NUR 590 Benchmark Evidence-Based Practice Project Proposal Final Paper

Benchmark – Evidence-Based Practice Project Proposal Final Paper Example

Problem Statement

In recent years, insertion of a central line has been a common procedure for both outpatient and inpatient settings. The central lines are used for renal replacement therapy, administration of medication, monitoring of hemodynamic state, and nutritional support, among others (Huybrechts et al., 2021). Likewise, patients in the intensive care unit (ICU) are in critical condition and require central lines for the aforementioned purposes. Therefore, central line insertion is a common procedure for ICU patients, and a correct insertion procedure must be adhered to.

Unfortunately, the central lines act as a passage of infective agents, including bacteria, viruses, and fungi. These infections are termed central-line-associated bloodstream infections (CLABSI). This is attributed to either wrong insertion procedures, poor maintenance of catheters, and failure to monitor the central lines. Once an infective agent accesses the body, it spreads through the bloodstream to cause severe systemic infection. CLABSI leads to an increased hospital stay that increases the cost of care, resulting in reduced patient outcomes.

Notably, up to 41000 new CLABSI infections are reported in the United States, with an estimated annual expenditure of 2.68 billion dollars (Huybrechts et al., 2021).  Furthermore, despite the achievement in treating CLABSI with antibiotics, there has been a recent increase in antibiotic resistance. As a result, most healthcare institutions focus on preventive measures to reduce the rate of CLABSI and improve patient outcomes.

The proposed preventive measures include; aseptic insertion of a central catheter; proper maintenance by either dressing, cleaning, or bathing; appropriate hand hygiene, and removal of unnecessary catheters when not in use (Karagiannidou et al., 2019). Chlorhexidine has been used for bathing the central line leading to a reduced CLABSI rate. Most healthcare providers understand the importance of chlorohexidine; however, few adhere to the guidelines.

Therefore, this evidence-based proposal will discuss the effectiveness of chlorhexidine compared to normal saline in reducing the rates of CLABSI. The project aims at increasing knowledge among healthcare providers to adhere to daily bathing of central line with chlorohexidine. The PICOT question is:  In patients admitted to ICU with a central line catheter (P), how does the use of chlorhexidine (I) compared with flushing the central line using normal saline (C) lead to the reduced central line-associated bloodstream infection (O) over six months (T)?

Literature Review

CLABSI is defined as any infection that develops within 48 hours of central line insertion or after catheter removal and cannot be related to other factors apart from the central line. It is the most common form of hospital-acquired infection (HAI) among patients admitted to the ICU. According to Haddadin et al. (2022), the annual incidence of CLABSI in the US is above 41000 cases, estimated as 0.8% per 1000 central line days. The same author states that the global incidence is estimated at 3.73% per 1000 central line days.

The increasing incidences lead to an increased hospital stay, reduced quality of life, increased mortality and morbidity, and increased cost of care. The estimated annual cost of care due to CLABSI has recently increased from 670 million dollars to 2.68 billion dollars (Karagiannidou et al., 2019). The increased expenditure strains the healthcare budget with an increased cost of care. However, untreated cases lead to mortality and morbidity. The global mortality rate is estimated at 12-25% (Payne et al., 2018). This rate is expected to rise if preventive measures are not adhered to.

Several microorganisms are known causes of CLABSI. They range from bacteria, viruses and fungi, with the commonest cause being bacteria. Staphylococci, including Staphylococci aureus and coagulase-negative staphylococci, are the leading causes of CLABSI. Enterococci, aerobic gram-negative bacilli, and yeast follow in that order (Haddadin et al., 2022). Notably, infections of the hemodialysis catheter are caused disproportionately by staphylococcus aureus. On the other hand, infections among patients with cancer are caused mainly by gram-negative bacilli. Yeast and gram-negative bacilli are common in femoral veins catheters, while candida infections are common in central lines for parenteral nutrition.  

Various risk factors exist that increase the likelihood of a certain population to develop CLABSI, unlike others. These factors are related to either patient, healthcare providers, and catheter-related.  CLABSI rate is increased among patients who are either immunocompromised, those with severe illness, granulocytopenia, or those with existing distant infections (Zerr et al.2020). Likewise, failure to adhere to aseptic procedures during central line insertion and catheter maintenance while in place increases the risks of disease.

In addition, failure to monitor catheters and prolonged use of central line catheters increase the risk of infection. Furthermore, the site of the central line also determines the risk of infection. The rate of infection increases in the following sites in descending manner; femoral catheters more than the internal jugular vein and lowest in the subclavian vein catheters. Preventive measures are required to reduce the rate of CLABSI while eliminating risks.

Prevention of CLABSI requires the use of evidence-based practice (EBP). These practices have been used in various settings with a resultant decrease in the CLABSI rate. According to Urbancic et al. (2018), these measures include correct insertion practice, good maintenance, and monitoring for the need for a catheter. When inserting a catheter, aseptic techniques should be used. This requires insertion by trained personnel, adhering to hand hygiene, preparation of insertion site skin with 0.5% chlorhexidine, and using sterile barrier precautions during insertion.

Maintenance of the central line requires bathing and dressing of the central line, preferably with Chlorhexidine, to reduce infection rate and educate both patients, healthcare providers, and relatives about the importance of daily bathing and the technique of bathing. Finally, monitoring of the central line should be done by healthcare providers.

The caregivers should assess the need for central lines in every patient and promptly remove those not needed by the patients. Consequently, prolonged stay of the central line increases the likelihood of new CLABSI. None of the preventive measures of CLABSI is superior to either. However, the use of chlorhexidine has been used by various centers with a positive result achieved.

Chlorhexidine gluconate is a disinfectant and antiseptic agent with bactericidal properties against antimicrobial agents, including aerobic and anaerobic agents. When applied to the skin, Chlorhexidine prevents skin colonization with germs and disease-causing microorganisms, reducing the infection rate (Payne et al., 2018). It is effective against broad-spectrum bacterium and has a fast onset of action after application. Notably, various studies have been done in multiple settings to assess the effectiveness of chlorhexidine in preventing CLABSI.

Several authors and researchers have done studies involving the use of Chlorhexidine to support its effectiveness and citing reasons why it should be used in clinical practice. To begin with, a study was done by Reynolds et al. (2021) that sought to evaluate the effectiveness of implementing the practice of daily bathing with chlorohexidine in combination with a multifaceted program to reduce CLABSI. A qualitative-clustered randomized study was done.

The involved nurses were given training regarding the proper technique of bathing central lines with chlorohexidine, and they were encouraged to adhere to daily bathing. The champion nurses then observed nurses as they bathed central lines. Findings from the study indicated a 24% reduction in the CLABSI rate among patients bathed daily. Likewise, another study conducted by Urbancic et al. (2018) in the Australian tertiary ICU showed a decrease in methicillin-resistant staphylococcus aureus (MRSA) and minimal CLABSI reduction.

Yet, in another study by Zerr et al. (2020), participants were grouped into cases and controls among pediatric patients undergoing hematopoietic stem cell transplantation. The cases or study groups received daily bathing with Chlorhexidine, unlike the controls who were not bathed. Blood cultures were collected from the groups, and results were compared. The findings revealed an increased rate of CLABSI among the controls compared to the study group.

Similarly, Giri et al. (2021) did another study at Duke University medical center. They aimed at ascertaining the relevance of using chlorohexidine for allogeneic transplant patients. The results showed a decrease in CLABSI rate among the study group by 15.6%. These two studies are relevant in ensuring adherence to daily bathing is mandatory (Giri et al., 2021).  

Furthermore, in a prospective crossover study by Lowe et al. (2017), the researchers aimed at comparing the effectiveness between soap and chlorohexidine in reducing CLABSI. While the study group received daily bathing with chlorhexidine, the controls were bathed with non-medicated water and soap. After eight months of follow-up of the patients and comparison of laboratory culture, the study group had a 55% reduction in the rate of CLABSI. On the other hand, the control group had a reduced rate of 36%.

The reduced CLABSI leads to improved patient outcomes and a reduction in the cost of care. Nonetheless, it is estimated that effective preventive measures can save healthcare from losses. For instance, according to Reagan et al. (2019), proper use of chlorohexidine to bathe the central line leads to reduced HAI with resultant decreased cost of care. The same study revealed that up to $815,301 was saved. Therefore, reduction of the healthcare burden requires proper use of preventive measures.

Organizational Culture and Readiness.

Assessment of the organizational culture and readiness is an essential element before implementing a project. Organizational readiness assesses the commitment and the willingness of members of an organization to accept and implement change within an organization. In centers where the readiness is high, the implementation of the project will also be possible. This is because members will be ready to use their resources, committing to ensure that change is achieved. In addition, members will likely cooperate, initiate change, and exert persistence resulting in effective implementation of the evidence-based project (EBP). Therefore, before implementing this project, I assessed Houston`s Methodist culture and readiness.

Like other best healthcare providers in the US and globally, Houston Methodist has a culture of incorporating EBP into the care of patients while improving interdisciplinary collaboration. The administration hires and retains healthcare providers with advanced skills and knowledge to provide cost-effective care while improving patient outcomes. Furthermore, improved interprofessional collaboration through enhanced communication and consultation improves patient care. Therefore, guided by the advanced culture and eagerness to improve, there is a need for periodic knowledge advancement regarding current issues and coming up with better strategies to enhance care while improving patient satisfaction.

In addition, the leadership of the facility is also commendable. Decentralized leadership of the organization involves employers in daily activities to ensure that patients receive the best care. As a result, Staff members are involved in various researches to come up with new innovative techniques that improve patient care. According to Puchalski Ritchie & Straus (2019), leadership that appreciates the contribution of other employers is likely to succeed because every member will be dedicated with improved satisfaction and are likely to offer positive contributions.  Furthermore, the organization is guided by Christian principles and teachings that emphasize protecting human life. This culture encourages members to provide quality care while improving patient outcomes and their quality of life.

Apart from good leadership, the organization is guided by its mission, values, and beliefs. The organization’s mission states its commitment to provide high-quality, cost-effective health care that delivers the best value to the people they serve in a spiritual environment of caring in association with internationally recognized teaching and research. Best value and quality care can be achieved by implementing evidence-based practice (EBP). EBP aims at improving clinical decision-making while ensuring that best practice is provided to patients.  Guided by the mission, the organization is likely to accept the implementation of an EBP process that improves patient care, improves the quality of care, enhances the patients` experience, reduces the burden of care through cost reduction, and reduces mortality rate.

The beliefs of Houston Methodist are grounded on Christian teachings as guided by the Texas Annual Conference of the United Methodist Church. It strives to provide quality healthcare services. The organization believes that God provides life and can heal humans through the actions, lives, and words of others. As a result, everyone is considered sacred and should be treated with utmost care and love. This belief makes it relevant to implement an EBP that will improve the quality of care.

In addition, the organizational values also dictate its commitment to quality care. The guiding values include integrity, compassion, accountability, respect, and excellence. The organization strives for excellence by incorporating EBP and retaining highly skilled healthcare providers who provide the best care with integrity and compassion. Furthermore, interprofessional collaboration enhances the quality of care through improved communication. The use of the TeamSTEPPS assessment tool further affirmed the findings of the organizational culture ad readiness for change.

Team Strategy and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a proven tool for assessing the level of organizational readiness for change. The tool assesses both the weaknesses and strengths of an organization while determining the skills, attitude, and knowledge towards change (Payne et al., 2018). Using the tool, it is possible to evaluate various parameters, including identified need, readiness about time, resources, and personnel, as well as change sustainability through review and measurement.

Measuring motivation and willingness to embrace change are also part of organizational preparedness. According to the evaluation instrument, Houston Methodist is ready to undertake change thanks to well-organized leadership and a strong organizational culture shaped by the mission, beliefs, and values. Furthermore, the company has a high level of team spirit, mutual support, and information flow, all of which contribute to change preparedness and change implementation.

Furthermore, Houston Methodist has various strengths, including but not limited to the following: encouraging and supporting research, innovation, improved interpersonal teamwork, resource availability, effective leadership, a strong stakeholder relationship, and skilled specialists dedicated to providing personalized patient-centered care. Most of the experienced people in the organization will be part of the stakeholders for this project.

Stakeholders will be required to take an active part in ensuring that the healthcare providers well understand the project to enhance its implementation. Knowledge will be guided towards training other nurses and encouraging them to adhere to bathe central lines with chlorohexidine. Stakeholders will include senior nurses in the ICU, nurse managers, informaticians, and physicians. Senior nurses will form part of champion nurses who will actively educate others through active demonstrations and videos about effective bathing procedures for central lines.

The correct bathing procedure requires observing hand hygiene and using a washcloth infused with chlorohexidine. They will also monitor the nurses as they take part in bathing patients. On the other hand, physicians will be involved in demonstrating the correct insertion technique for central lines while enlightening about symptoms of infections. The earliest sign of CLABSI is temperature abnormalities, either high or low. Finally, nursing informatics will monitor new incidences of infection and report data on the same.

Change Model or Frameworks

Implementation of EBP requires the adoption of an appropriate change model or framework. These frameworks or models will help quickly incorporate various research findings into an EBP to improve healthcare delivery and decision-making (van der Steen et al., 2019). Furthermore, the change model will guide the decision regarding data analysis, interpretation, and research perception. As a result, an appropriate change model must be chosen to ensure the project’s success.

Adopting the wrong model may hinder the implementation of an EBP and increase error incidences. These errors develop due to skewing in the proposed process while deviating to processes aided by personal interests (van der Steen et al., 2019). These interests cause bias. Bias can either be confounding, information-related, or selection bias. Furthermore, bias will likely cause errors that may impair the achievement of the research objectives. Therefore, various models exist, as discussed hereafter.

Various models were listed for consideration in this project to enhance the implementation of the EBP. They include the John Hopkins nursing EBP model, Lowa Model for EBP to promote quality care, advancing research and clinical practice through the close collaboration model (ARCC), and the promoting action on research implementation in health services (PARIHS) framework (Huybrechts et al., 2021). These models have been tried in various settings resulting in remarkable results. However, for this project, the ARCC model was chosen.

The ARCC model adopts the use of mentors to help implement the EBP project in a step-wise manner. Mentors are chosen from the existing team members. However, they are provided with further roles making them superior. Furthermore, they are directly involved with the organization’s daily activities and occasionally communicate with other members regarding the EBP project. They also improve organizational belief towards an EBP aided by the amount of knowledge and skills they depict during the implementation process.

Notably, previous trials using the model resulted in improved patient outcomes and job satisfaction due to reduced burnout. Similarly, I aspire to improve patient outcomes while advancing the quality of care and reducing the rates of CLABSI through bathing central lines with chlorohexidine. In addition, I believe that integrating nurse mentors will positively influence the other nurses to adopt the proposed practice. However, there is a need to adhere to all steps of the model to achieve positive outcomes.

The ARCC model has five major steps that describe the stepwise implementation process. These steps include; assessment of organizational culture and readiness; identification of barriers and strengths; identification and development of EBP mentors; implementation of the EBP, and outcomes evaluation (Huybrechts et al., 2021). Following these steps leads to the project’s success and improves healthcare services.

To begin with, assessment of the organizational culture and readiness is a vital part of the model. This is necessary to determine the preparedness of the organization for change. In this stage, various parameters are required for implementation, including personnel, time, resources, attitude, existing policies, and willingness to adopt change are assessed. Furthermore, both organizational strengths and weaknesses are identified in this stage.

In this project, I chose to use the TeamSTEPPS assessment tool for readiness evaluation. The tool identified various strengths and weaknesses. Decentralized leadership, team spirit, interdisciplinary collaboration, availability of resources, and willingness of the organizational members to accept changes were the identified strengths. In addition, the organizational mission, beliefs, and values favor the need for change and enhance implementation of the EBP.  Therefore, Houston Methodist has all that it takes to implement change.

Identifying facilitators and barriers to implementation is the second step of the model. Facilitators of implementation form the basis under which the whole process will be built, while barriers offer an opportunity for identifying better innovative ways. The anticipated barriers for implementation include limited time, inadequate skills, negative attitude towards change, limited supply from the administration, limited mentors, and increased theoretical knowledge with limited practical knowledge on carrying out research. These barriers may make it hard to implement change if they are not addressed and dealt with appropriately. On the other hand, facilitators include increased teamwork, interprofessional caregiving, ethical approval of the project, and the presence of EBP policies.

The next step of the model is the mentors’ identification and establishment. Mentors are essential for both educational and motivational factors. As educators, mentors will train other nurses using demonstrations on how to bathe lines effectively. On the other hand, their presence will improve the beliefs and confidence of other nurses regarding the EBP process and hence will likely support the process. For this project, mentors will be picked among the clinical team. Thereafter, special training will be offered through meetings, simulations, demonstrations, tutorials, and workshops to increase EBP knowledge and skills. With better skills and expertise, they will provide excellent training to enhance project implementation.

The evidence is then put into effect in the fourth stage. The implementation guarantees that the most up-to-date clinical knowledge is integrated into the clinical perspective to make informed patient care decisions (Yoo et al., 2019). Under the supervision of EBP mentors, nurses will participate in implementing the EBP practice. Research findings, the clinical skills of the attending healthcare practitioners, patient preference, as well as values and ethics, will all influence the practice. In this study, all ICU nurses will be trained in safe central line bathing and urged to bathe central lines regularly to lower CLABSI rates. The correct bathing process involves using Chlorhexidine bathed washcloths to clean skin around the central line to kill germs and prevent infections.

The fifth and last step is to evaluate the results of the practice adjustment. Project evaluation is relevant in assessing the success made compared to the objectives. Furthermore, it is necessary to establish the project’s relevance and the level of achievement in terms of efficiency, impact, effectiveness, project sustainability, and objectives attainment (Melnyk et al., 2017). Furthermore, review ensures that limited resources be used wisely to maximize impact. To improve an EBP, adjustments are performed during the evaluation.

These adjustments aim to fill the gaps identified in the whole process while improving the outlook of the project. Hence, in this project, the project’s expected outcomes include improved patient outcomes, enhanced patient and caregivers’ satisfaction, reduction in the cost of care, reduced readmission rate, improved cohesion, and patient turnover will be paramount during evaluation. Improved patient outcomes are projected due to the high-quality care provided guided by EBP knowledge and skills.   

Implementation Plan

The actualization of the project ideas into practice is dependent on the implementation plan.  The implemented EBP aims to improve knowledge and decision-making to improve patient outcomes. Having a clear implementation plan will enhance the actualization of the project`s ideas into reality, where poor planning is likely to inhibit the integration of the project into practice. Therefore, for effective implementation, it is paramount to have a clear strategy of activities including stakeholders, setting, time, management of barriers and facilitators, resources, cost, and data collection plan.

The project will be implemented in the ICU. ICU is chosen because it receives several patients with reversible life-threatening conditions who require close monitoring and stabilization. As a result, patients will receive life-saving procedures such as central lines. These lines, in turn, act as conduits for germs that cause infection (McDougle et al., 2020).

The conditions are expensive to treat and negatively impact a patient`s life and probably lead to death. Therefore, the project will require efforts from every healthcare giver in the ICU settings for its success. As a result, the ICU team will be the major stakeholders for the project. EBP mentors will offer training involving the use of chlorhexidine-soaked washcloths to wipe the skin around the central lines to prevent germ infestation.

Nonetheless, patients too will be involved in the project. Application of the prospective cohort study will require grouping patients. These groups will either be study groups or controls. Either group will sign a consent form to belong to the study and will be free to live the study anytime without objections. Study groups will receive daily bathing of central line with Chlorhexidine, while the controls will receive normal saline. Comparisons between the two groups will be made to determine the incidence rate among the two groups.

Yet another component of implementation is time management. Implementation of the project will require a minimum of ten weeks, with every activity given a stipulated time. The stakeholders of the project will be identified in week one. The stakeholders will be required to ensure the project’s contents are shared among healthcare providers. Each individual will be given specific roles with instructions on how to accomplish them. This will enhance knowledge and facilitate cooperation leading to implementation.

Resource identification will be happening in the second week. Training of staff will be accomplished in the third week. Training will involve tutorials, demonstrations, and webinars to improve skills and knowledge about the project. From week four to the ninth week, the project will be implemented into practice. Nurses will be observed as they undertake the process, while any concerns raised will be addressed in this period. In week ten, modifications will be made in areas of concern to improve the EBP. Upon implementation, data will be collected to ascertain the project’s feasibility.

The project will be deemed feasible if its outcomes outweigh its cost. As a result, data will be collected to determine if there is a decrease in the rate of CLABSI. Questionnaires, surveys, and medical data from the laboratory will provide the required data. The data will be grouped, tested using the chi-square test, and analyzed by the Statistical Package for the Social Science (SPSS). Thereafter, an auditing tool will be used to compare the project’s outcomes versus the previous data to determine any change achieved.

Finally, identification of barriers and addressing them must be considered. The potential barriers include limited time, insufficient EBP mentors, and resistance from some members. As a result, coming up with a clear implementation can help ensure that every activity is carried out within the stipulated time to avoid time limitations. Mobilizing EBP mentors while explaining the importance and objectives of the plan in improving the quality of care will attract many mentors who will be involved in project implementation (McDougle et al., 2020). The EBP mentors will, in turn, transfer the EBP knowledge to other nurses to help in reducing resistance and encouraging them to participate in the project.

Evaluation Plan

The final part of the project is the evaluation after implementation. Evaluation is vital in identifying any gaps and the success of the project. Therefore, any gaps can be addressed in this phase with various adjustments to perfect the project. Outcomes of the project will also be evaluated. For instance, in this project, I expect improved patient outcomes with reduced CLABSI rates like other studies done before. Likewise, according to Arunga et al.(2021), the correct implementation of daily bathing with chlorhexidine is intended to reduce the CLABSI  rate while improving outcomes, enhancing the quality of care, reducing mortality and morbidity, and reducing the cost of care. However, measurement of these outcomes is essential.

The project’s expected outcomes will be improved quality of care and adherence to the bathing process by nurses. Quality of care will be measured in terms of patient satisfaction, patient turnover, reduction in rehospitalization, and prompt recovery without complications. When patients and relatives are contented with the services, they will, in turn, encourage others to seek the same services, which increase patient turnover, improve income return, and attract more profit that can be used to improve other sectors of patient care (Frost et al., 2018).

On the other hand, adherence to daily bathing will be measured in terms of nursing attitude and acceptance of the project. Nurses with a positive attitude who understand the importance of the project will own patients and do daily bathing while encouraging others to do the same. As a result, the infection rate will reduce, thus limiting judicious use of antibiotics with a resultant decrease in resistance to antibiotics.

Furthermore, the outcomes observed from this project will not only impact one organization but also the neighboring institutions. This is because nurses will share the knowledge with others to improve care. Also, continuous education will be provided to maintain and extend it to other facilities. Finally, a contingency plan is necessary in case the initial plan fails.

 I am confident that the steps I have taken in this project will produce the desired results. However, if the predicted results are not met, I will be forced to re-evaluate the entire procedure. Assessing the availability of resources and employees used throughout the process and identifying deficiencies that could have led to deviations from the intended results would be part of the process review. In addition, I’ll get more information about the implementation process from the champion nurses, as well as their perspectives on the evidence-based project.

Furthermore, I will strengthen my tactics for training nurses and encouraging them to follow the process. This can be achieved by carrying out more demonstrations, encouraging small groups participation, and installing reminders in the ICU. These reminders can be in the form of charts and reminder notes to help nurses adhere to the practice. Finally, if none of the interventions provide the desired effects, I will consider restarting the entire process. More strategies, however, are required to address the gaps.

References

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NUR 590 Benchmark Evidence-Based Practice Project Proposal Final Paper Rubric

Organizational Culture and Degree to Which Culture Supports Change

12 points

Criteria Description

Organizational Culture and Degree to Which Culture Supports Change

5: Excellent

12 points

The organizational culture and the degree to which it supports change is thoroughly discussed. The various aspects of the culture are included. Thorough explanations and strong supporting research are provided.

4: Good

11.04 points

The organizational culture and the degree to which it supports change is discussed. Key aspects of the culture are included. In general, explanations and support are provided. Minor detail is needed for clarity or support.

3: Satisfactory

10.56 points

The organizational culture and the degree to which it supports change is summarized. Some key aspects of the culture are outlined but lack explanation and supporting research.

2: Less Than Satisfactory

9.6 points

The discussion of organizational culture and the degree to which it supports change is incomplete.

1: Unsatisfactory

0 points

The organizational culture and the degree to which it supports change is not discussed.

Organizational Readiness Tool and Readiness Assessment

13 points

Criteria Description

Organizational Readiness Tool and Readiness Assessment

5: Excellent

13 points

The organizational readiness tool is identified, and the survey results are presented. The degree to which the culture will support and sustain an evidence-based practice changes is thoroughly discussed. Strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources are clearly considered. Thorough explanations and strong supporting research are provided.

4: Good

11.96 points

The organizational readiness tool is identified, and the survey results are presented. The degree to which the culture will support and sustain an evidence-based practice changes is discussed. Strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources are generally considered. Some minor rationale is needed.

3: Satisfactory

11.44 points

The organizational readiness tool is identified, and the survey results are summarized. The degree to which the culture will support and sustain evidence-based practice changes is generally discussed. The narrative lacks explanation and supporting research.

2: Less Than Satisfactory

10.4 points

The organizational readiness tool is identified. The survey results and interpretation are incomplete.

1: Unsatisfactory

0 points

An organizational readiness tool is not selected; the level or readiness is not assessed.

Health Care Process and Systems Recommended for Improving Quality, Safety, Cost-Effectiveness (B)

10 points

Criteria Description

Health Care Process and Systems Recommended for Improving Quality, Safety, and Cost-Effectiveness (C.3.1)

5: Excellent

10 points

The health care process and systems recommended for improving quality, safety, and cost-effectiveness for the organization is thoroughly discussed. Thorough explanations and strong supporting research are provided.

4: Good

9.2 points

The health care process and systems recommended for improving quality, safety, and cost-effectiveness for the organization is discussed. Minor detail is needed for clarity or support.

3: Satisfactory

8.8 points

A summary on what health care process and systems are recommended for improving quality, safety, and cost-effectiveness for the organization is presented. The narrative lacks explanation and supporting research.

2: Less Than Satisfactory

8 points

A discussion on what health care process and systems are recommended for improving quality, safety, and cost-effectiveness for the organization is incomplete.

1: Unsatisfactory

0 points

A discussion on what health care process and systems are recommended for improving quality, safety, and cost-effectiveness for the organization is omitted.

Strategies to Facilitate Organizational Readiness

10 points

Criteria Description

Strategies to Facilitate Organizational Readiness

5: Excellent

10 points

Strategies to better facilitate the readiness of the organization are proposed. Minor detail is needed for clarity or support.

4: Good

9.2 points

Clear strategies to better facilitate the readiness of the organization are proposed. Thorough explanations and strong supporting research are provided.

3: Satisfactory

8.8 points

General strategies to better facilitate the readiness of the organization are proposed. The strategies lack explanation and supporting research.

2: Less Than Satisfactory

8 points

Strategies to better facilitate the readiness of the organization are incomplete.

1: Unsatisfactory

0 points

Strategies to better facilitate the readiness of the organization are not proposed.

Stakeholders and Team Members Needed

10 points

Criteria Description

Stakeholders and Team Members Needed

5: Excellent

10 points

The stakeholders and team members for the project, including their respective duties, are thoroughly identified.

4: Good

9.2 points

Key stakeholders and team members for the project, including their respective duties, are identified. Minor detail is needed for clarity or support.

3: Satisfactory

8.8 points

Some key stakeholders and team members for the project, including their respective duties, are outlined.

2: Less Than Satisfactory

8 points

Stakeholders and team members for the project are only partially identified.

1: Unsatisfactory

0 points

Stakeholders and team members for the project are omitted.

Information and Communication Technologies Needed (B)

10 points

Criteria Description

Information and Communication Technologies Needed (C.3.3)

5: Excellent

10 points

The information and communication technologies needed for implementation and how they will be integrated in the setting by the internal stakeholders are discussed. How they will help improve nursing practice and care delivery for individuals and populations for the intervention is explained. Minor detail is needed for clarity or support.

4: Good

9.2 points

The information and communication technologies needed for implementation and how they will be integrated in the setting by the internal stakeholders are clearly discussed. How they will help improve nursing practice and care delivery for individuals and populations for the intervention is thoroughly explained. Clear support is provided.

3: Satisfactory

8.8 points

The information and communication technologies needed for implementation and how they will be integrated in the setting by the internal stakeholders are summarized. More explanation is need for how these will help improve nursing practice and care delivery for individuals and populations for the intervention.

2: Less Than Satisfactory

8 points

The information and communication technologies needed for implementation and how they will be integrated in the setting by the internal stakeholders are only partially explained.

1: Unsatisfactory

0 points

The information and communication technologies needed for implementation and how they will be integrated in the setting by the internal stakeholders are omitted.

Required Sources

5 points

Criteria Description

Required Sources

5: Excellent

5 points

Number of required resources is met. Sources are current, and appropriate for the assignment criteria and nursing content.

4: Good

4.6 points

Number of required sources is met, but sources are outdated or inappropriate.

3: Satisfactory

4.4 points

Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content.

2: Less Than Satisfactory

4 points

Number of required sources is only partially met.

1: Unsatisfactory

0 points

Sources are not included.

Thesis Development and Purpose

7 points

Criteria Description

Thesis Development and Purpose

5: Excellent

7 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

4: Good

6.44 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

3: Satisfactory

6.16 points

Thesis is apparent and appropriate to purpose.

2: Less Than Satisfactory

5.6 points

Thesis is insufficiently developed or vague. Purpose is not clear.

1: Unsatisfactory

0 points

Paper lacks any discernible overall purpose or organizing claim.

Argument Logic and Construction

8 points

Criteria Description

Argument Logic and Construction

5: Excellent

8 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

4: Good

7.36 points

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

3: Satisfactory

7.04 points

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

2: Less Than Satisfactory

6.4 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

1: Unsatisfactory

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Mechanics of Writing

5 points

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5: Excellent

5 points

Writer is clearly in command of standard, written, academic English.

4: Good

4.6 points

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

3: Satisfactory

4.4 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

2: Less Than Satisfactory

4 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

1: Unsatisfactory

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Paper Format (Use of appropriate style for the major and assignment)

5 points

Criteria Description

Paper Format (Use of appropriate style for the major and assignment)

5: Excellent

5 points

Template is fully used; There are virtually no errors in formatting style.

4: Good

4.6 points

All format elements are correct.

3: Satisfactory

4.4 points

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

2: Less Than Satisfactory

4 points

Template is used, and formatting is correct, although some minor errors may be present.

1: Unsatisfactory

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to as

5 points

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5: Excellent

5 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

4: Good

4.6 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

3: Satisfactory

4.4 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

2: Less Than Satisfactory

4 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

1: Unsatisfactory

0 points

Sources are not documented.

NUR-550 Literature Review – Resubmission

Submit your literature review from NUR-550 for your NUR-590 instructor to review. If your NUR-550 instructor indicated areas for revision be sure to incorporate these improvements prior to submitting your paper for this assignment.

You will use the revised literature review for your final written paper in Topic, 8 detailing your evidence-based practice project proposal.

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 not required to submit this assignment to LopesWrite.

NUR 590 Topic 2: Making the Case for Evidence-Based Practice

Objectives:

1. Describe effective strategies to create an evidence-based practice culture within a healthcare setting.
2. Identify stakeholders needed for the evidence-based practice project.
3. Assess organizational readiness for the evidence-based practice project.

Topic 2 DQ 1

Compare two organizational readiness tools. Identify the tool you selected and explain why it is most appropriate for assessing your organization.

Topic 2 DQ 2

Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.

Benchmark – Evidence-Based Practice Project Proposal: Organizational Culture and Readiness

In order to successfully implement a change within an organization, the change agent must assess the organization’s culture and readiness for change. In 750-1,000 words, analyze the culture and level of readiness of the organization for which your evidence-based practice project is proposed. You will use the assessment of the organization’s culture and readiness in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal. 

Include the following:

1. Describe the organization’s culture and explain to what degree the culture supports change. Consider organizational and leadership structure, mission and values, interprofessional collaboration/team engagement, communication, perception of the organization by employees, etc.
2. Select an organizational readiness tool and assess the level or readiness for change within your organization. Identify the readiness tool and summarize the survey results. Discuss the degree to which the culture will support and sustain an evidence-based practice change. Consider strengths and weaknesses, potential barriers, stakeholder support, timing of the proposal, and resources. Provide rationale.
3. Discuss what healthcare process and systems you would recommend for improving quality, safety, and cost-effectiveness for the organization.
4. Propose strategies to better facilitate the readiness of the organization.
5. Identify the stakeholders and team members for the project. Include what their duties will be in the evidence-based practice project proposal.
6. Explain what information and communication technologies are needed for the implementation and how they will be integrated into the setting by the internal stakeholders. Explain how these will help improve nursing practice and care delivery for individuals and populations for your intervention.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum four 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.

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 an appendix at the end of your paper.

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:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

3.1:  Assess healthcare processes and systems to recommend measures for improving quality, safety, and cost-effectiveness across an organization.

3.3:  Integrate appropriate information and communication technologies to improve nursing practice and care delivery for individuals and populations.

NUR 590 Topic 3: Theoretical Framework and Models for Change

Objectives:

1. Apply a change model or framework to the evidence-based practice project proposal.
2. Describe the relationship between bias and a framework or model.

Topic 3 DQ 1

Discuss the significance of frameworks or models in guiding research or evidence-based practice projects. How can choosing an incorrect framework or model create bias in research?

Topic 3 DQ 2

Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Applying a model or framework for change ensures that a process is in place to guide the efforts for change. In 500-750 words, discuss the model or framework you will use to implement your evidence-based practice proposal project. You will use the model or framework you select in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

1. Identify the selected model or framework for change and discuss its relevance to your project.
2. Discuss each of the stages in the change model/framework.
3. Describe how you would apply each stage of the model or theoretical framework in your proposed implementation.
4. Create a concept map for the conceptual model or framework you selected to illustrate how it will be applied to your project. Attach this as an appendix at the end of your paper.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of four 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.

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 an appendix at the end of your paper.

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:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.2 Apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level.

NUR 590 Topic 4: Data Collection and Data Analysis

Objectives:

1. Select a research design for the evidence-based project proposal.
2. Select a statistical test for the evidence-based project proposal.

Topic 4 DQ 1

Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Identify which data collection tool you would specifically use and explain why this design is best for your evidence-based practice project proposal.

Topic 4 DQ 2

Identify which statistical test you would use in conjunction with your selected research design from DQ 1 to evaluate the outcomes for your evidence-based project proposal and explain why you selected this test. What kind of information will this test provide about your outcomes?

NUR 590 Topic 5: Evidence-Based Practice Implementation

Objectives:

1. Propose an implementation plan for the evidence-based practice proposal.
2. Propose strategies for overcoming barriers to the implementation of the evidence-based practice proposal.

Topic 5 DQ 1

What are some of the obstacles or barriers to implementing evidence-based practice (EBP) in nursing? Explain how at least one of the obstacles you have described could impact the implementation for your EBP project.

Topic 5 DQ 2

Identify two stakeholder barriers you might experience during the implementation phase of your evidence-based practice project. What strategies can you implement to gain stakeholder support for the project implementation? Provide a suggestion you would give to a colleague who is struggling with obtaining stakeholder support.

Evidence-Based Practice Project Proposal: Implementation Plan

In 1,250-1,500 words, discuss the implementation plan for your evidence-based practice project proposal. When required, create the appropriate form, table, image, or graph to fully illustrate that aspect of the intervention plan and include them in an appendix of your paper. You will use the implementation plan, including the associated documents in your appendices, in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal. 

Include the following:

1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Include a draft of the form as an appendix at the end of your paper.
2. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Based on the timeline you created, describe the amount of time needed to complete this project. Include a draft of the timeline as an appendix at the end of your paper.
3. Develop a budget and resource list. Consider the clinical tools or process changes that would need to take place. Based on the budget and resource list you developed: (a) describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution; (b) outline the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Include a draft of the budget and resource list as an appendix at the end of your paper.
4. Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Provide a rationale to support your selection.
5. Describe the methods and instruments (questionnaire, scale, or test) to be used for monitoring the implementation of the proposed solution. Include the method or instrument as an appendix at the end of your paper.
6. Explain the process for delivering the intervention and indicate if any training will be needed.
7. Discuss the stakeholders that are needed to implement the plan.
8. Consider all of the aspects of your implementation plan and discuss potential barriers or challenges to the plan. Propose strategies for overcoming these.
9. Establish the feasibility of the implementation plan.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five 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.

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 an appendix at the end of your paper.

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.

NUR 590 Topic 6: Evaluating Practice Change

Objectives:

1. Develop an evaluation plan for the evidence-based project proposal.
2. Identify gaps in the literature based on findings.
3. Evaluate evidence to determine and implement the best evidence for practice.

Topic 6 DQ 1

When reviewing the literature for your evaluation plan and different types of evidence for your project, what gaps in the findings did you encounter? How could these gaps influence other researchers?

Topic 6 DQ 2

Discuss the difference between statistically significant evidence and clinically significant evidence. How would each of these findings be used to advance an evidenced-based practice project?

Evidence-Based Practice Project Proposal: Evaluation Plan

In 750-1,000 words, develop an evaluation plan to be included in your final evidence-based practice project proposal. You will use the evaluation plan in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

1. Discuss the expected outcomes for your evidence-based practice project proposal.
2. Review the various data collection tools associated with your selected research design and select one data collection tool that would be effective for your research design. Explain how this tool is valid, reliable, and applicable.
3. Select a statistical test for your project and explain why it is best suited for the tool you choose.
4. Describe what methods you will apply to your data collection tool and how the outcomes will be measured and evaluated based on the tool you selected.
5. Propose strategies that will be taken if outcomes do not provide positive or expected results.
6. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five 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.

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 an appendix at the end of your paper.

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.

NUR 590 Topic 7: Disseminating Evidence

Objectives:

1. Propose strategies used to disseminate evidence to influence health care outcomes.

Topic 7 DQ 1

Propose strategies for disseminating your evidence-based practice project proposal. Consider the necessary stakeholders who need to review or approve the proposal (both internal and external) and what methods you will use to communicate.

Topic 7 DQ 2

After implementation, dissemination of the evidence-based practice outcomes is essential for evaluating the success of the project for ensuring sustainability. Propose strategies that you could use for disseminating the outcomes of your evidence-based practice project proposal. Consider what information would need to be communicated, which stakeholders would need to be involved and the communication methods that would be needed.

Evidence-Based Practice Project Proposal Presentation

The dissemination of an evidence-based practice project proposal is an important part of the final project. Dissemination of your project to a local association or clinical site/practice informs important stakeholders of evidence-based interventions that can improve clinical practice and ultimately patient outcomes.

For this assignment, develop a professional presentation that could be disseminated to a professional group of your peers.

Develop a 12-15 slide PowerPoint detailing your evidence-based practice project proposal. Create speaker notes of 100-250 words for each slide. For the presentation of your PowerPoint, use Loom to create a voice-over or a video. Refer to the topic Resources for additional guidance on recording your presentation with Loom. Include an additional slide for the Loom link at the beginning and an additional slide for References at the end. Be sure to consider your personal demeanor and tone during the recorded presentation.

Include the following in your presentation:

1. Introduction (include PICOT statement)
2. Organizational Culture and Readiness
3. Problem Statement and Literature Review
4. Change Model, or Framework
5. Implementation Plan
6. Evaluation Plan
7. Conclusion

You are required to cite a minimum of six 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.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style. 

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be 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.

NUR 590 Topic 8: Evidence-Based Practice Appraisal

Objectives:

1. Propose strategies for incorporating evidence-based practice into a personal practice.

Topic 8 DQ 1

For professional writing in nursing and health care, APA style is expected. It is also expected for the remainder of your graduate program and in doctoral programs for nursing. Discuss what you have learned, or how you have improved, by completing the “APA Writing Checklist” and from receiving feedback from your instructors. What aspects of APA do you still struggle with? In your response to peers, provide a resource from the Student Success Center (or in addition to something in the Student Success Center) or a suggestion for an area in which someone still struggles.

Topic 8 DQ 2

The evidence-based practice (EBP) process is a powerful way of advancing improvements in health care. Identify three strategies that you will now incorporate into your practice based on this course. Explain your rationale.