reate a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1(see below). 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 i
39288Purpose: Design for Change proposal
You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1(see below). 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: YOU MUST USE THE PICOT question I CHOSE IN MY FIRST MILESTONE WHICH IS AT THE END OF THESE INSTRUCTIONS:
PICOT QUESTION: Bathing or showering with a skin antiseptic, preoperative, will reduce post-operative surgical site infections compared to using an aqueous-based soap while hospitalized.
The topic I chose is based on Health-Associated Infections (HIA).
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.
What is the nursing practice issue you have identified related to the topic you have chosen?
The issue identified is the increased risks of postoperative complications to the old-aged patients undergoing surgery.
Fully describe the scope of the practice issue:
There has been a rise in the individuals undergoing surgical operation who also have complicated medical conditions. The old-age population is among the factors that accelerate the risk of experiencing such complications coupled with other factors such as overweight. Due to this, the nurses who are responsible for the assessment of these aged patients and offering them preoperative care has to be equipped with the knowledge of the current discoveries in this field. Doing this allows them to provide quality care while also guaranteeing positive outcomes after the surgery. Another way to avoid these complications is to allow patients and family members to have a say on treatment. Since the nurses are dealing with old individuals who may have gone through numerous treatment procedures in their life, they should be given a chance to contribute to the process as they may have information that may help evade any negative reaction from their body. Patients are the most critical players in healthcare, and any process should be tailored towards their convenience and concern.
Course Outcomes
This assignment enables the student to meet the following course outcomes.
•CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO1)
•CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)
Directions
1.Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Outline (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.
2.The format for this proposal will be a paper following the Publication manual of APA 6 th edition.
3.The paper is to be four- to six-pages excluding the Title page and Reference page.
4.As you organize your information and evidence, include the following topics. a.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.
b.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.
c.Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
d.Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
e.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.
5.Citations and References must be included to support the information within each topic area. . Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
6.
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Outline:
Title
Rosalina Osman
Chamberlain College of Nursing
NR451 RN Capstone Course
September 2018
Your title here
This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper.
Change Model Overview
In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process.
Define the Scope of the EBP
Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?
Stakeholders
You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).
Determine Responsibility of Team Members
Why are the members chosen important to your project? What are their roles?
Evidence
Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.
Summarize the Evidence
In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.
Develop Recommendations for Change Based on Evidence
What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.
Translation
Action Plan
You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.
Process, Outcomes Evaluation and Reporting
What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?
Identify Next Steps
How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?
Disseminate Findings
How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)?
Conclusion
Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan.
References
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Milestone 1- this is what I used!
Capstone Project Milestone 1:
Student Name: Rosalina Osman Date: September 23, 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.
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):
The topic I chose is based on Health-Associated Infections (HIA).
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.
What is the nursing practice issue you have identified related to the topic you have chosen?
The issue identified is the increased risks of postoperative complications to the old-aged patients undergoing surgery.
Fully describe the scope of the practice issue:
There has been a rise in the individuals undergoing surgical operation who also have complicated medical conditions. The old-age population is among the factors that accelerate the risk of experiencing such complications coupled with other factors such as overweight. Due to this, the nurses who are responsible for the assessment of these aged patients and offering them preoperative care has to be equipped with the knowledge of the current discoveries in this field. Doing this allows them to provide quality care while also guaranteeing positive outcomes after the surgery. Another way to avoid these complications is to allow patients and family members to have a say on treatment. Since the nurses are dealing with old individuals who may have gone through numerous treatment procedures in their life, they should be given a chance to contribute to the process as they may have information that may help evade any negative reaction from their body. Patients are the most critical players in healthcare, and any process should be tailored towards their convenience and concern.
What is the practice area?
_x_ Clinical
_x_ Education
___ Administration
___ Other (List):
How was the practice issue identified? (check all that apply)
_x_ Safety/risk management concerns
_x_ Unsatisfactory patient outcomes
_x_ Wide variations in practice
_x_ Significant financial concerns
___ Difference between hospital and community practice
___ 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:
The practice area is both clinical, and education as the nurse first need to identify the medical needs of the patient and then updated knowledge on preoperative assessment. The clinical aspect of this assessment is to prove beyond doubt that the patient is fit to undergo the operation and that preoperative bathing will reduce the chances of infections on the site of operation. The procedure is accepted in the clinical field to reduce microflora on the skin which might result in infection (WHO, 2016).
Preoperative bathing among the aged individuals is a safety/risk management concern as any chance of infection or complications after the surgery may result in permanent disability of the patient or even death. It may also cause a situation where more operations are required which may be devastating for old people who are less energetic and also increased treatment cost. The complication or infection may also result in more pain to the family when their patient doesn’t seem to get better or appear to be in more pain.
Unsatisfactory patient outcomes is another probability if there is an occurrence of infection after surgery or complications even after preoperative bathing. The hopes of every patient after an operation is a quick recovery free of any complication and therefore the proper application of the practice is very crucial towards reaching the satisfaction of the patient.
Preoperative bathing also offers a wide variation in clinical practice in efforts in providing quality care to the aged patients. Although other procedures can be used to clean the skin of this group of patients before surgery such as the use of aqueous soap, preoperative bathing provides another alternative that is more efficient. It reduces the chances of infection by 20%.
Performing preoperative bathing in aged patients reduces the chances of infection by a significant margin and therefore avoid the cost of another treatment cost that might apply due to the infection. The practice, therefore, saves the patient and the family the cost of treating complications occurring after the surgery. The care center will also save a lot like the time which would otherwise have been spent treating the infection can be used to serve other patients.
The major complication includes after surgery is the surgical site infection (SSI). Preoperative bathing may reduce such incidences which can be costly and sometimes complicated to treat. Among them include the development of antibiotic resistance and allergic reactions. Some of the harms that may result to use of these antiseptics include delayed reactions, toxicity when applied to sensitive areas and skin irritations which may not be the case when aqueous soaps are used.
What evidence must be gathered? (check all thact apply)
_x__ Literature search
_x__ Guidelines
___ Expert Opinion
___ Patient Preferences
_x__ Clinical Expertise
___ Financial Analysis
__x_ Standards (Regulatory, professional, community)
___ Other
Describe the rationale for your checked selections:
The evidence that must be gathered for my practice issue would be literature search, using key words such as hospital associated infections, post-operative infections, antiseptic handwashing are examples used for a literature search. Guidelines include the recommendations to how and when to properly wash the skin prior to surgery and what did previous research conclude. The clinical expertise would include the searching for journal articles from medical professionals and gathering their preferences of practice. This would also include clinical specialists, physicians and nurses who would be implementing the practice. The standards and policies from other facilities as well as the CDC recommendations to decrease the number of hospital-associated infections.
Evidence Summary Worksheet
Directions: Please type your answers directly into the worksheet.
Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:
The problem is among the adult surgical patients, who get a hospital associated infection following surgery. An intervention that was critical for the patient’s well-being required surgery but then develops a HAI following the surgery. Once a HAI is developed, the hospital is responsible for the treatment. Research suggests that surgical patients, bathing or showering with a skin antiseptic, preoperative, will reduce post-operative surgical site infections compared to using an aqueous-based soap.
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.
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.
Identify the objectives of the article:
The objective of the Cochrane article was, “To review the evidence for preoperative bathing or showering with antiseptics for preventing hospital-acquired (nosocomial) surgical site infections” (Webster, J., & Osborne, S., 2015).
Provide a statement of the questions being addressed in the work and how these relate to your practice issue:
Showering or bathing with antiseptics prior to surgery, will prevent surgical site infections which will decrease HAIs.
This would relate to my practice question because both are searching for ways to reduce the number of surgical site infections and HAIs.
Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.
The interventions suggested was to focus on interventions to decrease the nosocomial surgical site infections.
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.)
The review suggested no evidence of benefit for preoperative washing with chlorhexidine versus other wash products for prevention of SSIs.
Using chlorhexidine proved to decrease the growth of bacteria on the skin but it did not show evidence of reducing surgical site infections.
Outline evidence-based solutions that you will consider for your project.
Things I will consider using would be information related to different type of antiseptics and their cost. I would also look for better quality studies.
Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.
Limitations include low quality evidence which may decrease compliance amongst hospital team members.
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