NRS 465 Benchmark – Capstone Project Change Proposal Dissemination and Reflection

Benchmark – Capstone Change Project Implementation Plan

Patient falls, especially among the geriatric population, are a critical patient safety concern that requires facilities and providers to address because of their adverse effects on patients and the healthcare system. The Centers for Disease Control and Prevention (2024) asserts that one in every four older persons falls at least once every year with less than half reporting the incidents to their healthcare providers. Hourly purposeful rounding is an evidence-based practice (EBP) intervention that can reduce patient falls among the geriatric population if implemented in healthcare settings dealing with the population. The purpose of this paper is to discuss the implementation plan based on the formulated PICOT question to address the identified issue of patient falls in elderly patients.

Summary of the Problem or Issue

The identified issue involves patient falls among the geriatric population with over 1 million fall-related hospitalizations happening every year and leading to adverse effects. Falls are a patient safety concern as they lead to injuries like head fractures, increased cost of care, and longer stays in hospitals with patients susceptible to comorbidities (Roberts et al., 2020). As such, nurses need to implement evidence-based interventions to reduce and prevent the increasing prevalence of falls among elderly adults in their practice settings.

Proposed Solution

The proposed solution entails implementing hourly purposeful rounding in the facility to reduce and prevent the occurrence of falls. The assessment of the practicum site and the evaluation of existing literature support the implementation of purposeful rounding because of its benefits to patients and healthcare providers. The selected intervention will involve a consideration of sociocultural and linguistic aspects through effective communication to enhance the safety of the target population. Elderly individuals are susceptible to falls because of the fragility of their bodies and the use of medications due to age-associated conditions like dementia and schizophrenia. In their study, Gliner et al. (2022) note that hourly rounding by nurses in acute settings leads to better patient experience and outcomes since nurses can notice patients struggling to move; which increases their susceptibility to falls.

Khawaja et al. (2023) observe that hourly rounding ensures that healthcare providers like nurses have sufficient data on patient progress and closely monitor every patient to reduce the possibility of falling. Again, Anu (2021) shows that rounding improves patient safety by reducing falls within the facility. Studies by Leamy et al. (2023) Roberts et al. (2020) and Allari et al. (2020) demonstrate the effectiveness of the proposed intervention as it helps reduce falls and improve overall patient safety. Further, the studies are categorical that effective rounding ensures providers work in collaborative teams to attain quality outcomes. Di Massimo et al. (2022), Ryan et al. (2022), Sims et al. (2020), and Rasmussen et al. (2022) all agree that intentional hourly rounding by nurses plays a significant role in reducing falls and improving patient care outcomes. Therefore, the proposed solution will lead to a better patient experience and a lower rate of falls by 40% within three months.

Implementation Steps and Impact on Nursing Practice

Implementing the proposed solution in the practicum site will entail certain steps to achieve the intended objectives.

a). Assessment, identification, and development of the program

The initial step will be to assess and identify the magnitude of the problem through using data from the organization. For instance, the current data shows that ten falls occur each week at the practicum site. Secondly, the practicum site lacks an EBP intervention to curb these falls apart from normal rounding by nurses and other providers. The facility will develop the program using existing evidence and create a team to plan, implement, and evaluate.

b). Planning and Training

The selected team comprising nurse managers and leaders in the senior department will plan by gathering all requirements, communicating the need for change, engaging all stakeholders, and seeking resources and approval from the organizational management. The plan will also entail training nurses on the proposed intervention, its benefits, and strategies to implement it.

c). Implementation

Upon training and availing of sufficient resources, the practicum site will implement the intervention in one ward to evaluate its effects. The pilot implementation will take a week as providers gather data on the number of falls and tailor strategies for each patient. The facility has an average of 20 elderly patients at any time in the geriatric unit with at least five reporting falls each week. Based on the outcomes of the pilot implementation, the facility will roll out the project as part of its routine patient safety procedures and care provision.

d). Monitoring and Evaluation

Continuous monitoring of the implementation of the intervention and evaluation of its effects on the population will entail daily reports and documentation of the number of falls (Melnyk & Fineout-Overholt, 2022). The evaluation will involve quantitative measures like gathering data on the number of falls before and after the implementation to ascertain the effects of the intervention.

f). Impact of Nursing Practice

The implementation of purposeful hourly rounding will have a significant impact on nursing practice. It will improve care coordination and job satisfaction as nurses will work together and communicate effectively leading to better approaches to work and patient issues. The intervention will lower falls in the facility and improve patient outcomes. These will enhance the interactions and quality care provision for patients.

Objectives of the Proposed Solution/Intervention

The objectives of the proposed intervention include;

a). Reducing patient falls in the unit to improve patient outcomes

b). enhancing patient care experience and interactions with providers

c). Improving fall management and quality of care for better reimbursement

d). Improving inter-professional collaboration and multidisciplinary approach to patient issues

Measurable Outcomes

Positive outcomes are essential to ascertain the effectiveness of a proposed change project in reducing and preventing patient falls (Di Massimo et al., 2022). The outcomes of the proposed intervention include reducing the prevalence of falls in the target population by 40% within three months, increasing job satisfaction by nurses in the facility, and improving quality care for effective reimbursement through a value-based care approach. These outcomes will enhance care delivery and better results for patients and the facility.

Rationale and Respect for Autonomy

The rationale for the proposed intervention is to reduce and prevent patient falls among elderly individuals getting care from the facility. The proposed intervention respects the autonomy of individuals and diverse populations by ensuring dignity in their treatment and considering the impact of falls on their safety and quality of life. Through the intervention, patients will make better decisions and choices while in the facility to avoid poor outcomes (Melnyk et al., 2022). The four objectives focus on ensuring elderly patients have better outcomes and do not suffer from comorbidities emanating from preventable falls (Roberts et al., 2020). The rationale, objectives, and outcomes of the proposed intervention show respect for autonomy for the elderly patients as they will get tailored approaches based on their situation and health status.

Conclusion

The proposed change project is essential in reducing and preventing the ever-rising falls in geriatric facilities. Implementing the proposed project will result in better outcomes and quality of care for geriatric patients, including empowered decision-making. The proposed solution and its implementation are critical to improving the quality of care and life for the target population.

References

Allari, R. S., & Hamdan, K. (2023). Caring Behavior and Hourly Rounding: Nurses’ Perception.

The open nursing journal, 17(1). http://dx.doi.org/10.2174/18744346-v17-e230210-2022-118

Anu, J. A. (2021). Hourly Rounding and fall prevention among the elderly in long-term care: a

change process. Journal of geriatric medicine, 3(1): 1-5.

DOI:https://doi.org/10.30564/jgm.v3i1.2614

Centers for Disease Control and Prevention (CDC) (2024 May 6). Older Adult Fall Prevention:

Facts about Falls. https://www.cdc.gov/falls/data-research/facts-stats/index.html

Di Massimo, D. S., Catania, G., Crespi, A., Fontanella, A., Manfellotto, D., La Regina, M., … &

INTENTO Study Group. (2022). Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study. Journal of clinical medicine, 11(14): 3976.

DOI: 10.3390/jcm11143976

Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient

falls, nurse communication, and nurse hourly rounding in acute care: Linking patient experience and outcomes. Journal of public health management and practice, 28(2), E467-E470. DOI: 10.1097/PHH.0000000000001387.

Khawaja, I., Awan, S. A., Babar, M., Khan, T., & owais Khalil, M. (2023). Fall prevalence and

associated risk factors in the hospitalized adult population: a crucial step towards improved hospital care. Cureus, 15(8). DOI: 10.7759/cureus.46976

Leamy, M., Sims, S., Levenson, R., Davies, N., Brearley, S., Gourlay, S., … & Harris, R. (2023).

Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC health services research, 23(1):1341. DOI:https://doi.org/10.1186/s12913-023-10358-1

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &

            healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Rasmussen, T. R. (2022). An Enhanced Purposeful Hourly Rounding Program: Impact of

Proactive Toileting on Rates of Falls and Injurious Falls. Georgetown University. https://www.proquest.com/openview/32c90604dba320472434dd55cfdd467c/1?pq-origsite=gscholar&cbl=18750&diss=y

Roberts, B., Holloway-Kew, K., Pretorius, T., Hosking, S., Kennedy, A., & Armstrong, K.

(2020). Does 20-min rounding reduce falls in an aged-care setting? A pilot intervention study. Geriatric nursing, 41(5): 579-584. DOI: 10.1016/j.gerinurse.2020.03.003.

Ryan, L., Jackson, D., East, L., Woods, C., & Usher, K. (2022). Mixed Methods Study

Integration: Nursing student experiences and opinions of intentional rounding. Journal of advanced nursing, 78(6): 1787-1797. https://doi.org/10.1111/jan.15197

Sims, S., Leamy, M., Levenson, R., Brearley, S., Ross, F., & Harris, R. (2020). The delivery of

compassionate nursing care in a tick-box culture: qualitative perspectives from a realist evaluation of intentional rounding. International journal of nursing studies, 107, 103580. https://doi.org/10.1016/j.ijnurstu.2020.103580

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Assessment Traits

Benchmark

Assessment Description

The purpose of this assignment is to reflect on the dissemination of the Capstone Project Change Proposal PowerPoint developed in Topic 9 and presented this week.

Present the PowerPoint you created in Topic 9 to a group of relevant interdisciplinary leaders or stakeholders at your practicum site.

After presenting your PowerPoint, write a 250-500-word reflection that includes the following:

• Describe who was part of the audience for your presentation and their role related to the proposed project.
• Describe two ways in which you communicated professionally during your presentation.
• Discuss the feedback and questions received from the audience after your presentation. Identify any biases that might have affected your presentation of your project.
• Describe how this interprofessional collaboration and experience will affect your professional practice in the future.

APA style is not required, but solid academic writing is expected.

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

You are not required to submit this assignment to LopesWrite.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

6.4: Work with other professions to maintain a climate of mutual learning, respect, and shared values.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 6.4, 9.2, 10.2

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Benchmark – Capstone Project Change Proposal Dissemination and Reflection – Rubric

 

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Rubric Criteria

Total10 points

Criterion	1. Unsatisfactory	2. Insufficient	3. Approaching	4. Acceptable	5. Target
Audience Describe who was part of the audience for your presentation, including their role related to the proposed project.	0 points A description of who was part of the audience for your presentation, including their role related to the proposed project, is missing.	1.5 points A description of who was part of the audience for your presentation, including their role related to the proposed project, is incomplete or inaccurate.	1.58 points A description of who was part of the audience for your presentation, including their role related to the proposed project, is present but lacks detail.	1.78 points A description of who was part of the audience for your presentation, including their role related to the proposed project, is mostly detailed.	2 points A description of who was part of the audience for your presentation, including their role related to the proposed project, is thorough.
Professional Communication Describe two ways you communicated professionally during your presentation.	0 points A description of two ways you communicated professionally during your presentation is missing.	1.88 points A description of two ways you communicated professionally during your presentation is incomplete or inaccurate.	1.98 points A description of two ways you communicated professionally during your presentation is present but lacks detail.	2.23 points A description of two ways you communicated professionally during your presentation is mostly detailed.	2.5 points A description of two ways you communicated professionally during your presentation is thorough.
Feedback and Biases (B) (B) Discuss the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation. (C6.4)	0 points A discussion of the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation, is missing.	1.88 points A discussion of the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation, is incomplete or inaccurate.	1.98 points A discussion of the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation, is present but lacks detail.	2.23 points A discussion of the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation, is mostly detailed.	2.5 points A discussion of the feedback and questions received from the audience after your presentation, including any biases that may have affected the presentation, is thorough.
Interprofessional Collaboration (B) (B) Describe how this interprofessional collaboration and experience will affect your professional practice in the future. (C6.4)	0 points A description of how this interprofessional collaboration and experience will affect your professional practice in the future is missing.	1.5 points A description of how this interprofessional collaboration and experience will affect your professional practice in the future is incomplete or inaccurate.	1.58 points A description of how this interprofessional collaboration and experience will affect your professional practice in the future is present but lacks detail.	1.78 points A description of how this interprofessional collaboration and experience will affect your professional practice in the future is mostly detailed.	2 points A description of how this interprofessional collaboration and experience will affect your professional practice in the future is thorough.
Mechanics of Writing Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.	0 points Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.	0.75 points Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.	0.79 points Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.	0.89 points Few mechanical errors are present. Suitable language choice and sentence structure are used.	1 points No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

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