         If changing ventilator circuit only when visibly soiled or malfunctioning is beneficial in decreasing the incidence of VAP Design for Change Proposal Nursing Assignment

·         Minimizing days on ventilation

·         Use of frequent hand hygiene when handling invasive devices

·         Frequent caregiver education and demonstration of NICU bundles to ensure that bundles are being followed consistency and concisely

 

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in our project.

The main limitation that I can see with my study is that a NICU may have a hospital policy/bundle in place, but it is not implemented effectively by all staff, including nurses and doctors. Even though there may be a strict and effective prevention of invasive device-related infections in place, studies may still show that the rate of NICU acquired infections are still steadily increasing. As there is no way to closely monitor every nurse, on every shift, at every assessment, this is the only barrier I can see that may skew the results of infections acquired in the NICU.Design for Change Proposal Nursing Assignment