[ANSWERED] In collaboration with the approved course preceptor, students will identify a specific evidence-based topic for the capstone project change proposal.

Written By: Dan Palmer, RN

Edited By: Ethan Green, MSN-FNP

In collaboration with the approved course preceptor, students will identify a specific evidence-based topic for the capstone project change proposal.

Capstone Project Topic Selection and Approval

In collaboration with the approved course preceptor, students will identify a specific evidence-based topic for the capstone project change proposal. Students should consider the clinical environment in which they are currently employed or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a leadership or quality improvement initiative, or an unmet educational need specific to a patient population or community. The student may also choose to work with an interprofessional collaborative team.

Students should select a topic that aligns to their area of interest as well as the clinical practice setting in which practice hours are completed.

Write a 500-750 word description of your proposed capstone project topic. Include the following:

The problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project that will be the focus of the change proposal.
The setting or context in which the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project can be observed.
A description (providing a high level of detail) regarding the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
Effect of the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
Significance of the topic and its implications for nursing practice.
A proposed solution to the identified project topic with an explanation of how it will affect nursing practice.

You are required to cite to a minimum of eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Plan your time accordingly to complete this assignment.

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

Prepare this assignment according to the guidelines found in the APA Style Guide.

Expert Answer and Explanation

Capstone Project Topic Selection and Approval

Nurses should ensure that patients receive safe and quality care. This capstone project focuses on fall prevention, an issue that has significant implications on the safety and quality of care. The information concerning this topic is detailed as follows;

The Problem

This Capstone project centers on falls among geriatric patients. Patient falls are one of the major concerns affecting the safety and wellbeing of patients, especially in geriatric facilities. According to estimates by the Agency for Healthcare Research and Quality, approximately a million patients fall each year. The same report attributes almost 10% of total adverse events in health care facilities to falls resulting in significant injuries.

The problem poses a significant concern not only on the health outcomes of patients but also on the cumulative health care costs attributed to treating fall-related injuries. Based on these factors, it was considered a significant problem that needed to be addressed.

The setting in which the Problem Occurs.

Falls are an issue that occurs in both community settings and within health care facilities. From the estimates provided by the AHRQ, the cases of hospital falls show that it is a major challenge affecting the health outcomes of patients. The prevalence of community-related falls is even higher, with geriatric patients being at a higher risk than any other population group, as per Bor et al. (2017).

Due to the fragile nature of geriatric patients, the rate of falls in nursing homes and other geriatric care facilities experience higher cases of fall-related injuries compared to other health care settings. Therefore, a targeted solution focusing on this setting is essential in improving the health outcomes of geriatric patients (Prabhakaran et al., 2020).

Description of the Issue

Hopewell et al. (2018), in their study, noted that patients who are 65 years and above are at a higher risk of experiencing falls. There are various factors associated with falls among the elderly population. For example, a study by Hamza et al. (2019) identifies a positive link between falls and medication use in assisted living facilities. Moreira et al. (2018) noted that fall risk awareness, functional capacity, and physical activity level were significant predicting factors associated with falls among older adults. Understanding these factors is crucial in coming up with viable interventions to reduce falls-related injuries among older patients.

Effect of the Problem

Falls should be an issue of concern to all care providers as noted by Aryee et al. (2017). Aryee et al. note some of the implications relating to falls which include increased cost of care, long hospital stays, hospital readmissions, risk of permanent disability, and unfortunately, at times even death. Sherrington et al. (2017) list patient falls as a leading cause of morbidity and mortality among older adults, with significant socio-economic burdens for patients and their families. The significant impact of the issue makes it a cause for concern that should be handled with utmost priority by care providers.

Significance of the Topic and its Implications for Nursing Practice

Falls and falls prevention is a significant topic in nursing practice. Nurses are supposed to advocate for patient safety and quality of care (Abbasinia et al., 2020). Therefore, the prevention of falls among geriatric patients aligns with this mandate. Similarly, as a way of improving the health outcomes of patients, reducing falls-related incidents within geriatric facilities.

Proposed Solution

The proposed falls prevention solution is to initiate a nurse education intervention, to inform and remind nurses of some of the best evidence-based practices relating to falls prevention. Some of these practices include proper medication administration practices, effective risk assessment strategies, use of risk identification tags, to list a few. The efficacy of educational interventions for health care professionals as a way of reducing incidents of falls is supported by Shaw et al. (2020).

Conclusion

This paper has provided an overview of the capstone topic and why it is relevant in nursing practice. Addressing the issue of falls in older adults will go a long way in reducing health care costs and improving the health and wellbeing of geriatric patients in diverse settings.

Reference

Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141-151. https://doi.org/10.1177%2F0969733019832950

Agency for Healthcare Research and Quality. (2021). Preventing Falls in Hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html

Aryee, E., James, S. L., Hunt, G. M., & Ryder, H. F. (2017). Identifying protective and risk factors for injurious falls in patients hospitalized for acute care: a retrospective case-control study. BMC geriatrics, 17(1), 1-9. https://doi.org/10.1186/s12877-017-0627-9

Bor, A., Matuz, M., Csatordai, M., Szalai, G., Bálint, A., Benkő, R., Soós, G., & Doró, P. (2017). Medication use and risk of falls among nursing home residents: a retrospective cohort study. International journal of clinical pharmacy, 39(2), 408–415. https://doi.org/10.1007/s11096-017-0426-6

Hamza, S. A., Adly, N. N., Abdelrahman, E. E., & Fouad, I. M. (2019). The relation between falls and medication use among elderly in assisted living facilities. Pharmacoepidemiology and drug safety, 28(6), 849-856. https://doi.org/10.1002/pds.4775

Hopewell, S., Adedire, O., Copsey, B. J., Boniface, G. J., Sherrington, C., Clemson, L., Close, J. C., & Lamb, S. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. The Cochrane database of systematic reviews, 7(7), CD012221. https://doi.org/10.1002/14651858.CD012221.pub2

Moreira, N. B., Rodacki, A. L. F., Pereira, G., & Bento, P. C. B. (2018). Does functional capacity, fall risk awareness, and physical activity level predict falls in older adults in different age groups?. Archives of Gerontology and Geriatrics, 77, 57-63. https://doi.org/10.1016/j.archger.2018.04.002

Prabhakaran, K., Gogna, S., Pee, S., Samson, D. J., Con, J., & Latifi, R. (2020). Falling Again? Falls in Geriatric Adults—Risk Factors and Outcomes Associated With Recidivism. Journal of surgical research, 247, 66-76. https://doi.org/10.1016/j.jss.2019.10.041

Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC Geriatrics, 20(1), 1-13. https://doi.org/10.1186/s12877-020-01819-x

Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J., & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine, 51(24), 1750–1758. https://doi.org/10.1136/bjsports-2016-096547

Alternative Expert Answer

Addressing Hospital-Acquired C. diff through Handwashing

The Problem

The problem that will be focused on in this capstone project is a hospital-acquired infection caused by C. diff. According to Dai et al. (2020), C. diff is a bacteria causing diarrhea that can threaten the life of a patient. The disease is often associated with taking too many antibiotics (Liao et al., 2017).

The disease often occurs in older patients aged 65 and above and are under antibiotic medications. It is also common among individuals staying in hospital settings for a long time (Xu et al., 2017). In other words, it is often common among patients with chronic diseases that need a long hospital stay. The disease can cause a high mortality rate if not prevented on time.

The Setting

This capstone project will focus on the geriatric department. This department has been selected because most older patients often suffer diseases that need a long hospital stay. Jaiswal et al. (2017) note that chronic heart problems are high in older individuals compared to other populations. Diseases, such as diabetes, kidney problem, and liver issues are also high in the geriatric department.

This department was also selected because some patients there reported numerous diarrhea episodes for more than two days. A solution should be found fast to prevent the patients from experiencing more pain because of C. diff infection.

Effects of the Problem

The problem has adverse effects on patients within the departments, the healthcare organization, and the nurses. According to Azab et al. (2017), the disease can cause fever, frequent diarrhea, nausea, loss of appetite, dehydration, and stomach pain. The disease can also cause death if not treated on time (CDC, n.d; Johnson, 2018).

Healthcare organizations where the issue is reported might lose their public image and profits due to mortality, readmissions, and other effects of the disease. People might fear admitting themselves or family and friends in the hospital when the infection can be acquired there. Patients can also sue the hospital for negligence and ask for compensation for physical and mental problems they experienced while infected.

The disease can also prevent nurses from achieving their goals because it causes high readmission and mortality. The CDC (n.da) notes that more than 12, 800 people die from the infection each year.

Significance of the Topic

This topic is highly significant to nursing practice. Nurses who interact with the project will learn the evidence-based strategy they can employ to prevent C. diff and other hospital-acquired infections. The implication of the topic to nursing practice is that nurses cannot achieve their clinical and treatment goals if patients are at risk of contracting hospital-acquired diarrhea.

The Proposed Solution

The proposed solution to solve this problem is washing hands after visiting the toilet and crowded areas. The practice of washing hands has been supported by many scholars. One of the studies that support this practice was done by Haverstick et al (2017). The authors note that hand washing one of the easiest and the best methods of maintaining hand hygiene.

They conclude that hand washing can be used to prevent hospital-acquired infections. They note that patients should wash their hands often. Ragusa et al (2018) also agree that hand washing can be the best method to be used to prevent infections, such as C. diff. the authors also recommend that patients, as well as healthcare professionals, should wash their hands often to avoid being infected.

References

Azab, M., Doo, L., Doo, D. H., Elmofti, Y., Ahmed, M., Cadavona, J. J., Liu, X. B., Shafi, A., Joo, M. K., & Yoo, J. W. (2017). Comparison of the Hospital-Acquired Clostridium difficile Infection Risk of Using Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists for Prophylaxis and Treatment of Stress Ulcers: A Systematic Review and Meta-Analysis. Gut and liver, 11(6), 781–788. https://doi.org/10.5009/gnl16568

CDC. (n.d). Clostridioides difficile Infection. https://www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html

CDC. (n.da). Biggest Threats and Data: 2019 AR Threats Report. https://www.cdc.gov/drugresistance/biggest-threats.html#cdiff

Dai, W., Yang, T., Yan, L., Niu, S., Zhang, C., Sun, J., … & Xia, Y. (2020). Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China. BMC infectious diseases, 20, 1-11. https://link.springer.com/content/pdf/10.1186/s12879-020-05014-6.pdf

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3), e1-e8. https://resani.com/tag/hai/

Jaiswal, S., Natarajan, P., Silver, A. J., Gibson, C. J., Bick, A. G., Shvartz, E., … & Ebert, B. L. (2017). Clonal hematopoiesis and risk of atherosclerotic cardiovascular disease. New England Journal of Medicine, 377(2), 111-121. https://www.nejm.org/doi/full/10.1056/NEJMoa1701719

Johnson, S. (2018). A case study of organizational risk on hospital-acquired infections. Nursing Economics, 36(3), 128-135. https://www.proquest.com/openview/f7fe23af03669e07603148167042964b/1?pq-origsite=gscholar&cbl=30765

Liao, F., Li, W., Gu, W., Zhang, W., Liu, X., Fu, X., … & Lu, J. (2018). A retrospective study of community-acquired Clostridium difficile infection in Southwest China. Scientific reports, 8(1), 1-11. https://www.nature.com/articles/s41598-018-21762-7

Ragusa, R., Giorgianni, G., Lupo, L., Sciacca, A., Rametta, S., La Verde, M., Mulè, S., & Marranzano, M. (2018). Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control. Journal of preventive medicine and hygiene, 59(2), E145–E152. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069405/

Xu, Q., Chen, Y., Gu, S., Lv, T., Zheng, B., Shen, P., … & Li, L. (2017). Hospital-acquired Clostridium difficile infection in Mainland China: a seven-year (2009–2016) retrospective study in a large university hospital. Scientific reports, 7(1), 1-9. https://www.nature.com/articles/s41598-017-09961-0

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