OLME NUR 661: Nursing Leadership Practicum I
Clinical Project Proposal
A proposal for the clinical project is completed in NUR661 and operationalized in NUR662. The purpose of the written proposal is to communicate the project plans to your preceptor, NUR662 instructor and other program administrators.
1. Create a proposal for your Clinical Project.
2. Use the proposal template to write your paper. Your proposal should convince your management team of a practice problem you have uncovered that is significant enough to change current practice.
3. The format for this proposal will be a paper following the Publication manual of APA 7th edition.
4. The paper should include a title page, reference page, and all the sections outline in the template.
5. As you organize your information and evidence, include the following Sections.
Identification of the Clinical Problem: This needs to include the general area of concern, a brief background about the concern, and the significance of the concern. A justification of the need is also included. Support it with examples and citations, as appropriate. Conclude with a synopsis of the clinical problem.
Purpose: This is a broad reflection of the focus of your project.
PICO/PICOT Statement: It is stated as a clinical practice problem format, such as PICO (Population, Intervention, Comparison, Outcome) or PICOT (Population, Intervention, Comparison, Outcome, Timeline).
Stakeholders: Who are the relevant stakeholders?
Responsibility of Team Members: Why are the members chosen important to your project? What are their roles?
Conduct a search of evidence. Describe how literature was searched, selection criteria used, and databases searched over which years. Briefly discuss the strength of this research.
Summarize the Evidence: In this section, you need to synthesize the information from your literature review. What are some of the evidence-based interventions you discovered in your Evidence Summary that you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.
What is your recommendation based on the research? Provide a statement of recommendation, reference(s) in support of recommendation, and strength of evidence supporting recommendation. Ideally, you will have found enough support in your evidence to proceed with implementing your pilot program.
Fit and Feasibility: Discuss your examination of the fit and feasibility.
Barriers and Strengths: What are the barriers to the success of the change, and then what are strengths that can be leveraged to overcome barriers?
Provide a clear and concise summary by summarizing the key points. Summarize the problem, recommendations.
Citations and References
Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
Clinical Project Proposal
Falls are common in long-term care facilities and are some of the main contributors to poor health outcomes among residents. One of the most recommended evidence-based practices to mitigate the challenge of falls in long-term care facilities and to help in reducing fall rates is the utilization of a patient-centered care bundle. The utilization of patient-centered care bundle to reduce fall rates in healthcare facilities relies on different nursing-focused approaches, including patient engagement, purposeful rounding, leadership involvement, involvement of quality improvement personnel, and also professional development (Avanecean et al. 2017) The introduction of a patient-centered care bundle in a long-term care facility therefore requires the support of leaders and the involvement of quality improvement personnel to educate healthcare practitioners including nurses and their assistants on different patient-centered care approaches to reduce falls.
Identification of the Clinical Problem
Every year a significant proportion of all the people in the US fall in different settings, including long-term care facilities. Falls are the leading cause of both fatal and non-fatal injuries among elderly Americans (Morris et al. 2019). The consequences of falls can range from major trauma to minor bumps and bruises among patients. Estimates from the CDC indicate that every year nearly 50% of residents in long-term care facilities will fall, with many incidents going unreported(CDC, 2020).Ten to 20% of falls in long-term care facilities result in serious injury with an average of 1800 elders dying in long-term facilities as a result of injuries from falls. The repercussions of falls are also much greater than physical injuries because falls can result in reduced quality of life, functional decline, and fear of falling again, which can lead to mental health issues such as helplessness, low self-esteem, depression, and social isolation (Morris et al. 2019). Treating injuries associated with falls is also very costly, with an estimated $ 45 billion being spent in Medicare costs as a result of falls in 2019 and the average hospital costs from a fall injury being $30,000 (Morris et al. 2019). The implementation of fall reduction programs is important in long-term care facilities. Effective fall reduction programs can help to not only save on costs in healthcare facilities but also to improve the quality of life of residents and assure them of better health outcomes. The central clinical problem that is considered in this project is the reduction of falls in long-term healthcare units.
According to quality improvement personnel for my practicum place, the national falls benchmark for the year 2021 was 5.85(AHRQ, 2021).For the two floors, I am going to implement the fall reduction project; one of them had an average fall rate of 9.09 in 2021. The second one had an average fall rate of 6.84 in 2021. The purpose of this project is to reduce the fall rate in the long-term care facility units through the utilization of patient-centered care interventions.
Among elderly patients in the long-term care facility, would the implementation of patient-centered interventions be more effective compared to the usual fall prevention interventions in reducing the incidence of falls four weeks after implementation?
I will be the leader of the quality improvement project involving the utilization of patient-centered intervention to reduce fall rates in two units of a long-term care facility. The other stakeholders of the quality improvement project will involve the preceptor, life enhancement leader, nurse managers, the education department, the quality improvement department, and nursing staff.
Responsibility of Team Members
The main role of the preceptor will be to oversee the implementation of the whole quality improvement project involving fall reduction in long-term care units. The life enhancement leaders will oversee the introduction of patient-centered care approach to her team and collaborate with nursing team to achieve the project, while nurse managers will be to approve and supervise the introduction of patient-centered care interventions and to be active in implementation of a person centers care Fall Reduction project. The education department will be involved in teaching nurses on various patient-centered care interventions to reduce falls, while the main role of the nursing staff will be to introduce patient-centered care interventions among elderly patients with the quality improvement department assessing the effectiveness of patient-centered care interventions in reducing falls in the long-term care units.
In this research, only scholarly sources from scholarly databases and peer-reviewed journals were considered. Sources were searched from databases including Cochrane, Web of Science, PubMed, Eric, Science direct, and EBesco. The keywords that were utilized to conduct the search for evidence included fall prevention interventions in long-term care facilities, fall prevention strategies, and patient-centered care interventions to prevent falls. While searching for evidence, only sources that were current were considered, with only sources published within the past ten years being relied on. A total of 1000 sources were found with five being considered for the study. The sources utilized for evidence included a systematic review of randomized controlled trials, which was rated as level 1 evidence. The sources also included a quasi-experimental study which was rated as level two evidence. A mixed-method study which was rated as level three evidence, was considered, while the clinical practice guideline, which was rated as level IV evidence, was included. The sources also included an integrative review that was rated as Level V evidence.
Summarize the Evidence
According to Avanecean et al. (2017), patient-centered education and personalized care plans will be effective in helping reduce fall rates in long-term health care facilities. The adoption of a multi-component prevention program such as utilizing person-centered approaches engagement and relying on leaders in long-term care facilities can play a significant role in reducing falls Bastami & Azadi, 2020). According to Morris et al. (2019), the use of RESPOND, which was a telephone-based fall prevention program for elderly people, which was person-centered, played a significant role in helping elderly patients to avoid falls, especially through the use of personally relevant and positive messages. Ganz et al. (2013) highlighted enlisting of support from senior leaders as one of the most effective strategies that can be utilized to reduce falls in long-term care facilities. The assessment and development of leadership support for fall prevention programs and the identification of resources that are available and resources that are needed to effectively implement fall prevention is therefore important. According to Heng et al. (2020), fall prevention interventions that rely on person-centered approaches such as patient education can be more effective in reducing fall rates in long-term care facilities.
- Patient-centered education and personalized care plans will be effective in helping reduce fall rates in long-term health care facilities (Level I)(Avanecean et al.,2017).
- Adoption of a multi-component prevention program, such as utilizing person-centered approaches and relying on leaders in long-term care facilities, can play a significant role in reducing falls (Level II)(Bastami & Azadi, 2020).
- A telephone-based fall prevention program can help reduce falls in long-term care units (Level III) (Morris et al., 2019).
- Enlisting support from senior leaders is one of the most effective strategies that can be utilized to reduce falls in long-term care facilities (Level IV) (Ganz et al., 2013).
- Fall prevention interventions that rely on person-centered approaches such as patient education can be more effective in reducing fall rates in long-term care facilities (Level V) (Heng et al., 2020).
Fit and Feasibility
The quality improvement project involving the utilization of patient-centered care interventions to reduce fall rates in long-term care units is feasible and can effectively fit the healthcare setting. This is because the quality improvement project only requires the collaboration of different health care practitioners in the long-term care units.
Barriers and Strengths
The barriers related to the implementation of the quality improvement project to reduce falls in the long-term care units include resistance to change and heavy workloads among health caregivers. The most effective strengths that can be leveraged to overcome the barriers would include the utilization of change management models and seeking support from the leadership in the long-term care unit to have regular work schedules for health caregivers and allow them adequate time to implement the quality improvement project.
Falls are common in long-term care facilities and are some of the main contributors to poor health outcomes among residents. One of the most recommended evidence-based practices to mitigate the challenge of falls in long-term care facilities and to help in reducing fall rates significantly is the utilization of a patient-centered care approach. Patient-centered care interventions can help to significantly reduce the fall rates in a long-term care unit.
Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006–3048. https://doi.org/10.11124/jbisrir-2016-003331
AHRQ. (2021). NHQDR Web Site National Hospital Benchmark Summary. Ahrq.Gov. Retrieved February 23, 2022, from https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/summary/Setting_of_Care/Hospital
Bastami, M., & Azadi, A. (2020). Effects of a Multi-component Program on Fall Incidence, Fear of Falling, and Quality of Life among Older Adult Nursing Home Residents. Annals of Geriatric Medicine and Research, 24(4), 252–258. https://doi.org/10.4235/agmr.20.0044
CDC. (2020). Older Adult Falls. Cdc.Gov. Retrieved February 23, 2022, from https://www.cdc.gov/falls/index.html
Ganz DA, Huang C, Saliba D,. (2013). Preventing Falls in Hospitals A Toolkit for Improving Quality of Care (No. 13–0015-EF). Agency for Healthcare Research and Quality.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01515-w
Morris, R. L., Hill, K. D., Ackerman, I. N., Ayton, D., Arendts, G., Brand, C., Cameron, P., Etherton-Beer, C. D., Flicker, L., Hill, A. M., Hunter, P., Lowthian, J. A., Morello, R., Nyman, S. R., Redfern, J., Smit, D. V., & Barker, A. L. (2019). A mixed-methods process evaluation of a person-centered falls prevention program. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4614-z