Evidence-Based Practice Project Proposal Paper

Evidence-Based Practice Project Proposal Paper

Evidence-Based Practice Project Proposal Paper

Working as a nurse implies being centrally involved in primary care and encountering patients with varying problems routinely. The profession requires committed, knowledgeable, and passionate practitioners who serve and help patients as conditions necessitate. As a demanding profession, nurses have a mandate to explore patient care problems and intervene through evidence-based interventions. As a result, nurses should understand the principles of evidence-based practice (EBP) and implement them through projects that address practice problems. Such problems can be patient-related, workplace issues, or general problems hampering health outcomes. The purpose of this paper is to discuss the EBP project proposal. Discussion areas include the problem statement, organizational culture and readiness, literature review, change model, implementation plan, and the evaluation plan.

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Problem Statement

Nurses in the emergency department (ED) usually engage in critical care. Patients visiting the ED require a detailed assessment of their conditions, patient-centered interventions, and appropriate follow-up care. Leaders and staff should also collaborate to formulate interventions that guarantee lasting solutions. Falls among the elderly patients are typical in the ED. Nursing and health care research shows that approximately 30% of the elderly population fall at least once annually, leading to physical injuries, head damage, increased dependence, and extended hospital stay (Gettel & Goldberg, 2020; Shankar et al., 2020). Elderly adults are at high risk of falls since their physical and mental strength reduces as their age advances. Increased falls among the elderly in the ED is associated with increased health care costs and poor patient care. Medical costs associated with falls are as high as $31.3 billion and there is a high chance for the costs to increase as the aging population expands (Gettel & Goldberg, 2020). The worrying problem in the ED calls for timely and practical solutions. The proposed solution is fall assessment upon triage to decrease the incidence of falls in the ED.

PICOT Statement: among elderly patients seeking care in the emergency department (P), can accurate fall assessment upon triage (I) compared to when being evaluated by the primary nurse or provider (C) decrease  the incidence of fall (O) in six months (T)?

Organizational Culture and Readiness

Organizational Culture

The organizational culture determines whether change will succeed or fail. As a result, EBP change proponents should first assess the organization’s readiness for change and the overall culture. A glance at the leadership, roles distribution, and employee engagement reveals that the organization embraces adhocracy. The defining elements of adhocracy culture include encouraging innovation, risk-taking, and autonomy (Alsaqqa & Akyürek, 2021).  Since organizational change involves changing systems and processes, there is a high chance of succeeding in cultures that encourage innovation. Such cultures are dominated by people who understand the need for change, uncomfortable in the status quo, and ready to embrace evolution.

The organization’s guiding principles and core values further indicate a high chance of successful change. Leaders engage the staff in decision-making and each member’s contribution is highly valued. The organization remains committed to providing the best care to patients, which can only be achieved through innovation and establishing healthy relationships. Employees’ growth and development is supported through mentorship, self-care, support groups, and in-service training programs. Nurses are recognized as major stakeholders who need recognition and engagement when making key decisions.

Organizational Readiness Tool

The organization’s readiness was assessed through the TeamSTEPPS organizational readiness assessment tool. The tool assesses the organization by examining four critical factors. They include a) the need and whether it is clearly defined, b) readiness for change in culture, c) sufficiency of time, resources, and personnel, and d) the organization’s ability to sustain the proposed change (Agency for Healthcare Research and Quality (AHRQ), 2021). During the assessment, twelve questions are answered. The organization is considered ready for change if the ‘NO’ responses do not exceed three (AHRQ, 2021). The score was 10/12 denoting that it is the perfect time for change and resources needed to support the change are available (Appendix 1). The score further indicates the intended change is clearly defined and will be sustained after implementation.

Improving Quality, Safety, and Cost-Effectiveness

Various health care processes and systems can be used individually or jointly to improve care quality, safety, and cost-effectiveness. Regarding processes, informatics in health care delivery is critical for introducing data and technology in patient care (Dash et al., 2019). Informatics also enables health care professionals to analyze trends and respond effectively to at-risk patients and populations. Technology systems such as telehealth to support remote care are also necessary. They can be used in the ED to track elderly patients’ behaviors and monitor them remotely. Such technologies also reduce physical visits to hospitals, which helps patients, families, and health care facilities to reduce costs.

Strategies for Better Facilitate Organizational Readiness

An effective strategy is to meet the stakeholders and influential organizational leaders to ensure that they are ready for change. Readiness can be improved by ensuring that stakeholders and leaders are adequately informed about the proposed project and its envisioned outcomes. Leaders influence decision-making; thus, they will play a key role in influencing the staff to support the proposed change. Other strategies include leaders continuing to support innovation, horizontal communication, and change leaders being available to clarify any misunderstandings.

Stakeholders and Team Members

The project’s success relies on the support it will receive internally and externally. The organization’s management is a major stakeholder. Besides influencing major decisions, the management supports organizational change through personnel, material, and financial resources. The other relevant stakeholder group includes the nurse leaders. Especially in the ED, the departmental leaders are needed for human support and advice where necessary. Colleagues in the ED are crucial team members since they understand elderly patients and their needs.

Information and Communication Technologies

Leaders and the team involved in implementing the project should communicate and work seamlessly. The project should also be tracked against the timeline to ensure that all activities are completed as scheduled. As a result, mobile phones, computers, communication applications, and project management technologies will be used interchangeably. Computers are needed for planning, data storage, and communication alongside mobile phones and apps. Project management technologies include Gantt charts for tracking the project.

Literature Review

Search Methods

Nursing research should be sourced from current peer-reviewed literature. The articles for the project were searched from recognized databases including CINAHL, EMBASE, MEDLINE, and PubMed. Google Scholar was also used although sparingly. Various keywords and phrases were used to retrieve appropriate articles including ‘falls,’ ‘fall prevention,’ ‘fall risk assessment,’ ‘fall risk reduction among the elderly,’ and ‘fall prevention among the elderly.’ The articles included must have been peer-reviewed, published in the last seven years, and written in the English language.

Synthesis of the Literature

After an in-depth search, seven articles with appropriate information for the project were retrieved. The first article is a qualitative study by McEwan et al. (2018). In this study, McEwan et al. (2018) evaluated the determinants of adherence to NICE guidelines in managing elderly falls visiting the ED. The study was conducted in two EDs where 27 episodes of falls were observed and data collected via interviews. The principal finding was that enablers and barriers including support from senior staff, definition of falls, organizational factors such as preparedness, and communication affected adherence to the guidelines. The article was included since it illustrates the importance of fall prevention guidelines in reducing the incidence of falls in the ED.

The second article is by McCarty et al. (2018) that identified and implemented a fall-risk assessment tool in the ED. In this study, McCarty et al. (2018) adopted the Iowa Model of EBP to Promote Quality Care as the guideline. An educational session was delivered to nurses in 11 departments on the use of Memorial Emergency Department Fall-Risk Assessment Tool (MEDFRAT). The primary finding was that fall-risk tools identification and implementation are critical for fall prevention in the ED. The article was included since it expands research on fall prevention and provides insights regarding the effectiveness of fall-prevention tools to improve patient care outcomes.

In another study, LeLaurin and Shorr (2019) explored different studies focusing on fall prevention among hospitalized patients. They identified strategies and tools effective in fall prevention. Among the key findings, LeLaurin and Shorr (2019) established that tools for fall risk identification, alarms, sitters, multicomponent interventions, and interventional rounds are effective interventions for fall prevention. The article supports the use of fall prevention through risk assessment hence inclusion.

The other article is a study by Huded et al. (2015) on adoption of novel nursing program to prevent falls. The program involved adopting a screening tool for identifying elderly patients highly vulnerable to falls and implementing appropriate interventions using the geriatric nurse liaison model. The study’s participants included elderly patients above sixty-five years assessed for fall risks by ED nurses. The primary finding was that risk assessment for falls was effective in identifying and guiding the implementation of appropriate interventions. The article was included since it illustrates the importance of risk assessment tools in fall prevention among elderly patients.

Guse et al. (2015) conducted a randomized controlled trial for translating a fall prevention program into practice. Participants included elderly patients aged 65 years and above. The intervention group received special resources and was guided on fall prevention while the control group was not supported in any way. Guse et al. (2015) found a significant difference between the intervention and control group since the former has lower fall injuries. The study was included for review since it explains the use of fall prevention programs for elderly patients and their implementation.

The other important study included in the review is by GZ (2020) on the effectiveness of Agency for Healthcare Research and Quality patient falls’ reduction guidelines in addressing falls. In this study, GZ (2020) conducted translational research on the effectiveness of guidelines in reducing the fall rate. The primary finding was that guidelines played a significant role in reducing the fall rate in the ED. The article was included due to the effectiveness of the intervention. The last study was by van Wijck et al. (2019), a mixed-methods study on the unexpected challenges of fall prevention. Participants were patients aged 65 years and above seeking care in the ED. The main finding was that competing health issues and perception of fall risk are major challenges that should be addressed. The article was included since it demonstrates the areas requiring improvement to achieve the best results as far as fall prevention is concerned.

Comparison of Articles

Generally, the reviewed articles focus on fall prevention although they differ in design, settings, and tools used for risk assessment. McEwan et al. (2018) and van Wijck et al. (2019) assessed the factors that affect the effectiveness of the strategies used for fall prevention. Designs vary significantly. For instance, three of the reviewed studies (Guse et al., 2015; GZ, 2020; Huded et al., 2015) are translational research while McEwan et al. (2018) is a qualitative study. Van Wijck et al. (2019) conducted a mixed-methods study while LeLaurin and Shorr (2019) did a literature review. The article by McCarty et al. (2018) is a quality improvement project. Despite the differences in designs and focus areas, the articles have a common theme that falls among the elderly in the ED can be reduced through effective risk assessment. It is the same theme for this project since it conjectures that fall assessment upon triage can reduce the incidence of fall in the ED.

Suggestions for Future Research

The analysis of the articles revealed several gaps that can guide future research. One of the dominant gaps is that most hospitals have not yet assessed the effectiveness of risk assessment tools despite using them. There is also scarce evidence on the tools that can be used specifically in the ED. The other shortcoming is that most studies use small samples. Accordingly, future research should concentrate on the effectiveness of fall prevention tools and the elements that make them effective. Such studies should also consider using large samples and randomization as much as possible.

Change Model or Framework

Models for change provide a systematic, phased process for EBP change implementation. After evaluating various options, the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model (Appendix 2) seems the most effective for this project. Dang et al. (2021) the JHNEBP model as a problem-solving approach to clinical decision-making that enables nurses to implement changes using user-friendly tools. Through the JHNEBP model, change leaders implement change in three steps: formulating the research question, searching for evidence, and translating evidence to practice (Upstate Medical University, 2022). The model’s primary goal is ensuring that practice change is based on current research findings and best practices.

The current project is on the effectiveness of fall assessment upon triage instead of when being assessed by primary care nurse or physician. Falls in the ED hampers care quality and prevents organization from achieving the desired health outcomes. They are associated with unintended injuries, reduced mobility and productivity, poor quality of life, and high medical costs (Florence et al., 2018; Heng et al., 2020). As a severe health issue, patient falls require immediate and lasting solutions. The model is relevant to the project since it facilitates change by ensuring that it is based on scientific evidence. It is among the models promoting a culture of care based on scientific evidence.

The Model’s Stages

Implementing change through the JHNEBP model commences with formulating the practice question. In this step, health care professionals (change proponents) define the clinical problem through the PICOT approach (Upstate Medical University, 2022). The PICOT approach ensures that the problem is explicit, the proposed intervention is illustrated, and the time required to implement the project is stated. The second step is evidence search from appropriate nursing literature. It is a rigorous process where evidence to guide practice change as proposed in the PICOT question is searched from current peer-reviewed literature. The evidence obtained is also appraised to determine the strongest evidence for developing recommendations for practice change (Dang et al., 2021). The third and final step is translating the evidence obtained to practice. It is the step where change is actualized by developing an action plan and ensuring that there is adequate support from stakeholders. Stakeholders should be updated about the outcomes and the next course of action defined based on the outcomes.

Applying the Stages in the Proposed Implementation

As repeatedly mentioned, the project involves exploring whether fall assessment upon triage would effectively reduce the incidence of falls among the elderly in the ED. The practice question has already outlined in the PICOT question (problem statement section). The next step is searching for evidence that supports fall assessment upon triage and related literature. As discussed in the literature review section, fall risk assessment is an effective method for fall prevention in the ED. The last step will be translating this evidence into practice. Here, triage nurses will start fall assessment for all patients visiting the ED using appropriate tools and technologies.

Implementation Plan

The Setting and Access to Potential Subjects

Health care facilities have different departments with different functions. The ED is a critical unit where health care professionals must ensure that patients are served timely and sufficiently. As nurses continue encountering patients with varying health needs, determination to support every patient should dominate their core values. The ED is among the most studied areas in EBP projects. Change agents targeting the ED usually examine workplace challenges or patient care issues affecting health outcomes. The project’s potential subjects are nurses working in the ED because implementing the project requires triage nurses to start fall risk assessment to all patients visiting the ED. Nurses are the potential subjects since they will explain their experiences with the project and provide quantitative data on the changes in falls after implementing the project. Accessing the ED requires management and departmental approval regardless of whether a person works in the facility or not. The study also involves human subjects hence the need for approval. For an in-depth analysis of the outcomes, patients can also be observed or interviewed about their experiences with fall risk assessment upon triage. The approval form is attached in Appendix 3.

The Timeline

As stated in the PICOT, the project should consume approximately six months. It will involve several activities where each will lead to other (Appendix 4). During the six months, the change leader will first introduce the project to the organization’s leaders to demonstrate its rationale. The introduction should consume about a month. It is a priority area since leaders support is instrumental to the project’s success. A detailed presentation of the project to the leaders is an effective way of introducing the proposal. In the same month, information materials such as brochures will be distributed to the stakeholders to ensure that they are informed about the project as part of key decision makers. The appropriate policy changes will be in the second month and triage nurses’ orientation training will be conducted in the third month. Other activities requiring ample time allocation include tools and technology adoption (fourth month), project evaluation (fifth month) and standardization in the six month (Appendix 4).

A Budget and Resource List

EBP projects are typically labor-intensive ventures. They require adequate resource facilitation, including personnel and finances. As the things stand, the ED’s financial situation cannot accommodate more nurses. Hence, the current team will be facilitated through appropriate resources and technologies to implement the project as proposed. Resources needed include fall assessment tools in printed form, brochures summarizing the project for stakeholders, fall assessment technologies, and temporary nurse trainers. Computers are necessary for data entry, although at zero cost since they are available in the ED. Personnel cost includes remunerating nurse trainers and the main consumer-related cost is sensing technologies for fall assessment and software upgrade. Other costs include internet for steady communication and data exchange, questionnaires, and stationery (Appendix 5).

The resources selected are appropriate to facilitate phase-based implementation and enable nurses estimate fall risk accurately. The tools are required to assist nurses to assess fall risk by examining history, patient’s current medication, mobility, and cognition, among other guiding parameters. Brochures are for information resources to ensure that stakeholders understand the project comprehensively to readily support it. Training is vital for guiding triage nurses on the assessment process to ensure that they capture and report the correct information. Sun and Sonsnoff (2018) recommended some sensing technologies for fall assessment such as inertia sensors, laser sensing, and pressure sensors. They examine walking, dynamic balance, and functional mobility, among other elements that triage nurses would need to assess falls timely and correctly. The sensing technologies are needed for automating and enhancing accuracy and efficiency.

Data Collection Design and Evaluation

The most appropriate data collection design and evaluation method is the quantitative approach. The quantitative design deals with numerical data, making it easy for researchers and other data collectors to predict outcomes and test relationships (Almeida, 2018). As a result, quantitative data collection methods will be the main option. The same approach will be used to evaluate data. For instance, a quantitative evaluation of the differences in falls before and after implementing the project will accurately determine its effectiveness. Other advantages of quantitative data include the fact that it can be visualized through charts and graphs to allow insightful analysis.

Methods and Instruments for Monitoring Process and Outcomes

There are many methods for quantitative research design. Researchers and project leaders should consider the most convenient to implement and can be understood by all stakeholders.  A suitable option is to monitoring the process is a rating scale. It resembles a Gantt chart since it examines whether the project activities were completed as scheduled. Accordingly, it will rate the completion of the activities as successful or not depending on their completion date (Appendix 6a). For the outcomes, recording the patient falls and analyzing the percentage change in falls will effectively help to monitor the outcomes (Appendix 6b). For instance, a gradual decline in the falls will indicate successful outcomes.

Process for Delivering the Intervention

Typically, the treatment process commences once the patient steps in the ED. However, all patients are not assessed whether they are at risk of falls. Implementing this project denotes a process change where all elderly patients visiting the ED will be assessed for fall risk upon triage. Patients with mental disorders, dementia, and behavioral dysfunction are among the most vulnerable to falls. Triage nurses will be trained on fall risk assessment using appropriate tools and technologies and how to report the findings.

Stakeholders

The project’s success depends on how various stakeholders will play their roles. The first stakeholder group includes the organizational leaders. Due to their dominance in decision making and administrative power, the leaders will support the project through appropriate resources after the approval. The second stakeholder group includes nurses in the ED. They should embrace the process change and collaborate to ensure all elderly patients are assessed for fall risk. As Nilsen et al. (2019) posited, resistance to change is minimal where leaders and staff embrace a culture of change. A similar culture is needed to adopt the proposed change. Other stakeholders include the project leader and the patients. The project leader will guide the change adoption and the patients should also cooperate for the project to achieve the envisioned outcomes.

Potential Barriers and Overcoming Them

Typical challenges characterizing EBP projects include inadequate resources, resistance to change, and lack of leadership support. The current project is not immune to such barriers. Resource problems and lack of leadership support could lead to delays, disinterest, or project’s failure. Patients may also resist mandatory fall risk assessment irrespective of their conditions. Overcoming such challenges requires the project leader to actively involve stakeholders and communicate effectively with patients. Communication with stakeholders should be horizontal to ensure that all members receive the same information simultaneously. Doing so will improve collaboration and prevent project delays.

Feasibility of the Implementation Plan

Three elements show that the plan’s feasibility. The first element is that the implementation relies primarily on internal resources available in the organization or the ED. The internal availability of resources reduces the project’s costs hence quick implementation. The second element is that the project provides an elaborate plan to solve a serious problem in the ED. As a result, it stands a high chance of earning stakeholder support. The third element is that the implementation is phased, which makes it a convenient activity. Overall, these elements demonstrate that the project will not cause any significant inconvenient and it is the right time to implement it.

The Evaluation Plan

Expected Outcomes

As noted in the PICOT, the project’s primary purpose is ensuring that all elderly patients visiting the ED are assessed for fall risk. Unlike currently where they can only be assessed by the primary nurse or provider, all patients will be assessed for fall risk upon triage. The early assessment is expected to reduce falls among the elderly visiting the ED since it will facilitate timely interventions. Elderly patients are at high risk for falls due to their advancing age and increased vulnerability to physical and mental health problems. Timely intervention will reduce the cost involved in managing patients with falls. It will further improve health outcomes by reducing injuries associated with falls, hospital stays, and dependence on family and friends for care and support.

Data Collection Tools

As elaborated in the implementation plan, the project will rely primarily on the quantitative research design for data collection and evaluation. Typically, project leaders use questionnaires, quantitative observations, case studies, and document reviews for quantitative data collection. Surveys/questionnaires dominate the process and interviews are the main option for in-person data collection (Chong et al., 2021; DeJonckheere & Vaughn, 2019). Document review is appropriate when gathering data from clinical records. Since the most needed data to evaluate the project’s success is the number of patient falls before and after implementing the project, data will be obtained from clinical records (document review). The daily records will be tabulated to make monthly records and changes over time analyzed (comparative analysis). The sample will include all elderly patients visiting the ED and assessed for falls.

Statistical Test

The current project will apply simple statistics to make inferences. Appropriate statistical tests include correlations between numerical variables or hypothesis testing. The most appropriate test for the proposed project is hypothesis testing. Shreffler and Huecker (2022) explained that hypothesis testing involves testing assumptions about a population’s parameter. The current hypothesis is that fall assessment upon triage significantly reduces the incidence of fall in the ED. Hypothesis testing will be done by analyzing the percentage change in falls to prove or disprove it.

Methods to Measure and Evaluate Outcomes

The methods to measure and evaluate outcomes will remain as explained in the implementation plan. Patient falls are recorded daily in the ED. These records will be combined and tabulated to make up monthly data. From these records, a comparative analysis of the change over time will be conducted to evaluate whether the project contributed to any significant decline in the falls reported in the ED. A significant decline is expected, which will be the primary indicator that the project achieved the desired outcomes. The comparative change shows that outcome measurement and evaluation will be through numerical data analysis.

Interventions for Negative Results

Change agents usually look forward to successful EBP projects. However, success is not guaranteed since resistance to change, resource problems, and eventualities such as pandemics may affect the project negatively. The training may also be ineffective leading to poor project implementation. In case of negative results, a gap analysis will be conducted to examine where improvements are needed. The other strategy is entirely changing the current method (fall assessment upon triage) to reduce the incidence of fall in the ED. This implies that other strategies can be applied to reduce falls, although it will require a new project.

Maintaining, Extending, Revising, and Discontinuing the Proposed Solution

The proposed solution will be maintained if it achieves the desired outcomes (leading to a significant decline in patient falls in the ED after implementation). It should be extended if positive results are visible but there is a room for improvement. A revision is necessary if there are visible gaps hampering outcomes like inadequate training of nurses. The project will be discontinued if it does not provide positive outcomes even after a revision. It can also be discontinued if there are no resources to support it or better processes have been identified.

Conclusion

EBP projects are crucial in health care organizations to support evidence-based care processes. They help nurses to solve problems using current peer-reviewed evidence. Nurses should also understand the various change models and apply the most appropriate to guide change implementation. The current project proposes fall risk assessment upon triage for all elderly patients visiting the ED. The project will be best implemented via the JHNEBP model that includes practice question, evidence, and translation as the three basic steps. A comparative analysis of the number of patient falls as captured in clinical records will accurately measure the project’s success.

References

Agency for Healthcare Research and Quality. (2021). TeamSTEPPS. https://www.ahrq.gov/teamstepps/index.html

Almeida, F. (2018). Strategies to perform a mixed methods study. European Journal of Education Studies, 5(1), 137-151. http://dx.doi.org/10.5281/zenodo.1406214

Alsaqqa, H. H., & Akyürek, Ç. E. (2021). Assessment of organizational culture types, leadership styles and their relationships within governmental and non-governmental hospitals in Gaza Strip of Palestine. BMC Health Services Research, 21(1), 1-11. https://doi.org/10.1186/s12913-021-06351-1

Cho, Y., Kim, M., & Choi, M. (2021). Factors associated with nurses’ user resistance to change of electronic health record systems. BMC Medical Informatics and Decision Making, 21(1), 218. https://doi.org/10.1186/s12911-021-01581-z

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.

Dash, S., Shakyawar, S. K., Sharma, M., & Kaushik, S. (2019). Big data in healthcare: management, analysis and future prospects. Journal of Big Data, 6(1), 1-25. https://doi.org/10.1186/s40537-019-0217-0

DeJonckheere, M., & Vaughn, L. M. (2019). Semistructured interviewing in primary care research: A balance of relationship and rigour. Family Medicine and Community Health, 7(2), 1-8. http://dx.doi.org/10.1136/fmch-2018-000057

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693–698. https://doi.org/10.1111/jgs.15304

Gettel, C. J., & Goldberg, E. M. (2020). Fall prevention intervention in the emergency department for older adults. Journal of Aging Science, 8(1), 222. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386420/

Guse, C. E., Peterson, D. J., Christiansen, A. L., Mahoney, J., Laud, P., & Layde, P. M. (2015). Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial. American Journal of Public Health, 105(7), 1475–1481. https://doi.org/10.2105/AJPH.2014.302315

GZ, W. (2020). Translational Nursing Science: Implementation of a Patient Fall Reduction Strategy in the Emergency Department at a Community-Based Medical Center. Open Access Journal of Biomedical Science, 1. https://doi.org/10.38125/OAJBS.000148

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1-12. https://doi.org/10.1186/s12877-020-01515-w

Huded, J. M., Dresden, S. M., Gravenor, S. J., Rowe, T., & Lindquist, L. A. (2015). Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program. The Western Journal of Emergency Medicine, 16(7), 1043–1046. https://doi.org/10.5811/westjem.2015.10.26097

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

McCarty, C. A., Woehrle, T. A., Waring, S. C., Taran, A. M., & Kitch, L. A. (2018). Implementation of the MEDFRAT to Promote Quality Care and Decrease Falls in Community Hospital Emergency Rooms. Journal of Emergency Nursing, 44(3), 280–284. https://doi.org/10.1016/j.jen.2017.10.007

McEwan, H., Baker, R., Armstrong, N., & Banerjee, J. (2018). A qualitative study of the determinants of adherence to NICE falls guideline in managing older fallers attending an emergency department. International Journal of Emergency Medicine, 11(1), 33. https://doi.org/10.1186/s12245-018-0192-9

Nieswiadomy, R. M., & Bailey, C. (2018). Foundations of nursing research. Pearson.

Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: A qualitative study of professionals’ change responses. Implementation Science: IS, 14(1), 51. https://doi.org/10.1186/s13012-019-0902-6

Shankar, K. N., Lin, F., Epino, H., Temin, E., & Liu, S. (2020). Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall. BMJ Open, 10(12), e041054. http://dx.doi.org/10.1136/bmjopen-2020-041054

Shreffler, J., & Huecker, M. R. (2022). Hypothesis testing, P values, confidence intervals, and     significance. StatPearls Publishing.

Sun, R., & Sosnoff, J. J. (2018). Novel sensing technology in fall risk assessment in older adults: A systematic review. BMC Geriatrics, 18(1), 1-10. DOI 10.1186/s12877-018-0706-6

Upstate Medical University. (2022). What is the Johns Hopkins nursing evidence-based practice model?. https://guides.upstate.edu/c.php?g=1023176&p=7411252

van Wijck, S., Rizzo, C., S. Tsegai, N., Raybould, T., & W. Liu, S. (2019). Unexpected challenges to preventing falls in older adults: A mixed methods study of an emergency department-based falls prevention referral pilot project. Health Education and Care, 4(2). https://doi.org/10.15761/HEC.1000158

Appendices

Appendix 1:

Appendix 1: Organizational Readiness Assessment Checklist

Record your responses to the questions below:

Question	Response
Defined Need
1. Have you clearly defined the need that is driving your institution to consider implementing TeamSTEPPS?	Yes     No
2. Is building a stronger teamwork and safety culture an appropriate strategy to address your institution’s need?	Yes     No
Readiness for Change in Culture
3. Is now the right time for implementing a culture change (i.e., it will not compete with other major changes currently being made at your institution)?	Yes     No
4. Is a culture change that emphasizes the importance of teamwork and safety feasible and acceptable?	Yes     No
5. Will your institution’s leaders support culture change and the effort required to implement and sustain the TeamSTEPPS initiative?	Yes     No
Time, Resources, Personnel
6. Will your institution provide sufficient staff with the necessary characteristics and attitudes to serve as instructors?	Yes     No
7. Will your institution provide sufficient staff with the necessary characteristics and attitudes to serve as coaches?	Yes     No
8. Will your institution allow time to prepare the instructors and coaches for their role?	Yes     No
9. Will your institution allow time for personnel to attend training?	Yes     No
10. Will your institution allow time for instructors to potentially customize the course?	Yes     No
Sustainment of the change
11. Will your institution be willing to measure and assess progress and continuously improve processes??	Yes     No
12. Will your institution be able to reinforce and reward positive teamwork behaviors and improvements in processes?	Yes     No
Score	10/12

Appendix 2

Appendix 2: Change Model’s Concept Map

Appendix 3: Consent Form

Parameter	Project Leader’s Notes	Leaders’/Administrative Remarks
Project leader’s names and professional credentials
Title of the project
Type of the project
Time required
Resources required
Expected outcomes
Potential risks
Research subjects
Approved or Rejected	—————————————————————————————————————————————————————————

Appendix 4: Project Proposal’s Timeline

Activity No.	Activity	Implementation Time
1	Project’s introduction/presentation	First month
2	Distributing brochures/communication to stakeholders	First month
3	Policy/process change	Second month
4	Triage nurses’ orientation/training	Third month
5	Tools and technologies adoption and utilization	Fourth month
6	Project evaluation	Fifth month
7	Standardization	Six month

 

Appendix 5: Budget and Resource List

Required Item/Resource	Estimated cost/budget
Copies of fall assessment tools [printed]	$250
Brochures	$50
Fall assessment technologies (sensing technologies) and software update	$500
Internal training/remuneration	$150
Computers for data entry	$0.00
Internet, questionnaires, and stationery	$250
Total	$1,200

 

Appendix 6: Methods and Instruments

6a: Process Rating scale

Activity	Expected Completion Time	Success/Failure
Project’s introduction/presentation	First month
Distributing brochures/communication to stakeholders	First month
Policy/process change	Second month
Triage nurses’ orientation/training	Third month
Tools and technologies adoption and utilization	Fourth month
Project evaluation	Fifth month
Standardization	Six month

 

6b: Outcomes Rating Scale

Time	Number of patient falls	% change (reduction/increment)
First month
Second month
Third month
Fourth month
Fifth month
Sixth month
Overall Project’s rating based on % change in falls.

ORDER A PLAGIARISM-FREE PAPER HERE ON;Evidence-Based Practice Project Proposal Paper

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

Incorporate all necessary revisions and corrections suggested by your instructors.
Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper

The main body of your paper should include the following sections:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model, or Framework
Implementation Plan
Evaluation Plan
Appendices

The appendices at the end of your paper should include the following:

All final changes or revisions for the drafts that will be included in the appendices of your paper.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.
General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.