NRS 465 Week 8

Assignment: Benchmark-Capstone Project Change Proposal

NRS 465 Week 8 Assessment Description

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 2,500-3,000-word written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

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Background of clinical problem

Clinical problem statement (Topic 3 assignment)

Purpose of the change proposal in relation to providing patient care in the changing health care system (Topic 2 assignment)

PICOT question (Topic 3 assignment)

Literature search strategy employed (Topic 4 assignment)

Synthesis of literature review (Topic 6 assignment)

Applicable change or nursing theory utilized (Topic 4 DQ 2)

Proposed implementation plan with outcome measures (Topic 5 assignment)

Plan for evaluating the proposed nursing intervention (Topic 6 assignment)

Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (Topic 5 DQ 2 and any other barriers that have not yet been considered)

Appendix section: Update the Capstone Change Project Evaluation plan developed in Topic 7 as needed. Include it as Appendix A. Additional items developed for your capstone project (i.e., patient or staff education materials, etc.) can also be attached but are optional. NRS 465 Week 8

Review the feedback from your instructor on the Capstone Project assignments submitted throughout the course and referenced above. Use this feedback to make appropriate revisions to these before submitting.

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

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.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

1.3: Demonstrate clinical judgment founded on a broad knowledge base.

2.5: Develop a plan of care.

4.2: Integrate best evidence into nursing practice.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.3, 2.5, 3.3, 3.5, 4.2, 10.2, 10.3

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NRS 465 Week 8 Rubric

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Rubric Criteria

Total160 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Revision Evident

Revisions are incorporated as directed by instructor.
0 points

Revision is omitted.
6 points

Revision is incomplete. Many aspects are still incomplete, inaccurate, or unclear.
6.32 points

Most key aspects were revised. Some aspects are still vague or contain minor inaccuracies.

7.12 points

The key aspects were revised. The revision generally improves the accuracy and clarity of the project.

8 points

All revisions are incorporated. The revision greatly improves the accuracy and clarity of the project.

Background

Include the background of the clinical problem.
0 points

The background of the clinical problem is missing.

6 points

The background of the clinical problem is inaccurate or incomplete.
6.32 points

The background of the clinical problem is present but lacks detail. NRS 465 Week 8

7.12 points

The background of the clinical problem is mostly detailed.
8 points

The background of the clinical problem is thorough and accurate.

Clinical Problem Statement (B)

Include the clinical problem statement. (C4.2)

0 points

The clinical problem statement is missing.
6 points

The clinical problem statement is inaccurate or incomplete.
6.32 points

The clinical problem statement is present but lacks detail.
7.12 points

The clinical problem statement is mostly detailed.
8 points

The clinical problem statement is thorough and accurate.

Purpose

Explain the purpose of the change proposal in relation to providing patient care in the changing health care system.
0 points

An explanation of the purpose of the change proposal in relation to providing patient care in the changing health care system is missing.
6 points

An explanation of the purpose of the change proposal in relation to providing patient care in the changing health care system is inaccurate or incomplete.
6.32 points

An explanation of the purpose of the change proposal in relation to providing patient care in the changing health care system is present but lacks detail.
7.12 points

An explanation of the purpose of the change proposal in relation to providing patient care in the changing health care system is mostly detailed.
8 points

An explanation of the purpose of the change proposal in relation to providing patient care in the changing health care system is thorough and accurate.

PICOT Question

Provide the PICOT question and details.
0 points

PICOT question is missing.
6 points

PICOT question is inaccurate or incomplete.
6.32 points

PICOT question is present but lacks detail.
7.12 points

PICOT question is mostly detailed.
8 points

PICOT question is thorough and accurate.

Literature Search Strategy

Explain the literature search strategy employed in the student’s project.
0 points

An explanation of the literature search strategy employed in the student’s project is missing.

6 points

An explanation of the literature search strategy employed in the student’s project is inaccurate or incomplete.
6.32 points

An explanation of the literature search strategy employed in the student’s project is present but lacks detail.
7.12 points

An explanation of the literature search strategy employed in the student’s project is mostly detailed.
8 points

An explanation of the literature search strategy employed in the student’s project is thorough and accurate.

Synthesis of Literature Review

Describe the applicable change or nursing theory utilized in the student’s project.
0 points

A description of the applicable change or nursing theory utilized in the student’s project is missing.
6 points

A description of the applicable change or nursing theory utilized in the student’s project is inaccurate or incomplete.
6.32 points

A description of the applicable change or nursing theory utilized in the student’s project is present but lacks detail.
7.12 points

A description of the applicable change or nursing theory utilized in the student’s project is mostly detailed.

8 points

A description of the applicable change or nursing theory utilized in the student’s project is thorough and accurate.

Applicable Change or Nursing Theory (B)

Describe the applicable change or nursing theory utilized in the student’s project. (C1.3) NRS 465 Week 8
0 points

A description of the applicable change or nursing theory utilized in the student’s project is missing.
6 points

A description of the applicable change or nursing theory utilized in the student’s project is inaccurate or incomplete.

6.32 points

A description of the applicable change or nursing theory utilized in the student’s project is present but lacks detail.

7.12 points

A description of the applicable change or nursing theory utilized in the student’s project is mostly detailed.

8 points

A description of the applicable change or nursing theory utilized in the student’s project is thorough and accurate.

Implementation Plan and Outcome Measures

Describe the proposed implementation plan with outcome measures.

0 points

A description of the proposed implementation plan with outcome measures is missing.
12 points

A description of the proposed implementation plan with outcome measures is inaccurate or incomplete.
12.64 points

A description of the proposed implementation plan with outcome measures is present but lacks detail.
14.24 points

A description of the proposed implementation plan with outcome measures is mostly detailed.
16 points

A description of the proposed implementation plan with outcome measures is thorough and accurate.

Evaluation Nursing Intervention (B)

Outline plan for evaluating the proposed nursing intervention. (C2.5)
0 points

An outline of the plan for evaluating the proposed nursing intervention is missing.
12 points

An outline of the plan for evaluating the proposed nursing intervention is inaccurate or incomplete.
12.64 points

An outline of the plan for evaluating the proposed nursing intervention is present but lacks detail.

14.24 points

An outline of the plan for evaluating the proposed nursing intervention is mostly detailed.
16 points

An outline of the plan for evaluating the proposed nursing intervention is thorough and accurate.

Potential Barriers

Identify potential barriers to plan implementation, and discuss how these could be overcome. NRS 465 Week 8
0 points

An identification of potential barriers to plan implementation and a discussion of how these could be overcome are missing.

6 points

An identification of potential barriers to plan implementation and a discussion of how these could be overcome are inaccurate or incomplete.

6.32 points

An identification of potential barriers to plan implementation and a discussion of how these could be overcome are present but lack detail.
7.12 points

An identification of potential barriers to plan implementation and a discussion of how these could be overcome are mostly detailed.

8 points

An identification of potential barriers to plan implementation and a discussion of how these could be overcome are thorough and accurate.

Appendix

Appendix

0 points

Appendix is missing.
6 points

Appendix is inaccurate or incomplete.

6.32 points

Appendix is present but lacks detail.

7.12 points

Appendix is mostly detailed.
8 points

Appendix is thorough and accurate.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.
0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.
8.4 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

8.85 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.
9.97 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.

11.2 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.
8.4 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.
8.85 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.
9.97 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.
11.2 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.
0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

7.2 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

7.58 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present. NRS 465 Week 8
8.54 points

Relevant evidence that includes other perspectives is used.
9.6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.
0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.
7.2 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.
7.58 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

8.54 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.
9.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.
4.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.
5.06 points

Appropriate format and documentation are used, although there are some obvious errors.

5.7 points

Appropriate format and documentation are used with only minor errors.

6.4 points

No errors in formatting or documentation are present.

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NRS 465 Week 8 Benchmark-Capstone Project Change Proposal Sample

Background of Clinical Problem

Patient falls are a common and chronic clinical concern for hospitalized elderly patients. Vincent et al. (2023) note that older people are predisposed to falling due to unavoidable natural functions that occur as they age, including muscle weakness, instability, and poor vision. This vulnerability is heightened inside the hospital by the environment and treatment procedures.

The potential adverse effects of falls are vast and multidimensional, affecting different stakeholders. Among those impacted are patients who are exposed to the threat of fractures, head injuries, extended hospital stays, and mortality rates, among others. The Centers for Disease Control and Prevention (CDC) estimates that falls are the leading cause of both fatal and nonfatal injuries among older people in the United States (CDC, 2024). There are also significant costs in monetary terms due to falls. Falls are reported to cause billions of dollars in direct medical costs resulting from injuries every year (Vincent et al., 2023). These adverse effects call for practical fall prevention measures that can be easily incorporated into the working activities of the caregivers.

NRS 465 Week 8 Clinical Problem Statement

Among the apparent issues, given the prevalence of elderly patients in hospitals, is the case of falls. Despite considerable efforts to reduce the rates of falls, Gliner et al. (2022) argue that these levels continue to be high, negatively affecting the patients and the healthcare systems financially. Thus, the absence of a well-coordinated, research-proven fall prevention approach poses a significant threat to patient safety and demands immediate attention.

Prearranged hourly rounding has been identified as one of the practical solutions for this problem. Researchers hold that compared to normal rounding, which is random and unplanned, purposeful hourly rounding focuses on scheduled conversations with patients every hour (National Institute on Aging, 2024). In a similar direction, Vincent et al. (2023) reported in their study that the application of hourly rounding decreases the utilization of the call light, minimizes the risk of patient falls and improves patients’ satisfaction. For this reason, making hourly rounding significant and purposeful in hospitals can enhance patient safety, including reducing the incidence of falls.

NRS 465 Week 8 Purpose of the Change Proposal

This change proposal introduces and discusses the possibility of using purposeful hourly rounding by nurses to prevent falls in elderly patients in hospital settings. This structured protocol is likely to provide a solution to a significant challenge in the healthcare field because of its potential to impact the health of the patient and the cost of healthcare (Vincent et al., 2023). Standardizing the hourly check helps nurses reduce the risk variables that could lead to fall events among older hospitalized patients.

Dealing with fall rates is one of the primary objectives of this idea. Falls in older individuals could cause serious injuries, longer hospital stays, and expensive healthcare costs claims Gliner et al. (2022). By utilizing an organized hourly rounding system to assist the nurses in visiting patients, attending to their requirements, and reducing any risks in their proximity, this approach seeks to meet the following goals.

Raising patient happiness is still a significant goal of our proposal. Gliner et al. (2024) have shown that, by attending to their needs, engagement with nursing staff—mainly through hourly rounding—is predicted to raise patient satisfaction. Aging patients need help quite often, and the frequent presence of nurses can reduce anxiety and bring comfort and a feeling of safety.

Lastly, this proposal seeks to reduce the amount of money spent on health care due to fall-related complications. Scholars indicate that falls also result in the need for other interventions, longer hospital stays, and costs (Hakvoort et al., 2021). Due to reduced incidences of falls, the proposal will reduce the length of hospital stay, health costs for the patients, and the cost of providing care to the patients by the health facilities.

NRS 465 Week 8 PICOT Question

The PICOT question guiding this change proposal is: In elderly hospitalized patients (P), how does purposeful hourly rounding by nurses (I) compared to normal rounding (C) affect the rate of falls (O) within three months (T)?

The proposed change plan is grounded in this PICOT question, which assists in identifying whether intentional hourly rounding impacts the rates of falls experienced by senior hospitalized patients. In this age group, falls become a significant problem, increasing frequent hospitalizations, recurrent acute conditions, higher health costs, and poorer health-related quality of life (Yadav et al., 2021). The narrow focus of the given topic on a particular type of intervention and quantifiable results over a specified period makes it easy to convey the implementation and assessment strategies needed to address this significant clinical issue.

NRS 465 Week 8 Literature Search Strategy

Searches were done in computerized databases like PubMed, CINAHL, Cochrane Library, and Google Scholar. Some search terms selected for sources to be reviewed were ‘hourly rounding,’ ‘fall prevention,’ ‘elderly patient,’ ‘hospitalized patients, ‘ ‘nursing interventions,’ and ‘patient safety.’ The inclusion criteria for this study were peer-reviewed journals and those conducted in a hospital setting with old patients as participants.

The search criteria began with database searching. The recognized keywords were typed from the search bar using different Boolean operators. These searches yielded numerous articles related to the subject issues. An assessment of abstracts was followed, after which full texts of identified papers were retrieved based on the inclusion criteria. The last process was data extraction to obtain relevant information to support and guide the proposal.

NRS 465 Week 8 Synthesis of Literature Review

It has been proven through several studies that proactive nursing care interventions, such as hourly rounds, show incredible benefits in the avoidance of patient falls. In their studies, Dall’Ora et al. (2023) and Considine et al. (2023) revealed that regular nursing checks positively impact minimizing falling rate incidences and their adverse consequences. During hour rounding, nurses can anticipate patients’ needs, help them immediately, and identify fall risk factors related to their mobility or environmental problems.

Moreover, purposeful hourly rounding introduces order and allows for compliance with patient safety, efficiency, and utilization of resources in healthcare facilities. Hence, corroborating the evidence provided by López-Soto et al. (2023), it is conclusive to reveal that in-hospital falls can be significantly avoided with the help of nursing-led intervention arrangements in the form of temporal checks. It may improve patients’ health and be cost-effective regarding complications from falls and extended hospitalization. NRS 465 Week 8

This written proposal can only be implemented clinically if hourly rounding is appropriately integrated into nursing practice. Samide et al. (2022) and van den Ende et al. (2022) reported that a systematic application of the method brought about significant changes in the patients’ experience and contributed to the nurses’ lessening workload. In this context of nursing practice, incorporating the standard of hourly rounding can assist hospitals in developing patient-centered care in advance by risk mitigation.

Additionally, regarding the long-term success of these hourly rounding programs, other organizational factors should be considered, including safety culture, the number of nurses recruited, and proclaimed adherence to protocols (Alanazi et al., 2023). Safety cultures and organizational support for working environments relate to improved patient outcomes and show managerial support for developing and sustaining well-organized care procedures.

NRS 465 Week 8 Applicable Change or Nursing Theory

            The proposed intervention is anchored on Lewin’s Change Management Theory and Watson’s Human Caring Theory. According to Lewin’s Change Management Theory, there are frameworks for change at the individual and organizational levels. On the other hand, Florentin (2023) elaborated that Watson’s Theory of Human Caring is patient-centered and encompassing and offers the best framework for the transformation process. Both theories are essential for the overall design, execution, and sustainability of hospital strategic hourly rounding.

Lewin’s Change Management Theory

Kurt Lewin’s theory of change has three main processes: the unfreezing process, the change process, and the refreezing process. As Endrejat and Burnes (2022) report, the unfreezing stage comprises mobilization for change, which involves informing the organization about the change, why change is required, and how to handle resistance. In the process of change, new habits form, and new practices are introduced (Endrejat & Burnes, 2022). This stage aims to train and establish the hourly rounding procedure among the nursing personnel. The last step, refreezing, guarantees that the newly adopted changes remain incorporated into the organizational culture. It entails constant supervision, encouragement, and reminder to the individuals of new behaviors they were trained to adopt.

NRS 465 Week 8 Watson’s Theory of Human Caring

            Jean Watson’s theory incorporates the concept of caring relationships and the humanistic approach towards patients. Research proves that this theory forms a good base for the principles of hourly rounding since it calls for frequent communication with patients and preventing the occurrence of their needs (Florentin, 2023). When incorporated into the hourly rounding plan, the theory formulated by Watson can help nurses offer their patients medical attention and emotional and psychological comfort.

Proposed Implementation Plan with Outcome Measures

This implementation plan consists of several steps that need to be followed to introduce and maintain purposeful hourly rounding. The stages involved include preparation, training, and pilot testing. It also incorporates the plan’s full implementation, monitoring, and regular evaluation (See Appendix A).

Preparation Phase

The preparation phase is the most vital step for purposeful hourly rounding if it is to be executed as planned. It begins with assembling a team of cooperative professional nurses, nursing assistants, administrative support, and a project manager to steer the implementation paradigm (Hakvoort et al., 2021). In addition, Florentin (2023) elaborates that the members of this team will be in charge of planning, implementing, and assessing the outcomes. Hospital management, nurses, and patients are other stakeholders who must be involved in providing support and voicing their concerns. Further, resource management guarantees sufficient personnel, training resources, and other logistics like rounding logs and documentation tools. NRS 465 Week 8

Training Phase

In the training phase, the nursing staff is empowered with the knowledge and skills to implement hourly rounding. According to Hakvoort et al. (2021), this stage involves the creation of training aids in terms of presentations, manuals, and simulations, which contain clear instructions on the protocol. For all the nurses, orientation sessions are conducted to explain the general idea of the concept, the detailed procedure to follow, and practical exercises performed on cases that may be likely encountered (Hakvoort et al., 2024). During the training, theoretical and practical lessons are applied to fulfill the training phase’s objectives and make the nursing staff competent and confident in correctly performing the hourly rounding process (see Appendix B).

Pilot Testing Phase

The pilot testing phase entails using the hourly rounding protocol in a limited number of hospital units to determine if problems must be fixed before widespread application. In this phase, Decker et al. (2023) point out that information is gathered regarding the fall incidence rates and patients’ and staff perceptions, and feedback is gathered and evaluated to determine the protocol’s effectiveness and what can still be improved (Kawar et al., 2024). In objective terms, the pilot phase’s effectiveness is defined by identifying changes to the pilot units’ pre- and post-implementation indicators and demonstrating the protocol’s potential impact and relevance throughout the hospital. NRS 465 Week 8

Full-Scale Implementation Phase

Once the hourly rounding pilot is complete, the new rounding protocol will be implemented in all hospital units. Full-scale implementation means that the nursing staff must adhere to the protocol strictly, and some measures are taken to avoid disruption (Hakvoort et al., 2021). During this phase, it is crucial to regularly assess the fall rates, patients’ satisfaction, and staff compliance with the protocol with rounding logs and documentation tools. In the process, the nursing staff is regularly briefed, and any questions or problems they may be experiencing can be resolved during the session to ensure high compliance rates.

Evaluation Phase

            The assessment phase entails analyzing the accumulated data to determine the effects of hourly rounding on fall rates and patients’ satisfaction levels. Kawar et al. (2024) point out that quantitative techniques involve assessing the results before and after the implementation of the intervention to measure its efficacy. Under this stage, observations and comments made by the nursing staff and the patients shed light on practicalities and gains regarding the contention, enabling requisite modifications to the said protocol (Kawar et al., 2024). This stage also focuses on frequent feedback and further refinements to ensure the protocol stays useful and up to date. Continuous involvement of the stakeholders means that they will consistently support the implementation of hourly rounding to become standard practice in the hospital. NRS 465 Week 8

Outcome Measures

Several outcomes will evaluate the effectiveness of the proposed intervention. The primary variable of interest is the prevalence of falls among elderly patients admitted to the hospital (Decker et al., 2023). This objective will be assessed by identifying the number of falls per 1,000 patient days before and after the implementation of the hourly rounding strategy. The extent of the decrease in fall rates will show how successful the intervention is in increasing the safety of patients.

Patient satisfaction is also used as an outcome measure using structured questionnaires that contain questions that evaluate patients’ experiences of their care and encounters with the nursing staff. Since the implementation of hourly rounding directly focuses on patients, the patient satisfaction scores will also be assessed before and after this project (Gliner et al., 2022). A better score in the patient satisfaction index will testify that the intervention has averted the patient experience and perception for the better. NRS 465 Week 8

The overall conformance of staff with the hourly rounding protocol will also be assessed. Rounding logs and direct observations shall be used to monitor compliance. Higher compliance rates will suggest successful implementation and operationalization of the protocol among the nursing staff (CDC, 2024). Close supervision and performance reviews will assist in increasing the level of compliance and deal with any tendencies different from the protocol.

The last outcome measure is the feedback from staff. Surveys and focus groups will be conducted to garner the nursing staff’s experiences, concerns, and recommendations. This feedback will be essential and reveal the practical complexities and advantages of the hourly rounding protocol (Hakvoort et al., 2021). Staff and patient suggestions will assist the hospital in addressing those issues and ensure the initiative’s viability.

NRS 465 Week 8 Plan for Evaluating the Proposed Nursing Intervention

The assessment method is based on quantitative and qualitative data collection instruments to evaluate the effectiveness of the hourly rounding intervention. It will be conducted in three stages, namely, initial evaluation, intermediate evaluation, and final evaluation. Applying mixed methods ensures the intervention assessment encompasses quantitative data and qualitative experiences.

Baseline Assessment

The baseline assessment entails gathering essential information to create a benchmark that can be used to measure the interference outcomes. Data collection emphasizes obtaining the sample rates for the number of falls, patient satisfaction, and current rounding practices. This initial data will help compare the pre-implementation and post-implementation of the new system (Hakvoort et al., 2021). Furthermore, patients and nurses will be given questionnaires to assess their care experiences before and after implementing the intervention (see Appendix C).

Interim Evaluation

The interim evaluation stage entails constant assessment of the progress made in the intervention and the areas of concern. Systematic measurements will be taken monthly to determine the fall rates and overall satisfaction of the clients throughout the implementation process to notice trends that require immediate attention (Hakvoort et al., 2021). The oversight of the new hourly rounding technique will focus on the personnel by monitoring the rounding records and through direct observations. Moreover, interviews and questionnaires will be employed to obtain qualitative data about patient and staff perceptions to change the implemented intervention. NRS 465 Week 8

Final Evaluation

The final assessment step involves evaluating the effectiveness and impact of the intervention. In the process, outcomes data will be collected and compared statistically to assess the effectiveness of the intervention—hourly rounding. A cost-benefit analysis will be used to evaluate the advantages of decreasing the occurrence of falls and shortening hospital stays when required (López-Soto et al., 2023). Ultimately, a comprehensive report will be created that briefly outlines the study discoveries, programmatic implications, and approaches for expanding or maintaining the implementation of the intervention.

Potential Barriers and Solutions

            Due to several challenges, purposeful hourly rounding may not be easily integrated into healthcare, necessitating contingency plans to address them. A significant challenge that can be identified is the possible lack of cooperation from the staff since they may consider change as an added workload or have doubts about the efficacy of the new rounding schedule (López-Soto et al., 2023). Involving the personnel in the implementation process is obligatory, especially from the planning phase, and giving them adequate training in the intervention approach.

Another critical concern is the lack of time due to nurses’ tight schedules. In this direction, Hakvoort et al. (2021) recommend integrating the rounding protocol with other established policies. According to these researchers, proper staffing ratios must be established so nurses can effectively perform the hourly rounds. In addition, participating in discussions with leaders and presenting to them the benefits of this intervention will likely increase its chances of success. NRS 465 Week 8

Any lack of proper implementation of the hourly rounding schedule might sometimes be considered a weakness. Such barriers arise, especially when practicing in a tension-filled large hospital setting. In this case, López-Soto et al. (2023) have suggested that it would be necessary to look out carefully for feedback and reinforcement on how the procedure should be followed, just as planned and recommended. This sharing of complete information regarding the utility and role of the procedure will enhance effectiveness with active participation from patients, their families, and others in its intervention.

NRS 465 Week 8 References

Alanazi, F. K., Lapkin, S., Molloy, L. J., & Sim, J. (2023). The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study. Journal of Clinical Nursing, 32(19-20). https://doi.org/10.1111/jocn.16792

Centers for Disease Control and Prevention (CDC). (2024, May 6). Older adult fall prevention: Facts about falls. Retrieved from https://www.cdc.gov/falls/data-research/facts-stats/index.html

Considine, J., Berry, D., Mullen, M., Edmore Chisango, Melinda Webb-St Mart, Michell, P., Peteris Darzins, & Boyd, L. (2023). Nurses’ experiences of using falls alarms in subacute care: A qualitative study. Plos One, 18(6), e0287537–e0287537. https://doi.org/10.1371/journal.pone.0287537

Dall’Ora, C., Ejebu, O.-Z., Jones, J., & Griffiths, P. (2023). Nursing 12-hour shifts and patient incidents in mental health and community hospitals: A longitudinal study using routinely collected data. Journal of Nursing Management, 1–8. https://doi.org/10.1155/2023/6626585

Decker, K. L., Schwab, S. D., Bazzoli, G. J., Chukmaitov, A. S., & Wernz, C. (2023). Impact of performance-based budgeting on quality outcomes in U.S. military health care facilities. Health Care Management Review, 48(3), 249. https://doi.org/10.1097/HMR.0000000000000372

Endrejat, P. C., & Burnes, B. (2022). Draw it, check it, change it: Reviving Lewin’s topology to facilitate organizational change theory and practice. The Journal of Applied Behavioral Science, 60(1), 002188632211228. https://doi.org/10.1177/00218863221122875

Florentin, G. N. B. (2023). The human dimension in nursing. An approach according to Watson’s Theory. Community and Interculturality in Dialogue, 3, 68–68. https://doi.org/10.56294/cid202368

Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient falls, nurse communication, and nurse hourly rounding in acute care: Linking patient experience and outcomes. Journal of Public Health Management and Practice, 28(2), E467-E470. DOI: 10.1097/PHH.0000000000001387.

Hakvoort, L., Dikken, J., van der Wel, M., Derks, C., & Schuurmans, M. (2021). Minimizing the knowledge-to-action gap; identifying interventions to change nurses’ behavior regarding fall prevention, a mixed method study. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00598-z

Kawar, L. N., Fangonil-Gagalang, E., Kim Reina Failla, Aquino-Maneja, E., Vaughn, S., & Loos, N. (2024). Evidence-based practice implementation. JONA: The Journal of Nursing Administration, 54(1), 35–39. https://doi.org/10.1097/nna.0000000000001374

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NRS 465 Week 8 Appendix A: Implementation Timeline

Phase	Activities	Timeline (Months)
Preparation	Form multidisciplinary team, engage stakeholders, allocate resources	1-2
Training	Develop training materials, conduct training sessions, assess competency	2-3
Pilot Testing	Select pilot units, monitor and evaluate pilot implementation, make adjustments	3-4
Full-Scale Implementation	Rollout protocol across hospital units, ongoing monitoring	4-5
Evaluation	Data analysis, feedback collection, cost-benefit analysis, and report preparation	5-6

NRS 465 Week 8 Appendix B: Training Plan for Nursing Staff

Objective: To prepare nursing staff for the implementation of purposeful hourly rounding.

Training Components:

1. Introduction to Hourly Rounding: Overview of the intervention and its importance in fall prevention. Evidence supporting the effectiveness of hourly rounding.
2. Rounding Protocol: Detailed explanation of the activities involved in each round (e.g., checking for pain, positioning, personal needs, and ensuring the environment is safe). Rounding logs are used to document each round.
3. Role-Playing and Simulations: Interactive sessions to practice hourly rounding scenarios. Feedback and discussion to reinforce learning.
4. Addressing Concerns and Challenges: Open forum for staff to voice concerns and ask questions. Strategies for overcoming potential barriers to implementation.
5. Ongoing Support: Regular check-ins with staff to provide support and address any issues. Continuous education and refresher sessions as needed.

NRS 465 Week 8 Appendix C: Patient and Staff Feedback Questionnaire

Purpose:

To gather patient and staff feedback regarding the effectiveness and experience of purposeful hourly rounding.

Patient Questionnaire:

1. Overall Satisfaction:
   • How satisfied are you with the care you received during your hospital stay?
     • Very Satisfied
     • Satisfied
     • Neutral
     • Dissatisfied
     • Very Dissatisfied
2. Communication:
   • How would you rate the frequency of nursing staff checking in on you?
     • Excellent
     • Good
     • Fair
     • Poor
     • Very Poor
3. Needs Met:
   • Did the nursing staff address your needs promptly during hourly rounds?
     • Always
     • Often
     • Sometimes
     • Rarely
     • Never
4. Pain Management:
   • How well did the nursing staff manage your pain during hourly rounds?
     • Excellent
     • Good
     • Fair
     • Poor
     • Very Poor
5. Safety:
   • Did you feel safe and well cared for during your hospital stay?
     • Always
     • Often
     • Sometimes
     • Rarely
     • Never
6. Additional Comments:
   • Please provide any additional comments or suggestions for improving hourly rounding.

Staff Questionnaire:

1. Overall Experience:
   • How would you rate your overall experience with the hourly rounding protocol?
     • Excellent
     • Good
     • Fair
     • Poor
     • Very Poor
2. Training Effectiveness:
   • How practical was the training you received for hourly rounding?
     • Very Effective
     • Effective
     • Neutral
     • Ineffective
     • Very Ineffective
3. Workload Management:
   • Did the hourly rounding protocol significantly increase your workload?
     • Strongly Agree
     • Agree
     • Neutral
     • Disagree
     • Strongly Disagree
4. Patient Interaction:
   • How would you rate the quality of your interactions with patients during hourly rounds?
     • Excellent
     • Good
     • Fair
     • Poor
     • Very Poor
5. Protocol Adherence:
   • Were you able to adhere consistently to the hourly rounding protocol?
     • Always
     • Often
     • Sometimes
     • Rarely
     • Never
6. Support from Leadership:
   • How supportive was hospital leadership in the implementation of hourly rounding?
     • Very Supportive
     • Supportive
     • Neutral
     • Unsupportive
     • Very Unsupportive
7. Additional Comments:
   • Please provide any additional comments or suggestions for improving the hourly rounding protocol. NRS 465 Week 8