NRS 493 Benchmark – Capstone Project Change Proposal BERNIE
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NRS 493 Benchmark – Capstone Project Change Proposal
Nurses have a role to ensure patient safety and quality outcomes in their practice settings and environment. Hospital acquired pressure injuries or ulcer (HAPIs) among patients in critical care settings like the intensive care unit are a critical patient safety concern due to their rising prevalence and negative effects. Evidence shows that over 2.5 million patients are affected by HAPIs with about 60,000 dying each year due to related complications and comorbidities related to them (AHRQ, 2022). Again, the healthcare system spends close to $11 billion each year on HAPIs and their related effects like increased hospital stay and comorbidities (Amirah et al., 2020). Nurses in critical care settings encounter the increased vulnerability of patients who suffer from these injuries and require interventions that are evidence-based to reduce their prevalence and susceptibility in critical care settings (Saunders et al., 2019). Patients suffering from HAPIs require these interventions to improve their quality of life and attain better outcomes from the facilities.
Ensuring that nurses can implement care bundle approach to HAPIs can enhance the quality of life for the patients, reduce their prevalence and lower the associated cost of treatment and prolonged stay in hospitals (Lam et al., 2020). The purpose of this paper is to present a capstone project change proposal aimed at reducing and preventing the occurrence of HAPIs among patients in critical care settings. The paper combines different aspects and sections of the proposed project for effective implementation and evaluation of expected outcome. Implementing a care bundle approach will ensure that nurses have different intervention based on the status of individual patient to reduce their susceptibility to HAPIs. The care bundle model will ensure that nurses have sufficient knowledge about these interventions and use an evidence-based practice approach to integrate them in their practice settings for quality care provision and better patient outcomes.
As observed through existing evidence from literature, hospital acquired pressure injuries (HAPIs) are a critical patient safety concern, particularly in critical and progressive care units. These HAPIs impact the quality of patient care while also increasing nurses’ workload and costs for the healthcare system, families and patients. Pressure injuries or ulcers arise mainly due to the nature of patients in the critical care settings or units, particularly because of reduce mobility, severity of their conditions and delicate nature of their care (Zhang et al., 2020). These patients are at an elevated risk of HAPIs when there is interruption of blood supply to the brain or connected tissues. Risks also increase because of poor nutrition, poor hydration and poor sensory reception and perception.
Developing and implementing an evidence-based intervention or solution would confer benefits to patients and their families, healthcare providers, and the entire health system. Strategies like pressure distribution and repositioning of patients implore nurses to change the patents at least each one to two hours. Again, pressure distribution utilizing special devices like air mattresses are EBP strategies that can improve care and overall outcomes (Amirah et al., 2020). However, the implementation of a care bundle approach entails an organized set of interventions that lead to better compliance based on guidelines and integration of measures that are tailored to meet patient needs and situation. The care bundle approach will consist of best practices tested and proved in different settings and tailored at meeting the unique patient needs and improving the overall competencies among nurses to handle diverse situations. As stated, HAPIs are a safety issue and lead to increased cost of care patients, their families and healthcare system. Therefore, the problem requires interventions that are both nurse-driven and patient-centered to attain quality care outcomes and improve the patient conditions while in critical care settings.
Clinical Problem Statement
Hospital acquired pressure injuries (HAPIs) pose a critical threat to patient safety and quality care provision in critical care settings. The issue also results in increases cost of care and other complications like comorbidities and fatalities, in severe situations. Evidence shows that over 60,000 deaths occurs each year associated with HAPIs (Lavallée et al., 2019). HAPIs lead to increased stay in healthcare facilities which also exposes patients to other infections due to their vulnerability and susceptibility. The implication is that health care facilities and nurses need to implement interventions that will improve clinical outcomes by reducing the adverse effects of HAPIs and ensuring that patients have better conditions as they continue to stay based on their disease prognosis.
Existing studies show that a majority of HAPIs occur in critical care setting that include the intensive care unit, especially the surgical ICUs. Pitman et al. (2019) observe that despite preventive approaches, HAPIs continue to occur, particularly in critical care, raising concerns about if some of these injuries cannot be avoided. Cox et al. (2022) assert that older patients with a mean age of 63.5 years and mostly male have increased risk for getting these injuries. The study notes that the prevalence of HAPIs among critically ill patients is higher compared to other patients with those having diabetes mellitus, mechanical ventilation and vasopressor agents at the highest risk for the condition. Pitman et al. (2019) note that while unavoidable HAPIs can happen. However, in cases where preventive interventions are not identified, documented, and deployed effectively, hospitals and healthcare providers can experience HAPIs. The implication is that as a clinical problem, nurses must deploy the right interventions through care bundle to deal with the issue. HAPIs care bundle offers nurse the relevant knowledge and approaches to help patients mitigate the negative effects of the condition. Nurses require sufficient knowledge on HAPIs to develop right interventions through informed decisions and collaboration with other providers.
Purpose of the Change Proposal in Offering Patient Care & Health care System
Hospital acquired pressure injuries are a critical patient safety problem and affect patient care and the entire health care system through different ways that include increased cost of care, poor outcomes, and longer hospital stays and even fatalities. As such, the purpose of this proposed change is to implement a care bundle intervention tailored on patient’s health status to reduce and prevent the occurrence of HAPIs. The change proposal aims at increasing awareness among critical care nurses about hospital acquired pressure injuries (HAPIs) based on the rationale that effective understanding of these injuries will enhance nurses’ approach to the issue by offering them sufficient information to implement better interventions in their practice settings.
The second objective of this proposed change project is prevent and reduce the prevalence of HAPIs in critical care units. Reducing the prevalence of these injuries will lower the overall cost burden to individuals, health population and the entire health care system (Coyer et al., 2022). The third focus of this project is to improve patients’ and providers’ safety through quality care delivery. This aim is essential because it aligns with professional and regulatory requirements concerning standards of care and best practices expected of nurses by professional entities like the American Nurses Association (ANA) and the American Association of Critical Care Nurses (AACN). Patients in critical care are delicate and require safety measures to enhance their conditions and health statuses (Gaspar et al., 2019). Therefore, it is critical for these patients through nurse-led and driven interventions focused on patients, deliver better practices to improve their chances of attaining quality care.
The proposed change project also aims at implementing evidence-based practice (EBP) interventions to manage HAPIs among the most susceptible patients. The change project will entail effective implementation of the proposed intervention to reduce and prevent the occurrence of HAPIs by 50% through an EBP care bundle comprising different tailored components to meet patient needs. Through this implementation, the proposed project will lead to better care delivery, reduce the overall burden of these injuries on the health care system, and ensure that all providers have sufficient knowledge and information on prevention and management of HAPIs for critical care patients.
PICOT Statement & Question
The PICOT model is a critical part of EBP process and helps nurses and research to implement interventions after interrogating and gathering sufficient evidence. The PICOT model focuses on identification of the population, intervention, comparison, outcomes and the time required to implement proposed measures to reduce and prevent HAPIs in critical care settings. In this case, the PICOT statement for the proposed EBP Capstone change project proposal entails the following:
Population: Hospitalized patients in critical care units with hospital acquired pressure injuries
Intervention: Care bundle on HAPIs management for patients
Comparison: Normal interventions
Outcome: Reduce HAPIs by 40%
Time: 3 months
Among hospitalized patients in critical care unit with hospital acquired pressure injuries (HAPIs) (P), does the implementation of care bundle (I) compared to normal measures (C), reduce HAPIs by 40% (O) within three months (T)?
The identified population consist of patients who suffer the brunt of HAPIs due to the delicate nature of their health. Critical care patients have limited mobility and are at an increased risk for HAPIs due to the interruption of blood or death of brain tissue. The population may also experience other factors like poor nutrition, poor hydration and poor sensory perception. The intervention, care bundle is an evidence-based approach that implores nurses in the critical care to implement strategies that align with patient state of health and needs. This implies that not all strategies are a one-size-fits-all aspects because of the patient diversity in needs (Melnyk et al., 2022). The care bundle will have guidelines and best practices as well as devices that leverage technological advancements to improve the quality of care and reduce exposure to HAPIs for patients in these settings. Based on the suggested approach, nurses will get sufficient knowledge and information that will lead to reduced HAPIs while also avoiding those that can be avoided. They will improve their attitude and help alter their approaches and perspectives on HAPIs prevention to improve overall patient safety and care.
Evidence from literature suggests that compared to normal interventions like pressure distribution and use of air mattresses, care bundle will entail other guidelines and practices that improve the disposition of nurses and the targeted patients (Amirah et al., 2020; Lam et al., 2020). The care bundle approach will implore nurses to develop tailored interventions based on patient condition, level of delicacy, and integrate their opinions through the use of limited resources in an engaging manner for all stakeholders. The expected outcomes will enhance care delivery and reduce costs while also improving teamwork among all stakeholders, especially nurses Furthermore, the timeline for the implementation is appropriate as it include monitoring and evaluating the effectiveness of the care bundle to reduce prevalence and prevent occurrence (Floyd et al., 2021). As delicate patient safety issue, effective and timely interventions that do not require longer timelines would be appropriate for leaders to determine the impact of the initiative through a cost-benefit analysis approach.
Literature Search Strategy Used
Searching for supportive and evidence-based literature is critical when implementing changes through capstone projects. The EBP process implores one to get and critique existing literature to ascertain the evidence for their proposed intervention. Using current evidence gives nurses and other healthcare providers who want to implement best practices through EBP to collect relevant evidence to support and justify their proposed initiatives to enhance patient safety and care (Melnyk et al., 2022). The proposed capstone project deployed effective literature search strategies to get evidence and information on the implementation and effectiveness of HAPIs care bundle for patients in critical care settings.
The primary search strategy was the use of search engines to get peer reviewed journal articles from health-allied databases. These included journals that contained relevant information and articles. The databases included PubMed, Cochrane, CINAHL, and Google Scholar. The second strategy was to employ terminologies associated with the topic. These comprised terms like “hospital acquired pressure injuries,” “prevalence of HAPIs in critical care,” “care bundle approach for HAPIs,” “critical care nurses and HAPI prevention” “patient safety and HAPIs in critical care,” and “importance of care bundle for HAPIs.” Through these strategies, the paper generated several peer-reviewed journal articles. The paper also employed the CRAAP framework to attain evidence of current and relevant article to support the proposed initiative (Lam et al., 2020). The use of CRAAP implied that the collected evidence from literature was current or within the last five years, relevant to the issue under inquiry, accurate to imply that it is not only credible but also authoritative and written by subject matter experts (Melnyk et al., 2022). This implies that the strategies led to the identification of 15 peer-reviewed articles meeting the selection criteria and used in justifying the proposed intervention. The identified articles consisted of different levels of evidence; from systematic reviews and meta-analyses to randomized control trials and non-randomized articles. These sources also comprised of primary qualitative and quantitative studies within the required timelines based on the CRAAP framework. The sources also include authoritative organizational websites and industry reports from professional organizations like ANA, Centers for Disease Control and Prevention (CDC), AACN, and even Centers for Medicare and Medicaid Services as well as the Agency for Healthcare Research and Quality (AHRQ).
The evaluated literature focused on the effective implementation of care bundle by nurses in critical care settings to improve patient safety and reduce the overall cost implications. Through the evaluated literature, nurses and stakeholders in critical care units can compare the interventions, the research approaches by various authors based on their sample populations, research questions, methodologies deployed, and even limitations that may hinder effective use of such sources (Melnyk et al., 2022). In a majority of the evaluated studies and literature, the authors utilized sufficient and targeted population samples to determine the overall effectiveness of having care bundle in critical care settings. For instance, most of the sources deployed in this project proposal focused on determining the type of care bundle interventions that nurses can deploy based on the acuity levels of patients suffering from pressure injuries because of their stay in critical care units.
The majority of the reviewed literature based on the evaluation table shows that the authors asked critical research questions similar to the ones that this initiative advances. For instance, the article by Amira et al. (2019) explores the prevalence and risk factors related to critically ill patients making them vulnerable to HAPIs. Similarly, Qaddumi et al. (2019) raise similar questions. Studies by Edsberg et al. (2022), Yilmazer et al. (2022) and Coyer et al. (2022) focus on the effectiveness of having a care bundle approach to prevent the occurrence of pressure injuries in critical care settings in various hospitals.
The reviewed articles show that most of the researchers deployed sufficient and targeted samples in determining the effectiveness of care bundles to reduce HAPIs among patients. As such, a majority of the sources used in this project focused on sample population to illustrate the positive impact of using different interventions based on patient condition to reduce and prevent HAPIs. For example, Edsberg et al. (2022) used a sample population of over 290,000 patients in over 1800 acute care setting yet Lindhardt et al. (2019) and Coyer et al. (2021) used the intensive care units but do not disclose the sample size. Yilmazer et al. (2022) and Amirah et al. (2019) as well as Pitman et al. (2019) deployed diverse samples ranging from 200 to 460 and in various critical care settings. What is evident is that having diverse sample populations and settings is essential to improving the credibility and reliability of the suggested interventions as it means that they can work with different patients and parts of the critical care areas.
The evaluated literature shows that having samples and questions that align with the PICOT question and statement is critical to attaining better results during the implementation of any capstone change project. Comparing the limitations of the sources is also critical to understanding and appreciating findings and their application to the issue of HAPIs in critical care units (Lam et al., 2020). The core limitation of most of the evaluated study is the used methodology based on sample sizes and analytical methods used by the authors and even reviewers. For instance, small sample sized studies can have limitations associated with the overall implementation to larger populations while certain research designs can fail to consider the critical components of the investigations, and authors’ settings. The rise in incidences and prevalence of HAPIs in various settings also implies that researchers should integrate these areas to reduce their effects on patient safety. These limitations can reduce the overall significant effects of the findings and implementation of related projects to improve patient safety. It would be critical to expand the scope of HAPI as a patient safety issues not just for patients in critical care but even those who take longer times in general wards, particularly those with chronic and terminal conditions.
The sources used in this capstone change project demonstrate consistent outcomes and findings based on their effectiveness despite having limitations and issues related to the sample sizes. These studies are evident that HAPIs are a patient safety issue among patients in critical care settings. The studies all agree that facilities and their leadership should implement EBP strategies like the care bundle approach to reduce and prevent their occurrence and associated adverse effects that include, in serious cases, fatalities (Lam et al., 2020). Having the care bundle approach will prepare nurses and patients to implement patient-centered yet nurse-driven strategies to reduce and prevent HAPIs and their negative effects on patient care.
Applicable Change and Nursing Theory Used
Change is always unpredictable with increased chances of resistance from any people due to the alterations that it brings in any situation or setting. As such, to counter such situations that may jeopardize effective implementation and realization of set goals, the proposed change initiative will use a change model and an appropriate nursing theory to help stakeholders navigate any issues that may crop up. Change theories allow those involved to prepare staff appropriately to implement suggested measures and strategies aimed at quality improvement in any healthcare setting. As such, the project team will deploy Kurt Lewin’s change model that contains three critical areas or stages. These include unfreezing, change, and refreezing (Melnyk et al., 2022). The freezing stage implores organizational leaders and nurses to evaluate and assess the urgency and need for change using a needs analysis approach by collecting data on the number of HAPIs, their effects and ways to manage them to justify the suggested intervention or approach. The stage will be critical so that all providers and patients accept the idea and express the willingness to implement it.
The second stage would entail implementation of the proposed intervention, having a care bundle approach to reduce and prevent HAPIs in critical care settings. The implementation will ensure that the concept and its related aspects are integrated into care management based on patient’s condition and delicate nature. The third stage would be refreezing where the critical care units will embed the most appropriate measures based on effective assessment of patients and their needs (Park et al., 2021). The stage would mean that critical care units in different healthcare facilities make care bundle a part of their policy best practices and safety culture. Through the adoption of the strategy nurses and stakeholders will leverage nursing theories to attain overall care outcomes and patient satisfaction.
The relevant nursing theory is Imogene King’s goal attainment. The theory advances that nurses are part of patient’s environment and the nurse-patient interaction is aimed at meeting goals towards better health outcomes. The theory emphasizes the role of nurses and patients in attaining set goals like improving outcomes and reducing aspects like injuries. Nurses influence patients and their perspectives on disease condition and even recovery (Park, 2021). As such, goal attainment theory is applicable to the capstone change initiative as it emphasizes the importance of nurses interacting with patients to develop patient-centered interventions in critical care settings to eliminate issues like HAPIs.
Proposed Implementation and Outcome Measures
The implementation of the initiative will entail deploying a host of strategies and interventions based on the acuity level of patients in critical care settings. These strategies will include guidelines and best practices aimed at reducing and preventing HAPIs (Rivera et al., 2021). The facility will implement the intervention by establishing an inter-professional collaboration team and using the Lewin’s change model to communicate the need for changes and expected outcomes. Using this approach, the team will create an urgency for change by compiling available data of patients and their rates of HAPIs over the last six months. The team will them train nurses through educational sessions on the care bundle to understand the interventions that can work in the unit as well as those not appropriate (Melnyk et al., 2022) After the training sessions, nurses in collaboration with quality improvement and safety department will develop a plan for deployment of the interventions based on the level of acuity of patients. For example, nurses who change patients and allocate different devices and equipment will offer data about their conditions and identify the appropriate strategy for individual patient. Therefore, all patients will have diverse interventions based on their needs and concerns in the facility.
The project will have different yet fundamental outcomes, especially in the management of HAPIs. The primary outcome will be the reduction of HAPIs by 40% within the shortest time possible or three months as advanced. The second outcome will be a rise in nurses’ knowledge about HAPIs and how appropriate intervention can reduce their prevalence. The project will also aim at improving patient safety to better levels for the facility and its stakeholders.
Integration of EBP Process
Hospitals and healthcare providers can attain quality care through integration of EBP to create intervention like care bundle to reduce HAPIs. The proposed project leveraged different aspects of EBP to develop the intervention. The EBP process entails evaluation of the need for change, assessing and critiquing current literature for evidence and justification, and identification of appropriate change and nursing theory to execute the changes (Saunders et al., 2019). The model also implores implementation team to involve all stakeholders. As such, the development of suggested solution in this initiative through literature evidence demonstrates the integration of EBP process. The EBP process implores researchers to have sufficient evidence to implement certain initiatives for effective evaluation and eventual integration into care provision as part of the overall safety culture.
Evaluation Plan for the Proposed Nursing Intervention
The evaluation plan based on the strategic plan of the project will illustrate its effectiveness in mitigating hospital acquired pressure injuries (HAPIs). The evaluation will comprise collection of data on the prevalence of HAPIs before and after the implementation of the care bundle. The evaluation will collect information and satisfaction levels through surveys and questionnaires for patients and nurses in critical care settings. Through the summative assessment of HAPIs, the team will determine the associated reduction within the implementation timelines. Feedback from patients will also be critical to improving their overall safety to attain better outcomes (Mohamed-Mayhob et al., 2022). The effectiveness of the project will entail a significant reduction of HAPIs and attainment of set goals and outcome measures.
Potential Barriers to Planned Implementation & Overcoming Them
Planned change implementation may face barriers like resistance to change, insufficient organizational resources and support, limited time, and ineffective communication that can hamper the participation of all stakeholders. Furthermore, individual bias and attitude by nurses may also be barriers in the implementation of this capstone project (Melnyk et al., 2022). Barriers like organizational support and scarcity of resources can have significant effects on planned change. Having a supportive organizational leadership and culture is key to the success of any change initiative, particularly in quality care improvement focused on patient safety and delivery of quality measures. Consequently, it is important to overcome these barriers to execute this project in the most effective manner.
Navigating these barriers entail having a change team with change agents and champions and involving the leadership by justifying the need for change. Additionally, having effective communication, and engaging all stakeholders, especially nurses in the facility, will ensure that they embrace change and are willing to implement the interventions (Mohamed-Mayhob et al., 2022). Furthermore, it would be critical for the team to use appropriate change models like Lewin’s three step change approach to communicate change and involve all stakeholders.
Hospital acquired pressure injuries (HAPIs) in critical care settings are a patient safety and quality issue that affect patients and lead to adverse effects or outcomes as outlined in this capstone change project paper. Evaluated literature and evidence show that HAPIs can lead to increased cost of care and poor care as well as fatalities. The implementation of care bundles to reduce and prevent the occurrence of HAPIs is evidence-based practice best practice in many critical care settings and entails ensuring that nurses have sufficient knowledge on diverse strategies to tackle the problem. The proposed capstone project focuses on implementing care bundle to improve the management of HAPIs from occurrence to prevention and execution of patient-centered yet nurse-led approaches to benefit both patients and the healthcare system.
Amirah, M., Rasheed, A., Parameaswari, P., Awajeh, A., Issa, M., & Abdallah, M. (2019).
Pressure injury prevalence and risk factors among adult critically ill patients at a large intensive care unit. Journal of Intensive and Critical Care, 5(2), 9. DOI: 10.21767/2471-8505.100128
Cox, J., Edsberg, L. E., Koloms, K., & VanGilder, C. A. (2022). Pressure injuries in critical care
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Appendix: Lewin’s change model
Assignment: NRS 493 Benchmark – Capstone Project Change Proposal
Assignment: NRS 493 Benchmark – Capstone Project Change Proposal
NRS493 Professional Capstone And Practicum
Week 8 Assignment
Benchmark – Capstone Project Change Proposal
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:
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalClinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalLiterature search strategy employed.
Evaluation of the literature.
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Applicable change or nursing theory utilized.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalProposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalPlan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalAppendix 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.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalPrepare 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.
Assignment: NRS 493 Benchmark – Capstone Project Change ProposalBenchmark 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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