N492 - Change project plan - Implementing Early Ambulation After Surgery

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timer Asked: Jan 27th, 2021

Question Description

Find and topic of interest in your organization/hospital that you can change. See Rubric for description. Attach is rubric and example of plan change topic. My topic of Interest is Implementing Early Ambulation After Surgery

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CAPSTONE CHANGE PROJECT PLAN The purpose of this assignment is to apply nursing leadership and capstone concepts learned over the course of the semester to bring about change. The change can be actual, potential, or hypothetical. It must be addressed within the context of a health care setting and relate management concepts. The change should be written as though it will be implemented sometime within the next year - not a description of a change that has already been implemented. Ideas for the Capstone Change Project Plan include but are not limited to the following: • Developing staff training or educational programs • Introducing a change on a unit such as one to be in compliance with The Joint Commission • Developing and implementing new procedures/policies • Developing a specific protocol • Developing of a parish nurse program • Developing of a community health fair • Implementing a new piece of equipment • Implementing a best practice or quality improvement plan • Creating a new leadership structure • Improving recruitment or retention • Dealing with conflict The setting may be real or fictitious, but you should determine the location, size, setting, leadership models, etc. Anticipated length of paper is 7-8 pages (not including cover page or references section). Your paper must contain a minimum of 5 scholarly (peer reviewed) journal articles cited in the paper to support your chosen change and included in the reference list (this is in addition to any textbook citations/references). Please submit to the D2L “Assignments” area. Element Partially Addressed or Does not explain or say how so when asked Element Insufficiently Addressed or Not Addressed 4 10 4 8 Pts. earned PART 1 Elements Introduction (1 pt. each)  Introduce the proposed change-what is it? Include key highlights  Impetus for change-why is it needed?  Change theory you will use to implement the change (& cite theory)  What are the expected outcomes? Justification for Change-these are your bottom-line selling points: see guidelines below rubric for more details  What is the impact on employee workforce & workload? 1 pt.  What is the economic impact of this change? (PO 5) 1 pt.  Is the change R/T professional regulations? explain (PO 5) 1 pt.  Explain factors related to social justice (PO 5) 1 pt.  Is this change related to Quality/Safety? explain (PO 2) 1 pt.  Best practice evidence to support the change (need citations) 5 pts. Description of Setting: see guidelines below rubric for more details  Describe setting where change will take place 2pts  Describe factors (details) pertinent to change 2pts Description of Stakeholders 2 pts each  Identify those directly impacted by change & how so  Identify those indirectly impacted by change & how so  Will there be any community stakeholders? explain  What are legal/ethical implications? Explain Element Fully Addressed or Does explain or say how so when asked Pts. Possible PROJECT PLAN EVALUATION RUBRIC  IMPORTANT: Be sure your paper addresses every check box of the rubric in order to avoid unnecessarily losing points  Use rubric before, during and after writing your paper & check off each element as you complete it. When element says “explain”, or “how so” do elaborate with details. See also guidelines below rubric. PART II ELEMENTS Communication Strategies (PO 4 & 6) 2 pts. each  What is the communication structure like (describe both formal & Informal)?  How decisions are made (e.g. who makes the decisions & what is the organizational structure)?  How will the change be communicated?  What specific leadership support is necessary to accomplish this change? Managing Resources (1 pt. each)  Describe how you will prepare yourself for leading this changeconsider your current work load and how you will manage the increase responsibilities of a change agent  What concerns do you have for putting your change into action?  How confident are you in the success of this change? explain  What budgetary, space, or human resources needed for change implementation?  How can this change be sustained over time? explain Change Process: see guidelines below rubric for more details  Apply the change theory and implementation of the change to your proposed change including the stages of change (6 pts.)  Describe the proposed change timeline (1 pt.)  Explain how baccalaureate prepared nurses can lead this change through integration of evidence, clinical reasoning, and consideration of interprofessional perspectives (PO 3) (1.5 pts)  Explain-How can baccalaureate prepared nurses exemplify personal and professional accountability and model nursing values and standards? (PO 8) (1.5 pts.) Impact Assessment (2 points each)  How will you determine if the change is doing what it was designed to do?  How you will determine whether the proposed change will enhance or improve health outcomes and how could you measure the outcomes SLO 6)  How can the impact on the health of the population of your setting be determined? (PO 7) Conclusion  Summary of planning process and expected results (1 pt)  Summary of impact on the health care setting (1.5 pts)  Summary of how the project promotes, maintains, sustains, or regains the health of individuals, and/or families, and/or society (stakeholders) (PO 1 & 10) (1.5 pts) Format  Formal paper in APA format (Title page numbers, headings, in-text referencing, reference list, page numbering all according to APA.)  Free of spelling, typographical, and grammatical errors References  Minimum of 5 (five) scholarly (peer reviewed) journal articles cited in the paper to support your chosen change and included in the reference list (this is in addition to any textbook citations/references) Total Points 8 5 10 6 4 5 5 70 GUIDELINES FOR PROJECT PLAN PART 1 Introduction.  Introduce the change.  Outlines the problem or concern that is the impetus for change. What is it? Why is it needed?  What are the key highlights of the change?  What theoretical model will be used to implement the change? Be sure to cite the model.  What are the expected outcomes of this change? Justification for Change Think of these as the bottom line selling points for the change.  How will the change impact the employee workforce? AND What is the anticipated impact on workload?  What is the economic impact of the proposed change?  Is this change related to regulatory requirements? (e.g. The Joint Commission, Nurse Practice Act, RN Licensure)  Explain any factors Related to Social Justice.  Is this change related to quality and/or safety indicators?  What best practice evidence supports the change? You much se peer reviewed literature to support the change.  Include peer reviewed journal articles to support your change  and professional sources such as ▪ IHI toolkits (http://www.ihi.org/resources/Pages/Tools/Quality-ImprovementEssentials-Toolkit.aspx ▪ Cochrane (https://www.cochranelibrary.com/cdsr/about-cdsr) ▪ AHRQ (https://www.ahrq.gov/) Description of the Health Care Setting  Describe the setting where the place will take change. Identity the context in which the change will occur. It can be any health care setting, such as a clinic, community agency, long term care facility, hospital, etc. Your proposed change can pertain to the system or a unit within the system, a group of workers within the system, a shift within the system, etc.  Try to describe in as much detail as you can, factors which are pertinent to your proposed change, such as o number of employees impacted, o size and location of the unit, o mission/philosophy of the organization, o organizational structure, o health care delivery system used, o demographics of the geographical area, etc. Description of Stakeholders (those impacted by the change)  Who will be directly impacted by the change? How will they be impacted? Will this change impact customers? Explain.  Will there be others that are indirectly impacted? Who and how? Will this change impact customers? Explain.  Will there be community stakeholders? Explain (think of people like future patient or employees, health of the surrounding community, insurance holders who are part of the community)  Are there any legal/ethical implications? Explain (legal could be things like possible lawsuits, quality of care, ethical implications include quality of care, social justice, etc) PART 2 Communication  What is the current communication structure within the area of the proposed change, both formal and informal?  How are leadership decisions made (e.g. who makes the decisions, what is the organizational structure)?  Describe-how will the change be communicated?  What specific leadership support is necessary to accomplish this change? Managing Resources  How will you prepare yourself for leading this change? Consider your current work load and how you will manage the increase responsibilities of a change agent)  What concerns might you have about putting your change plan into action?  How confident are you in the success of this change?  What budgetary, space, or human resources are needed for change implementation?  How can this change be sustained over time? Proposed Change Process  Apply a change theory (such as one from your Marquis & Huston text, or the PDSA or Roger’s Stages of Innovation from the Planned Change and Quality Control online modules) to the change. Discuss the process as it relates specifically to your own proposed change, including specific strategies used to implement and bring about the desired change.  Describe the proposed change timeline.  Describe how baccalaureate prepared nurses can lead this change through integration of evidence, clinical reasoning, and consideration of interprofessional perspectives  How can baccalaureate prepared nurses exemplify personal and professional accountability and model nursing values and standards? Impact Assessment  How will you know that the project is doing what it is designed to do?  Describe how you will determine whether the proposed change will enhance or improve health outcomes?  How will you be able to measure these outcomes?  How can the impact on population health be determined? Conclusion  Summarize the expected results of the implemented change.  What is the final impact to the health care setting?  Summary of how the project promotes, maintains, sustains, or regains the health of individuals, and/or, families, and/or society (stakeholders) 1 Implementing Bedside Shift Report Student Name, RN School Course Date Paper Submitted 2 Implementing Bedside Shift Report “Communication among health care personnel is an essential component of safe, effective care. The most frequent period of professional communication in acute care hospitals is the shift-to-shift report by nurses” (Evans et al., 2012, p. 281). Currently, the shift-to-shift report by nurses at Woodwinds Health Campus takes place at the nurse’s station or in the hallway, which can lead to many issues including high levels of noise, frequent interruptions and distractions, patient dissatisfaction, and patient confidentiality issues. To improve these and other issues, change is needed to the current shift-to-shift report system. The change needed is implementing bedside shift report as that standard of practice. “Bedside shift reporting (BSR) is a process where shift-to-shift reporting between nurses is, if approved by the patient, executed at the patient’s bedside to improve the patient’s involvement” (Malfait et al., 2017, p. 482). The planned change will be implemented on the Medical/Surgical/Oncology unit with a goal and expected outcome of respecting patient confidentiality, promoting a calm and quiet environment throughout the hospital unit, improving “patient satisfaction, better clinical outcomes, improvement of health education, and enhanced team coherence” (Malfait et al., 2017, p. 482). This planned change will be implemented using the Plan, Do, Study, Act model (PDSA). Justification for Change Implementing BSR will have not greatly affect the workload of the nurses because current practice already includes a shift report, the planned change moves the shift report from various areas of the unit into the patient room to include them in the discussion and plan of care. The proposed planned change will have an upfront economic factor because nurses will have to be paid for the education regarding bedside shift report, however with the implementation of BSR the organization should see a decrease in overtime which will serve as a positive effect of 3 financial and economic factors. Currently, on the Medical/Surgical/Oncology unit employees are required to fill out a form each shift that they acquire overtime and have the form signed by a charge nurse, or the manager. This form requires the employee to indicate what caused the overtime whether it be the nurse to nurse report, floating to a different unit mid-shift, patient charting/patient care, or missed meal. Nurse to nurse report has ranked the highest reason for overtime consecutively over the past year. BSR “positively influence staff satisfaction, offer beneficial financial effects by reducing nurses’ overtime and allow direct patient care to start earlier” (Malfait et al., 2017, p. 483). This change is not related to regulatory requirements, although it is related to quality and safety indicators. Malfait et al., (2017) states, “The World Health Organization highlights the role that patients and their family can play in the improvement of health care. Active patient participation reduces communication errors, increases patient empowerment and is associated with positive health and psychosocial outcomes. A possible strategy to improve patient participation through communication is the bedside shift report” (p. 483). The Joint Commission also discusses the importance of “patient and family engagement in hospital quality and safety” and highlights bedside reporting through the following strategy, “implement safe continuity of care by keeping the patient and family informed through nurse bedside change-of-shift reports” (Guide to patient, 2013). Description of Health Care Setting Woodwinds Health Campus is an eighty-six-bed hospital surrounded by woods and wetlands in Woodbury, Minnesota. Woodwinds Health Campus is part of a larger organization called HealthEast which consists of three other hospitals, fourteen clinics, home care services, and a transportation center. The mission of this organization is to “improve the health of our neighbors” with a vision of “optimal health and well-being for our patients, our communities, 4 and ourselves” (HealthEast Infonet, 2017). The philosophy of HealthEast is to “provide a ministry of healing throughout the Twin Cities Metro area” and “remains committed to a ministry of compassion and healing in a way that respects the dignity of every person and honors her/his faith, culture, and community” (HealthEast Infonet, 2017). The proposed change will take place on the Medical/Surgical/Oncology inpatient unit at Woodwinds Health Campus. The Medical/Surgical/Oncology unit consists of eighteen private rooms that horseshoe around two nursing stations. This unit consists of two managers, one staff educator, thirty-two Registered Nurses, and twenty Certified Nursing Assistants/Health Unit Coordinators. At times nurses and nursing assistants from the float pool and from other units will be floated to the Medical/Surgical/Oncology unit based on staffing needs. Day and evening shift consists of a charge nurse, five staff nurses, three nursing assistants, and a health unit coordinator, while night shift consists of a charge nurse, three staff nurses, and two nursing assistants. The hospital also employs a nursing supervisor and a SWAT (or resource) nurse for each shift. The Medical/Surgical/Oncology unit consists of a wide variety of patients. Patients on this unit are over the age of seventeen. This unit cares for patients from diverse backgrounds and cultures. Typical patient diagnoses seen on this unit include confusion, altered mental status, weakness, syncope, small bowel obstruction, cellulitis, pneumonia, alcohol withdrawal, seizure, chronic obstructive pulmonary disease exacerbations, asthma exacerbations, and much more. Postoperative patients are also cared for on this unit following surgical procedures such as appendectomies, cholecystectomies, incision and drainages, colectomies, and more. Being a Medical/Surgical/Oncology unit also means that this unit cares for inpatient chemotherapy 5 patients who are cared for by specific nurses on the unit that have received their chemotherapy/biotherapy certification. Description of Those Impacted by Change The facilitators implementing this planned change will include the two nurse managers, the staff educator, and the charge nurses. This group of individuals will be the leaders of the change and act as role models during the change process (Marquis & Huston, 2017, p. 197). These leaders will have to incorporate strategies such as the rational-empirical strategy when it comes time to introduce the change to the staff by providing current research and evidence to support the change because “resistance to change often comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change” (Marquis & Huston, 2017, p. 193). Therefore, these individuals will be directly impacted by the change and have new responsibilities such as initiating and coordinating the change, introducing the planned change educating staff on the change, weekly follow-up with staff, follow-up with patients, and weekly/monthly/yearly audits. The nurses on the Medical/Surgical/Oncology unit will also be directly impacted by the proposed change of implementing BSR as the standard of practice. Change requires action and requires the nurses to step out of their comfort zones and their current practice of hand-off report at the nurse’s station to transition into the new practice of BSR. “Changing practice and sustaining it is challenging and one of the greatest hurdles to successful process improvement” (Lacey, 2017, p. e13). Buy-in by all the nurses on the unit will be necessary for the planned change to be successful. The use of factual evidenced-based information will increase the willingness of the nurses to adopt this new change. BSR will also allow the oncoming nurse to “visualize the patient themselves rather than rely on comments from colleagues” and “visualize 6 the environment; make checks of the IV line, site, and fluids; and ask questions of patients and their colleagues” (Evans et al., 2012, p. 284). Patients will also be directly impacted by this change. Currently, patients are not involved in the nurse to nurse report and may not even be aware that it is the change of shift, or that they suddenly have a new nurse. With the proposed change patients will now have nurses coming into their room at different times throughout the day to conduct BSR. Patients should be given the option on where they would like the report to be done, whether it is in their room with their involvement, or outside their room, if they wish not to be involved, have visitors, etc. By asking the patient what their preference is we are respecting their rights to confidentiality and privacy and offering freedom of choice, or autonomy. Patients will now be involved in their care, have an opportunity to meet the on-coming nurse, and express any follow-up questions/concerns that they may have that weren’t addressed/answered during the previous shift. BSR will also of ...
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