In this Benchmark Capstone Project Change Proposal Nursing Paper assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500-word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

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1. Background
2. Problem statement
3. Purpose of the change proposal
4. PICOT
5. Literature search strategy employed
6. Evaluation of the literature
7. Applicable change or nursing theory utilized
8. Proposed implementation plan with outcome measures
9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This Benchmark Capstone Project Change Proposal Nursing Paper assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Benchmark Capstone Project Change Proposal Nursing Paper Sample

Introduction

The implementation of projects in nursing practice should be supported by evidence-based research. Evidence-based research guides clinical decision-making based on the best available scientific evidence, patient values and belief system and expert knowledge, which increases the chances of more successful outcomes after implementation. This paper addresses the implementation of a fall prevention program among inpatients in psychiatric settings using an evidence-based approach. The purpose of evidence-based practice is to standardize clinical practice to the best recent scientific evidence. Translating the findings of evidence-based research to nursing practice guarantees patient safety, quality care, and improved clinical performance.

Background

The facility that purposes to implement the proposed fall prevention project is a regional-based psychiatric hospital, which provides mental healthcare services to a diverse population including young, adult and elderly patients from different races. The facility’s health workforce is primarily comprised of nurses besides other healthcare providers such as mental health specialists and physicians. The facility has registered a gradual increase in fall incidences among inpatients, which is attributed to the unwillingness of staff to implement fall prevention strategies and inadequate knowledge among staff on fall prevention.

A fall is an expected or accidental incident that results in involuntary rest on the ground. Fall risks are higher among mentally ill people since they are mostly out of bed and have increased mobility. Besides, the risk of falling is exacerbated by mental health problems such as mania, anxiety, depression, psychosis and dementia (Ali et al., 2018). Based on the report provided by the World Health Organization, fall incidences of mentally ill people are lower in community settings in comparison to mentally ill people in inpatient psychiatric units. Falls are a major cause of increased mortality and morbidity rates, longer hospital stay, additional, medical costs, poor health outcomes and limited functional capacity (Shin & Park, 2018). Similar to this inpatient psychiatric unit, the prevalence of falls in the US is significantly high.  Based on the increasing prevalence of mental disorders, limited financial resources, and health disparities, nurses must develop and implement sound fall prevention strategies that can improve mental health outcome’s in psychiatric inpatient settings.

Problem Statement

Based on the statistics provided by WHO, an estimated 5 million falls occur among hospitalized patients in the US. Inpatient psychiatric units account for up to one million falls. This projection is expected to increase by the year 2030. The Department of Health and Human Services highlights that falls that occur in inpatient psychiatric settings incur the most expenses. For instance, in the year 2018, they accounted for $20billion (Shin & Park, 2018).  It is for this reason that the US government through the department of health and human services has prioritized the prevention of falls through clinicians, nurses, and researchers.

Research suggests that team-based strategies that increase contact time with patients are the most effective strategies to prevent falls. A perfect example of such a strategy is purposeful hourly rounding which increases the quality of care and patient safety. Hourly rounding involves checking on patients at particular time intervals and keeping up-to-date records of the interaction. During rounding, nurses check on the status of the 5P’s: personal needs, positioning, placement, preventing falls and pain. Hourly rounding improves communication, efficiency, patient safety and reduces documentation (Heng et al., 2019).

Purpose of Change Proposal

Nurses play an integral role in the evaluation and management of psychiatric patients in inpatient settings. They are responsible for administering medications, conducting assessments, making care plans among other roles. Besides, they are responsible for preventing adverse health events such as falls. It is inarguable that falls account for most cases of prolonged admissions, poor health outcomes, physical related injuries and additional medical costs (Shin & Park, 2018).   Hourly rounding is a fall prevention strategy aims at ensuring that: reducing the incidences of falls and fall-related injuries,  reducing turnover and injuries among staff,  improving efficiency in patient care,  improving the quality of life,  improving staff knowledge and reducing frustration, improving patient and staff satisfaction(Ali et al., 2018).

PICOT

In inpatient psychiatric units (P), do hourly safety rounds (I) compared to no hourly safety rounds (C) help to reduce falls (O) within three months (T)?

Literature Search Strategy Employed

I conducted an initial search in the scientific databases of CINAHL, Cochrane, Medline, and PubMed. The following keywords were used to search for full-text articles that were specific to preventing or reducing falls in psychiatric settings through hourly rounding: falls, hourly rounding, intentional grounding, safety rounding, fall prevention, a psychiatric unit, and mental unit. Articles that discussed hourly rounding to prevent falls among mentally ill patients in medical, surgical and rehabilitation units were also considered. The search only incorporated articles in English published within the last five years. The entire search yielded 25 articles relevant to the subject matter. After a comprehensive review, the number of articles narrowed the finding to eight articles. Therefore, eight articles, which met the inclusion criteria, were included in the evaluation of literature.

Evaluation of Literature

Currently, existing evidence suggests that falls in inpatient psychiatric units have the largest emotional and economic burden with direct and indirect costs that gradually increase over the years. The systematic review by Mitchel et al. (2015) and Leone & Adams (2016) encourage nurse leaders to implement hourly rounding programs to improve safety and patient care in hospital settings. Shin & Park (2018) emphasize this information further by demonstrating that structured intentional nursing rounds improve nurses’ and patient satisfaction.

Ali et al. (2018) supported hourly rounding as an effective fall prevention strategy by proposing that, to increase patient safety, nurses should adopt programs that increase the contact time between nurses and patients. A perfect example of such a program is hourly rounding. Besides, fall programs should adopt a multifaceted approach to increase success chances (Estupinan et al., 2018). Powell-Cope et al., (2015) adds to this literature by highlighting that fall prevention measures and strategies should be individualized based on population/personal needs. Since patients have different needs, the only way to address these needs is through hourly rounding.

Goldsack et al. (2015) support hourly rounding as a fall prevention strategy in psychiatric units by explaining the significance of engaging front-line staff and nursing leadership in developing and implementing fall prevention interventions as a multidisciplinary approach to fall prevention. Heng et al. (2019) add to this finding by suggesting the integration of patient education in fall prevention strategies.

Applicable Change Utilized

There are various theoretical and conceptual change models used to implement the findings of evidence-based research in clinical settings. At the organizational level, the leadership is responsible for deciding the changes that should be made, supported with evidence-based research. Most change theories/models represent methodological approaches, break the entire change process into smaller, and simper steps (Nilsen, 2015). Change models and theories increase implementation success, allow equal resource allocation and avail ways to evaluate outcomes.

The Iowa change model will be used to implement hourly rounding as a fall prevention strategy in this evidence-based project. This model is easily understood and very effective in enabling the implementation of evidence-based practice, which makes it very user-friendly. Besides, the model emphasizes using the implementation team inputs, Interprofessional collaboration and organizational change (Nilsen, 2015). Caring for psychiatric patients in inpatient settings involves the collaboration of healthcare providers from various disciplines especially when patients have underlying medical conditions. Lastly, because it allows trials on a proposed change intervention before the actual implementation, the likelihood of failure reduces significantly.

Proposed Implementation Plan with Outcome Measures

The proposed plan of hourly rounding falls aims at preventing falls in the inpatient psychiatric unit. By implementing this intervention, it is expected that: there will be significantly lower incidences of falls and fall-related injuries in the psychiatric unit, staff knowledge on fall prevention will improve, staff turnover, injuries, and frustration will decrease, patients quality of life quality will improve, efficiency inpatient care will increase while staff and patient satisfaction will increase.

Potential Implementation Plan Barriers and How to Overcome Them

The major implementation barrier of this hourly-rounding fall prevention program is increased reluctance and skepticism among nursing staff to implement the proposed intervention. This may be attributed to additional roles and tight work schedules to be accomplished. Most nurses might think that this will require them to work within limited shift hours and will involve extra documentation and time. To address this barrier, a training program will be conducted with the aim of improving staff knowledge on hourly rounding as a fall prevention strategy (Heng et al., 2019).  Staff will also be educated on how hourly rounding impacts clinical performance, mental health outcomes, staff, and patient satisfaction.

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References

Ali M, Judge A, Foster C, Brooke A, James A, Marriott T & Lamb E. (2018). Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis, Age and Ageing, 47(6), 818–824, https://doi.org/10.1093/ageing/afy097

Estupinan A, Lord M, Crumblish H & Risher C. (2018). Fall Prevention: A Deliberative Nursing Process. J Gerontol Geriatr Res, 7(487). DOI: 10.4172/2167-7182.1000487.

Goldsack J, Meredith B, Mascioli, S & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success? Nursing, 145), 25-30. 10.1097/01.NURSE.0000459798.79840.95.

Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill A & Morris M. (2019). Educating hospital patients to prevent falls: protocol for a scoping review. BMJ Open, 1(9). doi: 10.1136/bmjopen-2019-030952.

Leone R & Adams J. (2016). Safety Standards: Implementing Fall Prevention Interventions and Sustaining Lower Fall Rates by Promoting the Culture of Safety on an Inpatient Rehabilitation Unit. Rehabilitation Nursing, 1(41), 26–32.

Mitchel, M, Lavenberg J, Trotta R, & Umscheid, C. (2015). Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of nursing administration, 44(9), 462–472. doi:10.1097/NNA.0000000000000101.

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 53.

Powell-Cope G, Quigley P, Besterman-Dahan K, Smith M, Stewart J, Melillo C, Haun J & Friedman Y. (2015). A Qualitative Understanding of Patient Falls in Inpatient Mental Health Units. Journal of the American Psychiatric Nurses Association, 20(5), 328 –339.

Shin N & Park J. (2018). The Effect of Intentional Nursing Rounds Based on the Care Model on Patients’ Perceived Nursing Quality and their Satisfaction with Nursing Services. Asian Nursing Research,12(3), 203-208.