PICO Change Project, health and medical homework

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You will need to use the attached files. The PICO Evidence worksheet file contains the PICO question and the references that you will need to complete this paper. The Design Proposal Guidelines must be followed appropriately. The third file is the template that you will need to use. Please don't create your own. Please follow all instructions from the guidelines as well as formatting it according to the template. It should be about 4-6 page, APA formatted and No plagiarism.

NR451_Milestone1_PICO_Evidence_Worksheets_5-18-15.docx 

NR451_Milestone2_Design_Proposal_Guidelines.docx 

NR451_Milestone2_Design_Proposal_Template_9-23-15.docx 


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Chamberlain College of Nursing NR 451 RN Capstone Course Capstone Project Milestone #1: PICO and Evidence Appraisal Worksheets PICO WORKSHEET Your Name: Date: Your Instructor’s Name: Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project. Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements. Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question. Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question) Step 3: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply. Step 4: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question? Step 5: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? What databases will you search? How will you narrow your search if needed? NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk 1 Chamberlain College of Nursing NR 451 RN Capstone Course PICO Worksheet What is the PICO question? What is the effectiveness of interventions to improve culturally appropriate health care for racial/ethnic minority children and adults? Define each element of the question below: P- (Patient, population, or problem): Racial/ethnic children and adults I- (Intervention): Cultural competence/ culturally appropriate care provider/ nurse education and training C- (Comparison with other treatment/current practice): No proper cultural competence education/ training or cultural competence/ culturally appropriate care provider/ nurse education and training O- (Desired outcome): Provider/ nurse knowledge, attitudes, and competencies (skills) in providing culturally competent health care; such as clinical decision-making, communication What is the practice issue/problem? With a large population of immigrants and refugees patients, providers/ nurses need to be more educated and trained on various cultures that different than their own. What is the practice area? _x__ Clinical _x__ Administration _x__ Education ___ Other How was the practice issue identified? (check all that apply) __x_ Difference between hospital and community _x__ Safety/risk management concerns practice _x__ Unsatisfactory patient outcomes _x__ Clinical practice issue is a concern _x__ Wide variations in practice ___ Procedure or process is a time waster _x__ Significant financial concerns ___ Clinical practice issue has no scientific base ___ Other: What evidence must be gathered? (check all that apply) _x__ Literature search _x__ Clinical Expertise _x__ Guidelines ___ Financial Analysis _x__ Expert Opinion _x__ Standards (Regulatory, professional, community) _x__ Patient Preferences _x__ Other NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk 2 Chamberlain College of Nursing NR 451 RN Capstone Course Search terms: Cultural competency, diversity, education, training, clinical decision making, disparities, nursing, communication, interventions, Databases to search: CINAHL, PubMed, Medline Search Strategies: Cultural competence OR cultural sensitivity OR cultural safety OR cross-cultural; Interventions “AND” training “AND” education EVIDENCE APPRAISAL WORKSHEET Your Name: Date: Your Instructor’s Name: Purpose: To find evidence to support an intervention that will change the outcomes. Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The fourth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources. Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual. Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source. Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for nonresearch evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk 3 Chamberlain College of Nursing NR 451 RN Capstone Course discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW. Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations? NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk 4 Chamberlain College of Nursing NR 451 RN Capstone Course Evidence Appraisal Worksheet PICO Question: APA Reference for Article Give the APAformatted reference for the article. Type of Source Strength of Research *Research: Peerreviewed article Discuss the strength of the sources. *Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238244 of your text and discuss the reasons why you have assigned a particular level of quality. Brief Description of Research Address the questions. *How does the information in the article apply to the project problem or proposed intervention? *Summarize in your own words. * Include results of the study and how these results are applicable to your project. * What is the recommendation of the source for clinical practice? 1 Loftin, C., Hartin, V., Branson, M., & Reyes, H. (2013). Measures of Cultural Competence in Nurses: An Integrative Review. The Scientific World Journal, 2013, 1-10. doi:10.1155/2013/28 9101 Non-research integrative review Low- due to the fact the limitations of the reviewed cultural competence instruments utilized were measured based on the individual’s self-perception of cultural competence or cultural selfefficacy NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk The article is based upon various instruments used to determine nursing students and nurse educators on cultural competency, there are many limitations due to various amounts and types of instruments used to gauge these individuals selfperception and did not really provide an actual or true assessment of cultural 5 Chamberlain College of Nursing NR 451 RN Capstone Course competence. These instruments give a system for assessment and reassessment that is promptly accessible and effortlessly directed. A few of the instruments can be controlled in as few as 10–15 minutes. It has been proposed that further improvement of these assessments incorporates some target measures or points of view of the client with an end goal to give a more finish evaluation of the nurse's cultural competence. Without some measure to survey cultural competence as far as results for the patients, the nurse's capacity to claim competence, as well as to give culturally competent care will stay obscure. 2 Like, R. C. (2011). Educating clinicians about cultural competence and disparities in health and health care. Journal Of Continuing Education In The Health Professions, 31(3), 196-206 11p. doi:10.1002/chp.2012 7 Peer-reviewed Good- Because it provide various methods of intervention on educating and training healthcare providers and nurses on cultural competency NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk This article provides an overview of healthcare policy, legislative, accreditation, and professional initiatives relating to these subjects. The status of CME offerings on cultural competence/inconsist encies is reviewed, examples provided of available curricular 6 Chamberlain College of Nursing NR 451 RN Capstone Course resources and online courses. Overall, the quantitative feedback was generally positive with excellent or very good ratings in the 84% to 66% range on Level1 (Participation) and 2 (Satisfaction) outcomes relating to program organization, content, presentation, and educational value. Training clinicians to give socially skillful consideration is a key methodology for decreasing these inconsistencies. Health care arrangement, administrative, accreditation, and expert activities have highlighted the significance of socially able administration conveyance and the end of racial and ethnic disparities. 3 Kutob, R. M., Bormanis, J., Crago, M., Harris, J. M., Senf, J., & Shisslak, C. M. (2013). Cultural Competence Education for Practicing Physicians: Lessons in Cultural Humility, Nonjudgmental Behaviors, and Health Beliefs Elicitation. Journal Of Continuing Peer-reviewed Great- This article provide in depth analysis of cultural competency of physicians caring for a diverse population of individuals with diabetes. NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx This article examined various gaps in knowledge of cultural competence teaching and assessment by describing the course in design and development process and also by focusing on practicing physicians. Of the 117 physicians who responded to the 5/18/15 mk 7 Chamberlain College of Nursing NR 451 RN Capstone Course Education In The Health Professions, 33(3), 164-173 10p. doi:10.1002/chp.2118 1 study invitation letter, 4 were ineligible and 3 did not complete the screening procedures. Of the remaining 110 physicians, 51 were assigned to the control group and 59 to the intervention group. A total of 90 physicians completed the study: 41 in the control group and 49 in the intervention group. All intervention group physicians completed the required minimum of three modules. This skills-based approach helps physicians to avoid coming to premature, judgmental conclusions regarding patients' adherence to therapy without asking about patients' views and preferences in regard to treatment. This model may also foster an increased sense of cultural humility. 4 Mareno, N., & Hart, P. L. (2014). Cultural Competency Among Nurses with Undergraduate and Graduate Degrees: Implications for Nursing Education. Nursing Education Perspectives, 35(2), 83-88 6p. Peer-reviewed Great article for my research because it provide information in terms of how nurses perceived cultural competency. NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk This article was aimed to compare the levels of cultural awareness, knowledge, skills and comfort of nurses with either an undergraduate or graduate degree when caring for patient of diversity. 8 Chamberlain College of Nursing NR 451 RN Capstone Course doi:10.5480/12-834.1 There were about 2,000 surveys sent to nurses in southeastern states; 360 nurses participated. It was stated that undergraduate degree nurses scored lower than graduate nurses on cultural knowledge and score for cultural awareness, skills and comfort varied between both groups. However, both groups reported little cultural diversity training in the work place of in nursing schools. It is important for nursing educators to focus on cultural competency so that when nurse enter into their filed they are well trained and educated. NR451 Milestone1 PICO Evidence Appraisal Worksheets.docx 5/18/15 mk 9 Chamberlain College of Nursing NR 451 RN CAPSTONE COURSE Capstone Project Milestone #2: Design for Change Proposal Guidelines PURPOSE You are to create a Design for Change proposal inclusive of your PICO and evidence appraisal information from your Capstone Project Milestone #1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program. COURSE OUTCOMES This assignment enables the student to meet the following course outcomes. CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through longterm planning. (PO #1) CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO #2) DUE DATE Milestone #2 consists of the proposal for your Design for Change Capstone Project. Submit this Milestone to the Dropbox by the end of Week 4. POINTS Milestone #2 is worth 225 points. DIRECTIONS 1. Create a proposal for your Design for Change Capstone Project. Open the template in Doc Sharing. You will include the information from Milestone #1, your PICO question, and evidence appraisal, as you compose this proposal. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. 2. The format for this proposal will be a paper following the Publication manual of APA 6th edition. 3. The paper is to be four- to six-pages excluding the Title page and Reference page. 4. As you organize your information and evidence, include the following topics. a. 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 NR451_Milestone2_Design_Proposal_Guidelines.docx 03/24/14 mk 1 Chamberlain College of Nursing NR 451 RN CAPSTONE COURSE Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution. b. Change Plan: Write an overview using the John Hopkins Nursing EBP Model and Guidelines (2012) i. Practice Question ii. Evidence iii. Translation c. Summary 5. 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. 6. 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. GRADING CRITERIA: DESIGN FOR CHANGE CAPSTONE PROJECT Category Points % Introduction 25 11% Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified. Change Plan; Practice Question (Steps 1–5) 50 22% Activities to achieve the first steps of change are fully described in detail and are based on the first five steps of the John Hopkins EBP Process; Practice Question. Change Plan; Evidence (Steps 6–10) 50 22% Activities to achieve steps six through ten of the John Hopkins EBP Process are fully described in detail; Evidence. Change Plan; Translation 50 22% Activities to achieve the final steps of change are fully described in detail and are based on steps 11 through 18 of the John Hopkins EBP Process; Practice Question. Summary 25 11% Clear, solid summary summarizing the key points and steps of the change plan is included; ways to maintain the change plan are described. APA Format 25 11% Minimal errors. 225 points 100% (Steps 11–18) Total Description NR451_Milestone2_Design_Proposal_Guidelines.docx 03/24/14 mk 2 Chamberlain College of Nursing NR 451 RN CAPSTONE COURSE GRADING RUBRIC: CAPSTONE PROJECT MILESTONE #2 Assignment Criteria Outstanding or Highest Level of Performance A (92–100%) Very Good or High Level of Performance B (84–91%) Competent or Satisfactory Level of Performance C (76–83%) Poor, Failing or Unsatisfactory Level of Performance F (0–75%) Introduction 25 points Introduction to the plan is nursing focused, with evidence-based problem identification and potential solutions clearly identified. 23–25 points Introduction to the plan is nursing focused, with evidence to support the problem and potential solution identified but convincing areas are missing. 21–22 points Introduction to the plan is provided; however, evidence to support the problem and potential solution is not convincing. 19–20 points Introduction lacks evidence to support need for change and/or potential solution is not realistic. 0–18 points /25 Change Plan Practice Question (Steps 1–5) 50 points Activities to achieve the first five steps of change are fully described in detail and are based on the first section of the John Hopkins EBP Process: *Practice question is identified. *Scope of the problem discussed (including supportive statistics). *Stakeholders identified. *Team is identified. 46–50 points Activities to achieve the first five steps of change are fully described, not in detail but are based on the first section of the John Hopkins EBP Process: *Practice question is identified. *Scope of the problem discussed (including supportive statistics). *Stakeholders identified. *Team is identified. 42–45 points Activities to achieve the first five steps of change are vague. The first section of the John Hopkins EBP Process is not clearly identified. *Practice question is identified. *Scope of the problem does not contain statistics to support the problem. *Stakeholders are identified but not appropriate or missing key members. *Team members are identified but not appropriate or missing key members. 38–41 points Activities to address and support change are not specifically addressed. Portions of the first five steps are missing or absent. 0–37 points /50 Change Plan Evidence (Steps 6–10) 50 points Activities to achieve steps six through ten of change are fully described in detail and are based on the first section of Activities to achieve steps six through ten of change are vague and are based on the first section of the John Hopkins Activities to achieve steps six through ten of change are vague and are based on the first section of the John Hopkins Activities to achieve steps six through ten of change may be missing or absent. *Less than four /50 NR451_Milestone2_Design_Proposal_Guidelines.docx 03/24/14 mk Total 3 Chamberlain College of Nursing Change Plan Translation (Steps 11–18) 50 points NR 451 RN CAPSTONE COURSE the John Hopkins EBP Process: Evidence is identified. *At least four reliable sources are used, three of which are peerreviewed. *Summary of evidence is thorough and detailed. *Strength of evidence is discussed. *Recommendation for change is based on evidence and is thorough. 46–50 points EBP Process: Evidence is identified. *At least four reliable sources are used, three of which are peerreviewed. *Summary of evidence is vague. *Strength of evidence is discussed. *Recommendation for change is based on evidence but connection is vague. 42–45 points EBP Process: Evidence is identified. *At least four reliable sources are used but less than three are peer-reviewed. *Summary of evidence is vague. *Strength of evidence is not discussed. *Recommendation for change is present but not weak connection to the evidence. 38–41 points reliable sources are used. *Summary of evidence is not present or missing important elements. *Strength of evidence is missing. *Recommendation for change lacks support from evidence. 0–37 points Activities to achieve the last steps of change are fully described in detail and are based on the last steps of the John Hopkins EBP Process: Translation. *Action plan is well-developed with specific timeline in place to include all elements of the plan. *Measurable outcomes and way to report results are discussed in detail. *Plan for implementation is thoroughly discussed. *Ways to communicate findings (internally and externally) are discussed. Activities to achieve the last steps of change are described and are based on the last steps of the John Hopkins EBP Process: Translation. *Action plan is developed with specific timeline in but some elements of the timeline are missing. *Outcomes are present but not measurable. Ways to report results are discussed in detail. *Plan for implementation is discussed. *Communication of findings is present but does not address both internal and external ways. Activities to achieve the last steps of change are vague. *Action plan is developed but timeline is missing. *Outcomes are vague and not measurable. Ways to report results are discussed but not in detail. *Plan for implementation is vague. *Communication of findings is missing. 38–41 points Activities to achieve the last steps of change are vague or missing. *Action plan is not well-developed or missing. *Outcomes are vague or not present. Ways to report results are discussed but not in detail. *Plan for implementation is not present. *Communication of findings is missing. 0–37 points NR451_Milestone2_Design_Proposal_Guidelines.docx 03/24/14 mk /50 4 Chamberlain College of Nursing NR 451 RN CAPSTONE COURSE 46–50 points 42–45 points Summary 25 points Clear, solid summary of the key points and the change plan are included; ways to maintain the change plan are described. 23–25 points A clear summary of the key points and part of the change plan are provided; ways to maintain the change plan are mentioned, but not in detail. 21–22 points A summary is present but is vague; parts of the change plan are highlighted; ways to maintain the change plan are not clear. 19–20 points A summary is difficult to determine or absent. Key points of the change plan are not recapped or are absent. 0–18 points /25 APA formatting, scholarly writing 25 points APA format sixth edition: third person, grammar, sentence structure, punctuation, and spelling; sources correctly cited and referenced; title page, headers, and page numbers. No errors to one error. 23–25 points Two to three errors. 21–22 points Four to five errors. 19–20 points Multiple errors 0–18 points /25 Total Points /225 Reference: Dearholt, S. L., & Dang, D. (2012).Johns Hopkins Nursing Evidence Based Practice: Model and Guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. NR451_Milestone2_Design_Proposal_Guidelines.docx 03/24/14 mk 5 Running head: TYPE SHORT TITLE IN ALL CAPS Title Your Name Chamberlain College of Nursing NR451 RN Capstone Course Term and Year 1 TYPE SHORT TITLE IN ALL CAPS 2 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 that you will keep all the bolded headings and just remove the non-bolded content when you start your paper. Change Model Overview In this first paragraph, provide an overview of the John Hopkins Nursing 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 John Hopkins EBP Process. Practice Question Step 1: Recruit Interprofessional Team 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) Step 2: Develop and Refine the EBP Question Restate your question. Include the PICO elements but make sure you write them in paragraph form and not in list format. Step 3: Define the Scope of the EBP Why is this a problem? Give statistics and information to back the scope of the problem. How does this problem impact healthcare on a broader scale? Steps 4 and 5: Determine Responsibility of Team Members TYPE SHORT TITLE IN ALL CAPS 3 Why are the members chosen important to your project? What are their roles? Evidence Steps 6 and 7: Conduct Internal/ External Search for Evidence and Appraisal of Evidence What type of evidence did you find? EBP guidelines? Quality improvement data? Position statements? Qualitative research? Quantitative research? 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. Steps 8 and 9: Summarize the Evidence Synthesize the information that you obtained from your sources. You will need at least four sources. Of these four sources, three must be from peer-reviewed articles. The other source can be from a reputable source. See page 44 of your text for examples of sources you can use. In this section, you need to synthesize the information from the articles. Feel free to cite multiple articles within one sentence. This section should be one paragraph that is a summation of information from the multiple articles. Be sure and cite all of your references, in proper APA format, from the articles into this one paragraph. Step 10: 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 Steps 11, 12, and 13, 14: 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 TYPE SHORT TITLE IN ALL CAPS 4 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. Steps 16 and 16: Evaluating Outcomes and Reporting Outcomes What are the desired outcomes? How will they be measured? How will you report the results to the key stakeholders? Steps 17: 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? Step 18: 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 three levels of change for the John Hopkins EBP process. TYPE SHORT TITLE IN ALL CAPS 5 References
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