Capstone Project: Milestone 2 Paper

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Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.
Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Outline (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.
The format for this proposal will be a paper following the Publication manual of APA 6 th edition.
The paper is to be four- to six-pages excluding the Title page and Reference page.
As you organize your information and evidence, include the following topics.
1. Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association(2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
2. Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
3. Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
4. Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
5. Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.
Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.

Rubric

NR451_Milestone2_2NR451_Milestone2_2CriteriaRatingsPtsThis criterion is linked to a Learning OutcomeIntroductionIntroduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified.)25.0 ptsIntroduction to the plan is nursing focused, and evidence-based. Potential interventions clearly identified.22.0 ptsIntroduction to the plan is missing one of the elements listed in the first column.20.0 ptsIntroduction to the plan is missing two elements listed in the first column.10.0 ptsIntroduction lacks evidence to support need for change and/or potential solution is not evidenced-based.0.0 ptsIntroduction is missing.25.0 pts
This criterion is linked to a Learning OutcomeChange Model OverviewAn overview of the ACE Star model as a guide for change is given. Scope of the problem is identified. Stakeholders are identified. Team members and their roles and practice area are identified and discussed. State how nurses should use this model as a guide to facilitate change.50.0 ptsOverview of the ACE Star model is given. Scope of problem is identified. Rationale for change is present. Stakeholders are identified. Practice area, team members and role are discussed.44.0 ptsAll elements in the first column are included but discussion of one or more items lacks details.40.0 ptsOverview is missing one of the elements from the first column.19.0 ptsOverview of the ACE Star model is given. Scope of problem is not identified. Rationale for change is not present. Stakeholders are not identified. Practice area, team members and role are not discussed.0.0 ptsChange Model Overview is missing all elements of the first column.50.0 pts
This criterion is linked to a Learning OutcomeEvidenceEvidence is provided thru basic information that indicates a change is needed. For example, there have been 6 urinary tract infections over the last two months and there were none present the last two years at the same time period. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use?50.0 ptsEvidence summary is thoroughly provided with information of the current problem in the work setting indicating a change is needed. Interventions discovered in Evidence Summary are used in planning for change.44.0 ptsEvidence summary contains all elements in the first column, however, one or more items lacks detail.40.0 ptsEvidence is vaguely provided through information of the current problem in the work setting indicating a change is needed. Some of the interventions discovered in Evidence Summary are used in planning for change.19.0 ptsEvidence is provided through information of the current problem but is not convincing. Interventions discovered in Evidence Summary are not used in planning for change.0.0 ptsEvidence summary is not provided.50.0 pts
This criterion is linked to a Learning OutcomeTranslationActivities to achieve the final steps of change are fully described. What is needed to achieve? How do you translate what information you have gathered into practice? Include measurable outcomes. How do you inform staff? What is your plan of action to pilot the plan? What is the timeline?50.0 ptsActivities to achieve final steps of change are fully described. Ways to translate evidence into practice are discussed (outcomes). Methods to inform staff, activities planned for plan of action and timeline are discussed.44.0 ptsActivities to achieve final steps of change are adequately described.40.0 ptsActivities to achieve final steps of change are briefly described.19.0 ptsMinimal description of the activities to achieve final steps of change.0.0 ptsActivities for final change plan are missing. Translation of evidence into practice is missing.50.0 pts
This criterion is linked to a Learning OutcomeConclusionClear, solid summary of the key points, ACE Star model and steps of the change plan are included; ways to sustain the change plan are described.25.0 ptsDetailed summary of main points using ACE Star model. Ways to sustain plan are thoroughly described.22.0 ptsSummary of main points/model is brief. Ways to sustain plan are briefly described.20.0 ptsSummary of main points/model is vague. Ways to sustain plan are vaguely described.10.0 ptsSummary of main points/model OR ways to sustain plan are not described.0.0 ptsSummary is missing. There is no plan to sustain change.25.0 pts
This criterion is linked to a Learning OutcomeMechanicsAPA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors25.0 ptsAPA format 6th edition. Grammar, sentence structure, punctuation, and spelling correct. References, citations correct. Paper formatted in APA format. 0-1 errors22.0 ptsTwo to three errors in elements from the first column.20.0 ptsFour to five errors in elements from the first column.10.0 ptsSix to seven errors in elements from the first column.0.0 ptsMore than seven errors.25.0 pts
Total Points: 225.0Previous Next

CAPTONEPROJECT1.odt

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

For Use July 2018

Student Name: Date

Directions

Practice Issue Worksheet

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

For my PICOT question: In surgical patients, does preoperative bathing showering with skin antiseptic solution compared to bath or showering with non antiseptic solution will reduced risk of postperative surgical site infections?.

(P) Surgical patients, (I) Intervention: Bathing or showering with skin antiseptics, (C)Comparison: Bathing with non antiseptics, (O) Outcome: Reduced risk of postoperative site infection, (T) 6 weeks

Preoperative bathing or showing with skin antiseptics to prevent surgical site infection:

Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5. Capstone Project: Milestone 2 Paper

Cowperthwaite, L., Holm, R. L., Cowperthwaite, L., & Holm, R. L. (2015). Featured article: Guideline Implementation: Preoperative Patient Skin Antisepsis. AORN Journal, 10171-80. doi:10.1016/j.aorn.2014.11.009

Jakobsson, J., Perlkvist, A., & Wann-Hansson, C. (2011). Searching for Evidence Regarding Using Preoperative Disinfection Showers to Prevent Surgical Site Infections: A Systematic Review. Worldviews On Evidence-Based Nursing, 8(3), 143-152. doi:10.1111/j.1741-6787.2010.00201.x

Al Maqbali, M. A. (2013). Preoperative antiseptic skin preparations and reducing SSI. British Journal Of Nursing, 22(21), 1227.

What is the nursing practice issue you have identified related to the topic you have chosen?

Working in the medsurg area for many years now, I always come in contact with surgical site infections, in men, women and children in any part of the body. Surgical site infection are major issue in hospitals settings. When surgical site infection rates rise, an intervention needs to be in place to decrease the problen and reduce the rates of infections. According to Al Maqbali (2013), “Surgical Site Infections(SSIs) can affect the quality of care and increase the morbidity and mortality rate in after-surgical procedure. The use of an antiseptic skin preparation agent before the procedure can reduce the pathogens in the skin surface around the incision” Indicating the type of skin antiseptic preparation could prevent the surgical infection site with non-antiseptics solutions. The factors associated with choosing the skin antiseptics solutions, such as patients’ allergies, skin condition and environmental risk, are also taken into account. The use of antiseptics has been added to patient’s preoperative instruction, because have seen several skin irritation and breakdown from skin antiseptics bath or showering which there should be need to look in it, if there is need to change the regimen or strenght of the antiseptic solution to help patient with sensitive skin compare to non antiseptics solutions.

Fully describe the scope of the practice issue:

Antiseptics solutions were defined as liquid soaps products containing an antimicrobial ingredient such as chlorhexidine, triclosan, hexachlorophine, providone-iodine or benzalkonium chloride. I dont want to be specific on any solution. Each patient has a specific solution that suits a specific patient skin, so that it will reduce or stop skin irritation. The factors associated with choosing the skin antiseptics solutions, such as patients’ allergies, skin condition and environmental risk, are also taken into account. The use of preoperative bathing or showing with antiseptics solution during surgery is very important compared to bathing or showering with non-antiseptic solutions. Patient’s preoperative instruction on how to use the preoperative antiseptic solutions has also been added to the instructions.

What is the practice area?

_X__ Clinical

__X_ Education

___ Administration

___ Other (List):

How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns

_X__ Unsatisfactory patient outcomes

_X_ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

The unsatisfactory patient outcomes was checked, because the patients expressing their opinion was the reason that we noticed that there was an issue. The patients were complaining that they couldn’t complete their pre-operative solution regimen while some patient are scared of postoperative bathing allergies. We, as a hospital, have been looking at ways to lower surgical site infections and the surgeons found research suggesting the use of antiseptic solutions would decrease the chance that a surgical site infection would occur.

The wide variations in practice box was checked because every hospitals has different setting for their own surgical department for the pre-operative cleansing regimen. Some hospitals only uses the chlorhexidine solutions, while other hospitals use more than one antiseptic solutions. All hospital has different protocols. Capstone Project: Milestone 2 Paper

What evidence must be gathered? (check all that apply)

__X_ Literature search

___ Guidelines

___ Expert Opinion

__X_ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections:

Finding research that shows what preoperative regimen the patients should follow that best protects patients from obtaining a surgical site infection is a key component. The key points include the need for the patient to take a preoperative bathing or showering and need for perioperative personnel to select safe and effective antiseptic for the patient to perform a safe preoperative akin antiseptic solution. Research literature obtained will also have the length of time patients should use the products along with the strength of the antiseptic solution. Since the patients are the ones that are actually using the solution, I think it would be best to ask patients as to which regimen is easier for them and which solution caused the least amount of itchiness and irritation.

Evidence Summary Worksheet

Directions: Please type your answers directly into the worksheet.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The problem in practice is that study by both review authors independently using a piloted data extraction sheet: type of study, study setting, number of participants, sex, mean age, predisposing risk factors, type of antiseptic solutions, use of prophylactic antibiotics, procedure and timing for full body wash, period of community follow-up, all primary and secondary outcome descriptions and outcome measures reported, including infection rates and study authors’ conclusions

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Al Maqbali, M. A. (2013). Preoperative antiseptic skin preparations and reducing SSI. British Journal Of Nursing, 22(21), 1227.

Identify the objectives of the article:

The objectives to review the evidence for preoperative bathing or showering with antiseptics solution in order to reduced the risk of surgical site infections. The authors are looking for evidence that suggest that preoperative bathing or showering with skin antiseptic solutions compared to bathing or showering with non-antiseptic solutions. We therefore accepted the defination used by the original authors to determine the proportion of patient who develop any surgical site infection before and after discharge fro the hospital. Capstone Project: Milestone 2 Paper

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

This systematic review is questioning whether or not the use of preoperative bathing or showing with skin antiseptics to prevent surgical site infection. This relates to my practice problem because this can help to identify that patients using preoperative bathing or showering with skin antiseptics solutions will reduced risk of postoperative surgical infections compared to patients bathing

or showering with non-antiseptic solutions

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

This systematic review is questioning whether or not the use of preoperative bathing or showering with antiseptics for the prevention of surgical site infections This relates to my practice problem because this can help to identify that patients using preoperative bathing or showering antiseptic solutions will reduced the risk of surgical site infections.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)

This author looked at studies that have all published and unpublished randomised controlled trials(RCTs) that allocat surgical patient individually comparing any antiseptic solution used for preoperative full body wash or showering with non-antiseptic solution. Quasi-randomised trials were not included ( ie trials that allocate treatment by day of the week medical recorde number sequential admitted order. Both reviews indepedently assessed the titles and abstracts of reference identified by the search strategy. Full report of all potentially relevant trails were then retrieved for assessment of eligiblity based on the inclusion creteria. Reference lists of retrieved studies were screened to identified further studies, which were also retrieved. Differences of opinion were settled by consensus or referral to the editorial based of the wounds groups.This study concludes that the use of preoperative bathing or showering skin antiseptic solution to prevent surgical site infections. This will help to support the fact to find with anseptic solution is appropriate for each patient.This research will also help to illustrate the fact that preoperative bathing or showering skin antiseptic solution helps to reduce the risk of surgical. site infections. Capstone Project: Milestone 2 Paper

Outline evidence-based solutions that you will consider for your project.

The author of this study used antiseptic bathing or showing solutions in comparison to non-antiseptic solutions. When a surgical site infection happens, it causes a chain.When a patient acquires this consition, the hospital is also now responsible for the cost of the patient for the rest of the length of stay. This can include increase re-admission within thirty-eight days. One intervention that has been proven to be factor in helping to reduced the risk of surgical site infections is the use of preoperative bathing or showering skin antiseptic solution prior to the patient’s arrival to the hospital. Research shows that when compared to using non-antiseptic solutions. There is a statistical significance in using antiseptic preoperatively to pevent surgical site infections. Antiseptic help to reduce the number flora on the skin. Patient are advised to use preoperative antiseptic bathing or showering regimen as order to reduce the risk of surgical site infections. Some hosiptal suggest three days regimen while other hospital prefer just bathing or showering a night before surgery.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

The limitations to the studies that I believe impact ability to utilize the research in my project is that they do not follow-up preoperative bathing or showing skin antiseptic solution regime before surgery and after discharge. They only looked at the time that the patients were actually inject the hospital for surgery until their first discharge from the facility. Many patients now days go home just a few hours following surgeries.

NR451 RN Capstone Course

NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets 7/2018 DP

NR451_W4_Milestone2_Design_Proposal_Outline1.odt

Title

Your Name

NR451 RN Capstone Course

Term and Year

Your title here

This paragraph(s) is to introduce the paper. State the problem and potential solutions backed by evidence. Briefly, introduce the nursing focused plan. Remember this is a scholarly APA assignment so you cannot use first person. Remember also that you will keep all the bolded headings and just remove the non-bolded content when you start your paper. Capstone Project: Milestone 2 Paper

Change Model Overview

In this first paragraph, provide an overview of the ACE Star model Evidence-Based Practice Process. Feel free to state why nurses should use this model as a guide to facilitate change. Under each of the second level headers listed below, you now link your identified topic to the ACE Star model EBP Process.

Define the Scope of the EBP

Restate your practice issue. Why is this a problem? Give statistics and information to back the scope of the problem at your facility/work area. How does this problem impact healthcare on a broader scale?

Stakeholders

You will be the leader of the team since this is your project. Who will you also include in your team? Make sure you choose relevant stakeholders. You should have no more than eight members. Do not list your team members by name but instead by position (pharmacists, charge nurse, etc.).

Determine Responsibility of Team Members

Why are the members chosen important to your project? What are their roles?

Evidence

Conduct internal/ external search for evidence. What type of evidence did you find in addition to you Evidence Summary? EBP guidelines? Quality improvement data? Position statements? Clinical Practice Guidelines? Briefly discuss the strength of this research. This is not where you describe the results of your studies. This is done in the following steps.

Summarize the Evidence

In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.

Develop Recommendations for Change Based on Evidence

What is your recommendation based on the research? Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.

Translation

Action Plan

You have not implemented your project yet, therefore, this section will be hypothetical. Develop your plan for implementation. What are the specific steps you will take to implement your pilot study? What is the timeline for your plan? Make sure you include a plan for evaluation of outcomes and method to report the results.

Process, Outcomes Evaluation and Reporting

What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders?

Identify Next Steps

How will you implement the plan on a larger scale? Will this be applicable to other units or the facility as a whole? What will you do to ensure that the implementation becomes permanent?

Disseminate Findings

How will you communicate your findings internally (within your organization) and externally (to others outside of your organization)?

Conclusion

Provide a clear and concise summary. Review the key aspects of the problem as well as the change model. Be sure to include important aspects of the five points of the ACE Star change model EBP process and ways to maintain the change plan. Capstone Project: Milestone 2 Paper

References

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