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Students must formulate an evidence-based and financially feasible strategic plan for their change proposal. Development of a written plan requires an assessment of the organization’s culture, stakeholders, potential challenges, barriers, and obstacles to the implementation of the change proposal. In this topic, students will develop their understanding of cultural aspects related to the organizational environment.
Students are required to initiate a mid-conference that will occur during Topic 5, using the “Practice Experience Conference Form (Mid-Conference)” resource. This conference is intended for the student, preceptor, and faculty to discuss progress toward meeting the learning goals and course objectives contained in the Individual Success Plan (ISP).
Progress toward completing the written capstone project will also be discussed, including faculty recommendations for project development. Student progress will be documented on the Clinical Evaluation Tool (CET), which is submitted in LoudCloud prior to the conference.
The CET will be discussed during the mid-conference and graded in LoudCloud by the faculty after the mid-conference. If the student receives an “Unacceptable” or “Below Expectations” in any category, the student will remediate for that category of the CET.
The preceptor will perform a midterm evaluation with the faculty. The preceptor will input the evaluation content into the Lopes Activity Tracker. The student will upload the evaluation into LoudCloud after meeting with the preceptor to discuss the midterm evaluation.
Students must meet all clinical expectations of the course, earn a passing grade on all benchmark assignments, and successfully complete remediation (if necessary) in order to receive a passing grade in the NRS-493 course.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Students who are not making appropriate progress on their capstone project and receive an “Unacceptable” or “Below Expectations” on the CET will be required to complete remediation activities. Required remediation activities are listed on the “NRS-493: Clinical Experience Remediation” document. The required activities must be submitted in LoudCloud upon their completion by the end of Topic 7. All required remediation activities will be reviewed and approved by the faculty.
Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.
This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).
In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below. In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to LopesWrite.
Falls are a reoccurring and expensive issue in healthcare. According to the Centers for Disease Control and Prevention, each year $50 billion is spent as a result of non-injury falls, and $754 million is spent as a result of fatal falls (CDC, 2020). It is crucial for healthcare facilities to take the appropriate and necessary measures in hopes of minimizing these occurrences.
The topic of falls is one that should concern all healthcare workers, as each and every one plays a role in prevention. Many facilities have fall policies and procedures in place that focus solely on a single fall contributing factor. The current literature, however, suggests that the most effective way to prevent falls is through the implementation of multifactorial fall prevention intervention.
This paper will discuss the effectiveness of multifactorial fall prevention interventions and provide some examples of these interventions.
Falls are accompanied with a significant financial cost, as well as physical and psychological costs to the patient. Falls can lead to fractures, loss of independence, increased length of stays, quality of life changes, and even death to the patient (Wallis, A., 2021). When asked, staff members have also reported feeling helpless and frustrated about their inability to control falls (Vlaeyen, E., 2017).
There are numerous and varying causes of falls, therefore the efforts to prevent falls should also vary. Falls can occur as a result of improper or lack of use of mobility aids, changes in mentation or coordination, weakness, impaired vision, side effects of medication, and/or chronic diseases. A decrease in frequency of falls would result in a decrease in fall related injuries, costs and deaths, improved patient outcomes and safety, improved quality of life, and decrease in length of patient stays.
Due to the above, there is a dire need to promote increased fall prevention practices in healthcare. The use of multifactorial fall approaches is identified by the Joint Commission as a evidence-based tool (Arrah, 2020).
The purpose of this change proposal project is to decrease the frequency of falls through the implementation of multifactorial fall prevention interventions, specifically for patients residing either short-term or long-term in long-term care facilities.
This change proposal aims at implementing various fall prevention interventions on a patient specific basis. By identifying the patient specific fall risk and implementing prevention measures based on that patient’s risk factors patient safety is being promoted for each individual.
The PICOT question being focused on in this capstone project is as follow: For residents at Crossroads Care Center in Sun Prairie, WI (P) does the use of multifactorial fall risk interventions (I) reduce the future risk of falls (C) compared to single fall risk interventions (O)?
In order to discover relevant literature, the writer first identified reliable databases to search for said literature. The databases utilized in this paper were found through the Grand Canyon University (GCU) library website resources. The databases chosen from the GCU library were EBSCOhost, CINAHL, and PubMed. Another database utilized was Google Scholar.
These databases were searched using combinations of the keywords “fall interventions”, “long-term care facility”, “eldery or geriatric”, and “multifactorial or multicomponent or multi-interventional”. The search excluded articles that did not fit the criteria of being peer-reviewed and published within the last five years.
Also Read:
NRS 493 Grand Canyon University Scholarly Virtual Tools Activities Discussion
NRS-493 Professional Capstone and Practicum Assignments
All of the articles chosen for this project were related to the PICOT question above, as well as peer-reviewed and published within the last five years. The research questions in the articles were all centered around multifactorial fall preventions interventions, but the specific focus of each article chosen varied.
The focuses include the effectiveness, costs and benefits, barriers and facilitators, and the long-term effects of multifactorial fall prevention. Two of the articles focused more specifically on the number of falls and reducing this number, while one article focused on the use of patient safety agreements in combination with other interventions to form a multifactorial fall prevention program.
The sample populations identified in each of the articles also large variability. The populations include residents in nursing homes and or long-term care facilities or rehabilitation units in the Netherlands, large southeastern metropolitan areas, Wisconsin, North Caroline, Virginia, Maryland and Texas, Quebec, Ontario and other mid-size Canadian cities, and New South Wales.
Another group of articles focuses specifically on those 65 years or older in an acute hospital setting, in Europe, North America, Oceania, and Asia, and one study includes the study of over 19,000 older adults living in the community.
The nursing change theory identified and chosen by the writer in this proposal project is the nudge theory. Instead of steps, the nudge theory identifies seven principles. These principles include defining changes, consider employee point of view, provide evidence to show the best options, present change as a choice, listen to employee feedback, limit options, solidify change with short-term wins.
This change theory is the most effective for this change proposal because it educates those effected by the practice change with the evidence that supports the change, as well as gives them an opportunity to provide their feedback, voice their concerns and ask questions. This also allows the management that is implementing he proposal to make any needed changes based on that feedback prior to fulling implementing the change.
The change proposal will be presented to the department heads and upon approval will be implemented beginning with current residents that have endured a fall within the last month, and further extending to any new admissions. These residents will be evaluated using a Morse fall risk scale. Based on this result, specific fall risk factors will be determined and fall prevention interventions will be implemented to prevent future falls.
Each individual fall prevent plan will include medication review and a form of physical activity a minimum of 3 times a week. This physical activity may include physical and/or occupational therapy, independent or accompanied walking for leisure, or facility organized activities. Facility organized activities may include chair exercise, bowling, balloon volleyball, ping-pong, and pool noodle strength training.
Other interventions may include patient safety agreements, low bed, placement near nurses’ station, non-slid socks, education of patient, staff, and or family, increased frequency of rounding, and proper instruction of use of mobility aids. The outcomes of the change would be assessed by comparing the number of falls in the facility before and after the change, as well as the number of falls per specific resident in a month time period before and after the change.
There are countless evidence-based studies based on falls, with many of those studies identifying that the use of multicomponent is effective in preventing and/or decreasing the occurrences of falls, as well as decreasing fall related costs overtime. In evaluation of the articles there was multiple common themes.
Each of the articles concluded that the use of multifactorial fall prevention interventions were effective at either preventing and reducing falls or decreasing fall related costs. In relation to the specific interventions identified, exercise and medication review were identified in six of eight articles. Therefore, each patient that is identified as a high fall risk, or that has a history of falls, must have both of these interventions initiated.
As with all change, there is the potential for some barriers to arise. Some potential barriers include determination from management that a change is not indicated or noncompliance from staff or residents. Although a need for new procedure in order to decrease the frequency of falls has been identified by the Director of Nursing for Crossroads Care Center, this does not ultimately determine that the department heads will identify this change project as the desired new procedure.
If approved and implemented by management, staff and/or residents may be noncompliant with the new practice. A change in practice my cause resistance from either of the above. It is the goal that since staff are being included in the implementation through the nudge change theory that they will be compliant. The residents, however, are mostly elderly and may not be willing to following the changes.
Falls in healthcare are financially, physically, and psychologically costly. Falls can increase cost, lengthen stays, cause injury, and even death. Not all falls are preventable, but it is the responsibility of the nurses and other healthcare workers to take the necessary steps to control factors that may lead to falls. Through the implementation of multifactorial fall prevention intervention protocol, staff have the ability to prevent falls as a result of varying causes.
Assess the culture of the organization for potential challenges in incorporating the nursing practice intervention. Use this assessment when creating the strategic plan.
Document your clinical practice hours using the Lopes Activity Tracker (LAT) in your student portal. Once you have opened the app, click on the link for your class to record your hours. Clinical practice hours should be documented and submitted within 48 hours of the clinical experience. After the hours have been submitted, the preceptor will verify the hours, which are then reviewed by the faculty.
Download the electronic summary of your practicum experience from the Lopes Activity Tracker. Save the file and submit it though the assignment dropbox for faculty approval.
This report is to be submitted in every topic.
Stakeholder support is necessary for a successful project implementation. Consider your internal stakeholders, such as the facility, unit, or health care setting where the change proposal is being considered, and your external stakeholders, like an individual or group outside the health care setting. Why is their support necessary to the success of your change proposal, and how you will go about securing that support?
Technology is integral to successful implementation in many projects, through either support or integration or both. Name at least one technology that could improve the implementation process and the outcomes of your capstone project change proposal. Do you plan to use this technology? If not, what are the barriers that prevent its use?
Inside Looking In or Inside Looking Out? How Leaders Shape Cultures Equipped for Evidence-Based Practice
Read “‘Inside Looking In’ or ‘Inside Looking Out’? How Leaders Shape Cultures Equipped for Evidence-Based Practice,” by Halm, from American Journal of Critical Care (2010).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN275158559&site=eds-live&scope=site
Defining What Evidence Is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight From Clinical Nurses
Read “Defining What Evidence Is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight From Clinical Nurses,” by Jeffs, Beswick, Lo, Campbell, Ferris, and Sidani, from Applied Nursing Research (2013).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN336184640&site=eds-live&scope=site
Best Practice in Nursing: A Concept Analysis
Read “Best Practice in Nursing: A Concept Analysis,” by Nelson, from International Journal of Nursing Studies (2014).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103894941&site=eds-live&scope=site
Read “Research at the Bedside: It Makes a Difference,” by Bridges, from American Journal of Critical Care (2015).
URL:
https://lopes.idm.oclc.org/login?url=https://s
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