Nursing Essay Sample(Capstone Project Proposal)

Capstone Project Proposal

Using Purposeful Hourly Rounding with Fall Alarm to Reduce Patients’ falls in An Acute Care Unit

Background and Significance


Hospital stays subject patients, their loved ones, and families to considerable stress. As they face complex medical conditions that require constant testing, monitoring, and attention from physicians and nurses, they are placed in dependent situations which make them emotionally and socially vulnerable. They are compelled to seek assistance with rudimentary needs such as eating, positioning, and elimination. They need high-quality, equitable, and efficient patient-centered care. Without patient safety, however, positive outcomes in an acute care setting remain a far stretch from reality. Unfortunately, it is now common for the unexpected to occur and cause harm to patients while in the hospital. Often, such harm is considered an identifiable, preventable and critical problem in the safety of hospitals and other healthcare facilities. One such unexpected events are “falls,” which refers to an unplanned to the floor with or without injury to the patient. Falls and injuries related to falls rank as some of the most commonplace and costly happenings in the acute care setting. A patient fall has devastating impacts on the patient, the medical facility, and the healthcare system. Patients are subjected to additional diagnostic tests and interventions thereby substantially delaying their plan of care. Such delays increase the length of hospital stay, leading to overcrowding in the acute care environment. Hospital falls may also result in life-threatening injuries and extreme cases, death. Sadly, falls continue to occur even when patients are under the watchful eyes of nurses and other clinical officers. Purposeful hourly rounding is one of the most proactive ways for nurses and clinical workers to discern patient needs and establish positive fall prevention outcomes. This capstone project examines a process improvement undertaking of an acute care unit that had experienced a rise in the rate of patient falls over a period of three months. The purpose of the project is to assess whether staff education and the implementation of an evidence-based purposeful hourly rounding program would help reduce the number of patient falls.

Significance of the Study/Relevance to Nursing Practice

Nursing staff in acute care units face the arduous task of keeping their patients safe from falls and any fall-related injuries on a day-to-day basis. Quigley (2015) reminds nurses that the American Nurses Association has designated patient falls as a nursing-sensitive indicator. As such, nurses play a critical role in preventing patient falls in the acute care setting and maintaining the safety of each patient’s environment. Nurses are in a position where they can determine the value of an evidence-based fall prevention program such as purposeful hourly rounding to achieve positive outcomes. Such outcomes may include a reduction in the rate of patient falls and injuries related to falls, increased patient satisfaction, and saving on costs. The outcomes are essential to the leadership of medical facilities and healthcare organizations since they demonstrate a commitment to the culture of quality and safety. The Agency of Healthcare Research and Quality (AHRQ) (2013) outlines the essence of educating all members of a healthcare team and integrating hourly rounding protocol into the day-to-day nursing staff activities as one of the best fall-prevention strategies.

Purpose Statement

The purpose of this capstone project is to evaluate the impact of the use (staff education and Implementation) of an evidence-based purposeful hourly rounding program on the patient fall rate of an acute care unit. Upon completion, the project seeks to evaluate the compliance of nursing staff members to the requirements of the program over a 3-month period and to achieve a 25 percent reduction in falls. The overall goal is to reduce the fall rate by 50 percent within six months. Clinical reasoning strategies will be applied with a view to developing optional strategies to evaluate the project’s alternative outcomes. Alternative outcomes considerations help in planning for potential alterations that could lead to a different outcome to the one intended by the project. Clinical reasoning is a complicated process that makes use of both formal and informal thinking methods to collect and assess patient information and determine the need for alternative actions. Clinical reasoning skills such as informal thinking, the things that could affect the project’s outcome include staff training time and documentation compliance, as well as existing generalizations with regards to tools for application by nursing staff. The project applies the Shewhart cycle- plan, do, check, act (PDCA). PDCA is a continuous improvement model that hospitals can use to ensure nurses and other staff practice interventions to meet the intended outcome measures.

Plan Identification of problem and planning changes

Increased rate of patient falls in acute care unit

Do Implementation of the change program.

Educate staff on purposeful hourly rounding and conduct trials.

Check Data collection, analysis of results, and identification of differences.

Monthly data is collected on number of falls and rounding of components.

Act Implement the necessary changes and continue to evaluate effectiveness.

Implementation of the changes identified from data evaluation.

Fig. 1. Table showing Shewart’s PDCA cycle

Purposeful hourly rounding enables nurses and relevant clinical staff to spend more time at Patients’ bedside and attend to their direct needs. Therefore, it enables them to communicate to hospital leaders, patients’ families, and other stakeholders that quality of care and patient safety are the priorities for patient-centered care. As such, the capstone project is in line with maintaining a culture of safety in medical facilities and improving the quality of care.

Literature Review

The literature review section uses carefully selected evidence-based and peer-reviewed journals. The review focuses on the academic evidence to find correlating studies to examine and incorporate in the research. The sources used for the search include the University’s Library and electronic databases such as MedLine, Science Direct, JSTOR, CINAHL, Google Scholar, and PubMed. The Boolean terms used for the search include purposeful hourly rounding, patients falls, falls in an acute care setting, fall prevention strategies, nurse, doctor of nursing practice, effectiveness, and program. The literature search aims to determine existing knowledge of the importance and effectiveness of purposeful hourly rounding programs. Nurses spend most of their time providing direct care to patients. Ensuring the safety of patients and protecting them from fall-related injuries is a critical aspect of nursing and it is important to medical organizations, patients, and their families. As such, nurses must have the requisite knowledge to protect patients from falls and fall-related injuries if they are to promote a culture of safety and improve the quality of care provided to patients. Medical organizations also have a responsibility to ensure their patients’ safety. Falls are often a burden to patients, nurses, patients’ families and hospitals. The pain, immobility, injuries and reduced functionality that falls cause affects the physical and psychological health of victims.

The primary stakeholders are the patients since the program affects them directly. Others include nurses, physicians, patients’ families, hospital management, clinical officers, and the entire community.

Barriers to Implementation and Sustainability

Hospital culture may inhibit the implementation and sustainability as nurses will need an adjustment period to reach full compliance and achieve a form completion rate of 100 percent.

Data Collection Plan

Unlicensed nursing staff will be designated to document a hard copy hourly rounding tool for all participants. That data collected on the rounding tool will address comfort, toileting, safety, and personal possessions as per the Studer Group model. The nurse manager will assign acronyms to each form for accountability purposes to address whether the participants were sleeping, out on pass, or in the lounge/dining area. The unlicensed nursing staff will be instructed to document a task’s letter code next to the hour it is completed. The data will then be reviewed after three months and again after six months.

Data Analysis Plan

The process of data analysis includes preparation of data, description of the sample, exploring and confirming analysis, and ensuring reliability. Care will be observed to prevent data entry errors, measurement errors, and identifying missing information. The statistical analysis will be confirmed with a statistician at the university.

Ethical Considerations

Human rights protections uphold the dignity, health, and self-respect of study participants. Before implementation, this study will be reviewed by the hospital’s Internal

Review Board as well as the University. The review will ensure that the program poses no harm

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