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Benchmark – Capstone Project Change Proposal
PICOT Question Paper and Literature Review from the previous assignment has to include with this paper.
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:
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Solution
Benchmark Capstone Project Change Proposal Example
Background
Hospital-acquired infection (HAI) is a leading cause of illness and fatalities in inpatients across the world.  For example, about two million HAIs occur every year, leading to more than 99 000 deaths nationally (Kuriyama et al., 2017). Besides the fatalities, HAIs also increase the healthcare costs incurred by the patient and the healthcare facility, and the government. The researchers’ further note that about 60% of the patients admitted in the Intensive care unit (ICU) and around 20% of non- ICU patients have urinary catheters, whereby 33% of all HAIs are attributable to urinary tract infections- again majority of which are associated with catheter use. Indwelling urinary catheters are synonymously known as Foley/ urethral/suprapubic) catheters have been utilized within organizations that offer health care services from the 1800s to treat people of both genders. These catheters are used to manage urinary incontinence and retention, decrease postoperative bladder dysfunction connected to anesthesia, surgery, and immobility. Despite the high numbers of fatalities, healthcare professionals acknowledge that about 70% of catheter-associated urinary tract infections are considered avoidable but only if appropriate CAUTI prevention practices are adhered to once successfully implemented (Cao et al., 2018). However, previous studies indicate that half of Foley catheters are inserted without appropriate indications, just like other types of catheters, namely intermittent (or short-term catheters) and external catheters or condom catheters). Therefore, the practice issue identified is the absence of a nurse-led catheter removal guideline to lower CAUTIs in ICU patients where standard practice uses intermittent catheters.
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Clinical Problem Statement
In the identified site of this capstone project, a nonprofit acute care hospital in West Virginia, the hospital administration has identified CAUTI as a clinical issue that requires urgent attention in the facility. An audit by the hospital leadership to establish the causes of the high rates of CAUTI revealed there were 84 incidents where 15 organisms ranging from E.coli to P. aeruginosa were the causative factors. Using hospitals compare to 2019 figures, the facility’s CAUTI rates, compared to other hospitals at the federal level, indicated ‘worse than national benchmark’ This implied that the hospital’s CAUTI rates are higher than 14 CAUTI, which is the benchmark for the unit. Most importantly, the audits revealed that nurses do not utilize the current protocol to remove the unnecessary inserted Foley catheters in the facility. As Murphy (2019) notes, there is a need to decrease the risk and complications arising from urinary catheters by using Foley catheters as they have more benefits than intermittent catheters.
Purpose of the Change Proposal In Relation To Providing Patient Care in the Changing Health Care System
The proposed change has the purpose of seeking to evaluate the efficacy of a nursing staff educational intervention in an ICU in an acute care hospital herein identified as Best Quality Medical Center (BQMC). The educational intervention focuses on the use and importance of an evidence-based practice led by nurses on removing Foley catheters every 24- 72 hours using a Foley Catheter Removal Protocol (FCRP) to decrease the incidence of CAUTI within 90 days. The clinical practice change intervention aims to decrease the incidence of CAUTI in the ICU within three months of the implementation of FPC.
Once the clinical practice problem was identified, the nurse researcher used the acronym PICOT as the framework to guide the current study where P stands for the population being studied or observed, who in the context of the proposed project are patients admitted in the ICU, I means the intervention or proposed change (FPC), C is the comparison being studies or the current standard practice of using intermittent catheters, O represents the expected outcome which is a decrease in the incidence and better patient outcomes while T stands for the projected time for the expected outcome to be measurable. As such, the PICOT framework question to guide the project states; ‘In ICU patients, how effective is it to remove Foley catheters within 24-72 hours in preventing infection versus intermittent catheterization in decreasing the incidence of infection within 90 days?’
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Literature Search Strategy Employed
Once the pertinent clinical issue was identified, a proposed intervention was identified, and a PICOT question to guide the study was identified, the investigator conducted a literature search to evaluate the inconsistencies and gaps in that literature. To retrieve the relevant sources, the nurse researcher utilized a systematic approach to analyze previous studies whose content amongst other thongs addresses using a nurse-led protocol to remove Foley catheters within 24-72 hours without a physician order. Key search terms used included nurse-led, urinary, indwelling catheters, and infection. Search engines used included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL and PubMed. The search yielded 1 239 articles. Using word limiters, nurse-led, and urinary had 678 articles retrieved while using nurse-led protocol and catheter retrieved 16 articles published between 2015 and 2020. Lastly, adding the term infection yielded six articles deemed relevant to the capstone project, where only one measured nurses’ knowledge after an intervention. In concise form, the inclusion criteria demanded the article be published in the English language, have contents focusing on Foley catheters and intermittent catheters, and have been published between 2010 and 2020.
Evaluation of the Literature
Retrieved evidence shows that urinary catheters are a leading source of CAUTIs. A urinary catheter is a device inserted into the bladder to empty with reports indicating catheters used for right reasons and appropriated inserted require to remove as soon as possible to prevent infection. The studies reviewed focused on the nurse-led Foley Catheter Removal Protocol within 24-72 hours, where some used cohort studies. It is also important to note that none of them used a randomized control study as their research design. In total, 28 articles were used to support the proposed FCRP intervention from expert opinion, systematic reviews, meta-analysis scholarly articles published in reputable nursing and other health care journals that are peer-reviewed. The investigator contends that inpatient incidence of CAUTIs would decrease, and patients record better outcomes once nurses are empowered through educational intervention, as is the proposed FCRP. The researcher argues that nurses’ increased knowledge of Foley catheter removal would decrease CAUTI and better patient outcomes. For example, Menegueti et al. (2019) note that healthcare workers’ education and daily evaluation of Foley catheter indications were highly effective in decreasing the incidence of CAUTIs.
Similarly, Zhang et al. (2015) conducted a meta-analysis that demonstrated that removing Foley catheters within 24- 48 hours after an operation was more beneficial than intermittent catheterization in preventing postoperative urinary retention (POUR). The rationale behind a nursing staff educational intervention on the use of Foley catheters and their removal within 24- 72 hours is that intermittent catheterization has several drawbacks: the high cost incurred (Saadat et al., 2019). Other drawbacks include increased risk of pain, bladder related complications, and urethral adverse events since the latter removal is conducted anywhere between four to six times every 24 hours. Moreover, CDC (2015) reports that CAUTI occurs 48 hours after catheterization or 24 hours after discontinued catheter use. Considering over 70% of the CAUTIs are preventable, the education intervention that would have the greatest impact and still be cost-effective is Foley Catheter use hence the nurses training on how to remove them within 24- 72 hours even without a physician’s order.
Applicable Change or Nursing Theory Utilized
For the successful implementation of the proposed change initiative, the investigator proposes to use Kurt Lewin’s change theory reinforced by Hill and Hachette’s Theory of Enlightenment. The integrated theoretical framework, since knowledge is a powerful instrument that motors change and whose secondary outcomes are improved quality and patient outcomes. Through the knowledge derived from the FCRP, educational intervention nurses in BQMC’s ICU are expected to experience change leading to decreased incidence of CAUTIs and better patient outcomes. Lewin’s theory of Planned Change has three phases: unfreezing, freezing and refreezing while Hill and Hatchet’s Enlightment Theory is pegged on the principles of hemodynamics that concentrate on the individual through life changes. As a person makes life transitions, they become one with the environment.
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Proposed Implementation Plan with Outcome Measures
The proposed project is to be implemented in the ICU of BQMC, a not-for-profit acute care hospital in a rural setting in West Virginia, infamously known for its high CAUTI rates. This facility is an 18-bed medical-surgical unit that admits an average of 50 patients every month. The average length of stay is 3- 7days. The project proposes to use a quantitative study with a pre- post-research design. The study’s purpose is to evaluate changes in nurses’ knowledge who attend the educational intervention program, namely FCRP, which will lead to decreased incidences of CAUTIs among the ICU patients admitted to the facility. The education intervention will be implemented over three months, with six education sessions each lasting two hours. At each session, 20 minutes will be consumed by reading the information and fill- in demographic details. This will be followed by 30 minutes, followed by another 30 minute- scenario and a 30-minute question and answer session. A verbal review or the information will be conducted where nurses will be encouraged to participate. 14 days after the intervention, a post-test will be given. The anticipated outcomes are that nurses’ knowledge will increase the use of FCRP within 24-72 hours, where intermittent catheterization will not be used. The education intervention will be the independent variable, while the dependent variables are increased nurse knowledge outcomes. The secondary outcome is that due to the increased nurse knowledge, the patients’ CAUTI rates would decrease by a minimum of 90% within 90 days of the proposed intervention- FCRP.
How Evidence-Based Practice Was Used In Creating the Intervention Plan
The purpose of FCRP is to evaluate the changes in nurses’ knowledge after undergoing an educational program within the facility. EBP was utilized in that the investigator started by identifying a clinical or practice issue then formulating a pertinent clinical question. Step two involved the investigator looking for relevant information/ evidence to answer the said question, while step three saw the researcher critically appraise\e the retrieved information and relevant evidence. The fourth step comprises integrating the appraised evidence with the nurse’s clinical expertise and patient prevalence. The fifth and last of the EBP steps used in developing this intervention evaluated the effectiveness and efficiency of implementing steps 1 to 4 and then seeking ways to improve both for the next time.
Plan for Evaluating the Proposed Nursing Intervention
Since the proposed quality improvement project assesses the impact of implanting a nursing staff educational program dubbed FCRP, the project utilizes a quasi-experimental pre-and post-intervention evaluation model. The educational intervention program is developed using educational materials and guidelines from CDC and IHI. Evidence-based information is taken from these organizations and the hospital policy of the BQMC- the selected site of the intervention. Nursing knowledge will be measured before and after the intervention and the inpatients CAUTI rates before and after the intervention. The post-test scores will be used to evaluate and determine whether FCRP is a success or not.
Identification of Potential Barriers to Plan Implementation, And How These Could Be Overcome
Mathieson et al. (2019) observe that while EBP has been an inspiration to healthcare professionals for several decades now, nurses continue to report various obstacles that block the way to the successful implementation of EBPs. Top among these barriers are time shortages, staff shortages, heavy patient caseloads, negative beliefs, and limited knowledge of EBP and family commitments. In this project’s context, the most noticeable barriers are opposition to the project and increased workload due to staff shortages. Coaching the nurses, sending them reminders, and motivating them would go a long way in winning them over to overcome the two. While staff time computed in dollars and cents has been a problem to the nurse unit manager, persuasive argument and comparing the costs of once CAUTI events would decrease resistance.
Conclusion
In conclusion, the proposed project herein known as FCRP has established that the use of Foley catheters removed between 24 and 72 hours, even without a physician’s order, is better than intermittent catheterization performed every four to six times every day. As the reviewed literature indicates, CAUTI is a preventable clinical issue that remains the leading cause of HAIs. As such, educating the nurses in the facility’s ICU on a recommended tool increases the professionals’ knowledge and competencies in managing and preventing CAUTIS and decreases their incidence leading to better patients within the ICU and all the other hospital departments in general.
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References
Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., … & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science, 15(1), 1-22.
Cao, Y., Gong, Z., Shan, J., & Gao, Y. (2018). Comparison of the preventive effect of urethral cleaning versus disinfection for catheter-associated urinary tract infections in adults: A network meta-analysis. International Journal of Infectious Diseases, 76, 102-108.
Center for Disease Control and Prevention (CDC). (2015). Operational Guidance for Acute Care Hospitals to Report Catheter-Associated Urinary Tract Infection (CAUTI).
Kuriyama, A., Takada, T., Irie, H., Sakuraya, M., Katayama, K., Kawakami, D., & Saint, S. (2017). Prevalence and appropriateness of urinary catheters in Japanese intensive care units: results from a multicenter point prevalence study. Clinical Infectious Diseases, 64(suppl_2), S127-S130.
Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators, and barriers to implementing evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20.
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. M., & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through implementing an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine, 98(8).
Murphy, S. (2019). Intermittent vs. Indwelling Urinary Catheterization: Factors to Consider for Optimizing Patient Success. Urology.
Saadat, S. H., Shepherd, S., Van Asseldonk, B., & Elterman, D. S. (2019). Clean intermittent catheterization: Single-use vs. reuse. Canadian Urological Association Journal, 13(2), 64.
Zhang, W., Liu, A., Hu, D., Xue, D., Li, C., Zhang, K., & Pan, Z. (2015). Indwelling versus intermittent urinary catheterization following total joint arthroplasty: a systematic review and meta-analysis. PLoS One, 10(7), e0130636.
Question – Capstone Project Change Proposal Example
Benchmark – Capstone Project Change Proposal
PICOT Question Paper and Literature Review from the previous assignment has to include with this paper.
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.
As you continue, thestudycorp.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us. (Benchmark Capstone Project Change Proposal Example)
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. Refer to the LopesWrite Technical Support articles for assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.1: Exemplify professionalism in diverse health care settings.
2.2: Comprehend nursing concepts and health theories.
3.2: Implement patient care decisions based on evidence-based practice.
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