Nursing
In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Background
Clinical problem statement.
Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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 required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.1: Exemplify professionalism in diverse health care settings.
2.2: Comprehend nursing concepts and health theories.
3.2: Implement patient care decisions based on evidence-based practice.
ANSWER
Nurses Role in Pediatric Care to Decrease Unplanned Hospitalization
Background
Over the years, the percentage of pediatric admissions has been unplanned. Unplanned hospitalization of pediatric patients is a complex issue that will be a matter of intense discussion in the years to come. At the current time, everyone who has children or takes care of them can imagine how difficult it would be if their child suddenly fell sick and they were unable to find an open bed for them in any hospital at one of the most crucial times. The problem being faced today is that hospitals will always be seeking ways to avoid overcrowding and unplanned visits that do not represent true medical needs. According to Husk et al., (2018), unplanned hospitalization of pediatrics has been disruptive and costly. However, pediatric admissions are characterized by minor conditions and self-limiting situations that last for less than two days.
Clinical Problem Statement
Unplanned hospitalization services have increased raising the cost of pediatric healthcare. According to Zhou et al., (2019), the demand for these services has increased due to the high probability of illnesses and bacterial infections among children. Most pediatric hospitals are experiencing unplanned hospitalization which requires overnight stay that was not planned or scheduled (Hargreaves et al., 2019). For many parents, their children’s chronic conditions make them particularly susceptible to frequent unplanned hospitalizations or unexpected trips to the emergency room. Often, these illnesses require multiple medications and constant monitoring by health care professionals which leads parents with little experience of their own in taking care of sick children, especially at night when they have no one to turn to for help.
Purpose of the Change Proposal
The simulation-based intervention aims to lead greater level of competency and confidence that will allow the caregivers to hand in the unplanned hospitalization incidents. The caregivers include the nurses and the family members. The nurses can rely on simulation-based interventions to educate the family members on how to offer care to the pediatrics to reduce unplanned hospitalization. Through the simulation-based intervention, the caregivers can gain knowledge on how to handle emergencies and apply care knowledge during stressful conditions to meet the pediatric care needs (Whitfill, Gawel, and Auerbach, 2018). Ideally, the simulation-based intervention aims to build knowledge on the provision of care during unplanned hospital admissions. The caregivers will learn how to handle stressful care situations during unplanned hospitalization.
PICOT Question
In pediatric patients, does utilizing simulation-based interventions among nurses compared to standard nursing practice reduce 90-day unplanned hospitalization?
Literature Search Strategy Employed
The literature search strategy employed was the abstract review approach. The abstract review search strategy is a systematic review approach where the abstracts of included studies are searched to identify additional studies to include in the review. Using the abstracts to identify studies can be faster than searching the full texts of all identified studies. This allows the systematic review to be completed more quickly. An advantage of this approach is that once a large number of citations have been gathered, it may not be necessary to read through every one of them in detail, provided that inclusion/exclusion decisions based on just the abstract are reliable and repeatable by others asked to make those decisions. After identification of different articles related to interventions for unplanned hospitalization admission article abstracts were used to broaden the results from all the available articles.
Evaluation of the Literature.
Many scholarly articles and publications have crucial information regarding interventions and practices that nurses can use to reduce unplanned hospitalization. Some of the publications support simulation-based interventions, whereas others support the use of the standardized nursing practice. The literature focused on simulation-based interventions and how they can be used in reducing unplanned hospitalization of pediatrics. For instance, Aebersold and Tschannen (2013) focused on the significance of simulation as a technique to replace real-life experiences.
Lemarie, et al. (2019focused on the role of utilizing simulation-based interventions among nurses in helping reduce unplanned interruptions. The research expounds on the role of nurses in Continuous Renal Replacement Therapy management, where their training program based on high fidelity simulation and its role in reducing the rate of an interrupted session is analyzed. On the other hand, Nowicki (2019), expounds on how to implement a is a Simulation-based Inter-professional Patient Safety Program, which is about the study topic in that the safety program can help in reducing unplanned hospitalization. Kim, Park, & Shin (2016), focused on simulation-based nursing education, which is becoming an increasingly popular pedagogical approach due to its efficiency, which can help in handling real-life situational experiences that can ultimately reflect on the reducing number of unplanned hospitalizations.
Applicable Change or Nursing Theory Utilized
Person-centered care theory is a theory based on the belief that people and their relationships are central to professional practice, and guidelines for effective interaction with clients. Person-centered care is an effective model and tenet of pediatric nursing since it focuses on a dynamic relationship to promote better health outcomes. Person-centered care will improve pediatric nursing since it maintains familial bonds during pediatric treatment (Park, Lee, Jeong, Jeong and Go, 2018). The pediatric nurses that adopt person-centered care in the nursing practice will promote positive patient outcomes through family interaction that creates a healing environment.
Proposed Implementation Plan With Outcome Measures.
The change intervention will be implemented in pediatric healthcare and clinical settings to reduce unplanned hospitalization among pediatrics. The simulation training will occur through two simulation exercises that will be delivered to the nurse and caregivers (family members). This will take place for nine days to ensure that the nurses and caregivers increase their knowledge, skills, and confidence in managing unplanned hospitalization. The caregivers especially the parents will form a simulation-based group that will be trained on child management while at home. On the other hand, the nurses will form the other simulation-based group that will be trained on how to offer quality care to the pediatrics to prevent unplanned readmissions.
Evidence-Based Practice In Creating The Intervention Plan.
Ideally, Evidence-based practice (EBP) involves the integration of best available research with clinical expertise and patient values (Shelton, Cooper, and Stirman, 2018). Engaging in EBP allowed application principles of critical thinking, problem-solving, and decision-making for patients since the nurses effectively analyzed the available literature. The primary objective was for nurses to make decisions about health care that are grounded in systematic reviews of the literature. Nurses examined whether interventions were effective or if there was no effect, then compared all possible options before choosing which intervention would provide a solution to the problem of unplanned hospitalization.
Plan For Evaluating The Proposed Nursing Intervention.
The healthcare institutions would be favorable in observing the issues as well as the impact of the quality improvement initiative. The healthcare institutions and clinical settings are the nurses’ working environment which will allow systematic assessment of the identified problem. The clinical settings will also design a set of activities to measure the outcomes of the improvement processes. The pediatric clinical settings will allow assessment of the problem of increased unplanned hospitalization among pediatrics. The pediatric clinical settings will allow a close examination of the clinical skills among the pediatrics and examine the issues linked to hospitalization among a broad range of real patients. The pediatric clinical setting will also be used in the implementation of interventions and quality initiatives to promote change.
Potential Barriers to Plan Implementation
Implementation of the intervention plan is likely to encounter potential barriers due to a lack of a common understanding. One of the potential barriers is the lack of involvement of nurses in the implementation of change. Considerably, like any other professionals, nurses are likely to fear and resist change unless they are involved in the change process. Lack of clarity and poor communication strategy is likely to influence the implementation of the plan. Without effective communication, the implementation plan is likely to fail. To overcome these barriers, there is a need to establish an effective communication strategy that will ensure that nurses are aware of the initiative and contribute to the implementation of the change initiative. An effective communication strategy means involving all the stakeholders, informing them about the change and the positive outcomes of the plan implementation.
References
Aebersold, M., & Tschannen, D. (2013). Simulation in Nursing Practice: The Impact on Patient Care. Retrieved from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Simulation-in-Nursing-Practice.html
Cecil, E., Bottle, A., Ma, R., Hargreaves, D. S., Wolfe, I., Mainous, A. G., & Saxena, S. (2018). Impact of primary preventive care on children’s unplanned hospital admissions: a population-based birth cohort study of UK children 2000–2013. BMC medicine, 16(1), 1-11.
Cesta, T. (2017). Transitions in Care and the Role of the Case Manager. Retrieved from https://www.reliasmedia.com/articles/141685-transitions-in-care-and-the-role-of-the-case-manager
Hargreaves, D. S., Arora, S., Viveiro, C., Hale, D. R., Ward, J. L., Sherlaw-Johnson, C., … & Cross, J. H. (2019). Association of quality of pediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study. The Lancet Child & Adolescent Health, 3(9), 627-635.
Husk, K., Berry, V., Tozer, R., Skipwith, G., Radmore, R., Ball, S., … & Logan, S. (2018). Interventions for reducing unplanned pediatric admissions: an observational study in one hospital. BMJ pediatrics open, 2(1).
Kim, J.-H., Park, J.-H., & Shin, S. (2016). Effectiveness of simulation-based nursing education depending on fidelity: A meta-analysis. doi:10.1186/s12909-016-0672-7
Nowicki, M. (2019). Implementation of a Simulation-based Interprofessional Patient. Retrieved from https://repository.usfca.edu/cgi/viewcontent.cgi?article=1213&context=dnp
Park, M., Lee, M., Jeong, H., Jeong, M., & Go, Y. (2018). Patient-and family-centered care interventions for improving the quality of health care: a review of systematic reviews. International journal of nursing studies, 87, 69-83.
Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual review of public health, 39, 55-76.
Whitfill, T., Gawel, M., & Auerbach, M. (2018). A simulation-based quality improvement initiative improves pediatric readiness in community hospitals. Pediatric emergency care, 34(6), 431-435.
Zhou, H., Roberts, P. A., Dhaliwal, S. S., & Della, P. R. (2019). Risk factors associated with pediatric unplanned hospital readmissions: a systematic review. BMJ Open, 9(1), e020554.
