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”, “elderly 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
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.
Capstone Change Project Proposal on Diabetes
Background
Diabetes is among the chronic conditions that result in multiple health and economic ramifications, including mortalities, increased care costs, and compromised quality of life. According to the Centers for Disease Control and Prevention (CDC, 2021), more than 37 million Americans have diabetes, representing one in ten Americans. Out of the total population with diabetes, 90-95% of them have type 2 diabetes which emanates from the body’s inability to respond normally to insulin, leading to insulin resistance. The high prevalence of type 2 diabetes is consistent with people’s exposure to multiple risk factors such as physical inactivity, sedentary lifestyle, alcoholism, smoking, unhealthy diets, and psychosocial issues like low education attainment (Bellou et al., 2018).
Although the disease’s symptoms are progressive and difficult to notice, diabetes type 2 manifests through fatigue, blurred vision, thirst, hunger sensations, unintended weight loss, slow-healing sores, and frequent urination (Mayo Clinic, 2021). Diabetes Self-Management Education and Support (DSEMS) and adherence to pharmacologic interventions emerge as the primary treatment and management approach for type 2 diabetes. Amidst the need to empower patients to address risk factors for the disease, it is essential to train and educate them to promote preventive behaviors and improve their quality of life.
Clinical Problem Statement
Undoubtedly, type 2 diabetes is among the leading causes of global mortalities and increased care costs. Goyal & Jialal (2021) contend that the international diabetes federation (IDF) predicts a global prevalence of about 600 million by 2040 if effective preventative and treatment measures are inadequate. With such expectations of the upsurge in the global prevalence of diabetes and the subsequent ramifications, it is essential to emphasize the need for educating and training diabetic patients about the tenets of self-management.
According to Dehghan et al. (2017), the primary focus of training and educating diabetic patients about self-care promotes self-efficacy. In essence, diabetes management self-efficacy is consistent with diabetic patients’ confidence in diet control, exercise, and medical treatment. The need to bolster self-efficacy when managing type 2 validates the rationale for shifts from the regular Diabetes Self-Management Training (DSMT) to more comprehensive, weekly self-management training and education programs.
Purpose of the Change Proposal concerning Providing Patient Care in the Changing Healthcare System
Undeniably, empowering patients to implement self-care interventions is one of the norms in the current healthcare systems that seek to reduce the burden of chronic conditions. When preventing and managing type 2 diabetes, training and educating patients about effective self-management interventions translates to improved outcomes.
According to Powers et al. (2020), diabetes Self-Management Education and Support (DSMES) can improve clinical and behavioral outcomes, including improving hemoglobin (A1C), reducing the onset and worsening of diabetes-related complications, improving quality of life, and enhancing lifestyle behaviors like healthful meal planning and participation in regular physical activity. As a result, implementing this capstone change project proposal is consistent with the overarching objectives of reducing the severity of diabetes-related complications and promoting preventative behaviors such as lifestyle changes and physical activeness.
PICOT Question
Among adults with type 2 diabetes (P), is it possible for a weekly self-management training and education program in a nursing home and rehab facility (I), in contrast with regular Diabetes Self-Management Training (DSMT) (C), to enhance greater understanding of diabetes self-management behavior and improve quality of life (O), within 2 months?
Literature Search Strategy
This study involved insights from external evidence, especially scholarly articles that support the tenets of diabetes self-management training and education. The criteria for selecting appropriate literature for this study involved various aspects, including the utilization of keywords and subtitles, considerations of peer reviews, publications’ databases, and literature’s currency.
The ideal keywords and subtitles for selecting literature include diabetes self-management training and education, diabetes management self-efficacy, educating diabetic patients, and patient education to promote preventive behavior. On the other hand, only sources from reputable databases such as SAGE, PUBMED, CINAHL, and the Centers for Disease Control and Prevention (CDC) satisfied the criteria. Finally, the study uses scholarly articles and publications published between 2017 and 2022 to ensure that the information is up-to-date.
Evaluation of Literature
Undoubtedly, evaluating the selected literature is an essential strategy for promoting the tenets of evidence-based practice. Although various frameworks and models for appraising evidence sources exist, this study relies massively upon the CRAAP (currency, relevance, authority, accuracy, and purpose) test as the primary strategy for evaluating the literature. According to Kurpiel (2018), this framework requires researchers to include current, relevant, authoritative, accurate, and purposeful evidence that answers clinical questions.
For example, it is essential to determine how the information relates to the topic or research question when assessing the sources’ relevance. Equally, it is crucial to establish authors’ or publishers’ credibility when assessing the sources’ authority (Kurpiel, 2018). By adhering to these considerations, it is possible to select and use credible evidence sources that support or answer the PICOT question.
Applicable Change or Nursing Theory
The nursing theory that resonates with the need to empower patients through training and education is Dorothea Orem’s self-care theory. Hellqvist (2021) contends that Orem’s self-care deficit theory operates under the premise that nursing interventions should aim at strengthening patients’ ability to perform self-management activities to maintain life, health, and well-being. The major contention of Orem’s theory positions patients at the forefront of concerted efforts to address health threats such as diseases. Borji et al. (2017) argue that nurses can help patients to regain their health by providing direct care and educating them. By educating and training patients grappling with type 2 diabetes, it is possible to improve their health and enhance the quality of their lives.
Proposed Implementation Plan with Outcome Measures
The proposed project encompasses educating and training diabetic patients about appropriate self-care interventions. In this sense, it contains various approaches, including educating patients about healthy diet planning, physical activities, self-monitoring approaches, and assisting them to transform risky behaviors and lifestyle habits like smoking and alcoholism. The implementation of weekly education programs will rely massively upon stakeholder collaboration and other components of the project cycle, including need assessment, proper planning, and budgeting, developing stakeholder partnerships, settings goals and objectives, allocating responsibilities, and evaluating the project. The desired outcome measures of the project include:
- Enhance patient’s knowledge and awareness of self-care interventions for reducing the severity of diabetes-related complications
- Improve patients’ knowledge of vital sign monitoring
- Promote preventative behaviors by enhancing patients’ participation in physical activities, healthy diet plans, and smoking cessation initiatives.
How Evidence-based Practice Influenced the Intervention Plan
Undoubtedly, evidence-based practice is a profound dimension that improves nursing research activities and clinical practices by prompting healthcare professionals to utilize the best available evidence in supporting decisions and improving practices (Dagne & Beshah, 2021). When developing the intervention plan, the need to consider insights from the current literature became a prerequisite for evaluating the effectiveness of weekly diabetes self-management training and education programs. In essence, many scholarly articles support the importance of educating and training patients on appropriate diabetes management strategies. The presence of scholarly backing renders the intervention plan empirically testable and justifiable.
Evaluation Plan
Project evaluation processes are essential in determining whether the project is consistent with the strategic objectives. Also, these processes reveal discrepancies between the implemented version and the proposed project. When evaluating this intervention plan, it would be essential to conduct weekly formative assessments and one summative evaluation.
In this sense, formative assessments will reveal unanticipated barriers, justify the processes for plan implementation, and expose participants’ satisfaction levels, opinions, and perspectives on the plan. On the other hand, a summative evaluation will determine whether the program has achieved the desired objectives and reveal the need to duplicate, replace, or improve the project. The evaluation team will conduct a summative evaluation after 2 months to determine the project’s outcomes and inputs in promoting participants’ ability to implement self-management interventions for managing type 2 diabetes.
Potential Barriers to Plan Implementation and Possible Solutions
The potential barriers to the plan implementation are lack of stakeholder support, knowledge constraints, and participants’ unwillingness to change their behavior. It is possible to address the problem of limited stakeholder support by convincing medical partners to support the change project by providing justifications for the change process. At this point, providing scientific findings that support the project can be ideal in convincing stakeholders to support the project. Secondly, it is plausible to address the problems of participants’ knowledge constraints and unwillingness to change their behavior by educating them about the adverse consequences of diabetes and appropriate self-management interventions. Notably, patient education is vital in dismantling unhealthy perceptions of the project and enhancing their knowledge of various self-care interventions.
Conclusion
Type 2 diabetes poses health and economic challenges to the global healthcare systems by increasing mortality rates, care costs and compromising quality of care. Amidst dynamics in healthcare systems, patients emerge as ideal stakeholders for improving health and addressing chronic conditions. As a result, educating and training them on appropriate self-management approaches for preventing and managing diabetes can improve their health and reduce the disease’s health and economic burdens. This paper discusses the background and clinical problem of diabetes, the purpose of educating and training patients, literature search and evaluation strategies, applicable nursing theory, evaluation processes for the intervention plan, and potential barriers to effective plan implementation and possible solutions.
NRS 493 Capstone Project Change Proposal Sample References
Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLOS ONE, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127
Borji, M., sharifi, A., Otaghi, M., & kazembeigi. (2017). The impact of Orem’s self-care model on the quality of life in patients with type II diabetes in Ilam. Biomedical and Pharmacology Journal, 10(1), 213–220. https://doi.org/10.13005/bpj/1100
Centers for Disease Control and Prevention. (2021, December 16). Type 2 Diabetes. https://www.cdc.gov/diabetes/basics/type2.html#
Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PLOS ONE, 16(8), e0256600. https://doi.org/10.1371/journal.pone.0256600
Dehghan, H., Charkazi, A., Kouchaki, G. M., Zadeh, B. P., Dehghan, B. A., Matlabi, M., Mansourian, M., Qorbani, M., Safari, O., Pashaei, T., & Mehr, B. R. (2017). General self-efficacy and diabetes management self-efficacy of diabetic patients referred to diabetes clinic of Aq Qala, North of Iran. Journal of Diabetes & Metabolic Disorders, 16(1). https://doi.org/10.1186/s40200-016-0285-z
Goyal, R., & Jialal, I. (2019, February 24). Diabetes mellitus type 2. Stat Pearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Hellqvist, C. (2021). Promoting self-care in nursing encounters with persons affected by long-term conditions—a proposed model to guide clinical care. International Journal of Environmental Research and Public Health, 18(5), 2223. https://doi.org/10.3390/ijerph18052223
Kurpiel, S. (2018). Research guides: Evaluating sources: The CRAAP test. Benedictine University. https://researchguides.ben.edu/source-evaluation
Mayo Clinic. (2021, January 20). Type 2 diabetes – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L. M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. The Diabetes Educator, 350–369. https://doi.org/10.1177/0145721720930959
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