Benchmark – Capstone Change Project Objectives

Benchmark – Capstone Change Project Objectives

PICOT Question

In ICU patients with central line devices inserted into patients, does having a dedicated team of nurses to oversee all central lines in the ICU decrease the CLABSI rate compared to having bedside nurses be responsible for the maintenance of the lines over a three month period?

 

Assignment

 

Assessment Description

Review your problem or issue and the cultural assessment. Consider how the findings connect to your topic and intervention for your capstone change project. Write a list of three to five objectives for your proposed intervention. Below each objective, provide a one or two sentence rationale.

After writing your objectives, provide a rationale for how your proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations.

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

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.5:  Advocate for autonomy and social justice for individuals and diverse populations.

 

Rubric

 

Objectives

1.25 points

Criteria Description

Objectives

5. 5: Excellent

1.25 points

Three to five objectives are presented.

4. 4: Good

1.11 points

NA

3. 3: Satisfactory

0.99 points

NA

2. 2: Less Than Satisfactory

0.94 points

NA

1. 1: Unsatisfactory

0 points

A list of objectives for the proposed intervention is omitted. Fewer than three objectives are presented.

 

Rationale for How Findings Relate to the Topic and Proposed Intervention

1.5 points

Criteria Description

Rationale for How Findings Relate to the Topic and Proposed Intervention

5. 5: Excellent

1.5 points

Rationale is clearly provided for each objective and thoroughly explains the relationship of the findings to the topic and proposed intervention.

4. 4: Good

1.34 points

Rationale is provided for each objective and explains the relationship of findings to the topic and proposed intervention. Some detail is needed for clarity.

3. 3: Satisfactory

1.19 points

General rationale is provided for each objective and generally summarizes the relationship of most findings to the topic and proposed intervention. There are some inaccuracies or minor omissions.

2. 2: Less Than Satisfactory

1.13 points

Rationale is incomplete. There are omissions. Rationale provided does not explain the relationship of findings to the topic and proposed intervention.

1. 1: Unsatisfactory

0 points

Rationale for each objective is omitted.

 

Rationale for Autonomy and Social Justice

1.25 points

Criteria Description

Rationale for How Proposed Project and Objectives Advocate for Autonomy and Social Justice for Individuals and Diverse Populations (C1.5)

5. 5: Excellent

1.25 points

Well-supported rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy for autonomy and social justice for individuals and diverse populations is clearly established.

4. 4: Good

1.11 points

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy is generally established.

3. 3: Satisfactory

0.99 points

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is summarized. Some advocacy is established.

2. 2: Less Than Satisfactory

0.94 points

Incomplete rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy is not established.

1. 1: Unsatisfactory

0 points

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is omitted.

 

Thesis Development and Purpose

0.25 points

Criteria Description

Thesis Development and Purpose

5. 5: Excellent

0.25 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4. 4: Good

0.22 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3. 3: Satisfactory

0.2 points

Thesis is apparent and appropriate to purpose.

2. 2: Less Than Satisfactory

0.19 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1. 1: Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

 

Argument Logic and Construction

0.25 points

Criteria Description

Argument Logic and Construction

5. 5: Excellent

0.25 points

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

4. 4: Good

0.22 points

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3. 3: Satisfactory

0.2 points

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

2. 2: Less Than Satisfactory

0.19 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1. 1: Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

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Introduction

Central venous line insertion is a vital procedure usually in managing and monitoring critically ill patients. Despite its massive benefits, the intervention poses infection risk factors to patients and predisposes them to increased morbidity and mortality. According to Al-Khawaja et al. (2021), the prevalence of central line-associated bloodstream infections (CLABSI) varies across different settings. The pooled CLABSI rate in the United States is approximately 1.25 per 1000. The rates are even high in resource-restricted countries. This paper aims to explore the evidence associated with the practices of having a dedicated team of nurses to oversee all central lines in the ICU and CLABSI reduction. It will also highlight the objectives of the intervention and its relationship with patient autonomy and justice.

Several interventions have been used to minimize the rate of CLABSIs in the ICU. One of the evidence-based interventions is having a dedicated team of nurses oversee all ICU central lines. These nurses have received special training about access and care of central lines. Various studies have demonstrated evidence of better outcomes in relation to CLABSI prevention when a dedicated team for central venous access is assigned in the ICU. For instance, in a study conducted by Levit et al. (2020), some nurses were trained to provider dedicated central line insertion and maintenance services. They acted as a team dedicated to central line access and management. Post-intervention findings indicated that the success rate of central line access in the first attempt increased by 56.6%. Central line complications such as CLABSI decreased from 12.8 per 1000 line days to 1-5.5. Equally, phlebitis and needle stick injuries were reduced significantly. Equally, Silva et al. (2020) conducted a comparative retrospective study to assess the effectiveness of reducing undesired catheter removal and other negative central catheter-related outcomes when done by a dedicated and regular team of nurses. The researchers found that central line placement and maintenance by a dedicated nursing team were associated with better patient outcomes. Therefore, it is imperative to adopt this evidence-based practice in all settings caring for the critically ill to achieve CLABSI.

Objectives for the proposed intervention

The following are the identified objectives to be achieved by assigning a dedicated team of nurses to oversee all central lines in the ICU and the rationale.

1. By 15^th June 2022, a team of nurses certified to maintain the central line should be recruited and mobilized to the ICU. As pointed out by Levit et al. (2020), a team of nurses dedicated to the care of central lines is often more knowledgeable, experienced, and compliant with guidelines and practices aiming to prevent CLABSI. They can contribute to lower central line-related complications.
2. By the end of three months of recruiting the team of nurses dedicated to the management of central lines, there should be a reduction of CLABSI cases to zero. Recruitment of this dedicated team reduces the need for float pool nurses, who are an independent risk factor for CLABSI (Scheier et al., 2021). Therefore, this intervention is expected to eliminate the incidence of CLABSI effectively.
3. By the end of 3 months from the onset of the project, all ICU nurses would have received educational training and expressed confidence in having knowledge and adherence to guidelines to prevent According to Aloush (2018), educational courses aiming to improve nurses’ knowledge about central venous catheter-related infections significantly impact understanding of central venous access and maintenance. The knowledge can translate to lower CLABSI and other associated complications.
4. By the end of the intervention period, the ICU staff should have 100% adopted a standardized flushing method with an aseptic non-touch technique. As stipulated by Gerçeker et al. (2018), the technique aims to promote reduced contact with the central line catheter and tubing to prevent the risk of infection.
5. By 15th June 2022, a team of dedicated nurses should oversee all central lines in the ICU, and they should demonstrate compliance in completing all components of the central line (CL) According to Lee et al. (2018), the CL bundle entails, among other interventions, the use of personal and patient protective gear. CL bundle is associated with lower CLABSI incidences.

How the proposed project advocates for autonomy and justice

Critically ill patients have unique needs compared to other patients. Interventions such as central line placement and the risk it poses to these patients demand that they be assigned more resources, such as a dedicated nursing team to oversee all central lines. According to Bhaskar et al. (2020), the distribution of resources according to need is exercising equity, and it is one of the tenets of social justice. Social justice that promotes equitable allocation of resources addresses the disproportionality in disease outcomes common among vulnerable groups and communities. On the other hand, the proposed project is preventive care, and it aims to prevent the deterioration of the patient’s health status due to CLABSIs. Preventing CLABSIs promotes the patient’s ability to make decisions autonomously.

 

 

References

Al-Khawaja, S., Saeed, N. K., Al-Khawaja, S., Azzam, N., & Al-Biltagi, M. (2021). Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain: Four years’ experience. World journal of critical care medicine, 10(5), 220–231. https://doi.org/10.5492/wjccm.v10.i5.220

Aloush S. (2018). Educating intensive care unit nurses to use central venous catheter infection prevention guidelines: effectiveness of an educational course. Journal of research in nursing: JRN, 23(5), 406–413. https://doi.org/10.1177/1744987118762992

Bhaskar, S., Rastogi, A., Menon, K. V., Kunheri, B., Balakrishnan, S., & Howick, J. (2020). Call for Action to Address Equity and Justice Divide during COVID-19. Frontiers in psychiatry, 11, 559905. https://doi.org/10.3389/fpsyt.2020.559905

Gerçeker, G. Ö., Sevgili, S. A., & Yardımcı, F. (2018). Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 33, 78–84. https://doi.org/10.1016/j.ejon.2018.02.002

Lee, K. H., Cho, N. H., Jeong, S. J., Kim, M. N., Han, S. H., & Song, Y. G. (2018). Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections. Yonsei medical journal, 59(3), 376–382. https://doi.org/10.3349/ymj.2018.59.3.376

Levit, O., Shabanova, V., & Bizzarro, M. (2020). Impact of a dedicated nursing team on central line-related complications in the neonatal intensive care unit. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(15), 2618–2622. https://doi.org/10.1080/14767058.2018.1555814

Scheier, T., Kuster, S. P., Dunic, M., Falk, C., Sax, H., & Schreiber, P. W. (2021). Does continuity in nursing staff matter? A pilot study on the correlation of central line-associated bloodstream infections and employee turnover. Antimicrobial resistance and infection control, 10(1), 90. https://doi.org/10.1186/s13756-021-00958-z

Silva, J. T., Lagares-Velasco, A., Fernández-Ruiz, M., González-Monterrubio, G., Pérez-Cárdenas, M. D., Aguado, J. M., & López-Medrano, F. (2020). Peripherally inserted central venous catheter placed and maintained by a dedicated nursing team for the administration of antimicrobial therapy vs. another type of catheter: a retrospective case-control study. Enfermedades infecciosas y microbiologia clinica (English ed.), 38(9), 425–430. https://doi.org/10.1016/j.eimc.2020.01.005