Benchmark – Capstone Project Change Proposal
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
- Problem statement
- Purpose of the change proposal
- Literature search strategy employed
- Evaluation of the literature
- Applicable change or nursing theory utilized
- Proposed implementation plan with outcome measures
- 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 Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components 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.
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Expert Answer and Explanation
Capstone Project Final
The nursing shortage is one of the major issues that need immediate attention in the US and other parts of the world. According to Kim, Park, Han, Kim and Kim (2016), the US government employed more than 100,000 new nurses in 2002. However, the demand for nurses in the country was not affected by the move. The author argued that the government should do more to combat the problem in a move to improve patient outcome. One of the issues that were found to cause a nursing shortage in healthcare facilities is low employee satisfaction. Lisa, Cydne, Altair, Paul and Michael (2017) mentioned that the majority of nurses who leave the healthcare industry often do that because they are not happy with their current working environment. Also, low wages can be another key factor that leads to a nursing shortage within healthcare facilities. Lack of motivation programs in the facility can also be linked to the high rate of nurse shortage in the health care sector. The ever-increasing world population also causes the nursing shortage. The population of the world is growing, but few people are joining the nursing profession.
Nurse shortage has many drastic effects on patients and hospitals. Alharbi (2017) reports that nurses often work for long hours without rest due to nurse shortage, and this can cause injury, fatigue, and tiredness among the nurses. Another effect of nurse shortage is employee dissatisfaction. Kim et al. (2016) argue that nurses are always dissatisfied in a working environment where they are overworked. Nursing shortage can also lead to medical errors and missed events because of fatigue and tiredness. As a result, care quality can be affected, and this can lead to patient dissatisfaction. Lastly, nurse shortage can cause an increased mortality rate and overcrowding of the emergency rooms (Tacy, 2016).
Clinical Problem Statement
The nursing shortage is one of the major problems affecting the healthcare sector. According to Nantsupawat et al. (2017), the nursing shortage causes the health industry about $400 million every year. Apart from the economic effect, the nursing shortage can lead to nurse burnout because the available few nurses are forced to work for long hours without rest. McKechnie (2016) argues that nurse shortage is the main reason for several cases of medical errors across healthcare institutions. When the nurses are fatigued and tired, they are most likely to conduct activities that may lead to medical errors and missed events. Thus, the healthcare sector should strive to reduce nurse shortage in a move to improve patient care.
Purpose of the change proposal concerning providing patient care in the changing health care system.
The sole purpose of this capstone project is to propose solutions that can be used to improve the number of nurses in the healthcare sector so that they can improve patient care by providing quality care.
For patients admitted in ICU (P), does putting in place a fixed nurse staffing ratios (I) as compared to not having fixed nurse staffing ratios (C) affect patient outcomes(O) during their hospitalization period under intensive care (T)?
Literature search strategy employed
The search for articles published not later than five years were conducted via Grand Canyon University online library. These databases include the Wiley online library, National Institutes of Health library (NIH), and National Center for Biotechnology Information library (NCBI). Google Scholar was also used to search for the articles. Nursing shortage, staffing ratios, and nurse burnout are some of the search terms used in the strategy. To ensure that the search was exhaustive, variations of the terms were used. After the search for the articles, the resources found were evaluated.
Evaluation of the Literature
Eight articles were used to answer the PICOT question. An article by Alharbi (2017) concluded that poor leadership management could lead to low job satisfaction, medical errors, and high turnover. Also, an article by Kollman (2019) found that acuity-based staffing (ABS) can be used to improve patient outcome. Fischer (2016) concluded that the education of nurses could be used to improve the nursing shortage. Kim et al. (2016) noted in their study that high patients’ readmissions are related to the nursing shortage. Lisa et al. (2017) shortage are unsafe because it can lead to low patient outcome. All the articles above agreed that nursing shortage could reduce patent outcomes. A full evaluation of the articles used in the study is available in the appendix section.
Applicable change or nursing theory utilized
The change theory used in this project is the Lewin’s Change Management Model. This model has been used because it clearly describes how a manager can implement change in his or her organization. The change model has three stages, namely “unfreeze”, “change”, and “refreeze” Fatema et al. (2017). In the unfreeze stage, the change will be communicated to the stakeholders and awareness created to propagate the importance of the change to the people affected. In the change stage, the proposed solution will be implemented by the project team. The change will be reinforced in the refreeze phase. Here, the manager is needed to follow-up and ensure that the change has been adapted well by the workers and other stakeholders (Al-Ali, Singh, Al-Nahyan & Sohal, 2017).
Proposed Implementation Plan with Outcome Measures
The first step in the implementation is developing a change proposal and presenting it to the management for approval. Second, developing a team that will lead to implementation. Third, creating a policy framework that will guide the implementation process. Fourth, based on the team’s recommendations, implementation schedule and budget will be designed and presented to the management for approval. Firth, the proposed change will be implemented. Sixth, the change will be monitored, and areas that need reinforcement will be reinforced. The last step in the implementation plan is evaluation. One of the ways to evaluate the project is through measuring the outcomes. If hospital deaths, the rate of morbidity, and readmission rates reduce six months after implementation, the project would have achieved its primary objective of improving patient outcomes.
Use of Evidence-Based Practice in Creating the Implementation Plan
Evidence-based practice will be so vital in this project. The team will rely on the results from the EBP when making vital decisions. For instance, the EBP will be used to create a proposal that will be presented to the management to convince them that the problem threatens the existence of the facility, and thus should be given first priority. The EBP will be explicitly used to create the background of the project. Most of the articles in this project have highlighted the negative impacts of the nursing shortage. For instance, Nantsupawat et al. (2017) concluded that low job satisfaction is linked to the nursing shortage. Also, the reliability and authenticity of the solution to the problem will be determined based on the EBP. Tacy (2016) argued that nurse shortage could be solved by improving job satisfaction in the healthcare environment. Satisfaction can be increased by putting in place a fixed nurse staffing ratio.
Plan for Evaluating the Proposed Nursing Intervention
A survey is a primary approach that will be used in the evaluation of the project. First, the conceptual model will be created to determine the key points in the program that should be evaluated. Second, appropriate questions will be created to guide the evaluation process and ensure that it is on track. Third, evaluation tools will be selected to aid in data collection. Two tools will be used to collect data in this process, and they include checklists and questionnaires. The next step after deciding on the instruments for data collection is gathering the actual data. Next, the data will be analyzed thematically to determine whether it has achieved its objectives or not. The last phase is presenting the evaluation report to the management for comments and reservations.
Potential Barriers and How they can be Mitigated
Many barriers will be experienced during the implementation of this project. However, the barriers will be handled amicably using EBP. The first barrier will be communication issues. The project may find it hand to decide on the channel to use in relying on the information. The barrier will be mitigated by developing a central communication channel where all the messages will be communicated. Second, conflicts within the team members might prevent the project from succeeding. The barrier will be handled by applying proper conflict resolution tactics to solve internal problems. The last barrier will be the availability of funds to implement the project. The manager will write a proposal to apply for a grant to support the project.
The purpose of this capstone project was to solve nursing shortage experienced in my practicum setting. Eight articles were analyzed in a move answer the PICOT question. The articles concluded that nursing shortage threatens quality care and patient outcome. The proposed solution for this project is putting in place a fixed nurse staffing ratio. The Lewis’ Change Management model will be used in implementing and managing the transition. The theory will provide strategies used in implementing the change. Evaluation of the project will be done using survey.
Al-Ali, A. A., Singh, S. K., Al-Nahyan, M., & Sohal, A. S. (2017). Change management through leadership: the mediating role of organizational culture. International Journal of Organizational Analysis. https://doi.org/10.1108/IJOA-01-2017-1117
Alharbi, A. Y. (2017). Leadership styles of nurse managers and their effects on nurse and organizational performance, issues, and problems. International Journal of Information Research and Review, 4(9), 4516-4525. http://vipspublisher.com/ijirr.com/sites/default/files/issues-pdf/2269.pdf
Fatema, K., Hadziselimovic, E., Pandit, H. J., Debruyne, C., Lewis, D., & O’Sullivan, D. (2017, October). Compliance through Informed Consent: Semantic Based Consent Permission and Data Management Model. In PrivOn@ ISWC. Retrieved from http://www.tara.tcd.ie/bitstream/handle/2262/82659/88248c5b669175f267069c3319d9ac2d3e84.pdf?sequence=1
Fischer, K. M. (2016). How the educational funding provisions of the Patient Protection and Affordable Care Act will affect the nursing shortage in the United States. Nw. JL & Soc. Pol\’y, 11, 54. http://scholarlycommons.law.northwestern.edu/njlsp/vol11/iss1/3
Kim, S. J., Park, E., Han, K., Kim, S. J., & Kim, T. H. (2016). Nurse staffing and 30-day readmission of chronic obstructive pulmonary disease patients: A 10-year retrospective study of patient hospitalization. Asian Nursing Research, 10(4), 283-288. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1016/j.anr.2016.09.003
Kollman, S. M. (2019). Acuity-based nurse staffing and the impact on patient outcomes (Order No. 13899530). Available from ProQuest Dissertations & Theses Global. (2245924567). Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/2245924567?accountid=7374
Lee, S. H. (2018). The Effects of Nurse Practice Environment and Organizational Justice on Job Embeddedness Among Hospital Nurses. https://sigma.nursingrepository.org/handle/10755/624442
Lisa A., W., Cydne, P., Altair M., D., Paul R., C., & Michael D., M. (2017). On the Threshold of Safety: A Qualitative Exploration of Nurses’ Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments. Journal of Emergency Nursing, 2, 150. https://doi-org.lopes.idm.oclc.org/10.1016/j.jen.2016.09.003
Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O. A., Thienthong, H., & Poghosyan, L. (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), 91-98. https://onlinelibrary.wiley.com/doi/full/10.1111/inr.12342
Tacy, J. (2016). Understanding the effects of technology acceptance in nursing faculty: A hierarchical regression. https://sigma.nursingrepository.org/handle/10755/624001
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