CU Prevention of Pressure Injuries During Hospital Stay Capstone Project

CU Prevention of Pressure Injuries During Hospital Stay Capstone Project CU Prevention of Pressure Injuries During Hospital Stay Capstone Project I need help finishing my capstone project. It has to consists of 4 part- two first parts are already finished. The two parts I need help with are: LITERATURE REVIEW OF SOLUTION ( I have two articles needed) and IMPLEMENTATION. I need you to write three to four additional pages to the two I already have. The whole paper needs to have 5 full pages in total. it needs to be in APA form. I will also provide an student sample of the paper but it completely different topic so please don’t take anything from it as an example to mine. Also, look at the student sample and in red wrote what should be included in the section. Thanks cap_instructions_and_rubric_2020.docx martin_et_al_2017_worldviews_on_evidence_based_nursing.pdf healthcare_03_00574.pdf sample_cap_paper_for_students.docx draft__capstone.docx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Clinical Application Project (CAP) Instructions and Rubric Description: The Clinical Application Project (CAP) is an opportunity for the BSN student to identify an issue, topic, or challenge that is relevant to their Role Transition clinical placement. The student will examine the research related to their topic and investigate the literature regarding a potential solution for, or intervention to improve, the issue. The student then creates a final project, intervention, or solution to their identified topic. They will present their work in a professional paper and electronic poster presentation. Directions: Identify a problem, issue of concern, or area for improvement relevant to your clinical setting. Describe the importance of the area of concern (include facts, statistics etc.). Consult with your RN preceptor and ResU clinical faculty regarding your topic. Your clinical instructor must approve the topic before work is initiated. Critically analyze the literature related to the area of concern. Identify possible solutions to the selected area of concern, based on the evidence in the literature. Review each for its strengths, weaknesses, and feasibility. Select one solution. Engage in the necessary work for this quality improvement project (e.g., develop a new form and identify approvals required for its use). Although students may not have enough time to actually implement their entire project or quality improvement activity, the final work product should clearly outline the plan for implementation, including a timeline. Students will provide evidence of the final work product (e.g., educational program outline, instructional pamphlets, nursing form, pocket resource, new policy). Appendix E (cont’d) Professional Role Transition Grading criteria for PAPER Introduction • Introduces topic and provides overview of the issue (2 pts.) • Discusses why this issue is pertinent to the particular unit/organization and what led student to choose the topic (2 pts.) • Identifies unit, manager, etc. support for the project (1 pt.) • Identifies how the project will specifically benefit the unit/organization (2 pts.) Literature review: topic/issue • Includes two recent articles (less than 5-7 years) from professional nursing or health sciences journals (2 pts.) • For each article: provides brief summary and discusses how the article is pertinent and relevant to the topic/issue (4 pts./each article=8 total) Literature review: solution/intervention • Includes two recent (less than 5-7 years) articles from professional nursing or health sciences journals (2 pts.) • For each article: provides brief summary and discusses how the article is pertinent and relevant to the solution or interventions (4 pts./each article=8 total) • Articles support the student’s chosen solution or intervention (2 pts.) Implementation/intervention • Clearly describes final project or intervention (2 pts.) • Outlines specific steps to implement final project/solution, including timeline for how the project could be “rolled out” (4 pts.) • Discusses how the project will address/improve the clinical issue (2 pts.) • Discusses future follow-up, evaluation, and/or measurement of the impact of the project (3 pts.) • Points /7 /10 /12 /11 • /10 Comments DONE DONE NEED NEED Original Article Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice Donna Martin, RN, PhD • Lisa Albensi, RN, MSN • Stephanie Van Haute, RN, BN • Maria Froese, BMR-PT, MClSc-WH • Mary Montgomery, BMR – OT • Mavis Lam, BA, BHEcol, RD • Kendra Gierys, RN, BN • Rob Lajeunesse, RN, BN • Lorna Guse, RN, PhD • Nataliya Basova, RN, BN ABSTRACT Keywords evidence-based practice, mixed methods, on-line tutorial, pressure injury, pressure ulcer, pressure ulcer prevention Background: In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled “Healthy Skin Wins” with an online tutorial about PU prevention. Aims: To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff’s knowledge level about PU prevention, and to explore frontline staff’s perspectives of the PUPP.CU Prevention of Pressure Injuries During Hospital Stay Capstone Project Methods: This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff’s knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff’s perspectives of the PUPP. Results: A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p < .001). The online tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirtyfive frontline staff shared their perspectives of the PUPP with “it’s definitely a combination of everything” and “there’s a disconnect between what’s needed and what’s available” as the main themes. Conclusions: Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. Linking Evidence to Action: Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare aides, patients and families. INTRODUCTION A pressure ulcer (PU) is a localized injury to the skin or underlying tissues resulting from pressure or shear forces over bony prominences (Stinson, Gillan, & Porter-Armstrong, 2013). Recently, PUs have also been referred to as pressure injuries (Chaboyer et al., 2015; McInnes, Jammali-Blasi, Cullum, Bell-Syer, & Dumville, 2013). Pressure ulcers range in severity from non-blanchable erythema (Stage 1) to superficial skin loss (Stage 2), to loss of fat, muscle, and bone (Stages 3 and 4; Stevenson et al., 2013). Contributing and confounding factors include immobility, moisture, poor nutritional status, and sensory perception disorders (Gallant, Morin, St-Germain, & Dallaire, 2010; Garcia-Fernandez, Agreda, Verdu, & PancorboHidalgo, 2014). Pressure ulcers develop primarily in elderly, debilitated, and immobile individuals in hospitals, personal care homes, and home care (Pamaiahgari, 2014). Pressure ulcers result in high human and economic costs with a lower quality of life and significant pain, diminished functional autonomy, serious infections, and longer hospital stays with extra costs to the healthcare system (Chan, Ieraci, Mitsakakis, Pham, & Krahn, 2013; Chou et al., 2013; Frumenti & Kurtz, 2014; Gallant et al., 2010; Tayyib & Coyer, 2017). 473 Worldviews on Evidence-Based Nursing, 2017; 14:6, 473–483. C 2017 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Healthy Skin Wins Patients with a PU often experience emotional and psychological trauma from pain and physical limitations, significantly reducing their quality of life (Shannon, Brown, & Chakravarthy, 2012). Occurrences of PUs are correlated with amputation, immobility, and shortened life span (Zhou, Xu, Tang, & Chen, 2014). “Pressure ulcers are a recognized indicator of the quality of health care both in Canada and the USA” (Gallant et al., 2010, p. 184). Although there is consensus that not all PUs can be avoided, their development is preventable in most instances (Gallant et al., 2010; Beeckman, Defloor, Schoonhoven, & Vanderwee, 2011). Evidence-based practice guidelines about PU prevention and treatment have been developed and promoted locally and globally (British Columbia Provincial Nursing Skin and Wound Committee, 2014; National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance, 2014; Registered Nurses’ Association of Ontario, 2016; Winnipeg Regional Health Authority, 2012). Changing material resources and interventions may be challenging for some healthcare providers, but educational opportunities about evidence-based practice have enhanced adoption of best practices (Baldelli & Paciella, 2008; Chaboyer et al., 2016; Chaboyer & Gillespie, 2014; Hunter, Kelly, Stanley, Stilley, & Anderson, 2014; Murray, 2012; Roberts et al., 2016; Schmidt & Brown, 2012). CU Prevention of Pressure Injuries During Hospital Stay Capstone Project A PU prevalence of 29.9% was estimated in acute care hospitals in Canada with half of the PUs assessed as Stage 1 (Woodbury & Houghton, 2004). In a 304-bed community hospital in Winnipeg, Canada, an observational survey was conducted in November 2013 to determine the prevalence and incidence of PUs. The prevalence of PUs was 34.3% (83/242) with two thirds of PUs at Stage 2 or higher. Six days later, another observational survey was conducted among patients who had remained hospitalized to determine the incidence of PUs, which was 16.5% (19/115). These results triggered the need to implement an evidence-based pressure ulcer prevention program (PUPP). CREATION AND IMPLEMENTATION OF A PRESSURE ULCER PREVENTION PROGRAM A steering committee, comprised of academics, nurses, allied health professionals, educators and administrators was established to oversee the development and implementation of the PUPP, which was entitled “Healthy Skin Wins.” The Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler et al., 2001) in conjunction with Rogers’ (2003) Diffusion of Innovations Model served as guiding frameworks for the PUPP (Buss, Halfens, Abu-Saad, & Kok, 1999). This committee facilitated the adoption of best practices in PU prevention with the objective of decreasing PUs on all in-patient units. Several subcommittees reviewed current evidence to determine best practices in prevention and management of PUs (Titler et al., 2001). “Innovations in the hospital 474 setting can be defined as changing standard practices based on current knowledge and research data” (Tayyib & Coyer, 2017, p. 8). These subcommittees were comprised of multidisciplinary members from various hospital departments including nursing, dietetics, occupational therapy, physical therapy, materials management, and wound care. Staff Awareness Campaign A logo was created to illustrate “Healthy Skin Wins” and communicate that PU prevention was a hospital-wide priority. The logo was used on all communications to staff about changes in material resources and practices to prevent and manage PUs. With multiple components of the PUPP, a strategic roll-out was vitally important. Updates were shared with all nurse leaders and quality and management teams with the PUPP as a standing item on meeting agendas. Front line managers were tasked with communicating changes in resources and practices to healthcare providers via posters, staff meetings, and huddles. Screening and Referral Tool With permission from the British Columbia Provincial Nursing Skin and Wound Committee (2014), information from their PU prevention form was incorporated and adopted into a PU screening and referral form. This document was based on the aforementioned form and the Braden Scale (Braden & Bergstrom, 1989). It was piloted, revised, and implemented hospital-wide with education of the staff provided by the hospital’s nurse educators. With a predictive validity of the modified Braden Scale found to be .72 and its higher interrater reliability, it was deemed appropriate for the patient population in this community hospital (Chen, Cao, Zhang, Wang, & Huai, 2017; Park, Lee, & Kwon, 2016). The PU screening and referral form was completed by nurses within the first 8 hours of a patient’s admission and then repeated every 48 hours. For patients with length of stays over 8 hours in the emergency department and all patients in the intensive care unit, nurses completed and documented these assessments every 24 hours. High risk scores (dependent on the category) alerted nurses to the need to refer patients to allied health professionals, certified wound care nurses, and physicians (Keast, Parslow, Houghton, Norton, & Fraser, 2007). CU Prevention of Pressure Injuries During Hospital Stay Capstone Project A nutrition screening tool was developed and piloted to track patients’ nutritional intake and identify patients who would benefit from dieticians’ expertise. The hospital’s dieticians taught the healthcare aides and nurses how to use the nutrition screening tool during unit staff meetings. Material Resources Specialty sleep surface mattresses were purchased hospitalwide and 12 powered therapeutic sleep surfaces were obtained for high risk patients (D’Arcy, 2014; Pamaiahgari, 2014). Turning sheets were removed from stock and their use was discouraged. After purchasing additional sliders for all units, sliders were reintroduced to facilitate repositioning of Worldviews on Evidence-Based Nursing, 2017; 14:6, 473–483. C 2017 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing. Original Article patients requiring assistance with mobility. Allied health professionals provided educational sessions at the unit level to support appropriate use of sliders for patient repositioning (Moore, Cowman, & Conroy, 2011). Changes in these material resources and practices served to: (a) eliminate extra layering under patients, (b) improve moisture reduction, and (c) decrease friction and sheer. Heel-lift boots were introduced for patients identified as at-risk for heel and foot wounds (D’Arcy, 2014; Pamaiahgari, 2014). Heel-lift boots were used in the emergency department, the operating room, and on in-patient units. Incontinence care was enhanced by limiting the availability and use of washable soakers. Disposable soaker pads were provided when patients had special needs such as exudative wounds. New incontinence products were obtained and evaluated to provide appropriate moisture-reduction. Staff Education The wound care committee collaborated with members of regional programs to ensure that nurses were offered continuing education about PU prevention and management (Buss et al., 1999). Several nurses from in-patient units received training in advanced wound care. Advanced wound care nurses served as referents at the unit level until a certified wound care nurse completed a comprehensive patient assessment with further recommendations. Advanced wound care nurses also conducted observational surveys of in-patients to determine PU prevalence and incidence. Hands-on tutorial. Hands-on instruction was provided to nurses and healthcare aides about the aforementioned new equipment. Vendors for mattresses, sliders and incontinence products introduced the materials, provided demonstrations, and answered questions related to the use of new products. Online tutorial. To further facilitate the education of allied health professionals, nurses, and healthcare aides, a 15-minute on-line tutorial was developed, piloted, and evaluated. Content was based on current evidence and tailored to address items in the PU knowledge assessment tool (Beeckman et al., 2010). The tutorial was introduced using Sussman’s famous statement, “We need to treat the whole patient—not the hole in the patient.” Current evidence was used to compile information about PU pathophysiology, assessment, prevention, and treatment. The format was a PowerPoint with voiceover and embedded instructional videos. The 15-minute timeframe was appropriate to facilitate direct care providers’ availability and engagement and was supported by unit managers. This multi-media tutorial summarized best practices in PU screening, prevention, and management and it is available at = 0C_AB4qBE2s. AIMS AND OBJECTIVES This study aimed to evaluate the effectiveness of the PUPP in reducing prevalence of PUs and enhancing hospital staff’s knowledge about PU prevention. Research questions were: (a) Did the online tutorial produce a statistically significant elevation in the knowledge level of PUs and PU prevention among healthcare aides, nurses, and allied health professionals? (b) Did the PUPP produce a statistically significant reduction in the prevalence and incidence of PUs (all stages)? (c) What were healthcare aides, nurses, and allied health professionals’ perceptions and experiences of the PUPP? METHODS An explanatory sequential mixed methods study was used. It began with quantitative data collection and analysis followed by a qualitative component. A biostatistician was consulted to determine appropriate sample size to answer the first two research questions. CU Prevention of Pressure Injuries During Hospital Stay Capstone Project Beeckman et al.’s (2010) 26-item knowledge assessment tool was used with permission as psychometric assessments deemed it as reliable and valid. Beeckman et al.’s PU knowledge assessment tool was shortened to 18-items and used in pre-tests post-tests. Shortening the knowledge assessment tool was deemed necessary to facilitate frontline staff participation and limit their time away from patients. Each correct answer provided a score of 1 with a perfect score being 18. A power analysis indicated that a sample size of 90 was required for the pre-test post-test design used to answer the first research question. Following approval from two research ethics boards, recruitment began. A pre-test post-test design was used to evaluate the effectiveness of the online tutorial in improving staff’s knowledge level. Using, an informational letter, demographic survey, pre-test, 15-minute online tutorial, and post-test was offered to healthcare aides, nurses, and allied health professionals. A $5 gift card to the in-hospital coffee shop and a chance to win a $150 gift card at an on-site fitness center were used as incentives to participate. Subjects completed the demographic survey, an 18-item PU prevention knowledge assessment tool (pre-test), viewed the 15-minute online tutorial, and then completed the post-test. A paired sample t test was used to compare mean pre-test and post-test scores. A biostatistician determined that a total sample size of 480 (240 in the 2013 and 240 in the 2014 observational surveys) was required to answer the second research question. To answer the second research question, an observational survey of in-patients’ skin was repeated in November 2014 to determine the prevalence and incidence of PUs using a modified Braden scale. In this regional health authority, observational surveys are conducted on an annual basis to determine PU prevalence and incidence among in-hospital patients. Prior to observational surveys, surveyors are trained to identify, stage, and document PUs. Survey teams were comprised of three staff members with at least one advanced wound care nurse per team. Wound care committee members, as well as certified wound care nurses, were available as additional resources to verify or refute observational survey results. However, interrater reliability tests were not formally conducted. 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