DPI Project – Proposal Defense PowerPoint and Call
DPI Project – Proposal Defense PowerPoint and Call
This project requires using the ATTACHED PowerPoint template to complete the assignment.
Please see the ATTACHED SAMPLE from a previous student
You will need to use the CORRECTED VERSION of Word document from the initial project submission ATTACHED
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In this topic, you will participate with your full DPI committee in the DPI Project Proposal Defense call. This meeting requires that you present your revised DPI Project Proposal live in PowerPoint form as it stands at this time.
Use the following information to ensure successful completion of the assignment:
· While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines.
· You are required to submit this assignment to LopesWrite.
1. Using the “DNP Project Proposal Oral Defense Template” as your guide, create a PowerPoint presentation of your DPI Project Proposal, to be used during your DPI Project Proposal Defense call.
2. Present the revised Project Proposal PowerPoint to your full DPI committee.
You are required to complete your assignment using real-world application. Real-world application requires the use of current evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting.
The Impact of implementation of code blue nurse champion for cardiac arrests
By: Beverly Holland, MSN, MBA, RN, NEA-BC
Registered nurse with 34 years in acute care hospital settings
20 years in leadership roles
Clinical Education Department director
Involvement in ministry wide quality improvement, for example:
Code Blue committee
New employee orientation and Transition into Practice (TIP) RN onboarding
Cardiovascular disease is the primary cause of death resulting in 840,768 deaths in the United States (US) in 2017, with 379,133 due to cardiac arrest (Varini et al., 2019).
An estimated 209,000 in hospital cardiac arrests (IHCA) occur each year in the US, with a survival rate of 24% (Andersen, Holmberg, Berg, Donnino, & Granfeldt, 2019).
Impacting factors for survival include:
skilled front line response by bedside nurses
skilled resuscitation team,
prompt initiation of cardiopulmonary resuscitation and defibrillation, and
organizational structures to support resuscitation care (Guetterman et al., 2018).
Cardiovascular disease (CVD) is a primary cause of death in the United States. In-hospital cardiac arrest (IHCA) events pose a significant risk for patients. Survival and favorable outcomes for IHCA events are highly dependent on factors such as having a skilled resuscitation team in-house, prompt initiation of cardiopulmonary resuscitation (CPR) and defibrillation and established organizational structures to support resuscitation care. The Institute of Healthcare Improvement (IHI) recognizes the need for having a safety measure to assist healthcare professionals at the bedside in the prevention and identification of patient deterioration (IHI, 2008). Current evidence illustrates the variability in cardiac arrest survival in and out of the hospital, demonstrating a substantial opportunity to save lives (Bhanji, Finn, et al., 2015).
Determinants for survival
High quality CPR (Bhanji, Donoghue, et al., 2015).
Nurses as first responders
Delay in response
Early initiation of CPR (Bircher, Chan, & Xu, 2019).
For IHCA, provider-dependent determinants of survival are early defibrillation for shockable rhythms and high-quality cardiopulmonary resuscitation (CPR) (Bhanji, Donoghue, et al., 2015). Nurses are most likely first responders to witness an IHCA and provide treatment (McHugh et al., 2016). Furthermore, when rescuers respond slowly, survival is lower; early initiation of CPR links with improved outcomes for both out-of-hospital and IHCA (Bircher, Chan, & Xu, 2019). Therefore, CPR training for all hospital personnel has been mandatory in hospital systems for decades, facilitating the rapid identification and management of cardiac arrest before the arrival of the cardiac arrest team. DPI Project – Proposal Defense PowerPoint and Call
Acquisition and retention of resuscitation skills
Rapid response systems and teams
Evidence Based Practice (Maglangit, 2015)
IHI 100,00 Lives Campaign (IHI, 2008)
Delays associated with high mortality
Early intervention, improves patient outcomes (Readron, Fernando, Maruphy, Rosenberg, & Kyeremantegn, 2018).
Rapid response systems are considered a powerful tool in patient safety (Jung et al., 2016). A rapid response team (RRT) is an evidence-based practice (EBP) that most hospitals in the country are utilizing (Maglangit, 2015). The RRT is one of the six initiatives that the IHI 100,000 Lives Campaign identified in 2004 (Mate, 2017). Delays in activating RRT calls are associated with high mortality, while early intervention during clinical deterioration can improve patient outcomes (Reardon, Fernando, Murphy, Rosenberg, & Kyeremanteng, 2018). Early RRT calls are associated with decreased mortality, while late calls are associated with increased patient morbidity and mortality (Jones, Moran, Winters, & Welch, 2013). Early requests for assistance allow identification of patients at risk of deterioration and target interventions to improve patient care (Maharaj, Raffaele, & Wendon, 2015). Recognition of altered physiological observations to complex process involves knowledge and experience (Guinane, Bucknall, Currey, & Jones, 2013).
Issues of delayed response and failure to notify the RRT are related to the inability to recognize patients’ deterioration and be associated with environmental factors. According to Jenkins, Astroth, and Woith (2015), recognition and addressing barriers can improve rapid response’ system safety culture and can have a positive impact on cardiac or respiratory arrests and mortality outside the intensive care unit (ICU). These barriers are related to perceptions that one has the necessary skills and abilities to perform or face issues or challenges related to navigation of the intra-professional and inter-professional hierarchies that lead to delays in activating the team when the patient condition deteriorates (Jenkins et al., 2015). Other possible system failures identified are multiple factors including delays in diagnosis and misdiagnosis (on physician’s side), inadequate interpretation of clinical symptoms, incomplete treatment, inexperienced staff, and patient management in appropriate clinical areas (Bagshaw et al., 2010 as cited in Jenkins et al., 2015).
Clinical nursing staff often provides suboptimal CPR during IHCA
Due to inadequate skills retention (Maiken, Castren, Nurmi, & Niemi-Murola, 2016; McHugh et al., 2016; Saramma, Raj, Dash, & Sarma, 2016)
Delay in recognition of clinical deterioration (Andersen et al., 2019)
Survival is lower; early initiation of CPR links with improved outcomes for both out-of-hospital and IHCA (Bircher, Chan, & Xu, 2019).
Perceived low level of confidence in ability to perform CPR
Infrequent opportunities to perform CPR
Lower proficiency, leading to hesitancy (Makinen et al., 2016)
The incidence of IHCA in the medical-surgical setting poses distinct challenges for acute care nurses. Considering that early interventions could save lives, issues concerning delays in calling the RRT do exist. The recognition of physiological observations and response to complex processes involves knowledge and experience, and early intervention and escalation of care are essential (Guinane et al., 2014). The clinical staff is often providing suboptimal CPR due to inadequate skills retention (Makinen et al., 2016; McHugh et al., 2016; Saramma et al., 2016), recognition of clinical deterioration leading to delay initiating CPR (Andersen et al., 2019), and hesitation to start CPR, which is associated with perceived low level of confidence in their ability to perform (Adcock et al., 2020; Makinen et al., 2016).
Nurses’ self-efficacy with a timely response to IHCA is a critical link to the delivery of American Heart Association (AHA) basic life support (BLS) recommendations with the outcome of survival of cardiac arrest (Makinen et al., 2016).
History at project site:
Rolling 12-month data for IHCA indicates that 44.6% of cardiac arrests occurred outside of the ICU
59.60% occurred in the medical-surgical division (i.e., outside of ICU and Progressive Care Unit (PCU)) equating to 5.16 per 1,000 discharges.
For the month of May 2020, the incidence rate per discharges of IHCA in the medical surgical areas/units was 6.08 per 1,000 discharges.
Survival to discharge rate of 29%, better than the national average of 24.8%; however, only 38% of non-ICU codes had a rapid response within the previous 24 hours.
Code Blue committee:
Appropriate patient placement outside of ICU
Patients are sicker than their level of care placement
Delay in recognition of patient deterioration resulting in the delayed activation of the rapid response team (RRT)
Failure to rescue in medical-surgical patient population
The project site Code Blue committee notes appropriate patient placement as a factor outside of ICU IHCA; patients are sicker than their level of care placement. Whenever the RRT is activated, patients are treated then transferred to a higher level of care. However, as noted in previous slide, only 38% of codes occurring outside of the ICU had a rapid response within the previous 24 hours. Clinical staff outside of the critical care areas may not have the exact knowledge, skills and experience in treating critically ill patients, however, they are instrumental in implementing a timely and appropriate intervention to prevent deterioration and reduce mortality and morbidity because timely deployment most often depends on staff nurses (Massey et al., 2017). Currently, there exists a nursing practice issue of failure to rescue in the medical-surgical patient population (i.e., a delay in recognition of patient deterioration resulting in the delayed activation of the RRT).
The rationale for many of these strategies on implementing a timely and appropriate intervention is to prevent patients from deteriorating through providing education, informing staff of data, and providing them with the necessary skills (Massey et al., 2017). Due to their proximity to patients and familiarity with their clinical conditions, bedside nurses are ideally positioned to alert the RRT for anticipatory response and intervention (Connell et al., 2016). They are the first caregivers to identify the subtle changes in the patient’s condition, indicating clinical deterioration. They must be educated and trained to activate preemptively and proactively the rapid response system (RRS) (Jenkins, Astroth, & Woith, 2015).
Code blue nurse champion
The literature is sparse on code blue nurse champion roles; however, Banks and Trull (2012) employed a process improvement strategy implementing code blue nurse champions. The strategy educates code blue champions by using simulations and a communication framework. Educators collaborated with experienced code leaders to develop a framework for the tasks, roles, and priorities of code management. Each person was responsible for a specific task to provide a focused approach to a potentially chaotic situation (Banks & Trull, 2012). Team training included the application to simulated realistic patient situations allowing individuals to practice as a team. The champions then use their education to improve practice in their departments (Banks & Trull, 2012). The authors note findings demonstrated that nurses’ report increased confidence and competence in managing a code blue situation, and patient outcomes reflect the improvement in skills. The results of code blue champions on each unit reported a 74% survival rate compared to the national average of 44% (Banks & Trull, 2012).
The purpose of the project is to compare the impact of the implementation of the code blue nurse champion role in a select nursing medical-surgical division patient care department on nurses’ self-efficacy to initiate cardiac resuscitation and survival of IHCA.
The focused education for the code blue nurse champion role includes IHI rapid response education (IHI, 2008) and participation in cardiac arrest in situ simulation scenario (Liaw, Rethans, Scherpbier, & Piyanee, 2011).
Importance of project
Survival depends on early recognition (Chang et al., 2018).
Literature indicates that adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016).
Interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation (Connell et al., 2016).
When a nurse has self-confidence, recognizing, and responding appropriately to an emergency is increased (Horowitz, 2018).
Adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016).
Patient safety is a hospital priority. Survival of cardiac arrest event depends on early recognition of the event and immediate response including activation of a “code blue” team and initiation of high-quality CPR (Chang et al., 2018). An integrative review of the literature revealed that CPR skills retention and poor-quality CPR remain a major challenge in the clinical setting. The findings have consistently demonstrated that the quality of CPR is directly related to survival outcomes. Literature indicates that adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016). CPR training helps individuals learn and apply cognitive, behavioral, and psychomotor skills then develop the self-efficacy to provide CPR when necessary (Bhanji, Finn et al.,2015; Horowitz, 2018). Nurses are often the first to activate the chain of survival when a cardiorespiratory arrest happens. It is crucial that nurses keep their knowledge and skills up to date, as well as attitudes to resuscitation are very important (Tiscar-Gonzalex, Blanco-Blanco, Gea-Sanchez, Molinuevo, & Moreno-Casbas, 2019). Many times, nurses lack the confidence to identify a deteriorating patient. When a nurse has self-confidence, recognizing, and responding appropriately to an emergency is increased (Horowitz, 2018). Adequate training and evaluation are essential to ensure that CPR skills are correctly acquired, translating into clinical practice (Brennan et al., 2016; Gonzalez et al., 2016). DPI Project – Proposal Defense PowerPoint and Call
Bandura self-efficacy (BSE) theory
Bandura (1982) defined confidence as “the perception that one is competent and capable of fulfilling particular expectations’” whereas self-efficacy is the personal judgment of “how well one can execute courses of action required dealing with prospective situations” (p. 122).
Confidence is important as it may influence the degree of self-efficacy experienced
Individuals are more likely to engage in behaviors if they have confidence in their ability to perform the task (Bandura, 1995).
Applying this theory, Participants that have received the training will potentially respond to patient deterioration with more confidence.
The Transtheoretical Model (TTM)
Health behavior change involves progress through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination
Focus on the individual’s decision making
Model of intentional change
Key assumption: people do not change behaviors quickly and decisively; instead, change in behavior, especially habitual behavior, occurs continuously through a cyclical process (Boston University School of Public Health [BUPH], 2019).
Based on the processes of change in TTM, behavioral change in the attitude stage facilitated by raising awareness, discussing relevant events and cases, and providing effective models, media campaigns, and group discussion opportunities (Keshmiri et al., 2017).
For nurses to move from the pre-contemplation to the termination stage, education needs to be effective, focusing on the harmful effects of “failure to rescue” [current state] and identify with the positive benefits of timely initiation of cardiac resuscitation.
Does the implementation of a code-blue nurse champion role, as a cardiac arrest first responder, improve nursing self-efficacy to initiate cardiac resuscitation and survival of IHCA patients when compared to current practice among adult medical surgical patients in an acute care hospital in California over four-weeks?
Q1: Does educational training consisting of IHI rapid response education, and cardiac arrest in situ simulation for code blue nurse champion nurses’ increase self-efficacy in responding to cardiac arrest?
Q2: Does the implementation of a code blue nurse champion role increase survival of IHCA?
This project is based on the following overall question—
Sub questions include…
Statistical analysis to analyze data
Objective measurements; used to test or confirm theories and assumptions (Fain, 2017).
Cause and effect relationship; convey numerically what is seen in research; arrive at specific, observable conclusions (Klazema, 2014).
One Group quasi-experimental design
Assess the effectiveness of implementation of the code blue nurse champion role to improve IHCA survival
Identify if the additional training makes a difference in nurses’ timely recognition of patient deterioration and if appropriate action impacts the survival of IHCA
In other words, Discover through statistical analysis quantifiable, objective data related to the implementation of code blue nurse champion role on nurses’ self-efficacy to respond cardiac arrest and survival of IHCA. DPI Project – Proposal Defense PowerPoint and Call
Specifics on Methodology: PICOT
P=Acute Care Registered Nurses’; Hospitalized patients experiencing IHCA
I=Code blue nurse champion role
O=Improved nurse knowledge, self-efficacy [attitude] towards CPR; improved IHCA survival
T=Over six weeks timeframe
Specifics on methodology: Variables
Characteristics of Variables
Specifics on methodology: Population and Sample
Voluntary convenience sample of RNs (at least 16) from medical-surgical department, 4S
Equal representation from night shift (1900 to 0730) and day shift (0700 to 1930)
To achieve the effect size of 0.80 and an alpha level of significance of 0.05, twenty-five subjects are required
IHCA patients during project timeline
Hispanic ethnicity represents a high proportion of the population
Cardiovascular disease (CVD) is a leading cause of death among Hispanic adults (Balfour et al, 2016).
Hispanic population, compared to the non-Hispanic population, less than 10 percent of affected Hispanic patients are effectively managing their disease (e.g., use of anti-hypertensive medications) (Carlson et al., 2019) leading to higher US health care costs and hospitalization.
Specifics on methodology : Instrument
Nursing Knowledge and Attitude in Cardiorespiratory Arrest (CAEPCR) questionnaire (Tiscar-Gonzalez et al., 2019)
Three distinct sections
Knowledge of CPR
Attitude / Self-efficacy
Three Delphi rounds
Piloted on a test-retest basis with a convenience sample of 30 RNs (Tiscar-Gonzalez et al., 2019); psychometric characteristic evaluated by 347 nurses
The Knowledge and Attitude of Nurses in the Event of a Cardiorespiratory
Arrest (CAEPCR) questionnaire comprised three sections: sociodemographic
information, theoretical and practical understanding, and attitudes of ethical issues.
The questionnaire was designed using the Delphi technique (three rounds). The
questionnaire was adjusted and it was piloted on a test-retest basis with a convenience
sample of 30 registered nurses. Psychometric characteristics were evaluated using
a sample of 347 nurses using Cronbach’s alpha. Descriptive analysis was performed
to describe the sociodemographic variables and Spearman’s correlation coefficient
to assess the relationship between two scale variables. Pearson’s chi-squared test used to study the relationship between two categorical variables. Wilcoxon Mann
Whitney test and the KruskalWallis test were performed to establish relationships
between the demographic/work related characteristics and the level of understanding. DPI Project – Proposal Defense PowerPoint and Call
Cronbach’s alpha for the internal consistency of the attitudes questionnaire was 0.621.
The knowledge that nurses self-reported with regard to cardiopulmonary arrest directly
affected their attitudes. Their responses raised a number of bioethical issues.
Conclusions. CAEPCR questionnaire is the first one which successfully linked knowledge
of cardiopulmonary resuscitation to the attitudes towards ethical issues Health
policies should ensure that CPR training is mandatory for nurses and all healthcare
workers, and this training should include the ethical aspects.
Specifics on methodology: Instrument (cont.)
Electronic Medical Record (EMR)
Source of data for cardiac arrest events
Queried based on an internal report from hospital operator for activation of code blues
Code blue documentation record embedded in the EMR as a scanned document
Process is determined to be sound based on random audits of actual code blue events and cross validation with internal operator report
Specifics on methodology: Intervention
Code Blue Nurse Champion role education:
Rapid response education (IHI, 2008)
Includes rapid response team (RRT) composition, role, and purpose, patient physiological changes and early warning signs of deteriorating status, when to call RRT, how to call RRT, and the SBAR (Situation, Background, Assessment, and Recommendation(s)) communication that should be used during calls.
In situ simulation—cardiac arrest scenario
Focused on responding to a deteriorating patient, specifically on cardiac arrest
team roles, prioritizing actions, and effective communication, inclusive of the role of RRT.
Scenario is based upon AHA BLS and ACLS standards for frontline responders (Liew et al., 2011).
The staff must identify the unresponsive, apneic adult patient, call the code, assess the carotid pulse, and provide high quality CPR. Additional responders arrive with the crash cart and automated external defibrillator (AED), turn on AED and apply pads, analyze rhythm, and safely defibrillate if the AED indicates a shockable rhythm. Responders set up oxygen and suction, appropriately communicate with the code team (e.g., through SBAR format), and prepare to assist physician provider with endotracheal intubation. DPI Project – Proposal Defense PowerPoint and Call
Specifics on Methodology: data collection (cont.)
Day of class:
Each participant receives CAEPCR questionnaire. Instructed to be anonymous
Seal and place their completed pre and post survey tools in a marked separate envelopes (pre-survey and post-survey) after completion.
Each envelop is labeled by the project lead with a numerical value (e.g., one to 16, depending on the number of participants); identical numbers for pre and post envelops will correlate to associate with same participant.
Completed survey tools will only be accepted when they are placed in an envelope and are sealed by the participants.
The surveys will be placed in a locked cabinet in the project lead’s office on hospital property and will only be opened by the project lead during data coding and analysis.
The data will be entered into a password protected computer for analysis.
Survey results will not be shared with any personnel not directly associated with the development and implementation of the project. After the study is completed, survey results will be shredded and disposed of in a protected hospital bin. DPI Project – Proposal Defense PowerPoint and Call
Specifics on methodology: Data collection (cont.)
Provided by Quality Management Specialist; internal reports on documented code blue activations, initiated by the hospital operator.
Data extracted from the electronic health record (EMR) including scanned code blue documentation records.
Data is compiled in an excel spread sheet.
Data points include inpatient location, date and time of cardiac arrest, and outcome of arrest (i.e., survival or expired). Only cardiac events occurring within the project site’s nursing department on a single medical-surgical unit will be included.
Quality Management Specialist to provide project lead raw data; no PHI included.
Specifics on methodology: data analysis
Descriptive statistics for categorical variables (gender, age, years of experience as RN, last completed CPR course, frequency of performing CPR, recommended frequency of renewal, able to attend a real CPR event). DPI Project – Proposal Defense PowerPoint and Call
Scores range from zero to 11—reflective of correct answers
Paired one tail t test to analyze data—difference between paired scores and ranking difference
Attitude (self-efficacy) section
Likert scale one (strongly disagree) to five (strongly agree)
Total scores maximum of 60
Paired one tail t test to analyze data–difference between paired scores and ranking difference
Specifics on methodology: data analysis (cont.)
Data extracted by Quality Management Specialist
Numerator survival of IHCA
Denominator total IHCA during project timeline
Data analysis using one tail paired t test for dependent means
Specifics on methodology: data analysis (cont.)
Nurses knowledge of CPR
Nurses attitude (self-efficacy)
Survival of IHCA
One-way multivariate analysis of variance (MANOVA) will be used to determine whether there are any differences between the dependent groups
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Practice Hours Completion Statement DNP-960
I, Beverly Holland, verify that I have completed 10 clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and preceptor/mentor.
Variable Variable Type Level of Measurement Code Blue Nurse Champion Role Independent Nominal Patient survival IHCA Dependent Ratio Nurses’ self-efficacy (attitude) Dependent Ratio Nurses’ knowledge Dependent Ratio
Code Blue Nurse Champion Role Independent Nominal
Patient survival IHCA Dependent Ratio
Nurses’ self-efficacy (attitude) Dependent Ratio
Nurses’ knowledge Dependent Ratio