NRS 493 Capstone Project Change Proposal Sample
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.
CDC Data on Patient Falls
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 Capstone Project Change Proposal Sample Resources
8 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
6 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.
7 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.
4 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
5 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
2 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
3 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
1 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 Benchmark – Capstone Project Change Proposal Instructions
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 2,500-4,000 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:
Background
Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, for evaluation tools and educational materials, etc. are created.
Review the feedback from your instructor on the PICOT Question Paper, and 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.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.4: Implement patient care decisions based on evidence-based practice.
2.2: Manage patient care within the changing environment of the health care system.
NRS-493 Individual Success Plan
REQUIRED PRACTICE HOURS: 100 Direct Clinical Experience (50 hours community/50 hours leadership) – 25 Indirect Clinical Experience Hours.
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| Course Faculty Information | GCU | ||
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| Practicum Preceptor Information | Practice Setting | ||
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ISP Instructions
Use this form to develop your Individual Success Plan (ISP) for NRS-493, the Professional Capstone and Practicum course. An individual success plan maps out what you, the RN-to-BSN student, needs to accomplish in order to be successful as you work through this course and complete your overall program of study. You will also share this with your preceptor at the beginning and end of this course so that he or she will know what you need to accomplish.
In this ISP, you will identify all of the objectives and assignments relating to the 100 direct clinical practice experience hours and the 25 indirect clinical practice hours you need to complete by the end of this course. Use this template to specify the date by which you will complete each assignment. Your plan should include a self-assessment of how you met all applicable GCU RN-to-BSN Domains & Competencies (see Appendix A).
General Requirements
Use the following information to ensure successful completion of each assignment as it pertains to deliverables due in this course:
- Use the Individual Success Plan to develop a personal plan for completing your clinical practice experience hours and self-assess how you will meet the GCU RN-to-BSN University Mission Critical Competencies and the Programmatic Domains & Competencies (Appendix A) related to that course.
Show all of the major deliverables in the course, the topic/course objectives that apply to each deliverable, and lastly, align each deliverable to the applicable University Mission Critical Competencies and the course-specific Domains and Competencies (see Appendix A).
Completing your ISP does not earn clinical practice experience hours, nor does telephone conference time, or time spent with your preceptor.
- Within the Individual Success Plan, ensure you identify all graded course assignments and indirect clinical assignments listed in the table on the next page.
| Topic | Graded Assignment | Indirect Clinical Assignments |
| Topic 1 | 1. Individual Success Plan2. Reflection Journal Entry | 1. List of potential topics for the change proposal |
| Topic 2 | 1. Topic Selection Approval Paper2. Reflection Journal Entry | 1. Search the literature for supporting journal articles2. Summary of topic category; community or leadership |
| Topic 3 | 1. PICOT Question Paper2. Reflection Journal Entry | 1. List of objectives |
| Topic 4 | 1. Literature Evaluation Table2. Reflection Journal Entry | 1. List of measurable outcomes |
| Topic 5 | 1. Reflection Journal Entry | 1. Summary of the strategic plan2. Midterm Evaluation Tool |
| Topic 6 | 1. Literature Review Table2. Reflection Journal Entry | 1. List of resources |
| Topic 7 | 1. Reflection Journal Entry | 1. Summary of the evaluation plan2. Remediation-if required |
| Topic 8 | 1. Benchmark Written Capstone Project Change Proposal2. Reflection Journal Entry | |
| Topic 9 | 1. Reflection Journal Entry | 1. Professional Presentation |
| Topic 10 | 1. Finalized ISP2. Scholarly Activity Summary
3. Benchmark-Reflection Journal Summary |
1. Summary of presentation2. Final Clinical Evaluation Tool
3. Practice Clinical Evaluation Tool-Agency 4. Practice Clinical Evaluation Tool-Preceptor |
| Application-based Learning Course Assignments | List of Current Course Objectives | AssignmentDate Due | Self-Assessment:Programmatic Domains & Competencies
(see Appendix A) |
Self-Assessment:GCU RN-to-BSN
University Mission Critical Competencies (see Appendix A) |
DateAssignment
Completed |
By typing in his/her signature below, the student agrees to have read, understood, and be accountable for the instructions, assignments, and hours shown above and that all questions have been satisfactorily answered by the faculty.
Preceptors will sign upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.
| Student Signature | |
| Name: | |
| Date: | |
| Preceptor Signature [Upon Initiation of Course] | |
| Name: | |
| Date: | |
| Preceptor Signature [Upon Completion of Course] | |
| Name: | |
| Date: | |
APPENDIX A:
GCU RN-to-BSN Domains & Competencies
- University’s Mission Critical Competencies
How does this Individual Success Plan support the GCU Mission?
MC1: Effective Communication: Therapeutic communication is central to baccalaureate nursing practice. Students gain an understanding of their ethical responsibility and how verbal and written communication affects others intellectually and emotionally. Students begin to use nursing terminology and taxonomies within the practice of professional and therapeutic communication. Courses require students to write scholarly papers, prepare presentations, develop persuasive arguments, and engage in discussion that is clear, assertive, and respectful.
MC2: Critical Thinking: Courses require students to use critical thinking skills by analyzing, synthesizing, and evaluating scientific evidence needed to improve patient outcomes and professional practice.
MC3: Christian Worldview: Students will apply a Christian worldview within a global society and examine ethical issues from the framework of a clearly articulated system of professional values. Students will engage in discussion of values-based decisions made from a Christian perspective.
MC4: Global Awareness, Perspectives, and Ethics: The concept of global citizenship is introduced to baccalaureate students in the foundational curriculum. Some courses will focus on the human experience across the world health continuum. The World Health Organization (WHO) definitions of health, health disparities, and determinants of health are foundational to nursing practice.
MC5: Leadership: Students are required to develop skills and knowledge associated with their professional role. Courses require students to develop self-leadership skills such as time management, setting priorities, self-control, and evaluation of their abilities and performance.
- Domains and Competencies
How does this Individual Success Plan support the Program Domains and Competencies?
Domain 1: Professional Role
Graduates of Grand Canyon University’s RN-BSN program will be able to incorporate professional values to advance the nursing profession through leadership skills, political involvement, and life-long learning.
Competencies:
1.1: Exemplify professionalism in diverse health care settings.
1.2: Manage patient care within the changing environment of the health care system.
1.3: Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.
1.4: Participate in health care policy development to influence nursing practice and health care.
1.5: Advocate for autonomy and social justice for individuals and diverse populations.
Domain 2: Theoretical Foundations of Nursing Practice
Graduates of Grand Canyon University’s RN-BSN program will have acquired a body of nursing knowledge built on a theoretical foundation of liberal arts, science, and nursing concepts that will guide professional practice.
Competencies:
2.1: Incorporate liberal arts and science studies into nursing knowledge.
2.2: Comprehend nursing concepts and health theories.
2.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
Domain 3: Nursing Practice
Graduates of Grand Canyon University’s RN-BSN program will be able to utilize the nursing process to provide safe quality care based on nursing best practices.
Competencies:
3.1: Utilize the nursing process to provide safe and effective care for patients across the lifespan
3.2: Implement patient care decisions based on evidence-based practice.
3.3: Provide individualized education to diverse patient populations in a variety of health care settings.
3.4: Demonstrate professional standards of practice.
Domain 4: Communication/Informatics
Graduates of Grand Canyon University’s RN-BSN program will be able to manage information and technology to provide safe quality care in a variety of settings. In addition, graduates will be able to communicate therapeutically and professionally to produce positive working relationships with patients and health care team members.
Competencies:
4.1: Utilize patient care technology and information management systems.
4.2: Communicate therapeutically with patients.
4.3: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
Domain 5: Holistic Patient Care
Graduates of Grand Canyon University’s RN-BSN program will be able to provide holistic individualized care that is sensitive to cultural and spiritual aspects of the human experience.
Competencies:
5.1: Understand the human experience across the health-illness continuum.
5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.
5.3: Provide culturally sensitive care.
5.4: Preserve the integrity and human dignity in the care of all patients.