Nursing Milestone #2
Capstone Project Milestone #2:
Design for Change Proposal Guidelines
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.
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 long-term 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)
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.
Milestone #2 is worth 225 points.
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 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
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.
Here is the PICO question I used for Milestone#1-
For the hospitalized patient, is it more beneficial to utilize a computerized systematic reminder based system, versus traditional written protocols that lack follow-up assessment, for indwelling urinary catheter removal to obtain lower incidences of catheter associated urinary tract infections (CAUTIs) measured over the length of stay? Here is the evidence appraisal info I used in Milestone #1- Evidence Appraisal Worksheet
PICO Question: For the hospitalized patient, is it more beneficial to utilize a computerized systematic reminder based system, versus traditional written protocols that lack follow-up assessment, for indwelling urinary catheter removal to obtain lower incidences of catheter associated urinary tract infections (CAUTIs) measured over the length of stay?
APA Reference for Article
Give the APA-formatted reference for the article. Type of Source
*Research: Peer-reviewed article
*Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review Strength of Research
Discuss the strength of the sources.
Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 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 Author Unknown. (Jan/Feb2015). American Nurse. Vol. 47 Issue 1, p11-11 This article is a peer reviewed article that offers clinical practice guidelines to prevent CAUTIs by first determining the need for a urinary catheter. This article shows evidence of high quality because it is sponsored The American Nurses Association.
(ANA) has spearheaded an initiative to reduce catheter-associated urinary tract infections (CAUTIs) — one of
the most common and costly infections contracted by patients in hospitals through an assessment and decision-making tool RNs and other clinicians can use at the bedside to determine the best way to provide care. The CAUTI Tool, designed to prevent harm and save lives, incorporates best practices based on Centers for Disease Control and Prevention (CDC) guidelines. The CAUTI Tool is a one-page guidance to assist clinicians in determining whether a urinary catheter is appropriate to insert; recommending alternative treatments for urinary retention and incontinence; evaluating indicators for timely catheter removal to prevent harm; and following a checklist on catheter insertion and cues for essential maintenance and post-removal care.
2 Mori, Candace. “A-Voiding Catastrophe: Implementing a Nurse-Driven Protocol”. MEDSURG Nursing. Jan/Feb2014, Vol. 23 Issue 1, p15-28 This is a peer reviewed article based on extensive literature, case study research, and expert opinion that was conducted to establish an awareness and severity of the problem of over use of indwelling catheters. From there, a prevalence study was done to establish the need within the hospital. A surveillance study tool was developed to evaluate all patients with indwelling urinary catheters. This article is of high quality given the fact it is provides both the literature review and the survey data, and provides the necessary evidence to implement a nurse-driven urinary catheter removal protocol to reduce the duration of catheter use. Because nurses spend substantial time with the patient, the assumption was nurses would be the most instrumental in affecting catheter use.
Facilities implementing a combination of nurse-led interventions may assist in preventing and/or decreasing CAUTI rates
?Choice to continue or discontinue indwelling catheter is through collaborative discussion with physician. Based on these indications, a nurse-driven protocol was developed to allow nurses to discontinue urinary catheters without a physician’s order if the appropriate indications were not met.
3 Palmer, Jennifer A.; Lee, Grace M.; Maya Dutta-Linn, M.; Wroe, Peter; Hartmann, Christine W. (Jan/Feb 2013). “Including Catheter-Associated Urinary Tract Infections in the 2008 CMS Payment Policy: A Qualitative Analysis” Urologic Nursing. Vol. 33 Issue 1, p15-23 This is a peer reviewed article based on clinical practice guidelines. The study presented in this article addresses the impact of the 2008 nonpayment policy of the Centers for Medicare and Medicaid Services (CMS) on catheter-associated urinary tract infections (CAUTIs) from the perspective of infection preventionists. With rich qualitative data, it sheds light on the day-to-day impact of this recent health policy on CAUTI prevention. This article is of high quality given the subject of the hospital being responsible for “footing the bill” of any hospital acquired CAUTIs if the proper precautions of preventing CAUTIs are not implemented. Established clinical guidelines that exist for preventing CAUTIS.
CAUTI is related to reasonably modifiable factors, including method and duration of catheter use and catheter care. Increasingly focused on improving quality of care and minimizing preventable harms occurring in health care settings, payers have begun to link reimbursement to quality through pay-for-reporting and pay-for-performance programs.
In an example of this, the Centers for Medicare and Medicaid Services (CMS) is using a novel approach to link payment and quality. With the passage of the Deficit Reduction Act of 2005 and the implementation of the Final Rule in October 2008, CMS no longer pays hospitals for the additional cost of care resulting hospital acquired conditions
4 http://www.cdc.gov/HAI/ca_uti/uti.html This is a non research systematic review website that gives research on clinical practice guidelines on hospital acquired infections, with emphasis on CAUTIs. The article is of good quality because it is sponsored by a government agency, The Centers for Disease Control.It provides information on CAUTIs without using medical jargon that a lay person can understand. Appropriate selection of catheter with respect to gender, length, material, size, and balloon volume is important
?Duration may be short or long-term
Bladder health begins to deteriorate if drainage bags are used for about six months
?Discomfort, blockage, and trauma to the urethra may be associated with indwelling catheter use
?Consideration between indwelling catheter placement and intermittent straight-catheterization is necessary to ensure proper emptying of the bladder and also accurate recording of the measurement. Understanding the impact that prevention practices have on patient care decisions is critical for developing more effective approaches
?By understanding these perceptions, successful uptake of key patient safety practices and thus safer care for hospitalized patients can occur
?An educated hospital staff can work more efficiently towards the goal of decreased incidence of CAUTI.
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