Please make revision in the prospectus checklist assignment based on my professor feedback. For now, she wants to only focus on (1) the problem statement, (2) the practice focus question, (3) the social change.

I’m also attaching a copy of the previous prospectus draft  which the professor returned to me with her feedback. Also, I included an outline of the project in the file section (see attached file).

Include as many scholarly references (at least 10) as needed and cite often.

APA format required.

Due on Sunday 10/06/19 by 12pm America/New York time.

Problem Statement must include:

· Why it’s necessary to have standardized care plans (their importance and benefit, why are care plans necessary). Why do nurses need to have care plans for the patients

· How will the standardized care plans affect patients care.

b) Summarize preliminary, supporting evidence that provides justification that this problem is meaningful and relevant to the local setting as well as the broader field of nursing practice, citing key scholarly sources.

· The facility recently upgraded their system to include standardized care plans. Unfortunately, since the implementation of the standardized care plans, the nurses compliance with adding care plans to the patients’ chart upon admission based on the patients’ diagnosis decreased from 90% compliance to 40% which was supported by the findings of the Joint Commission who recently paid a visit to the facility and had penalized the facility for poor compliance by the nurses in adding the standardized care plans to the patients’ charts.

· Why are the nurses not utilizing the standardized care plans? The nurses stated that the facility had not provided them with the proper training on how to use the new standardized care plans.

· Some nurses also expressed their concern on the standardized care plans being time consuming and impede the workflow.

c) Explicitly state the gap in nursing practice or problem that will be the focus of this doctoral project

· Implementing a teaching tool to educate the nurses on how to use the standardized care plans.

· The importance of standardized care plans.

· Also, to increase the nurses’ knowledge on using the standardized care plans

The Practice Focus Question

a) Describe the meaningful gap-in-practice that this doctoral project addresses.

b) State the guiding practice-focused question(s) for this doctoral project.

Will an educational tool increase the inpatient nurses’ compliance in using the standardized care plans from 40% to 90% as compared to non-standardized care plans.

c) Briefly explain the practice focused question as it is relevant to the identified gap in practice.

Social Change

a) Discuss how the healthcare consumers support positive social change in the community.

b) Discuss how Walden University support social change and be specific (google “Walden University social change).

c) Specify who might benefit from the project and in what ways the information from the project might result in positive social change.

Context for Doctoral Change

a) Briefly describe the intended setting for the doctoral project.

Inpatients hospital

b) Explain how this project can be accomplished in the identified setting or context.

· Approval from the institution. I need to speak to the facility to get their approval to build a teaching tool for the inpatients’ nurses.

· Approval from the stakeholders, the nurses and anyone involved in the project.

· The research design is pre presentation questionnaire and post presentation questionnaire

Sources of Evidence

· The library

· Joint Commission

· Literature search, review and appraisal

Ethical Considerations

This section should include how do you protect the involved parties. Also reassure the involved parties that the follow-up test would be done anonymously. Also, how do you protect the involve parties from not reporting their Get consent for all those who will participate in the teaching program ( example: by continuing to complete this questionnaire, you are giving your agreement to participate in this questionnaire).

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DNP Prospectus Comment by Cynthia Fletcher: This is a good beginning Ann Marie. There are many areas that we will discuss at our meeting to improve clarity and congruence with a DNP Project.

Educating Inpatient Nurses to use Standardized Care Plans

Anne Marie Wouapet

Doctor of Nursing Practice – Nursing Informatics

A00505587

Prospectus: Educating Inpatient Nurses to use Standardized Care Plans

Problem Statement

Standardized care plans can be described as the pre-determined menu of interventions which are used for different patient situations (Monsen, Swenson & Kerr, 2016). Evidence-based care is the conscientious use of the most recent evidence to make decisions on the care of individual patients or in the delivery of health care services (Murdaugh, Parsons & Pender, 2018). The current best evidence is the most recent information which has been obtained from valid and relevant research about the effects of different types of healthcare, the accuracy of diagnostic tests, the potential for harm from exposure to different agents, or predictive power of prognostic factor (Schmidt & Brown, 2017). Standardized care plans form the main basis for the implementation of evidence-based care directly in practice and for the improvement of patient outcomes (Nussbaum et al., 2015; Yehuda & Hoge, 2016). A health care facility recently transitioned to the use of a new and better electronic health record system. The facility also purchased standardized care plans to increase efficiency in their operations. However, the compliance with using the standardized care plans was only 40 percent among the inpatient nurses. Comment by Cynthia Fletcher: ? Comment by Cynthia Fletcher: Questionable purpose. Comment by Cynthia Fletcher: Was it different for those who were not inpatient nurses?

Accordingly, the facility recently had a visit from the Joint Commission on Accreditation of Healthcare Organizations and received a negative rating because the nurses were not adding care plans based on the patients’ primary problem or diagnosis in the patients’ charts upon admission. This presents several specific problems in the healthcare facility. There is poor compliance from the nurses concerning the addition of standardized care plans to the charts of patients based on their diagnosis or primary problem(s). The system which the facility invested in was not being used for the improvement of patient outcomes and quality of care delivered. The focus of this project is the failure of inpatient nurses to make use of standardized care plans. The gap in nursing is the failure of delivery of evidence-based practice using the standardized care plans which result in poor patient outcomes and quality of life. One of the areas of knowledge that has not yet been explored is the cause of low rates of adoption of standardized care plans by nurses. Another gap is the lack of studies on nurses’ perception of the standardized care plans and how they affect their use in inpatient care setting. Further, the study also seeks to explore the effectiveness of a training program on the implementation of standardized care plans. Comment by Cynthia Fletcher: Why is this a reason to cite the facility? Comment by Cynthia Fletcher: What the negative rating? Comment by Cynthia Fletcher: Rephrase: the policy requires the use of ….The compliance rate is low. Comment by Cynthia Fletcher: This is what should be included when you first identify this program. Comment by Cynthia Fletcher: You have not identified that this is a problem and validation for a gap was not presented. Comment by Cynthia Fletcher: Where is your evidence for this statement? Comment by Cynthia Fletcher: ? Comment by Cynthia Fletcher: You are not conducting a study; you are implementing a teaching program to increase knowledge about Comment by Cynthia Fletcher: You do not train professionals to perform a professional function; they are educated.

Practice-Focused Question

The guiding practice-focused questions which is the focus for this study is as follow:

1. What are the causes of low use of standardized care plans by in-patient nurses?

2. What are the nurses’ perceptions of the standardized care plans?

3. Can the nurses’ training andWill an education program to teach nurses how to use on standardized care plans increase their use of in the inpatients’ settings for their patients according to the establish guidelines, increase their knowledge about the use of the plans?

The practice-focused questions are relevant to the practice and identified gaps in various ways. While standardized care plans are increasingly being embraced in inpatient care settings, there is scarcity of knowledge about ways of successfully implement them. Jansson et al. (2010) observed that nNurses’ understanding of how to use standardized care plans is critical to their successful implementation (Jansson et al., 2010). Therefore, these research questions can guide inquiry into the factors that influence the successful adoption of standardized care plans by inpatient nurses in hospital settings. Comment by Cynthia Fletcher: reference Comment by Cynthia Fletcher: reference Comment by Cynthia Fletcher: this reference is not on the reference list Comment by Cynthia Fletcher: this is outside the scope of the project.

Social Change Comment by Cynthia Fletcher: Ann Marie, this is a beginning; we can review at our meeting.

Social change involves alteration of the social order of the society including changes in the social relations, behaviors, and institutions (Yanicki, Kushner & Reutter, 2015). The project will impact the social change for healthcare consumers and professionals in several ways. There would be appropriately developed care plans from which nurses can select reducing the need for nurses to develop them from scratch for every patient (Altman & Brinker, 2016). The selection and addition of a care plan by a nurse would lead to the automatic population of the chart of an individual patient. Furthermore, the educational tablets of the patients would be dependent on the completion of the nurses adding the care plan to the patients’ chart. There would also be a decrease in workflow time of nurses because of the presence of a preset care plan. Finally, there would be no need for nurses to do any follow up teaching on the care plan.

The mission of Walden University is to develop a diverse community of career professionals with the chance to change themselves as scholar-practitioners so that they can promote positive change. This project seeks to meet this mission by exploring providing knowledge on implementation of standardized care plans (Monsen et al., 2011). Such knowledge can be integrated into practice in order to improve patient outcomes and nurses’ productivity in health settings. Also, a positive social is any deliberate process of creating ideas, strategies, and actions which are aimed at promoting the work, development, and dignity of people, communities, organizations, cultures, and societies (Yob et al., 2016).

The parties that might benefit from the project include the nurses and the patients. Standardized care plans make it possible for all patients to receive good care irrespective of who is caring. This project improves the works of nurses and also leads to an improvement in the quality of care delivered to patients. Patient safety increases as a result of implementation of standardized care plans (Andreae, Ekstedt, Snellman, 2011). Nurses also benefit from standardized care plans in terms of ease of work since they can easily access a rich body of evidence to integrate into practice. In addition, nurses benefit in terms of the ease of access and the documentation of medical records. Comment by Cynthia Fletcher: ?

Context for Doctoral Change

The intended setting for the project is a community small teaching hospital where the inpatient nurses deliver care to patients. The main foundation of the project is the education of the inpatient to educate the nurses on the benefits and use of standardized care plans and the need for the nurses to make use of these care planswhen planning patient care. Comment by Cynthia Fletcher: This is not clear

The research design that will be used for the study is a descriptive design. Stratified random sampling procedure will be used to select participants, who will mainly be inpatient nurses. The interviews will be administered on the nurses to explore the causes of poor use of the standardized care plans and their perceptions on the health institution’s standardized care plans. Comment by Cynthia Fletcher: ?

Sources of Evidence Comment by Cynthia Fletcher: Ann Marie, please use the Checklist to identify what is required in this area.

The main source of evidence is the Joint Commission’s standard for a care plan which details the information which should be considered for standardized care plans (Baker, 2017). The medical records of patients contain numerous clinical information (Garrett, 2016). They contain the reason for admission, initial diagnosis or diagnostic impression, findings of assessments, food allergies, medication allergies, and conclusions from the medical history and physical examination. The records also have information on complications, hospital-acquired infections, consultation reports, observations that are relevant to care, noted progress, all orders, a medication which have been administered, adverse drug reactions, treatment goals, and discharge plan (Carter, 2015). The records should guide standardized care plans formulation. The use of the electronic system enables the selection of the appropriate care plan based on the patient medical record as the system is automatic and integrates the different patient information. This makes it necessary to educate the nurses on the use of the standardized care plan as a way of improving patient care. Also, standardization is an aspect of clinical practice that has been emphasized by different healthcare stakeholders for the purpose of improving the quality of patient care. For instance, the World Health Organization emphasizes the need for consistence in clinical procedures through standardization to minimize confusion among healthcare workers as provided in the EBP guidelines (World Health Organization, 2017). Furthermore, standardization increases effectiveness of communication among healthcare workers when sharing patient information across different healthcare units and among different healthcare facilities (Adelson et al., 2017). Also, standardization has been found to reduce the likelihood of misinterpretation of data among different healthcare workers, which increases patients’ quality of life through administration of accurate treatment processes, and also reduces the number of hospital readmissions (Adelson et al., 2017). Further afield, standardization of healthcare procedures reinforces a safety and accuracy organizational culture in which high quality patient care is part of healthcare values. As a result, the quality of patient care will be high hence high patient satisfaction with healthcare services provided by healthcare organizations (Kasiri, Cheng, Sambasivan & Sidin, 2017). Standardization of clinical procedures has also been shown to minimize cases of misdiagnoses, which in turn reduces health risks to patients and expenses associated with continued treatment (Douketis et al., 2016). Lack of standardized procedures is often associated with high risks of misdiagnoses and other medical errors since some healthcare procedures such as administration of anticoagulants in perioperative units can cause serious health effects or even fatalities. As such, there is a need to introduce education on standardization to minimize errors thereby increasing the quality of patient care and the efficiency and effectiveness of clinicians when performing medical procedures.

Lack of standardization of medical procedures is associated with high likelihood of errors when treating or handling patients. For instance, the manner in which patient details such as medical history is entered can cause confusion when being analyzed by other hospital units if the data has not been entered in a standardized manner (Badano et al., 2015). Furthermore, the use of different standards for interpreting the same information such as the use of different color codes when interpreting images can cause confusion when the same information is being interpreted using a different color in a different healthcare facility, which can lead to misinterpretation of images, which can lead to misdiagnoses and prescription errors (Badano et al., 2015). It is thus necessary for clinical practitioners to use standardized criteria for interpreting data that have been provided in different modes in order to ensure consistency in interpretations, and to enhance interoperability of clinical equipment (Wager, Lee & Glaser, 2017). Lack of standardization also has negative implications on healthcare workers. Confusion and miscommunication often occur in clinical settings that lack standardized operating procedures. The confusion leads to significant wastage of time and effort, which significantly slows down activities and increases anxiety and depression among healthcare workers (Wager et al., 2017). Such situations occur when nurses start to develop the perception that they are less competent than expected thereby lowering their self-esteem and increases negative perception of their work and overall job satisfaction.

Procedural Steps

In order to successfully complete the project, data will be gathered from different sources using different approaches. One way of sourcing relevant information that can be applied for the project is to search in scholarly databases for information on the approaches of implementing standardization in practical clinical settings. Secondly, I would use questionnaires with open-ended questions to inquire from the inpatient nurses in the hospital that the program is to be implemented about the challenges that they encounter as a result of lack of standardization of clinical procedures. The questionnaires will be issued to willing participants who will respond to the questions in their own free time, and in privacy settings. Questionnaires answered in private settings have the potential to yield genuine and detailed information since they give respondents a sense of anonymity and limiting factors such as influence from the management is not experienced (Corr, 2016). The third approach will involve physical assessments of the clinical procedures used in the hospital to check the degree of standardization in the healthcare institution. Comment by Cynthia Fletcher: This is the information required in the previous section.

In order to succeed in such an assessment, it will be necessary to seek for permission from the management in advance, and to request the management to provide information on the levels of standardization in the hospital, the challenges faced due to ineffective or lack of standardized procedures. Information will also be gathered from the management concerning the level or lack of educational programs on standardization so as to have a clear view of how to introduce the program (Corr, 2016). Lastly, it is also necessary to consult other stakeholders such as patients to give their views on the quality of care with relation to standardized clinical procedures in order to have a clear understanding of the effects of lack of standardization on the quality of patient care.

This project on education on standardization is supported by the DNP resources page. The project falls under evidence-based approaches that can be used to improve the quality of patient care. This project takes the educational approach on standardization to improve the quality of patient care.

Ethical Considerations

Several ethical considerations will be put in place. The first consideration is that the project has a favorable risk to benefit ratio with the benefits outnumbering the risks involved (Ketefian, 2015). The selection of nurses for the project will be fair based on the scientific objectives and not vulnerability. The nurses will also be required to sign consent forms which will be voluntary after being informed of all that is required of them and risks involved in the program (Hoyland, Hollund & Olsen, 2015). The subjects will also be accorded with respect in the lines of privacy, confidentiality and an opportunity to withdraw from the study (Oye, Sørensen & Glasdam, 2016).

The regions of data sources will be inpatient units in the hospital. Data will also be sourced from the admissions unit, in wards, and from the hospital’s inventory.

Data will only be collected after receiving full approval from the committee and the IRB. Finally, the project will obtain approval from an independent review organization before the collection of information.

The potential ethical issues that can arise include psychological and emotional harm to some inpatient nurses in units that perform the poorest with regards to the use of standardized care plans, and negative ratings of the hospital’s use of standardized procedures. Comment by Cynthia Fletcher: ?

Alignment Comment by Cynthia Fletcher: ?

All the aspects of the project from the data-gathering phase to planning and implementation are in harmony and follow a systematic and sequential order.

The use of a standardized care plan is supported by different organizations both locally and internationally as they have been found to contribute to an improvement of patient outcomes and the quality of care. The practice-focused question and the procedural steps will help in addressing the practice problem by revealing the importance of using standardized care plans.

Credible sources that support the practice problem include but not limited to healthcare organizations such as the Joint Commission, WHO, and scholarly researches. They will help to convince inpatient nurses in the affected units to make use of the standardized care plans which will see an improvement from the current 40% compliance and positive rating from the Joint Commission for Accreditation of Healthcare Organizations.

The practice-focused questions will address the lack of standardization by inquiring about the levels of standardization, barriers and reinforcing factors, and the best approaches to implement the project. The feedback will be used to align project activities to specific needs and conditions of the healthcare workers in the hospital.

References

Adelson, K., Paris, J., Horton, J. R., Hernandez-Tellez, L., Ricks, D., Morrison, R. S., & Smith, C. B. (2017). Standardized criteria for palliative care consultation on a solid tumor oncology service reduces downstream health care use. Journal of oncology practice, 13(5), 431-440.

Altman, M., & Brinker, D. (2016). Nursing social entrepreneurship leads to positive change. Nursing Management47(7), 28-32.

Baker, D. W. (2017). History of The Joint Commission’s pain standards: lessons for today’s prescription opioid epidemic. Jama317(11), 1117-1118.

Carter, J. T. (2015). Electronic medical records and quality improvement. Neurosurgery Clinics26(2), 245-251.

Corr, P. J. (2016). Reinforcement sensitivity theory of personality questionnaires: structural survey with recommendations. Personality and Individual Differences, 89, 60-64.

Garrett Jr, J. H. (2016). Effective perioperative communication to enhance patient care. AORN journal104(2), 111-120.

Høyland, S., Hollund, J. G., & Olsen, O. E. (2015). Gaining access to a research site and participants in medical and nursing research: A synthesis of accounts. Medical Education49(2), 224-232.

Ketefian, S. (2015). Ethical considerations in research. Focus on vulnerable groups. Investigación y Educación en Enfermería33(1), 164-172.

Martin, S. A., & Sinsky, C. A. (2016). The map is not the territory: medical records and 21st-century practice. The Lancet388(10055), 2053-2056.

Monsen, K. A., Swenson, S. M., & Kerr, M. J. (2016). The perceptions of public health nurses using standardized care plans to translate evidence-based guidelines into family home visiting practice. Kontakt18(2), e75-e83.

Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018). Health promotion in nursing practice. Pearson Education Canada.

Nussbaum, D. P., Penne, K., Stinnett, S. S., Speicher, P. J., Cocieru, A., Blazer III, D. G., … & White, R. R. (2015). A standardized care plan is associated with a shorter hospital length of stay in patients undergoing pancreaticoduodenectomy. journal of surgical research193(1), 237-245.

Øye, C., Sørensen, N. Ø., & Glasdam, S. (2016). Qualitative research ethics on the spot: Not only on the desktop. Nursing Ethics23(4), 455-464.

Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses. Jones & Bartlett Learning.

Sowan, A. K., Leibas, M., Tarriela, A., & Reed, C. (2019). Nurses’ Perceptions of a Care Plan Information Technology Solution with Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study. JMIR human factors, 6(1), e11846.

Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: a practical approach for health care management. New Jersey: John Wiley & Sons.

World Health Organization. (2017). Facilitating evidence-based practice in nursing and midwifery in the WHO European Region. WHO. Retrieved from http://www.euro.who.int/_data/assets/pdf_file/0017/348020/WH06_EBP_report_complete.pdf?ua=1

Yanicki, S. M., Kushner, K. E., & Reutter, L. (2015). Social inclusion/exclusion as matters of social (in) justice: a call for nursing action. Nursing Inquiry22(2), 121-133.

Yehuda, R., & Hoge, C. W. (2016). The meaning of evidence-based treatments for veterans with posttraumatic stress disorder. JAMA Psychiatry73(5), 433-434.

Yob, I. M., Danver, S. L., Kristensen, S., Schulz, W., Simmons, K., Brashen, H. M., … & Penland, D. R. (2016). Curriculum alignment with a mission of social change in higher education. Innovative higher education41(3), 203-219.

 
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