NUR699 GCU Organizational Culture and Readiness Assessment Final Paper Throughout this course you will be developing a formal, evidence?based practice prop

NUR699 GCU Organizational Culture and Readiness Assessment Final Paper Throughout this course you will be developing a formal, evidence?based practice proposal.

The proposal is the plan for an evidence?based practice project designed to address a problem, issue, or concern in the professional work setting. Although several types of evidence can be used to support a proposed solution, a sufficient and compelling base of support from valid research studies is required as the major component of that evidence. Proposals are submitted in a format suitable for obtaining formal approval in the work setting. Proposals will vary in length depending upon the problem or issue addressed; they can be between 3,500 and 5,000 words. The cover sheet, abstract, references page, and appendices are not included in the word limit.

Section headings and letters for each section component are required. Responses are addressed in narrative form in relation to that number. Evaluation of the proposal in all sections is based upon the extent to which the depth of content reflects graduate?level critical?thinking skills.

This project contains seven formal sections: These are the ones we worked over past weeks and links provided at the end .

Section A: Organizational Culture and Readiness Assessment

Required revision – Need to add discussion of barriers. Make sure to include for final paper

Section B: Problem Description

Required revision – None

Section C: Literature Support

Required revision – Add description of the validity

Section D: Solution Description

Required revision -You have developed a nice program. You nicely developed a solution. Can you describe what barriers you might experience?

Section E: Change Model

Required revision – None

Section F: Implementation Plan

Required revision – There are a couple of sections that are missing (budget and references). In addition, a couple of sections need a little more detail – setting, instruments – what are you going to collect? When? how? Where will the data be stored? Dr. Gallegos

Section G: Evaluation of Process

Required revision – None

Each section (A?G) will be submitted as separate assignments so your instructor can provide feedback (refer to applicable modules for further descriptions of each section).

The final paper will consist of the completed project (with revisions to all sections-), title page, abstract, reference list, and appendices. Appendices will include a conceptual model for the project, handouts, data and evaluation collection tools, a budget, a timeline, resource lists, and approval forms.

Use the “NUR?699 EBP Implementation Plan Guide” and “NUR?699 Evidence?Based Practice Project Student Example” to assist you. Also refer to “NUR?699 Evidence?Based Practice Project Proposal Format.” (ATTACHED)

RUBRIC (ATTACHED)

https://www.studypool.com/discuss/12676846/evidence-based-practice-proposal-section-c-literature-support-1

https://www.studypool.com/discuss/12537200/evidence-based-practice-proposal-1

https://www.studypool.com/discuss/12264457/benchmark-change-initiative-implementation-evaluation-and-sustainability-3

https://www.studypool.com/discuss/12816916/evidence-based-practice-proposal-section-d-solution-description-3

https://www.studypool.com/discuss/12932371/evidence-based-practice-proposal-section-e-change-model-1

https://www.studypool.com/discuss/13084558/evidence-based-practice-proposal-section-g-evaluation-of-process-2 Course Code
NUR-699
Class Code
NUR-699-O501
Criteria
Content
Percentage
55.0%
Abstract
Presents a complete, concise
overview of all phases of the proposed project.
10.0%
Project / Content Comprehension
25.0%
Sections A-G Synthesis
20.0%
Organization and Effectiveness
30.0%
Appendices
15.0%
Mechanics of Writing (includes spelling,
punctuation, grammar, language use)
15.0%
Format
15.0%
Research Citations (In-text citations for
paraphrasing and direct quotes, and reference
page listing and formatting, as appropriate to
assignment and style)
15.0%
Total Weightage
100%
Assignment Title
Benchmark – Evidence-Based Practice Proposal Final Paper
No Submissions (71.00%)
None
None
None
None
None
None
Total Points
250.0
Unsatisfactory (75.00%)
No abstract
Content is incomplete or omits most of the requirements
stated in the assignment criteria. Does not demonstrate an
understanding of the basic principles. Does not demonstrate
critical thinking and analysis of the overall program subject.
The main sections are not easily identified; some of the
subconcepts do not successfully integrate to form a cohesive
whole. Within section revisions methods and strategies are
described poorly. Basic descriptions, connections, and
alignment are not clearly presented. Logic flow is random,
not easily understood.
Several of the appendices are missing. Designs are
not
neat or organized, and do not include all required elements.
Unprofessionally developed.
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice
and/or sentence construction are used.
No reference page is included. No citations are used.
Less Than Satisfactory
(83.00%)
Abstract minimally written, clearly not sufficient to provide
the reader with an understanding of the project.
Content is incomplete or omits some requirements stated in
the assignment criteria. Demonstrates shallow understanding
of the basic principles. Within section revisions components
may be missing details, only a surface level of evaluation is
offered, methods are described but flawed or unrealistic and
strategies are discussed, but incomplete.
The main sections are somewhat identified; some of the
subconcepts branch appropriately from the main sections.
Basic descriptions, connections, and alignment as well as a
clear logic flow are somewhat fragmented, not easily
understood.
Several of the appendices are missing. Design detracts from
purpose. The work is not neat and includes minor flaws or
omissions of required elements. Limited understanding of the
topic is present as evidenced by the design.
Frequent and repetitive mechanical errors distract the
reader. Inconsistencies in language choice (register), sentence
structure, and/or word choice are present.
Reference page is present. Citations are inconsistently used.
Satisfactory
(88.00%)
Abstract provides overview of part of the project, but does
not cover each section.
Content is complete, but somewhat inaccurate and/or
irrelevant.
Demonstrates adequate understanding of
the basic principles. The major sections have had revisions
but some components may be missing details. Reasonable
but limited inferences and conclusions are drawn but lack
development. Supporting research is inadequate in relevance,
All of the main sections are easily identified, and subconcepts
branch appropriately from the main sections. Recognizes links
among sections; however, some connections may be
ambiguous. Basic descriptions, connections and alignment as
well as basic logic flow are understandable, but are
somewhat lacking in a clear progression.
All of the appendices have been provided. Design is fairly
clean, with a few exceptions. Appearance is general, and
major elements are missing. Provides minimal details.
Appropriate for the audience and the content but some of
the development of the material is inadequate. Basic
understanding of the topic is present as evidenced by the
Some mechanical errors or typos are present, but are not
overly distracting to the reader. Correct sentence structure
and audience-appropriate language are used.
Reference page is included and lists sources used in the
paper. Sources are appropriately documented, although
some errors may be present.
Good
(92.00%)
Abstract provides a quick or too brief overview of all phases
of the proposed project. Contains project title, project
director’s name, and affiliation.
Content is comprehensive and accurate, and definitions are
clearly stated. Sections form a cohesive logical and justified
whole. All of the major sections have been revised based
upon logical feedback, conclusions, and sound research.
Shows careful planning and attention to details and
illuminates relationships. Research is adequate, current, and
All of the main sections are easily identified, and subconcepts
branch appropriately from the main sections. Descriptions,
connections, and alignments are provided. Logic flow is
smooth and easily understood, facilitating a thorough
understanding of the various sections as they interrelate.
All of the appendices have been provided. Designs are
appropriate and present quality products. Appearance is
neat, with a few minor flaws or missing elements. Provides
details with accuracy. Reveals a solid understanding of the
topic as evidenced by design.
Prose is largely free of mechanical errors, although a few may
be present. A variety of sentence structures and effective
figures of speech are used.
Reference page is present and fully inclusive of all cited
sources. Documentation is appropriate and citation style is
usually correct.
Excellent
(100.00%)
Abstract provides a complete concise overview of all phases
of the proposed project and flows well with the rest of the
paper. Contains project title, project director’s name,
and affiliation.
Content is comprehensive. Presents ideas and information
beyond that presented throughout the course, and
substantiates their validity through solid, academic research
where appropriate. Research is thorough, current, and
relevant, and addresses all of the issues stated in assignment
criteria. Final paper exhibits process of creative thinking and
All main sections are easily identified, and sub concepts
branch appropriately from main sections. Descriptions,
connections, and alignments are obvious and well supported.
Logic flow is smooth and easily understood, facilitating a
thorough understanding of various sections as they
interrelate. Connection to extraneous materials are well
All of the appendices have been provided. They are effective
and functional. The work is well presented and includes all
required elements. The overall appearance is neat and
professional. Gives sufficient detail with precision and
specificity. Reveals a solid understanding of the topic as
evidenced by the design.
Writer is clearly in command of standard, written, academic
English.
In-text citations and a reference page are complete and
correct. The documentation of cited sources is free of error.
Comments
Points Earned
EBP Implementation Plan Guide
PICOT Question
Topic 1
•
Preliminary
Checkpoint
•
•
•
Topic 2
•
•
Checkpoint 1
•
•
•
•
•
Topic 3
•
Checkpoint 2
•
•
•
Topic 4
•
Checkpoint 3
•
•
Identify a health care issue you
want to see change.
Understand the culture of the
organization in its readiness for
EBP implementation.
Develop PICOT question.
Build EBP knowledge and skills.
Define project purpose.
Who are the stakeholders for your
project?
Identify active (on the
implementation team) and
supportive (not on the team, but
essential to success) roles.
Identify project team roles and
leadership.
Begin acquisition of any necessary
approvals for project
implementation and dissemination
(e.g., system leadership, unit
leadership, ethics board [IRB]).
Feasibility: Briefly integrate the
evidence with stakeholder
influence to inform evidencebased recommendations.
Hone PICOT question.
Conduct literature search and
retain studies that meet criteria for
inclusion.
Connect with librarian.
Critically appraise literature.
Summarize evidence with focus
on implications for practice.
Begin formulating a detailed plan
for implementation of evidence.
Include who must know about the
project, when they will know, how
they will know.
Connect the evidence and the
Notes:
Notes:
Notes:
Notes:
© 2014. Grand Canyon University. All Rights Reserved.
•
•
Topic 5
•
Checkpoint 4
•
•
•
•
•
Topic 6
•
Checkpoint 5
•
•
Topic 7
•
•
Checkpoint 6
Topic 8
•
•
Checkpoint 7
project.
Identify and address known
barriers and facilitators of project.
Define post-project outcome
indicators of a successful project.
Define baseline data collection
Notes:
source(s) (e.g., existing data set,
electronic health record), methods,
and measures.
Identify resources (human, fiscal,
and other) necessary to complete
project.
Gather outcome measures.
Write data collection protocol.
Write the project protocol (data
collection fits in this document).
Finalize any necessary approvals
for project implementation and
dissemination (e.g., system
leadership, unit leadership, IRB).
Finalize protocol for
Notes:
implementation of evidence.
Complete final data collection for
project evaluation.
Include specific plan for how the
evaluation will take place: who,
what, when, where and how, and
communication mechanisms to
stakeholders.
Complete proposal.
Notes:
Develop proposal presentation.
Present proposal.
Review proposals, addressing new
questions generated from process
of the peer review.
Notes:
Adapted from Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2010). Evidence-based practice in
nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Lippincott Williams
& Wilkins.
1
Evidence-Based Practice Project Student
Example
2
Table of Contents
Generating Evidence for Evidence-based Practice
Part 1: Introduction
I. The problem statement ………………………………….……………………….……….3
II. The evidence-based question ………………………………………..……….……….…4
Part 2: Assemble relevant evidence & related literature
III. Locating credible evidence………………………………………………….……………3
IV. Appraise the evidence……………………………………………………….……………4
Part 3: Implementation of the intervention
I. Planning of change………………………………………………………………..…….8-9
II. Clinical protocol and pilot project………………………………………………9-14 & 23
III. Integration and Maintenance …………………………………………………….…..14-15
IV. Barriers and strategies………………………………………………….……………15-18
Part 4: Conclusion ………………………………………………..…………………………….18
Part 5: References……………………………………………………………………………20-22
Part 6: Appendices …………………………………………………………..…………….……23
I. Management of Mechanically Ventilated Patients: Pilot Project ……………………23-24
II. Questions for Patient Ventilator Rounds ………………………………………………..25
III. Methodological matrix ………………………………………………………………26-28
IV. Prevention In- Service Flyer ……………………………………………………………27
3
Problem Statement
The development of pneumonia caused by mechanical ventilation is a significant problem
in the intensive care units of hospital facilities. Ventilator-associated pneumonia (VAP) is the
“most commonly reported healthcare-acquired infection” in patients requiring mechanical
ventilation support (Garcia et al., 2009, p. 524). One of the most common reasons for an ICU
admission is related to respiratory distress or failure. VAP is described as a form of nosocomial
infection which occurs after the first 48 hours of receiving mechanical ventilation (Augustyn,
2007). The length of stay (LOS) for patients developing VAP is higher than those never
requiring mechanical ventilation by an increase of approximately six days (Garcia et al. 2009).
In intensive care units (ICUs) across the United States (US), ventilator-acquired pneumonia also
results in prolonged periods of actual mechanical ventilation, the excess use of antimicrobial
products, increased utilization of healthcare resources and costs, and significant increase in
morbidity and mortality (Coffin et al., 2008). Garcia et al. (2009) found on average, estimated
costs of an additional $11, 897 to $150,841 per individual case were spent. VAP has a
significant economic impact on our society, costing hospitals money which potentially could
have been saved.
Numerous risks factors contribute to the development of ventilator-acquired pneumonia
as mechanical ventilation presents a unique set of challenges for the patient requiring intubation
and ventilator support. Rigorous clinical studies show oral secretions pose an increased risk for
developing VAP (Augustyn, 2007). Treatments, strategies and evidence-based interventions
have been developed to decrease the risks and reduce the prevalence of VAP. There is evidence
indicating the use of oral chlorhexidine and the removal of oral secretions before position
changes may diminish the risks of developing ventilator-acquired pneumonia. By reducing the
levels of bacteria in the oropharynx there would theoretically be a decrease in the prevalence of
4
nosocomial pneumonia (Houston et al., 2002). Research demonstrates the use of 0.12%
chlorhexidine gluconate oral rinse (CHX) pre and postoperatively reduces the incidence of VAP
in patients who are intubated greater than 24 hours.
Foreground Question
In adults supported with mechanical ventilation, what is the effect of oral chlorhexidine
use and removal of oral secretions prior to position changing on the development of ventilatoracquired pneumonia?
Review of Evidence and Synthesis of Literature
This is a literature analysis of research reports and literature reviews which studied the
effects of removal of oral secretions prior to position change on the occurrence of VAP. A
summary of the articles can be found in Appendix C. The studies varied in design; from
randomized to non-randomized, placebo, to longitudinal and a pilot study. Strength for each
study is noted at Level II on the hierarchy as each one is a randomized or nonrandomized clinical
study. The research supports our clinical question and was utilized with the development of
additions to be incorporated into the already existing ICU VAP protocol.
The studies focused on in this review consisted of evidence evaluating oral secretion
removal and the use of chlorhexidine gluconate oral rinse to prevent VAP. The cost
effectiveness of these interventions was found to be significant. Studies showed oral secretions
as being the medium to carry pathogens within the oropharyngeal site down into the respiratory
track. The literature hypothesized removing oral secretions prior to the position change of a
patient can prevent or minimize the movement of organisms into the respiratory tract which lead
to VAP development. Some researchers also concluded the significance of chlorhexidine use for
reducing nosocomial infections. The combination of both interventions creates a profound effect
5
on reducing VAP occurrences its research importance, which this practice change aims to
strongly support.
The review of literature consists of evidence dating from 1996 to 2008, indicating the
need for continued research and close monitoring of clinical practice changes based on the best
evidence at the moment. This problem was identified long ago and yet still needs further
evidence for best practice. Three articles discuss removing oral secretions prior to position
changes of patients which are one of the two independent variables of interest for this review.
In one of those studies, VAP was diagnosed in 24 of 159 patients in the control group, but only
in five of 102 patients in the study group within the study group receiving oral suctioning prior to
all position changes (Chao, Chen, Wang, Lee, & Tsai, 2008). A similar study showed VAP
occurrence at 2.6% in the study group and 11% in the control group with probability of < 0.001 (Tsai, Lin, Chang, 2008). Studies by DeRiso et al. (1996) and Houston et al. (2002) each sought to evaluate the efficacy of oropharyngeal decontamination on nosocomial infections in patients undergoing heart surgery using CHX before and after surgery. Both DeRiso et al. and Houston et al. discovered an overall reduced rate of VAP (52% and 69% respectively for each study). The significance level for both studies was less than .01 (use the higher of the two) with the use of CHX with oral suctioning of subjects for these studies. Another related intervention assessed in a similar randomized clinical study was the use of subglottal suctioning by Smulders et al. (2002) and its effect on VAP incidence. This intervention was appropriate for this review of literature; four percent of patients who underwent continuous suctioning developed VAP as compared to 16% in the control group. A common finding in the studies reviewed was the savings in spite of the costs of using CHX and equipment 6 for oral and subglottal secretion removal. The majority of these studies revealed a significantly reduced duration of mechanical ventilation and LOS in the ICU. All research studies in this literature review, with the exception of Tsai et al.’s study, consisted of study groups homogenous in patient samples, which suggest effective randomization. Tsai et al.’s study has patient heterogeneity (of both medical and surgical ICU patients) which may have confounded the results. Also, the results of Chao et al.’s study did yield a significant difference with the distribution of patients having a history of COPD, DM, use of antacids, and surgery. These variables were then evaluated with logistic regression for their relationship in VAP development, and the results of the logistic regression showed no significant impact on the direct development. Overall the reviews are well organized, use appropriate language, and use mostly all paraphrasing. This review summarizes key finding of evidence for clinical practice, and provides similar conclusions like our study regarding interventions to implement in practice. This literature review consisted of all but one study which were experimental in nature and hold “a high degree of internal validity because of the use of manipulation and randomization” (Polit & Beck, 2008, p. 295). Tsai et al.’s study was a time-sequenced, nonrandomized quasi-experimental study most vulnerable to threats to internal validity out of all the literature reviewed. But the remaining study participants in the rest of these experimental designs were all randomized after meeting inclusion criteria. Only two studies (by Houston et al. and Tsai et al.) may have had questionable internal validity. Houston et al.’s study group was large but possibly too broad with subjects intubated for too short of a period to have the intervention be significant. This provides evidence for the need to implement such an intervention and continue research. This may have led to potential Type I and II errors. Tsai et al.’s weakness was the limitation of a non-randomized control study and patient heterogeneity as 7 previously mentioned. In addition, Chao et al. used a staff nurse of the ICU to conduct data collection; because it is her ICU she may want “her unit” to do well with compliance with the study, creating bias. Also, in both this and Smuld... Purchase answer to see full attachment