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NUR 590 Week 7 Assignment Benchmark – Evidence-Based Practice Proposal Final Paper

NUR 590 Week 7 Assignment  Benchmark – Evidence-Based Practice Proposal Final Paper

Throughout this course, you have developed a formal, evidence-based practice proposal.

Abstract

Osteoporosis is one of the health problems that African American women face. Osteoporosis is associated with negative health outcomes such as increasing the risk of fractures and increased hospital visits by the affected women. Lifestyle and behavioral interventions are effective in reducing the risk of adverse outcomes in osteoporosis. Therefore, this evidence-based practice project aims at determining the impact of educating African American women with osteoporosis about dietary supplementation of calcium and vitamin D on risk and rates of fractures. The project will be implemented in our institution. The project will be implemented following a carefully developed plan that will include training of nurses, recruitment of subjects, provision of health education, monitoring and follow-up, data collection, analysis and presentation of data. The trans-theoretical model of change will guide the implementation of the project. It is anticipated that the project will contribute to the improvement in quality, safety, efficiency, and provision of patient-centered care. The evaluation outcomes will inform the decisions made about the project.

 

 

Section A: Organizational Culture and Readiness Assessment

Assessing the organizational culture and readiness is an essential step for the effective implementation of evidence-based practice. This process helps in examining the scope of change, affected stakeholders, change capacity, and the preparedness of the concerned stakeholders for the change. This paper utilizes the “Organization Culture and Readiness for System-Wide Integration of Evidence-Based Practice” as the survey tool for assessing the organizational culture and readiness (Pittman et al., 2019).

Organization’s Readiness Level

            Based on the survey tool findings, all stakeholders are quite ready for the change. The findings suggest that clinical nurses have a positive EBP belief level, with quite insufficient levels of EBP knowledge. Other stakeholders such as physicians among other clinicians displayed almost the same results (Pittman et al., 2019). The model displayed a positive correlation between the stakeholder’s EBP knowledge, beliefs, and readiness for change implementation.

The Barriers

The main challenges encountered for the organizational preparedness for the change were both internal and external. One of the challenges is inadequate time for carrying out a literature review on the change for a better understanding of EBP (Yoo et al., 2019). The other challenges include inadequate EBP experience from the stakeholders and lack of enough resources to support the EPB process.

The Facilitators and Conclusion

            Human resources comprising of EBP mentors should be trained to serve as facilitators for the change. Consequently, during the development of the EBP education program, a “hands-on education” must be adopted in collaboration with the librarian so as the practical performance can be conducted beyond the EBP concept with an emphasis on its importance (Pittman et al., 2019). Generally, this will help boost the organizational culture and readiness for the change.

Section B: Proposal/Problem Statement and Literature Review

 

Osteoporosis is a metabolic bone disorder characterized by reduced bone mass, that renders bones fragile hence susceptible to fracture. In the United States, among adults above the age of 50 years, approximately 1 in every 2 women, and 1 in every four men will experience an osteoporosis fracture. The risk increases with advanced age. Studies show that women are at high risk of developing osteoporosis than men. In as much as African American women may have a higher BMD, as compared to white women, they still have a significant risk of osteoporosis. In support of the above statement, studies show that African American women tend to have an increased risk of osteoporosis as they tend to consume limited amounts of calcium below the recommended dietary allowance. Consequently, African Americans are more prone to lactose intolerance as compared to individuals from other ethnic groups. Lactose intolerance undermines optimal calcium intake, as individuals with this disorder normally avoid dairy products such as milk, which are excellent dietary sources of calcium. In relation to white women, African American women are less likely to take part in routine osteoporosis screening, for early diagnosis and treatment (Tsai, 2019). This makes them suffer the health burden associated with the disorder, when not early detected. As such, it is recommended that patient education on dietary Calcium and Vitamin D intake among African American women can help reduce the incidences of osteoporosis fractures.

Research Summary

            Several articles were reviewed for this research project. Al-Muraikhi et al. (2017) carried out a cross-sectional study with 766 participants, to determine the kind of information that is required to help reduce the prevalence of osteoporosis among women. According to their result, the knowledge of osteoporosis risk factors, weight-bearing exercise, and dietary consumption of calcium and vitamin D rich diet was low in Qatar. As such, the study concluded that there was a need to advance comprehensive women health education programs on osteoporosis risk factors and dietary intervention to reduce the burden of the disease among these populations.

The second study by Fatma et al. (2018), was based on the fact that diet can help reduce the prevalence of osteoporosis. The study was carried out through a telephone survey of 888 participants all over the United States. A total of 20% of the participants were diagnosed with osteoporosis. The study focused on assessing the difference in diet, self-related health, quality of life, and physical function among these participants. It was noted that more than half of the participants consumed diets with lower than the recommended calcium levels. As such, it was recommended that educational programs supporting improved nutrition be introduced to help reduce the prevalence of osteoporosis.

The last study by Tsai (2019) was aimed at addressing the disparities associated with osteoporosis and help enhance the quality of bone care among disadvantaged groups. The study utilized data from the National Health and Nutrition Examination Survey, collected between 2005 to 2010 and 2013 to 2014. The results suggested that osteoporosis was more prevalent among Non-American adult citizens, less educated, low income, and unemployed individuals. As such it was suggested that interventions such as dietary education should be introduced among these socioeconomically disadvantaged groups, to help reduce the burden associated with osteoporosis.

Limitations

            Even though studies have confirmed the significance of dietary intervention in the prevention of osteoporosis among the most vulnerable populations, very little effort has been made to display this information to community members. As such, there is limited evidence-based intervention on measures that can be used to enhance patient education on calcium and vitamin D-rich diet in the prevention of osteoporosis (Fatma et al., 2018). Consequently, very few studies were population-specific, in the management of osteoporosis among African American women. Lastly, very few recent studies touched on the topic.

Conclusion

            Osteoporosis has been associated with several health burdens associated with both care costs and deteriorated quality of life. The condition is common among African American women, among other vulnerable populations such as low income, socioeconomically disadvantage, and uneducated individuals (Al-Muraikhi et al., 2017). Some of the main reasons behind osteoporosis among these individuals are a result lack of adequate finances for routine screening and low knowledge on osteoporosis preventive measures. As such, it is recommended that patient education on dietary Calcium and Vitamin D intake among African American women can help reduce the prevalence of osteoporosis.

 

 

 

Section C: Solution Description

Nurses and other healthcare providers have an essential role to play in developing effective solutions to address the health problems facing their populations. Nurses utilize the existing sources of evidence to implement best practices in nursing care. The use of best practices promotes the realization of outcomes of care that include safety, efficiency, performance and quality. Therefore, this essay examines the solution of the proposed product by focusing on aspects such as organizational culture, expected outcomes, method to achieve outcomes and outcome impact.

Proposed Solution

The proposed solution entails the provision of health education on dietary calcium and vitamin D to African American patients with osteoporosis. The aim of the project is to reduce the incidence of fractures within 12 months. The proposed solution aligns with the existing evidence. According to evidence, health education on the intake of dietary calcium and vitamin D is effective in improving the health outcomes of patients with osteoporosis. For example, the study by Park et al. (2017) showed that the provision of educational opportunities on dietary calcium and vitamin D intake resulted in the improvement in the osteoporosis knowledge, self-efficacy and fall self-efficacy. The improvement in these parameters reflected the reduction in adverse events affecting patients with osteoporosis such as fractures. Similar results can be seen in the systematic review by Morfeld et al. (2017) where health education on the dietary intake of calcium and vitamin D were associated with increased level of knowledge, improvement in bone mineral density and the adoption of healthy behaviors such as adherence to the prescribed treatment interventions. According to Holland and Moffat (2017), health education on the dietary and behavioral modifications for patients with osteoporosis increases the level of patient engagement in health promotional activities and perceptions towards the management of osteoporosis. Therefore, the proposed solution aligns with the existing evidence. The intervention is realistic in our setting because it does not require a significant use of the organizational resources. The healthcare providers are also trained to provide patient-centered education on the management of different health problems, including osteoporosis.

Organizational Culture

The proposed solution aligns with the organizational culture. Firstly, it supports the provision of high quality and safe care to patients with osteoporosis. Health education on calcium and vitamin D intake will increase the level of patient awareness about the management of their health problems, hence, positive outcomes, safety and quality of care. The solution also strengthens the use of best practices in the management of osteoporosis. The use of health education seeks to promote lifestyle and behavioral change using evidence-based practice interventions. Our hospital advocates the use of best practices in the provision of healthcare. As a result, the proposed solution underpins the realization of this objective.

Expected Outcomes

One of the expected outcomes of the project is the positive change in the habits and behaviors of the African American women with osteoporosis. It is anticipated that health education on the importance of dietary calcium and vitamin D will increase the level of awareness and behaviors of the patients for improved health outcomes. The other expected outcome is the reduction in the rate and risk of fractures in African American women with osteoporosis (Park et al., 2017). The reduction will be attributed to increased intake of dietary calcium, vitamin D and adoption of behaviors and lifestyles that minimize their risk to falls and other adverse events.

Method to Achieve Outcomes

African American patients with osteoporosis will be obtained from the emergency department. The prospective participants will be informed about the project and willingness to participate. The patients will provide informed consent prior to their participation. Trained registered nurses will be involved in the implementation of the project. The nurses will be trained on the aspects that are critical for the success of the project. The training will equip them with the desired competencies for the successful implementation of the project. Patients who consent will be provided with weekly educational sessions on dietary calcium and vitamin D on preventing falls among them. The weekly sessions will be done for a period of three weeks after which patients will be followed on a monthly basis to determine their risk of fractures, adherence, and number of fractures experiences. The data will be obtained at the end of the program to compare the rates of fractures in African American women who were provided with health education versus those who did not receive any intervention. One of the barriers that may be experienced in the program is withdrawal of the participants during the period of investigation. The issue will be addressed by maintaining a close follow up with them. The assumption of the program is that all the African American women with osteoporosis enrolled will complete the 12 months of investigation.

Outcome Impact

The program will improve the quality of care given to African American women with osteoporosis. The improvement in the quality of care will be attributed to the lifestyle and behavioral change among them leading to reduction in the rates of fractures. The program will also lead to improved efficiency of processes. The improvement in the efficiency will be attributed to the reduction in workload due to less rates of fractures and need for hospitalization by African American women with osteoporosis. The program will also lead to environmental changes. It will strengthen the use of best practices in health care in the organization (Huffman et al., 2018). Lastly, the program will strengthen professional expertise by increasing the awareness and understanding of the nurses and other healthcare providers on the importance of health promotion interventions in disease management.

Conclusion

Osteoporosis is a critical health problem affecting African American women. The affected patients are highly at a risk of other health problems such as fractures due to loss of bone density. Health education on dietary intake of calcium and vitamin D is an important approach to improving the health outcomes of the women affected by the problem. Therefore, it is anticipated that the successful implementation of the solution will lead to a drastic reduction in the risk and rate of fractures among African American women with osteoporosis.

Section D: Change Model

The successful implementation of the proposed evidence-based project will depend on largely on the adopted model of change. Models of change provide frameworks that guide the interventions that are used to introduce the initiative in the clinical settings. Models also provide information about the different ways in which the implementation process of the change can be evaluated. Therefore, this section of the project explores the theory of change that will be adopted in the implementation of the evidence-based practice project.

Selected Model and Relevance to the Project

The selected model for use in the implementation of the project is the transtheoretical model of change. The transtheoretical model of change is also referred as the stages of change model. DiClemente and Prochaska developed it in the 1970s following their study on the experiences of smokers as they quit their smoking behaviors. The transtheoretical model focuses on the steps that individuals take in chancing their behaviors. The model also provides insights into the interventions that implementers of change need to embrace to initiate intentional change. The model is applicable to the project because it provides information on the ways in which gradual adoption of the change initiative can be achieved (Gellman & Turner, 2019). Transtheoretical model proposes that change occurs in steps that include pre-contemplation, contemplation, preparation, action, maintenance, and termination.

Stages and their Application

The first step in the transtheoretical model is pre-contemplation. Pre-contemplation is characterized by the adopters of change not willing to take any action that supports the change in the near future. The adopters are not willing to embrace the change due to their low level of awareness or lack of access to the support that they need to embrace the change. The adopters also have low level of awareness about the negative effect that their existing behaviors have on their health. As a result, they tend to underestimate the benefit of embracing interventions that will contribute positively to their behavior, health and wellbeing (Quartuch et al., 2021). African American women with osteoporosis are not aware of the importance of dietary supplementation of calcium and vitamin D to prevent fractures in this stage. Their low level of awareness affects their participation in healthy behaviors and lifestyle that minimize the risk of fractures. Therefore, they do not show any intentions of embracing dietary supplementation for calcium and vitamin D.

The second step in the transtheoretical model is contemplation. Contemplation is the stage where the adopters of the change begin to engage in healthy behaviors in the near future. The adopters of the change have become aware about the negative consequences of their behaviors. As a result, they explore the benefits as well as risks of adopting healthy behaviors and lifestyles that promote their health. Despite being informed about the benefits of change in their behaviors, the adopters are still ambivalent towards embracing change in this stage (Hagger et al., 2020). African American women will demonstrate the intention to embrace dietary supplementation of calcium and vitamin D in the contemplation stage. They also begin embracing dietary supplementation of calcium and vitamin D in their routines. However, they are unsure of the absolute use of the interventions as a way of minimizing and preventing the risk of fractures among them.

The third step in the model is preparation. Preparation is the stage where the adopters are willing to implement the change within a short period, usually 30 days. The adopters have made the decision to implement the change and use its interventions to promote their desired change in behavior. The adopters believe that changing their behaviors will contribute to their health and wellbeing (Boff et al., 2020). African American women with osteoporosis will have made a decision to implement dietary supplementation of calcium and vitamin D as part of their healthy lifestyle and behavior. They do so with a belief that the use of dietary supplements will improve their health by minimizing their risk of adverse events such as fractures and unnecessary hospitalizations.

The fourth step in the transtheoretical model is action. Action entails the adopters having changed their behaviors and willing to keep implementing additional interventions that will contribute to their positive change in behavior. The adopters modify their lifestyles and behaviors to accommodate the new interventions that contribute their health (Friman et al., 2017). The African American women with osteoporosis will have transformed their lifestyle and behaviors in this stage. They intend to maintain the use of dietary supplementation of calcium and vitamin D to prevent fractures. They also demonstrate willingness to learn about additional interventions that they need to promote their health.

The fifth and sixth stages in the transtheoretical model are maintenance and termination. The adopters of change having sustained their behavioral change characterize maintenance stage. The adopters explore interventions that they need to embrace to prevent relapse to their traditional behaviors and lifestyles. African American women with osteoporosis will have stabilized in the adoption of dietary supplementation of calcium and vitamin D at this step. They therefore explore interventions that they need to prevent relapse to their earlier behaviors that predisposed them to fractures and poor health outcomes due to osteoporosis. The termination stage is the last stage where the adopters do not have the desire to relapse to their unhealthy behaviors (Hagger et al., 2020). The African American women with osteoporosis have incorporated dietary supplementation of calcium and vitamin D into their routines.

Conclusion

Overall, transtheoretical model will be adopted in the implementation of the proposed change. The model will guide the development of the interventions that are needed for the success of the project as well as its evaluation. Transtheoretical model will also provide insights into the interventions that are needed to ensure project sustainability. Therefore, it is anticipated that effective use of the model will contribute to the success of the project.

Section E: Implementation Plan

The successful implementation of evidence-based practice requires that the implementers adopt effective methods and interventions for the process. The selected methods should align with the aims and objectives of the project. The methods should also be evidence-based to underpin the realization of the goals of the intervention. Therefore, this section of the project examines the methods that will be used in implementing the proposed solution in the organization. The areas that are examined include setting and access to potential subjects, time needed, resources, methods and instruments, process for delivering the intervention, data collection plan, strategies for managing any barriers, feasibility and decisions that will be made based on the project outcomes.

Setting and Access to Potential Subjects

The proposed solution entails the provision of health education to African American women with osteoporosis on the importance of dietary supplementation of calcium and vitamin D. The aim of providing health education on calcium and vitamin D supplementation is to reduce the predisposition of African American women with osteoporosis to fractures. The project will be undertaken in our hospital. The specific department where it will be undertaken is the emergency department. African American women who come to the emergency department for medical assistance due to osteoporosis will participate in the project. The emergency department is the most appropriate due to the high number of patients that are seen due to different health problems. The potential clients for the project will be approached and informed about the project. They will be informed about the benefits and the role that they will play in the project. Informed consent will be obtained from the participants that express their interest in the project. Informed consent will be used to show that the participants understand the aims, benefits, risks, and their roles in the project (Perrin, 2020). Approval for undertaking the project will be sought from the quality assurance department of the hospital prior to project initiation process.

Time Needed

The proposed project seeks to promote lifestyle and behavioral changes among African American women with osteoporosis. As a result, adequate time is needed to achieve the desired lifestyle and behavioral change and determine the impact of the interventions that will be used in the project. The proposed time for undertaking the project is 12 months. It is anticipated that this period will be enough to determine the effect of project interventions. The period will also enable the incorporation of additional interventions to improve the outcomes of the project. Therefore, it is expected that the effectiveness of calcium and vitamin D dietary supplementation will have been determined by the end of 12 months (O’Gorman, 2020).

Resources

The successful implementation of the project will require the adequate and effective use of resources. Human and financial resources will be required for the implementation of the project. The human resources that will be needed will include trained nursing staffs, data analyst, data, data collectors, and physicians. Trained registered nurses will be involved in the provision of health education to African American women with osteoporosis. The nurses will also play the role of following-up the participants and obtaining the data that will be needed for the project. A data analyst with be hired to analyze the data and making meaning of it. Physicians will assist in the identification of the potential participants for the project. Financial resources will also be needed for the successful implementation of the project (Nations, 2021). The finances will be used for training, hiring experts, purchasing training materials, and undertaking other tasks such as follow-up of the participants. The finances will also be used for purchasing printing materials and educational booklets for the participants. The last resource is time. Registered nurses, physicians, and data analyst will have to spend their time in engaging in project activities for its successful implementation.

Methods and Instruments

Questionnaires will be used to collect the data needed for undertaking this project. Questionnaires will be administered before and at the end of the project. The questionnaires will obtain information such as demographic data of the participants, their level of awareness and practices related to management of osteoporosis, and health risks related to osteoporosis such as history of fractures. The baseline data obtained from the questionnaires will be compared with the data obtained at the end of the project to determine whether dietary supplementation of calcium and vitamin D was effective in reducing the risk of fractures among the participants. Questionnaires are effective for the project because of their ease of administration. Little time will be used in the acquisition of data needed for the project. Questionnaires will also enable the acquisition of extensive project data (Rowe, 2020). The extensiveness of the data will increase the understanding of the effectiveness of the project in nursing practice.

Process for Delivering the Intervention

As noted above, the participants for the project will be obtained from the emergency department of our hospital. Nurses will work in collaboration with the physicians in identifying potential participants for the project. African American women with osteoporosis will be approached and informed about the project. They will be informed about the benefits and their role in the project. They will also be informed about the support that they will receive through their participation in it. Informed consent will then be obtained prior to educating them on the dietary supplementation of calcium and vitamin D to minimize and prevent the risks of fractures. Training will be provided to the registered nurses who will be involved in the implementation of the project. Training will aim at ensuring that the registered nurses have the required knowledge and skills on the available dietary supplements for patients with osteoporosis. Training will also increase the level of awareness of the participants, hence, minimizing the possibility of their resistance to implementing the needed interventions for the project (Gorecki, 2020).

Outline of Data Collection Plan

The data collection plan for the project will be comprehensive in nature. Firstly, registered nurses will be trained on the collection of baseline and final data for the project. The nurses will be trained on the accurate acquisition of data from the participants. They will also be trained on checking the consistency of the data obtained for the project. As noted initially, questionnaires will be used for data collection. Self-administered questionnaires will enable easy collection of the needed data for the participants. The data will be collected at the beginning and end for comparison purposes. A data analyst will be hired to analyze and interpret the data for the project. Quantitative methods of data analysis will be used to increase the objectivity and accuracy of the results. The analyzed data will be presented using tables, charts and graphs to increase the understanding of the audience. The analysis of data will be focused on determining whether the risk and rate of fractures among the participants decreased or not. The data will also focus on determining the changes in lifestyle and behaviors of the participants, as evidenced by the consistent dietary supplementation of calcium and vitamin D. The nurse manager of the hospital will be tasked with the responsibility of data management.

Strategies to Manage any Barriers, Facilitators and Challenges

One of the strategies that will be used to manage barriers in the project is training. Registered nurses who will be involved in implementing the project will be trained. They will be trained on aspects of health education, participant monitoring and follow-up and data collection. Training will equip them with the needed knowledge and skills, hence, minimizing the resistance from them (Harned, 2017). The other intervention that will be used to manage challenges that may be experienced in the project is the close monitoring and follow-up of the participants. The participants will be followed-up on a regular basis to ensure their consistent use of calcium and dietary supplements as a way of preventing and minimizing the risk of fractures. Follow-up and monitoring will improve the retention rate of the participants. Regular evaluation and provision of feedback will also be used to address the challenges and barriers in the project. Regular evaluation will be performed to identify areas of strengths and weakness in the project. Through it, interventions that aim at strengthening the effectiveness of the project will be embraced.

Feasibility of the Implementation Plan

The proposed project is feasible in the organization. The implementation process uses the readily available resources in the organization such as registered nurses and physicians. The resource needs of the project are also easily achievable. The estimated cost of implementing the project is $60,000. The cost will be used for provider training, purchase of the needed resources, hiring of a data analyst, remunerating the staffs, and data presentation.

Plans to Maintain, Extend, Revise or Discontinue the Proposed Solution after Implementation

The evaluation outcomes will influence the decisions that will be made relating the project. The project will be maintained if it is found to have no harm to the participants. The project will also be maintained if the outcomes of evaluation show that participants consistently use of the interventions. The project will be extended if a small number of participants enroll for it. Extension will enable the acquisition of an adequate sample that will increase the generalizability and accuracy of findings. The project will be revised if the strategies used do not yield objective outcomes. The project will be discontinued if it is found to have negative effect on the participants such as increasing their risk to fractures and frequent hospitalization (Layton et al., 2020).

Conclusion

In summary, this section of the project has explored in detail the methods that will be used for project implementation. The target audience for the project will be African American women with osteoporosis obtained from the emergency department. Questionnaires will be used for data collection. The implementers will be trained on the essential knowledge and skills needed for the project. Data analysis will inform the effectiveness of the interventions. The decisions made will largely depend on the outcomes of the project.

Section F: Evaluation

The Rationale for the Methods used in Collection of the Outcome Data

Different methods were used in the collection of outcome data in this project such as questionnaires, chart audits, follow-ups interviews, clinical interviews, and test monitoring. The utilization of various methods of outcome data collection was informed by numerous reasons. To begin with, questionnaires were used because they contain many crucial elements that helped in measuring the rate of participants’ satisfaction in the entire EBP implementation process. The test monitoring on the other side was used to assist in follow the development of the project, establish suitability of the process of implementation, and to gather information that can be used to foster the implementation processes in the future (Gao et al., 2019). On the other hand, other strategies such as follow-up interviews, clinical interviews, and chart audits were essential in identifying areas where patients should be supported and also recognize areas that needs improvement.

Ways In Which Outcome Measures Evaluate The Extent To Which The Project Objectives Are Achieved

Outcome measures refer to transforms in the health of an individual, a fraction of people, or population which can be associated with an intervention or various interventions. Outcome measures such as patient experience connote quality and cost aims that health care settings strive to enhance. In the current project, outcome measures can evaluate the extent to which the project objectives are realized by scrutinizing the extent that the project implementation has impacted the health outcomes of the target population (Kingsley & Patel, 2017). Essentially, the outcome measures make it possible to gauge whether or not the project has achieved its objectives. In situations where the project neither has nor achieved its objectives, the outcome measures can play a crucial role of assisting in informing the modifications to the project to enable the realization of goals.

How the Outcomes will be Measured and Evaluated Based on the Evidence

Outcomes connote benefits to the project target population since it influences knowledge, attitude, conditions, behaviors, or life status for the participants. The outcome measures in this project would be measured and evaluated using the typical data collections tools that have been established to be effective. In particular, outcome-based evaluation can be used in this project. This evaluation involves measurement of results and it recognizes observations that can realistically show desirable outcomes or changes. Outcome-based evaluation systematically gathers information concerning the different project indicators and uses that information to indicate the scope in which the program has attained its goals (Barnes et al., 2019). This method is ideal in helping to communicate the quality and value of the project to many audiences.

However, this strategy may need to be realigned to meet the local needs of the target population. If such situations arise, it is important to perform a preliminary test prior to implementation to the target population. On the other hand, the validity of the project will be determined when the data accurately measure what it was purposed to measure. The reliability on its side will be achieved if the outcome measures correspond with the universal definitions and methods. On the other hand, the applicability will be determined when the outcomes to promote lifestyle and behavioral changes among African American women with osteoporosis.

Description of the Strategies to take if Outcomes do not Provide Positive Results

During project implementation process, sometimes it is common for project outcomes to yield negative results. Therefore, if it happens that the outcomes of the project fail to provide positive results, the best strategy that can be taken by the team in charge of implementation is to take control, become focused, and create an effective communication system to manage and guide the project back to the right track. It is imperative to design the project in a flexible way which can simply be modified in case the outcomes fail to produce desirable results. The project implementation team should also be able to determine the cause of the problems and take initiatives to resolve problem and steer back the project to the appropriate path of implementation. Moreover, it is project should be designed with contingency plans to act as a safeguard to the project (Fischer et al., 2016).

Description of the Implications for Practice and Future Research

The proposed solution in this project entails the provision of health education to African American women with osteoporosis on the importance of dietary supplementation of calcium and vitamin D. Education on calcium and vitamin D supplementation aims to reduce the predisposition of African American women with osteoporosis to fractures. Essentially, nurse educators can play essential role in the success of this project. However, lack of cultural competency care, especially for nurses who are non-Africans, can potentially create cultural barriers that may compromise the success of the project, thus leading to adverse outcomes (Foronda et al., 2018). Therefore, it is recommended that the future research should consider cultural diversity and ensure provision of educational programs and interventions that are culturally responsive to the population in focus.

Conclusion

Osteoporosis is one of the health problems that affect adult and elderly women. Osteoporosis increases with the advancing age in women due to hormonal imbalance in menopause and post-menopausal period. Osteoporosis is associated with negative health outcomes such as bone pain, fractures, and inability to engage in strenuous activities. Osteoporosis affect women disproportionately based on their ethnicity. African American women have been shown to have a high risk of developing osteoporosis when compared to women from other ethnicities. Therefore, the proposed evidence-based project seeks to address the health inequality in African American women by educating them on the importance of dietary supplementation of calcium and vitamin D. The aim of the project is to reduce the risk and improve the overall health of the African American women with osteoporosis. Consequently, it is anticipated that the project objectives will be achieved if the developed interventions are implemented as expected.

 

 

References

Al-Muraikhi, H., Said, H., Selim, N., & Chehab, M. (2017). The knowledge of osteoporosis risk factors and preventive practices among women of reproductive age in the state of Qatar: A cross-sectional survey. International Journal Of Community Medicine And Public Health, 4, 522. https://doi.org/10.18203/2394-6040.ijcmph20170284

Barnes, E. L., Kappelman, M. D., Long, M. D., Evon, D. M., Martin, C. F., & Sandler, R. S. (2019). A Novel Patient-Reported Outcome Based Evaluation (PROBE) of Quality of Life in Patients with Inflammatory Bowel Disease. The American Journal of Gastroenterology, 114(4), 640–647. https://doi.org/10.14309/ajg.0000000000000177

Boff, R. de M., Dornelles, M. A., Feoli, A. M. P., Gustavo, A. da S., & Oliveira, M. da S. (2020). Transtheoretical model for change in obese adolescents: MERC randomized clinical trial. Journal of Health Psychology, 25(13–14), 2272–2285.

Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016). Barriers and Strategies in Guideline Implementation—A Scoping Review. Healthcare, 4(3), 36. https://doi.org/10.3390/healthcare4030036

Foronda, C. L., Baptiste, D.-L., Pfaff, T., Velez, R., Reinholdt, M., Sanchez, M., & Hudson, K. W. (2018). Cultural Competency and Cultural Humility in Simulation-Based Education: An Integrative Review. Clinical Simulation in Nursing, 15, 42–60. https://doi.org/10.1016/j.ecns.2017.09.006

Friman, M., Huck, J., & Olsson, L. E. (2017). Transtheoretical Model of Change during Travel Behavior Interventions: An Integrative Review. International Journal of Environmental Research and Public Health, 14(6), 581. https://doi.org/10.3390/ijerph14060581

Gao, Z., Nguang, S. K., & Kong, D.-X. (2019). Advances in Modelling, Monitoring, and Control for Complex Industrial Systems. Complexity, 2019, e2975083. https://doi.org/10.1155/2019/2975083

Gellman, M. D., & Turner, J. R. (2019). Encyclopedia of Behavioral Medicine. Springer New York.

Gorecki, A. (2020). Benefits of Project Management Training to Leaders of the Nonprofit Sector. Project Management Institute.

Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N., & Lintunen, T. (2020). The Handbook of Behavior Change. Cambridge University Press.

Harned, B. (2017). Project Management for Humans: Helping People Get Things Done. Rosenfeld Media.

Holland, A., & Moffat, T. (2017). Comparing measured calcium and vitamin D intakes with perceptions of intake in Canadian young adults: Insights for designing osteoporosis prevention education. Public Health Nutrition, 20(10), 1760–1767. https://doi.org/10.1017/S1368980017000386

Huffman, F. G., Vaccaro, J. A., Zarini, G. G., & Vieira, E. R. (2018). Osteoporosis, Activities of Daily Living Skills, Quality of Life, and Dietary Adequacy of Congregate Meal Participants. Geriatrics, 3(2), 24. https://doi.org/10.3390/geriatrics3020024

Kingsley, C., & Patel, S. (2017). Patient-reported outcome measures and patient-reported experience measures. Bja Education, 17(4), 137–144.

Layton, M. C., Ostermiller, S. J., & Kynaston, D. J. (2020). Agile Project Management For Dummies. John Wiley & Sons.

Morfeld, J.-C., Vennedey, V., Müller, D., Pieper, D., & Stock, S. (2017). Patient education in osteoporosis prevention: A systematic review focusing on methodological quality of randomised controlled trials. Osteoporosis International, 28(6), 1779–1803. https://doi.org/10.1007/s00198-017-3946-y

Nations, F. and A. O. of the U. (2021). Evaluation of the project “Strengthening the adaptive capacity and resilience of rural communities using micro watershed approaches to climate change and variability to attain sustainable food security in Cambodia”: Project code: GCP/CMB/036/LDF GEF ID: 4434. Food & Agriculture Org.

O’Gorman, M. (2020). Strategic Corporate Conservation Planning: A Guide to Meaningful Engagement. Island Press.

Park, K.-S., Yoo, J.-I., Kim, H.-Y., Jang, S., Park, Y., & Ha, Y.-C. (2017). Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly. BMC Public Health, 17(1), 966. https://doi.org/10.1186/s12889-017-4966-4

Pittman, J., Cohee, A., Storey, S., LaMothe, J., Gilbert, J., Bakoyannis, G., Ofner, S., & Newhouse, R. (2019). A Multisite Health System Survey to Assess Organizational Context to Support Evidence-Based Practice. Worldviews on Evidence-Based Nursing, 16(4), 271–280. https://doi.org/10.1111/wvn.12375

Quartuch, M. R., Broussard Allred, S., Markowitz, E., Catanzaro, P., & Markowski-Lindsay, M. (2021). Applying the Transtheoretical Model of Change to Legacy Planning Decisions. Small-Scale Forestry. https://doi.org/10.1007/s11842-021-09476-7

Tsai, A. J. (2019). Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States. European Journal of Internal Medicine, 64, 85–89. https://doi.org/10.1016/j.ejim.2019.04.011

Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS One, 14(12), e0226742.

The proposal is the plan for an evidence-based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals must be submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed (3,500 and 5,000 words). The cover sheet, abstract, references pages, and appendices are not included in the word count.

The implementation of hand hygiene protocols and measures to reduce and prevent the occurrence of hospital acquired infections (HAIs) among healthcare workers (HCWs) in pediatric care setting is focused on enhancing patient safety, quality care, and better outcomes. The evaluation of its implementation is essential to ascertaining if the evidence-based practice project proposal will attain its expected goals and outcomes (Albarqouni et al., 2018). The purpose of this evaluation is to discuss the expected outcome of the EBP project proposal, review data collection tools related to the selected research design and select a suitable statistical test and methods to apply to data collection and measuring of the outcomes and their assessment based on selected tool.

Section headings for each section component are required. Evaluation of the proposal in all sections will be based upon the extent to which the depth of content reflects graduate-level critical thinking skills.

This project contains seven formal sections:

Section A: Organizational Culture and Readiness Assessment

Section B: Proposal/Problem Statement and Literature Review

Section C: Solution Description

Section D: Change Model

Section E: Implementation Plan

Section F: Evaluation of Process

 

Each section (A-F) will be submitted as a separate assignment in Topics 1-6 so your instructor can provide feedback (refer to applicable topics for complete descriptions of each section).

The final paper submission in Topic 7 will consist of the completed project (with revisions to all sections), title page, abstract, compiled references list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms, as previously assigned in individual section assignments.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Also Read: NUR 590 Week 6 Assignment  Evidence-Based Practice Proposal – Section F: Evaluation of Process

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NUR 590 Week 7 Assignment  Benchmark – Evidence-Based Practice Proposal Final Paper

The healthcare sector, healthcare professionals, and other stakeholders have, in the past and present, focused on improving patient outcomes using various strategies. Such strategies aim at improving the efficiency of patient care and the safety of patients while in the patient care environment. The efforts and initiatives aimed at improving care outcomes are usually triggered by a host of incidences happening in the care settings, such as patient falls, patient injuries, pressure ulcers, and healthcare-acquired infections, among other incidences. (Jaul et al.,2018) Among the most common healthcare-acquired infections are catheter-associated urinary infections (CAUTIs). CAUTIs have been shown to cause various negative impacts, such as increased healthcare spending, longer hospital stays, and other adverse impacts, such as death. Therefore, this evidence-based practice project focuses on lowering the rates of CAUTI among patients in admission settings and using indwelling catheters(Shadle et al.,2021). As such, the purpose of this paper is to formulate aproposal for the EBP. Various aspects which will be explored include the problem statement, the organizational culture, the literature review, the change framework, and the implementation and evaluation plans.

Problem Statement

Hospital-acquired infections have been shown to be on the rise in the past and present. One of the most common types of such infections is catheter-acquired urinary tract infections caused by the use of urinary catheters, especially indwelling ones. According to Flores-Mireles.(2019), CAUTIs lead to various adverse impacts. Even though the condition is largely preventable, it continues to cause havoc as it leads to increased patient morbidity and mortality, longer hospital stay, and increased healthcare spending (Kranz et al.,2020). This problem can, however, be prevented by applying various nursing interventions. It is important to note that, while various nursing interventions have been implemented, especially single activity-based interventions, the problem still persists hence calling for the use of more robust approaches which can integrate various interventions such as the use of CAUTI bundle.

Organizational Culture and Readiness

The process of evidence-based practice is impacted by various aspects, some of which are organizational aspects. The implication is that the EBP implementers should take their time and assess the nature of the organization, such as its culture related to EBP implementation and the readiness of various staff. Such a step is key in determining how easy or difficult the process of implementing an EBP project can be since a positive culture is needed for a successful implementation to occur (Cleary‐Holdforth et al.,2021). The assessment revealed that the organization’s leaders support patient improvement initiatives such as the EBP process for better patient outcomes. The organization also focuses on gaining magnet status, which has made them support various change initiatives. The assessment of the organization’s aim and mission showed that it focuses on offering exemplary and excellent patient services by using the latest care strategies at affordable costs. In addition, it was also noted that the organization adores interprofessional collaborations and teams in the provision of care. Therefore, it is evident that the organization’s culture is ready for change and also supports EBP.

The organization’s culture and readiness were assessed using a chosen tool, the System-Wide Integration of the EBP survey tool. This tool has widely been applied, especially to assess an organization’s capacity to adapt to and cope with change (Melnyk et al.,2022). This tool was used to explore the staff’s and the leader’s understanding of the proposed change of application of the CAUTI bundle to control the CAUTI rates. The survey tools showed that up to 91% of the staff support the proposed change, which is a majority. In addition, the majority of the leaders also supported the initiative, as up to 80% indicated that they were ready for the change. Therefore, this tool also revealed that the organization’s culture could support and sustain the proposed change.

Even though the culture supports the proposed change, it is worth noting that there are potential barriers and weaknesses that may derail implementation. For example, lack of support by minority leaders as staff can be a major drawback. The assessment will also be key in exploring the staff knowledge in using the proposed CAUTI bundle, which will then help to formulate strategies for improving their knowledge. The leaders supporting the initiative will play an important role in availing the required resources and supporting the project through making effective decisions and formulating change champions who can then help on driving the change initiative as appropriate. It was also important to identify the relevant stakeholders (Melnyk et al.,2022). Therefore, various stakeholders were identified, stakeholders include physicians, nurses, unit leaders, nurse managers, patients, and their families

Literature Review

The identified problem which informed the formulation of this project is increased rates of CAUTI in patient care settings. Therefore, the use of CAUTI bundles has been proposed as a potential EBP intervention. As such, it was important to perform a literature review to explore the existing evidence on the use of CAUTI bundles to reduce the rates of CAUTIs among patients admitted to the hospital and using indwelling urinary catheters. A PICOT question formulated earlier was used in the literature search. The formulated PICOT was: Among patients using indwelling urinary catheters, what is the efficacy of using CAUTI bundle care as compared to no intervention in lowering the rates of CAUTI by at least 60% within six months?

An article search strategy was also used to access the most relevant articles and evidence as appropriate. The search was accomplished in various article databases such as PubMed, google scholar, CINHAL, and Cochrane databases. The search also focused on peer-reviewed articles published in the last five years. Various search terms were also used in the search for relevant articles, including CAUTI, CAUTI bundles, intervention, and prevalence. Even though the search yielded several articles, the most relevant was chosen, and the literature review of the ten articles was performed and presented in the next section.

Elkbuli et al.(2018) conducted a study on the prevention of CAUTI among the trauma population. This study aimed at determining the efficacy of using a 5-S CAUTI bundle in the reduction of CAUTI rates among trauma patients. In a quantitative study, the researchers recruited a total of 2926 trauma patients. The analysis of the data showed that the use of the 5-S bundle led to a significant reduction in CAUTI rates among trauma patients (p-value of 0.002).

Davies et al.(2018) also conducted a study to explore the impact of using a CAUTI bundle. In a pre-and-post-study design, the researchers recruited a total of 6236 patients to take part in the study. The analysis of the data compared the rates of infections before the application of the CAUTI bundle and after its implementation. The results showed that the rates of CAUTI after the implementation of the CAUTI bundle were significantly lower compare as compared to the rates before, showing the efficacy of the CAUTI bundle.

Recently, Reynolds et al. (2022) conducted research that aimed at exploring the impact and sustainability of a multifaceted intervention in lowering CAUTI rates. This study was conducted in three large adult intensive care units among patients using urinary catheters. The analysis of the data showed a significant impact of bundle care. For example, the researchers noted a drop in CAUTI rates and the use of indwelling catheters. The positive impacts were directly associated with the implementation of the CAUTI bundle care as a strategy.

In a similar study, Mundle et al. (2020) explored the effectiveness of implementing a CAUTI bundle in preventing CAUTI incidences. The researchers conducted the study in internal medicine units where every patient admitted during the study took part in the study. The analysis of the data showed significant results relevant to this study as the researchers observed a 79% reduction in the rates of CAUTI among the patients, showing that the implementation of the CAUTI bundle care positively impacted CAUTI rates.

Sultan et al. (2022) explored the effect of using a CAUTI bundle to help prevent CAUTI occurrence among critically ill patients. In a quantitative study, the researcher recruited a total of eighty patients admitted to the intensive care units. The analysis of the data showed that the implementation of the CAUTI bundle led to a significant reduction in CAUTI rates. For example, they noted that upon the implementation of the CAUTI bundle, the CAUTI rates among the ICU patients were reduced by 50%, showing the efficacy of the intervention.

Another relevant study was conducted by Tyson et al. (2020), which focused on implementing a nurse-driven protocol designed to support catheter removal approaches to help reduce CAUTI rates. The aim of the study was to compare the CAUTI rates and the use of indwelling urinary catheters before and after implementing a nurse-driven CAUTI bundle among patients admitted to the surgical trauma intensive care unit. The analysis of the collected data led to significant results. For example, upon the implementation of the protocol, the researchers noted a significant reduction in the rates of catheter use. In addition, they also found that the protocol led to a reduction in CAUTI rates.

Shadle et al. (2021) also conducted a study to determine the impact of using a CAUTI bundle to reduce CAUTI rates. In a quantitative study design, the researchers collected data using electronic health records. The analysis of the collected data also showed relevant results. For example, the researchers realized that during the study, no CAUTI cases or incidences were reported showing that the CAUTI bundle implemented was highly effective in preventing and controlling the CAUTI rates.

More recently, Pajerski et al. (2022) carried out research that explored the impact of using CAUTI bundles in controlling the rates of CAUTI. This study was conducted in a trauma brain injury rehabilitation unit. Upon the analysis of the data, the researchers noted that there was a reduction in the CAUTI rates when the CAUTI bundle care approach was implemented. Soundaram et al. (2020) also carried out research with the aim of exploring the impact of implementing a CAUTI bundle in the control and prevention of CAUTI rates and incidence. The researchers carried out the study in adult intensive care units. The analysis of the data showed that upon the use of the CAUTI bundles, the cases of CAUTI were observed to reduce significantly by sixty percent. As such, this is another study that shows the efficacy of using a CAUTI bundle in controlling and preventing CAUTI incidences and rates.

Another study was conducted by Ravi and Joshi (2018). This study was conducted with the major aim of exploring the efficacy of a CAUTI care bundle in lowering CAUTI rates. The researchers used a bundle care approach which included training and educating the nursing staff on how to appropriately use and manage the indwelling catheters. Upon the analysis of the data, the researchers also noted a significant reduction in the rates of CAUTI among admitted patients. Therefore, this is another study that shows the efficacy of using CAUTI bundles in the prevention and control of CAUTI.

Change Model or Framework

Change models play a crucial role in the implementation of evidence-based practice projects since they offer foundations upon which the project is implemented (Jayatilleke & Lai, 2018). As such, the selected change model for this project is Kurt Lewin’s change model. According to Lewin change occurs in three distinct faces, and there are two major forces involved in a change process, the driving and restraining forces. The driving forces are known to enhance the change process, while the restraining forces oppose the change. As such, the driving forces have to overcome the restraining forces for the change process to occur successfully.

The three phases include unfreezing, change, and refreezing. In the first phase, which is refreezing, the major activity is creating an urgent need for change by pointing out the evidence of why the change should urgently be undertaken (Hussain et al.,2018). Letting the stakeholders know that there is a need for change requires effective communication.  The second phase, which is the change phase, is associated with the implementation of the proposed intervention, where the change implementers implement the initiatives to help solve the identified clinical issue. The third phase is known as refreezing. This stage entails using various efforts to ensure that the implemented change becomes part of the organization’s culture and supporting the staff to accept and sustain the change.

The stages of the model will be applied to implement the CAUTI bundles. In the unfreezing stage, the stakeholders will be alerted to the urgent need for change to help reduce the rates of CAUTI in the care setting. Appropriate communication channels will be used to inform the staff of the need to address the issue of rising CAUTI cases. The second phase, which is the change phase, will involve training the nursing staff on the proposed new bundle and how to use it. The process will then be followed by the implementation of the CAUTI bundle to help reduce the rates of CAUTI. Effective communication will also be key in this phase(Hussain et al.,2018). The last phase, which is the refreezing stage, will entail sustaining the implemented change and ensuring that the CAUTI bundle becomes part of the organization’s protocol for preventing CAUTI incidence.

Implementation Plan

Implementation is one of the most important phases of an EBP project cycle. Therefore, a conducive environment should be created to enhance the implementation process. It is also important to explore various aspects, such as the setting and how to access the potential subjects. As discussed earlier, this project involves using CAUTI bundles to reduce or lower the rates of CAUTI among patients using indwelling urinary catheters (Elkbuli et al.,2018). Therefore, the targeted setting for the project is the admission wards with patients who used indwelling urinary catheters. The patients to be considered are those who will be admitted to the admission units and using the indwelling catheters. The other targeted population is the nurses who offer nursing care to the patients in these settings. The data for evaluating the project will be obtained from electronic health records. Therefore, there will be no need to obtain informed consent. Nonetheless, the organization leaders will need to offer permission to allow the implementation process.

It is also important to consider a suitable timeline for the proposed project. A timeline acts as a guide to knowing when particular activities should be accomplished (Melnyk & Fineout-Overholt, 2019). Therefore, a period of six months has been proposed for the project. It is hoped that this duration will be sufficient to cover various project phases such as project, initiation, literature review, project implementation, monitoring, and evaluation. This duration will also be used in obtaining project feedback from the stakeholders, such as indications of carrying out corrective measures to help solve various identified problems.

The Budget and Resource List

The success of a project heavily depends on the availability of needed resources; therefore, it is important to procure the necessary resources in time. There will be a need to train the staff on the use of the new CAUTI bundle. Therefore, both material and financial resources will be required to support such an education and training process (Melnyk & Fineout-Overholt, 2019). Besides, additional resources will also be needed to help in the development of the CAUTI bundle protocol to be used in controlling and preventing the CAUTI rates. Human resources will also be required to help accomplish the project goals. The budget implication is that the project team will need to get sufficient resources that can help in training and educating the nursing staff, purchasing the training materials, hiring the educators, collecting data, data analysis, project monitoring, and well as outcome evaluation. It has been projected that the cost of the project will be $36,000, and the detailed budget and resource list have been included in the appendix.

The Study Design

A study design is important in guiding a project; therefore, it is important to choose various aspects of study design appropriately. As such, the design chosen for this project is the quantitative design which will be used in both data collection and analysis. This design has been chosen since the targeted project data is quantitative. Statistical tests will also be used as part of the project to analyze the project data, which further corroborates the use of the quantitative study design as compared to the qualitative study approach (Jolley, 2020). The quantitative study approach also supports easier data collection and analysis. The quantitative study approach is also relatively cheaper in comparison to the qualitative study design and approaches.

Methods and Instruments

            Instruments and methods are a crucial part of the implementation plan, and they are important for various activities such as data collection, data analysis, and data evaluation. One of the instruments to be used in this project is the questionnaire. Questionnaires will be applied to test the nurse’s knowledge of CAUTI prevention and management. The nurses’ knowledge will be assessed before and after the education (Gunawan et al.,2021). The rationale for choosing questionnaires is that they are easier to use in collecting data. Another instrument is electronic health records which will be used to obtain the baseline data on CAUTI rates. The same instrument will also be used to obtain data on CAUTI incidences after the implementation of the proposed CAUTI bundle care.

The Process of Delivering the Intervention

The success of the implementation process hinges on the process of delivering the intervention. As part of the plan, the intervention will be delivered in various phases. In the initial phase, an assessment of the clinical setting is to be undertaken through a needs assessment approach to explore the nature of the needs (Grove & Gray, 2018). The assessment involves studying the CAUTI statistics within the organization, including the impacts and trends among patients admitted to the facility. The assessment also involves assessing the nurses’ levels of knowledge and awareness regarding CAUTI and control of CAUTI using CAUTI bundles. The process will be key in coming up with relevant strategies to use in the project. The next step will entail educating and training the nurses on the use of the proposed CAUTI bundles to help reduce the rates of CAUTI. The next step will then involve the implementation of the intervention, where the efficacy of the intervention will be tested. As part of the plan, the staff will be closely supervised for a considerable duration to ensure that they are correctly and adequately implementing the bundle elements. The next part involves collecting the data associated with the intervention and analyzing the data to determine the efficacy of the intervention in reducing the CAUTI rates.

The Stakeholders Required to Complete the Project

Stakeholders form a crucial part of the project. As such, it is crucial that they be identified in time so that they can be involved from the onset of the project (Lehane et al.,2018). Early involvement of stakeholders helps in limiting the chances of resistance. The following stakeholders have been identified; the chief executive officer, the nurse manager, the unit managers, the hospital finance officer, the nursing staff working in the admission wards, and the physicians. The hospital’s chief executive officer will give permission to accomplish the project in the organization. The nurse manager will play a critical role in coordinating the unit activities related to the project implementation. The unit managers will discharge duties related to each unit. The finance officer will also help with feasibility assessment, financial viability, and the best ways to acquire the needed resources. The nurses are at the forefront of the project and will help in the active implementation of the intervention. The physicians also take part in the treatment of the patients admitted to the wards and, therefore, will support the nursing team in implementing the proposed CAUTI bundle.

Potential Barriers or Challenges to The Plan

Implementing an evidence-based practice project may face various challenges or barriers which may need to be mitigated if the project implementation process is to be a success. The implication is that appropriate strategies should be formulated in time to help overcome the challenges or barriers. Among the potential challenges are potential difficulties in obtaining the resources needed, especially financial resources (Lehane et al.,2018). Project failure may be the result if sufficient funds are not obtained. Therefore, a solution should be explored. One of the solutions is writing funding proposals to potential sponsors or financiers. The other expected barrier or challenge is resistance by the leadership or the nursing staff. The nursing staff may offer resistance to the use of the proposed bundle since it may need more time. The resistance can be reduced by training the nurses to help them have a better understanding of the proposed initiative to reduce the chances of resistance.

Evaluation Plan

Evaluation is one of the most important stages and the last stages of evidence-based practice project initiatives. As such, it is crucial to come up with an evaluation plan which can be applied in assessing the impact of the implemented intervention. This phase is also crucial in exploring how effective the strategies or methods used in the project have been (Dang et al.,2021). As part of the evaluation plan, it is important to explore the expected outcomes as far as the project is concerned. In the previous sections, it was indicated that the nursing staff would need training regarding the use of the proposed CAUTI bundle. Therefore, among the expected outcomes is improved nurse knowledge and skills in the use of CAUTI bundles to control the rates of CAUTI (Elkbuli et al.,2018). The next expected project outcome is the reduction in CAUTI rates. It is hoped that the implementation of the CAUTI bundle will lead to a reduction in CAUTI rates by at least 60%. Such a feat will be used as a reflection of the efficacy of the intervention. Another expected outcome is that the organization will adopt the CAUTI bundle protocol as a standard intervention for preventing and managing CAUTI in the organization. Such an expectation will be made easier by positive project outcomes.

The Data Collection Tools

Data collection tools are important in the project phases, especially the evaluation phase in obtaining project data to be used in evaluating the efficacy of the implemented intervention. One of the data collection tools is electronic health records. The electronic health records will be applied to obtain data on the rates of CAUTI after implementing the CAUTI bundle protocol. This data will then be compared with the baseline data which was obtained at the start of the project. Such a comparison will ventilate more on whether the intervention has been effective or not.

The next targeted tool is the questionnaires. The questionnaires will be used to assess the nurses’ skills and knowledge concerning the use of the CAUTI bundle to prevent and control CAUTI. The knowledge gained after education will be compared with the baseline knowledge to determine the efficacy of the education program. Questionnaires will also be used to assess the attitude of patients and nurses concerning the implementation of the new CAUTI bundle. Questionnaires will be appropriate as the project utilizes a quantitative design approach. The tool is also valid as they have been validated and shown to be effective in measuring knowledge (Yaddanapudi& Yaddanapudi, 2019). The tool is reliable since the same set of questions will be used

The Statistical Tests

Statistical tests are used in the data analysis process to help determine the efficacy of the intervention. The major thrust of this project is to compare the rates of CAUTI in the admission units before and after the implementation of a CAUTI bundle. Therefore, one of the most appropriate statistical tests to use in this case is paired t-test. The paired t-test has been chosen since it has been shown to be effective in measuring the variation between a set of paired samples. This project will focus on the pre and post-test rates scores and CAUTI rates. Therefore, the chosen statistical test will help in determining the significance of the considered set of scores. Mean will also be used, especially in the nurse knowledge scores regarding the use of CAUTI bundles to control the rates of CAUTI.

The Methods of Use and the Evaluation of the Outcomes

            Methods and strategies used in the project may impact project outcomes; hence it is important to explore them. The questionnaire to be applied in the project, as part of the plan, is expected to have scaling questions, multiple-choice questions, and dichotomous questions. It is important to use different formats and approaches to questions since the project should determine various changes associated with the implemented initiative. Various validated scales will be used in formulating the scaling questions and use scales, such as 1 to 5. On the other hand, the dichotomous questions require the research subjects to either answer a yes or a no. It is important to use these kinds of questions for a complete evaluation of the project (Melnyk & Fineout-Overholt, 2022).

Strategies to Be Taken If the Outcomes Do Not Provide Positive Results.        

Quality improvement projects and evidence-based practice projects are usually designed with the hope and aim of positive outcomes. Indeed, positive outcomes are usually achieved under normal circumstances (Linsely et al.,2019). It is important to note that in some cases, positive outcomes may not be the results observed. Hence the project team should always put measures in place that can be used as part of the mitigation process in the event that the results obtained are not positive. As part of the plan, among the strategies to be used in the event that the results are not positive is the do a reexamination of the implemented intervention. Reexamination can be vital in offering insights into particular or specific areas which might have led to the observed failure. Another expected strategy is the extension of the project timeline. Extending the project timeline can be necessary to help the project team identify areas of weakness, revise vital parts of the project and implement corrective measures to help in improving the chances of the project succeeding.

The Plans to Maintain, Extend, Revise, and Discontinue the Proposed Solution

An implemented evidence-based practice project can lead to various outcomes; in some cases, the outcomes can be desirable, while in other cases, the outcomes may not be desirable. Therefore, it is important to put in place an appropriate plan to maintain, extend, revise, or discontinue the implemented solution or initiative as part of the overall plan; the project will be maintained if the outcomes turn out to be as expected. In other words, the project will be maintained if the outcomes are positive and the implemented solution is positively affecting or impacting the patients.

As part of the plan, the project will also be maintained if it is cost-effective. Healthcare cost has recently become an important point in the healthcare environment as the costs have been going up. As such, any quality improvement projects or evidence-based practice projects should be cost-effective. Therefore, this project will not be different and will, therefore, be maintained if it is cost-effective. In some cases, the evaluation phase may produce or give results that are not conclusive. In such cases, there may be a need to get appropriate results that can be used in evaluating the project outcomes. Such cases require that the project be extended. Therefore, the project will be extended if the outcomes and inconclusive (Melnyk & Fine-Overholt, 2022). The major purpose of extending the project is to obtain appropriate additional data that can then be applied to determine the effectiveness of the project.

Under certain conditions, the project may need to be revised. A revision will be pursued if the strategies do not align with the project outcomes. The revision will be undertaken to get more time which can be used in adopting improvement interventions. Such improvement interventions will increase the chances of the project succeeding. As part of the plan, the project may also be discontinued under particular instances or circumstances. For example, discontinuation will occur in the case that the project causes harm to the patients and the staff. The solution will also be discontinued if it pauses a risk to the lives of the staff and the patients.

Conclusion

The adverse impacts of CAUTI have led to research efforts over the years to help control and prevent these infections. Therefore, various evidence-based interventions exist. However, it is worth noting that these evidence-based interventions have shown varied efficacy; in addition, the problem still persists in the patient care setting. As such, the proposed evidence-based approach or intervention is the use of a CAUTI bundle. As opposed to single interventions which can be applied to prevent and reduce the rates of CAUTI, a bundle-based care approach entails combining or integrating various interventions for better outcomes. Therefore, the bundle care approach chosen entails various activities that can have a synergistic effect of reducing CAUTI rates or preventing them. It is expected that the proposed evidence-based practice solution of using a CAUTI bundle will lead to a significant reduction in the number of patients acquiring CAUTI in hospital settings. The literature review performed showed that the use of CAUTI bundles in controlling the rates of CAUTI could largely be effective when appropriately applied. This write-up has also explored various aspects of the project, such as literature review, organizational culture and readiness for change, the change framework, project implementation, and project evaluation.

References

Cleary‐Holdforth, J., O’Mathúna, D., & Fineout‐Overholt, E. (2021). Evidence‐based practice beliefs, implementation, and organizational culture and readiness for EBP among nurses, midwives, educators, and students in the Republic of Ireland. Worldviews on Evidence‐Based Nursing18(6), 379-388. https://doi.org/10.1111/wvn.12543

Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., … & Brown, C. V. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control46(7), 758-763   ttps://doi.org/10.1016/j.ajic.2017.11.032

Elkbuli, A., Miller, A., Boneva, D., Puyana, S., Bernal, E., Hai, S., & McKenney, M. (2018).   Targeting catheter-associated urinary tract infections in a trauma population: a 5-S bundle preventive approach. Journal of Trauma Nursing| JTN25(6), 366–373. 10.1097/JTN.0000000000000403

Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, treatment, and prevention of catheter-associated urinary tract infection. Topics in Spinal Cord Injury Rehabilitation25(3), 228-240. https://doi.org/10.1310/sci2503-228

Grove, S. K., & Gray, J. R. (2018). Understanding nursing research e-book: Building an evidence-based practice. Elsevier health sciences.

Gunawan, J., Marzilli, C., & Aungsuroch, Y. (2021). Establishing an appropriate sample size for developing and validating a questionnaire in nursing research. Belitung Nursing Journal7(5), 356-360. https://doi.org/10.33546/bnj.1927

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics18(1), 1-11. https://doi.org/10.1186/s12877-018-0997-7

Jayatilleke, S., & Lai, R. (2018). A systematic review of requirements changes management. Information and Software Technology93, 163-185. https://doi.org/10.1016/j.infsof.2017.09.004

Jolley, J. (2020). Introducing Research and Evidence-Based Practice for Nursing and Healthcare Professionals. Routledge

Kranz, J., Schmidt, S., Wagenlehner, F., & Schneidewind, L. (2020). Catheter-associated urinary tract infections in adult patients: Preventive strategies and treatment options. Deutsches Ärzteblatt International117(6), 83. https://doi.org/10.3238%2Farztebl.2020.0083

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., … & Hegarty, J. (2018). Evidence-based practice education for healthcare professions: an expert view. BMJ Evidence-Based Medicine. http://dx.doi.org/10.1136/bmjebm-2018-111019

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Wolters Kluwer.

Melnyk, B. M., Hsieh, A. P., & Mu, J. (2022). Psychometric properties of the Organizational Culture and Readiness Scale for System‐Wide Integration of Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing19(5), 380-387. https://doi.org/10.1111/wvn.12603

Mundle, W., Howell-Belle, C., & Jeffs, L. (2020). Preventing catheter-associated urinary tract infection: A multipronged collaborative approach. Journal of Nursing Care Quality35(1), 83-87. Doi: 10.1097/NCQ.0000000000000418

Pajerski, D. M., Harlan, M. D., Ren, D., & Tuite, P. K. (2022). A clinical nurse specialist–led initiative to reduce catheter-associated urinary tract infection rates using a best practice guideline. Clinical Nurse Specialist36(1), 20-28. Doi: 10.1097/NUR.0000000000000643.

Ravi, P. R., & Joshi, M. C. (2018). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society20(2), 116. Doi: 10.4103/jmms.jmms_8_18

Reynolds, S. S., Sova, C. D., Lewis, S. S., Smith, B. A., Wrenn, R. H., Turner, N. A., & Advani, S. D. (2022). Sustained reduction in catheter-associated urinary tract infections using multifaceted strategies led by champions: a quality improvement initiative. Infection Control & Hospital Epidemiology43(7), 925-929. https://doi.org/10.1017/ice.2021.135

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse41(2), 62-71.https://doi.org/10.4037/ccn2021934

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J. (2020). Impact of care bundle implementation on the incidence of catheter-associated urinary tract infection: A comparative study in intensive care units of a tertiary care teaching hospital in South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine24(7), 544. https://doi.org/10.5005%2Fjp-journals-10071-23473

Sultan, M. A., Ahmed, H., & Kandeel, N. A. (2022). The Effect of Implementing CAUTIs Bundle on Prevention of Hospital-Acquired Urinary Tract Infections among Critically Ill Patients. Mansoura Nursing Journal9(1), 141-153. https://mnj.journals.ekb.eg/article_259013_7bf12c0832ee68848bd1ddcedfa1e4f7.pdf

Tyson, A. F., Campbell, E. F., Spangler, L. R., Ross, S. W., Reinke, C. E., Passaretti, C. L., & Sing, R. F. (2020). Implementation of a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a surgical trauma ICU. Journal of Intensive Care Medicine35(8), 738-744. https://doi.org/10.1177/0885066618781304

Yaddanapudi, S., & Yaddanapudi, L. N. (2019). How to design a questionnaire. Indian Journal of Anesthesia63(5), 335–337. https://doi.org/10.4103/ija.IJA_334_19

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Professional writing is so important not only in the academic setting but also in our profession. As an APRN there may be times I am involved in research, writing abstracts, grants, policies, etc. In all these areas it is important to not only be a competent writer but to show you are a professional through professional writing. In the various courses through my program, I have grown in my writing with input from my instructors. As for APA, it is always challenging at first, for some of the resources such as books I still struggle. I do not use books as a resource very often so it is challenging for me when I do. I am now an expert in citing and referencing peer-reviewed articles. The APA checklist is a wonderful resources, yes it is one extra thing to tack on to your paper but it truly has saved me from making silly mistakes causing point deductions. I have a co-worker who is in her BSN program and is coming to me to check her APA! I would have never thought I would be a mentor or resource when it comes to APA when I first started the class. Although students complain and struggle with APA I will say it does make any of your writing more substantial and evidence-based. The resources provided by GCU in the student success center have really been a blessing in making constructing and writing an APA paper thoughtfully, thoroughly, and professionally.