NUR 590 Evidence Based Project Proposal Evaluation Plan

NUR 590 Evidence-Based Project Proposal Evaluation Plan Sample Solution

Expected Outcomes.

After implementing the evidence-based project, I anticipate results not differing from other previous pieces of research done on the same project.  I expect nurses to implement the skills and knowledge gained to adhere to daily bathing of the central line with chlorohexidine in ICU patients. As a result, I expect a decrease in the rate of central line-associated bloodstream infections (CLABSI).  According to Arunga et al.(2021 NUR 590 Evidence-Based Project Proposal Evaluation Plan ), reduced CLABSI would decrease hospital stays, reduce the cost of care, improve patient satisfaction, reduce rehospitalization, and improve patient outcomes.

Data collection Tools, Research Design, and Statistical test

This research project adopted a prospective cohort study design, a quantitative design. Nurses will be trained on how to do daily chlorhexidine bathing in ICU patients. Patients will be grouped into cases and control. Patients in the study group will be bathed with chlorhexidine, while those in the control group will receive a normal saline infusion. All standards of care will be observed with the patient’s interests prioritized. Follow-up will be done to determine the rates of CLABSI among the study groups.

Data will be collected using questionnaires, interviews, and laboratory tests, including blood cultures, temperature measurements, and medical health records. I will prefer to use a questionnaire for data collection in this project. Questionnaires are valid, reliable, and applicable in this project as they have been used before with higher success rates (Hammoudeh et al., 2018). Questionnaires are standardized and hence valid to provide accurate data from the project. In addition, questionnaires are reliable as they can provide the same results if used appropriately in repeated trials. In addition, a questionnaire will address various aspects of the project; hence it is applicable to provide extensive data (Haddadin et al., 2021).  Finally, Questionnaires are preferable because they are cheap to use and can be used to collect extensive data that can easily be analyzed.

 After collecting data, a Chi-square test will be used to analyze categorical variables. The Chi-square test is helpful in hypothesis testing while providing an association between variables (McDougle et al., 2020). Furthermore, the probability of dependence between classified variables is applicable while using a chi-square. In this project, chi-square will help determine the relationship between using normal saline or chlorhexidine in reducing the rates of central line infections.

How outcomes will be measured and evaluated

The anticipated outcome of this project is aimed at improving patient outcomes in terms of reducing central line infection through the use of chlorohexidine. Nurses are expected to adhere to the training offered and bathe daily patients with chlorhexidine. Patients will also know the importance of using chlorhexidine in addition to maintaining general hygiene to prevent CLABSI.

Once nurses have mastered the technique of daily bathing, the rate of CLABSI will reduce. As a result, patients will have improved outcomes in terms of reduced hospital stay, reduced cost of care, improved quality of care, reduced readmission rate, and reduction in mortality and morbidity (Frost et al., 2018). Furthermore, there will be reduced exposure of patients to long-term antibiotics, resulting in antibiotic resistance. Healthcare providers will also learn about different monitoring strategies to suspect CLABSI while ordering specific tests to assess patients.  Likewise, the institutional expenditure on caring for patients will reduce, and the cash could be used to improve other patient care sectors (Arunga et al., 2021 NUR 590 Evidence-Based Project Proposal Evaluation Plan ). Finally, the knowledge gained in this project will be spread by nurses to other institutions that will adopt the same practice. As a result, patient care across the institutions will improve with better patient outcomes.

Strategies to be taken if outcomes do not provide positive results.

I believe the steps I have in this project will yield the expected results. However, if the expected outcomes are not achieved, I will be obliged to review the whole process. Reviewing the process will include assessing the availability of resources and personnel used during the entire process while identifying gaps that would have led to deviation from the expected results. Furthermore, I will gain more insight from the champion nurses regarding the implementation process while gathering views regarding their perception of the evidence-based project. In addition, I will improve on the strategies of training nurses and encouraging them to adhere to the process. Finally, if all the interventions fail to yield the results, I will consider starting the whole process afresh. However, more strategies will be implemented to cover the gaps identified during the initial process.

Plan to maintain, Extend, or Revise, Discontinue a Proposed Solution.

The outcome of the project will determine its fate and application. The project will be maintained and extended in clinical practice if the expected outcomes are achieved. Maintenance and extension will be done through continuous training and educating nurses on daily bathing and its importance (McDougle et al., 2020 NUR 590 Evidence-Based Project Proposal Evaluation Plan ). The benefits can be extended to other centers through information sharing and training.

However, if the expected outcomes are not achieved, the project may be revised. The revision will include identifying gaps and improving in those particular areas to increase the efficiency of the project. Nonetheless, if the risks of the intervention outweigh its benefit, the project may be discontinued, and the whole process rewritten and started again. The ultimate goal is to ensure that the project improves clinical outcomes and enhanced decision-making.

References

Arunga, S., Mbarak, T., Ebong, A., Mwesigye, J., Kuguminkiriza, D., Mohamed-Ahmed, A. H. A., Hoffman, J. J., Leck, A., Hu, V., & Burton, M. (2021). Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology, 6(1), e000698. https://doi.org/10.1136/bmjophth-2020-000698

Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y

Haddadin, Y., Annamaraju, P., & Regunath, H. (2021). Central line associated bloodstream infections. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430891/

Hammoudeh, S., Gadelhaq, W., & Janahi, I. (2018). Prospective cohort studies in medical research. In Cohort Studies in Health Sciences. InTech. https://doi.org/10.5772/intechopen.76514

McDougle, J., Sabirovic, M., Pietropaoli, S., & Hamilton, K. (2020). The gulf between emergency plans and the resources needed: a global review: -EN- -FR- Le fossé entre les plans d’urgence et les ressources nécessaires: un examen au niveau mondial -ES- El abismo que media entre los planes de emergencia y los recursos necesarios: panorámica mundial. Revue Scientifique et Technique (International Office of Epizootics), 39(2), 373–384. https://doi.org/10.20506/rst.39.2.3088

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Evidence-Based Practice Proposal – Evaluation of Process, NUR590 Sample  Solution 2

In an attempt to decrease pharmacologic treatment, decrease costs and length of stay (LOS) it is imperative to evaluate a non pharmacological treatment of infants experiencing neonatal abstinence syndrome (NAS) symptoms. Rooming-in or non-separation of parent and infant may be an effective treatment plan. More maternal-infant interaction improves NAS outcomes but is difficult to obtain in the neonatal intensive care unit (NICU). Rooming-in care allows parents to be at the infant’s bedside 24-hours a day unless separation is indicated for medical reasons or safety reasons, (MacMillan, Rendon, Verma, Riblel, Washer, &Volpe Holmes, 2018). NUR-590 Evidence-Based Practice Project Proposal: Evaluation Plan

Methods Used in Collecting the Outcome Data

The most appropriate way to collect the data for this EBP project is utilization of structured observation as well as physical assessment. The observation will be systematic and purposeful by utilizing forms to document specific observations and assessments at specific times. The first tracking form will be the Modified Finnegan Withdrawal Scale (MFWS), a tool used to assess and score NAS infants based on subjective and objective data, this form will be utilized every four hours. The second will collect data on parent interactions, breastfeeding, NAS score, as well as transfer to NICU and discharge date. The third will collect demographic information and a unique identification number for each rooming-in pair to be completed when rooming-in begins. These structured observations and physical assessments can be coded and quantified for use in evaluation of the project, (Tappan, 2016).

Ways in Which the Outcome Measures Evaluate the Project Objectives

Typically when implementing a project the goal is to successfully achieve the project’s objective. “Senior executives use the general  term  project  success  to  both subjectively  describe  and  objectively   evaluate   the   achievements   of   their projects”, (Meredith, & Zwikael, 2019). In this project the outcome being measured is infant LOS for infants that go directly to the NICU for treatment (the current standard of care) vs the LOS for infants rooming-in with parents (the intervention group). By comparing the LOS for the standard of care through chart reviews with logs kept by nurses on the rooming-in infants it can be determined if there is a decrease in LOS for the intervention group.

Outcome Measurement and Evaluation

As each family begins to room-in data will be collected in real time. Basic information will be collected on an EXCEL file that consists of:

1. Infant Name
2. Infant Medical Record Number (MRN)
3. Infant Birthdate
4. Parent’s name and contact information
5. Unique Identification (ID) Number (A number specific to this project to utilize in data collection in order to protect participant confidentiality)

All other data collection will be recorded using the unique ID number. Bedside RNs will be utilizing a printed tracking form to collect the following data on each infant:

1. Admission date
2. Discharge date
3. Transfer to NICU
4. Administration of medications
5. Feeding method
6. NAS score every 4 hours
7. Parental interventions every 4 hours

The best practice team will meet weekly to analyze data early and transfer into EXCEL files.

The team is already familiar with EXCEL and it is provided for use from the facility. Performing preliminary analysis of the data helps avoid a large amount of data to be processed at the end of the project, helps catch problems early, helps detect safety problems early, and helps check interrater reliability, (Tappan, 2016). The actual analysis of data for this project is simple, the LOS of infants in the intervention group compared to LOS in infants who received the standard of care. The effect size will be determined by comparing the mean LOS of each group, (Melnyk & Fineout-Overholt, 2015). The test will be valid due to utilizing the same analysis for both groups and reliable because the same inclusion criteria will be used for both groups.

Strategies if Outcomes Do Not Provide Positive Results

“Quantitative studies are frequently conducted to find out if there is an important and identifiable difference between two groups”, (Melnyk & Fineout-Overholt, 2015). If there is not a statistical difference in the effect size it does not mean the project was a failure. After attempting to find reasons for the results not providing positive results it can be concluded that the standard of care is working and does not need to be changed.

Implications for Practice and Future Research

The results of this project will determine future care of infants experiencing NAS symptoms. If the effect size proves that rooming-in leads to a decrease in LOS then this should become the standard of care. By collecting additional data during this project further research can be done. The best practice team can evaluate if breastfeeding or certain comfort measures had a significant impact on the LOS of infants in the intervention group.

References

MacMillan K., Rendon C., Verma K., Riblet N., Washer D., Volpe Holmes A. Association of rooming-in with outcomes for neonatal abstinence syndrome: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(4):345–351. doi:10.1001/jamapediatrics.2017.5195 Retrieved from https://jamanetwork-com.lopes.idm.oclc.org/journals/jamapediatrics/fullarticle/2672042

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice. The American journal of nursing, 110(1), 51–53. https://doi.org/10.1097/01.NAJ.0000366056.06605.d2

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

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The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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