Capstone Project Milestone 2: Design for Change Proposal Guidelines

Purpose

You are to create a Design for Change proposal inclusive of your Practice Issue and Evidence Summary worksheet from your Capstone Project Milestone 1. Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced. In the event you are not currently working as a nurse, please use a hypothetical clinical situation you experienced in nursing school, or nursing education issue you identified in your nursing program.

Course Outcomes

This assignment enables the student to meet the following course outcomes.

• CO1: Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO1)
• CO2: Proposes leadership and collaboration strategies for use with consumers and other healthcare providers in managing care and/or delegating responsibilities for health promotion, illness prevention, health restoration and maintenance, and rehabilitative activities. (PO2)

Due Date

Milestone 2 consists of the proposal for your Design for Change Capstone Project. Use the Turnitin Inbox to submit this assignment by the end of Week 4.

Rubric

Click to view and download the NR451 Milestone 2: Design for Change Proposal Rubric (Links to an external site.).

Points

Milestone 2 is worth 225 points.

You are required to use one of the required articles from the Week 3 Milestone 1 assignment or you will earn a “0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required article will be evaluated for evidence of an academic integrity violation.

After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. It is your responsibility to submit the correct assignment to the correct submission area.

Directions

1. A tutorial with tips for completing this assignment may be viewed at https://atge.webex.com/atge/ldr.php?RCID=b0c912eaf53b4aabb1347a026466c60e (Links to an external site.)
2. Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.
3. Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Template (Links to an external site.). Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.
4. The format for this proposal will be a paper following the Publication manual of APA 6 ^th edition.
5. The paper is to be four- to six-pages excluding the Title page and Reference page.
6. As you organize your information and evidence, include the following topics.
   1. Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.
   2. Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.
   3. Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.
   4. Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.
   5. Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.
7. Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.
8. Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.
9. Submit your paper by 11:59 p.m. MT by Sunday of the end of Week 4.

**Academic Integrity Reminder**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

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Sample

The effectiveness of Video Discharge Instructions in Reducing Hospital Readmission

Whereas the stakeholders in the healthcare sector have put commendable efforts in reducing re-hospitalization of patients, the rates of readmissions have continued to surge in the recent past. Notably, the global populace has witnessed a heightened prevalence of re-hospitalization and associated financial penalties, an issue mainly attributable to the ineffectiveness of the strategies adopted by the hospital facilities. Typically, patients are not often in good shape or right mind to adhere to the hospital discharge procedures while leaving hospital facilities. The discharge instructions may encompass an array of complex procedures and aspects, including hygiene, nutrition, prescription, medication, exercise, therapy, wound care, and warning signs among other elements. Given the fact that ignoring one of the discharge procedures may lead to readmission, hospital facilities have acknowledged the need to adopt an effective discharge plan to curb the growing trend. This study attempts to explore the video discharge instructions as an effective approach to reducing hospital readmissions.

Change Model Overview

ACE Star model Evidence-Based Practice Process entails a framework of integrating evidence into practice in a systematic manner and based on knowledge transformation (Schaffer, Sandau, & Diedrick, 2013). The model encompasses interdisciplinary research and educational projects as vital elements of evidence-based practice initiatives. According to Schaffer, Sandau, & Diedrick (2013), the investigations and projects under this framework revolve around two objectives, including EBP-based elementary and professional workforce development as well as the study of EBP quality improvement processes and outcomes. By adopting the ACE Star model, nurses can organize the evidence-based initiatives, including synthesizing the evidence and translating it into practice, while transferring the knowledge acquired through the investigation into the decision-making process.
Schaffer, Sandau, & Diedrick (2013) note that the framework stated above entails a five-point star explaining the knowledge transfer process, from primary research, through the evidence summary, translation, integration, and evaluation stages. More importantly, the model not only contextualizes the nurses’ previous work based on EBP but also essential in investigating the roles, methodology, and process of evidence-based practice.

Define the Scope of the EBP

The heightened prevalence in rates of hospital readmission has continued to dog the healthcare sector irrespective of the initiatives put in place by the hospital facilities. The issue mentioned above may be attributable to ineffectiveness in the strategies adopted by such facilities to reduce the readmission rates. In so doing, the various hospitals and patients have reported varied levels of readmissions. Kripalani et al. (2013) note that patients with heart failure, for instance, had the highest 30-day readmission rates of about 26.9%, compared to psychosis at 24.6%, and pneumonia at 20.1% among other diseases. According to Joynt and Jha (2012), Medicare beneficiaries have reported a constant risk-adjusted 30-day readmission rate during the last decade. On the other hand, other studies also argue that close to 20% of the elderly beneficiaries of Medicare hospitalized in various medical facilities undergo readmission within 30days (Bernheim et al., 2010; Jencks, Williams, & Coleman, 2009; Vloothuis et al., 2014). Different hospital facilities, however, exhibit varied rates of readmission. The heightened levels of readmission not only present adverse financial impacts such as financial penalties to hospitals but also jeopardize the health conditions of the patients subjected to such a process.

Stakeholders

The intended project to reduce hospital readmission through adopting effective video discharge instructions will involve the hospital representative, particularly the nurse educators and surgeon, who will be instrumental in demonstrating and explaining the components of the clip to the audience. Besides, the plan would also include two representatives from the hospital management to affirm the effectiveness of the initiative in reducing readmissions. Involving the management is vital due to its instrumentality in resource allocation. Moreover, the plan will also involve a government’s representative, particularly in the healthcare sector to approve and oversee the initiative as well as acknowledge its effectiveness in reducing readmissions or otherwise. Lastly, the patients will be critical in the implementation of this plan as they remain the main target of the initiative.
Determine Responsibility of Team Members
Every member of this project will be instrumental in ensuring the success of the initiative. As noted in the previous chapter, nurses and the doctor would engage in offering health education services and demonstrations, particularly about the discharge instructions. The hospital management, on the other hand, will avail the necessary resources required for the program as well as oversee and evaluate the initiative to ascertain its viability for possible resource allocation. The government’s representative will ensure that the program conforms to the government’s health agenda as well as establish its effectiveness in reducing hospital readmissions. Finally, the patients will be the primary target for this plan, thus, would be instrumental in helping the planners to ascertain its effectiveness.

Evidence

Evidence retrieved from the scholarly and peer-reviewed articles used in this study points towards the increased prevalence of readmission and address the quality improvement strategy. For instance, Berry et al. (2013), established that the rates of readmission varied across hospitals and health conditions of the patient, vital information in the quality improvement initiatives in hospitals. On the other hand, Kripalani et al. (2013) attributed the effectiveness of readmission reduction initiatives to the inclusion of many components in the process. Vloothuis et al. (2014) aver that interventions involving multiple components such as patient education, telephone follow-up, and patients’ needs assessment have succeeded in reducing readmission rates. Besides, Joynt and Jha (2012) also acknowledge the adverse financial implications of hospital readmission as well as their variability in the prevention. By imposing financial penalties on hospitals with excessive levels of 30-day readmissions, the Medicaid and Medicare have succeeded in reducing rates of readmission as well as the associated costs. In their study, Jencks, Williams, & Coleman (2009) also reiterate the heightened rates of re-hospitalization within 30days of discharge of hospital. For instance, the researchers established that 34% of the 11,855,702 beneficiaries of Medicare underwent hospitalization within 90days of discharge while 19.6% were discharged from the hospital within 30days. Similarly, Jencks, Williams, & Coleman (2009) concludes by affirming the expensive nature and prevalence of re-hospitalization among the beneficiaries of Medicare.
The study has utilized several scholarly and peer-reviewed articles and books on hospital readmission, more so those revolving around the approaches involved in reducing the readmission rates. It utilized various types of sources with varied strengths, in respect to the types of evidence as stipulated in their research methodology, results, and discussion sections.

Summarize the Evidence

From the above-discussed articles, it is vivid that the rates and prevalence of readmission are high and the associated costs unbearable (Joynt & Jha, 2012; Jencks, Williams, & Coleman, 2009; Kripalani et al., 2013). Besides, it is notable that the various initiatives employed by the hospitals to reduce readmission rates have not been effective. In so doing, this study intends to adopt an effective plan aimed at reducing hospital readmission. The plan entails the use of discharge video instructions to curb the readmission rates in the contemporary healthcare sector. Importantly, this project will adopt the idea of including and integrating of all the components as highlighted by Kripalani et al. (2013). Such an initiative has proven effective in tackling the ever-increasing trend of hospital readmission. Nonetheless, Berry et al. (2013) reiterates the variance in the rates of readmission across hospitals and health conditions of patients, vital information in the quality improvement initiatives in hospitals

Develop Recommendations for Change Based on Evidence

There is need to adopt an all-inclusive approach to tackling the menace of hospital readmission in the contemporary healthcare sector. Notably, the intervention involving the use of video discharge instructions should encompass such components like patient education, telephone follow-up, and patients’ needs assessment to effectively reduce readmission rates and costs. The intended project should not only involve all stakeholders, including caregivers, management, government, and the patients but also adopt the ACE Star model Evidence-Based Practice Process to ensure effectiveness in curbing readmission rates.

Translation
Action Plan

The project will engage all the stakeholders in developing the video discharge instructions to ensure that it captures all the components discussed above. Afterward, the caregivers will organize an occasion to showcase the initiative, where the nurses and doctors will demonstrate how the project works (Vloothuis et al., 2014). The involved patients will be discharged for their homes, before a follow-up study conducted to establish their well-being. The project will take about 6months from the start to the end before presenting the findings to the management for approval. The project will be evaluated based on the outcome of the stakeholders. Notably, the readmission rates will be used to compare the previous findings with the outcome of this project, and effectiveness established based on the phenomenon.

The process, Outcomes Evaluation, and Reporting

The desired outcome of this project is reduced rates of hospital readmission as well as costs attributable to financial penalties imposed on hospitals as a result if high readmission rates. The outcomes will be measured through a comparison of statistics based on previous findings and the outcome of the project. For instance, reduced rates of hospital readmission will imply a positive outcome and vice versa. The authors of the project will report to the principal stakeholders through an organized forum where they will disseminate the findings and address any potential inquiries concerning the plan.

Identify Next Steps

Implementation of the project on a larger scale would involve the engagement and subsequent participation of all stakeholders in the health sector. These stakeholders include not only the hospitals but also the government through health ministry as well as the consumer protection sector. It is notable that the outcome of this project will apply to the whole facility given the fact that every department aspires to offer quality healthcare to the patients in the attempt to minimize readmission rates.

Disseminate Findings

As noted earlier in this article, the authors of the project will disseminate the findings of this initiative not only through an official written report detailing the findings but also through oral method. Notably, they will organize a meeting with the relevant stakeholders to disseminate the findings and respond to any potential concerns. Externally, the hospital management will have the authority and responsibility to disseminate the findings of this project by publishing the results in a relevant medical journal as well as sending the reports to the relevant ministry for further reference. The approach mentioned above will enable other organizations to access the reports as well as utilize the literature easily.

Conclusion

While there have been mechanisms of reducing hospital readmissions in the past, such undertakings have shown a minimal success. As a result, there is an increasing urge by the contemporary health sector, particularly hospitals to adopt a suitable and innovative strategy to curb the ever-rising hospital readmission trend. According to the outcome of this study, adopting a video discharge instruction initiative is critical not only in reducing costs but also in curbing the rising hospital readmission levels. Such an initiative will also enhance healthcare delivery, thereby improving the well-being of patients after being discharged from hospitals. In the attempt to ensure effective implementation, the project will adopt the ACE Star model Evidence-Based Practice Process in transferring knowledge from primary research to decision-making in the nursing practice. The model encompasses interdisciplinary research and educational projects as vital elements of evidence-based practice initiatives. The project not only defines the scope of evidence-based practice but also highlights the stakeholders involved in the plan, including nurses, doctors, and patients among others as well as discussing their roles. The project has outlined the evidence retrieved from the previous literature regarding hospital readmission and effective and innovative initiatives to curb readmissions. Lastly, this plan also encompasses the implementation approach as well as the evaluation strategies, including establishing the readmission rates and associated costs. Maintaining a change plan would require the involvement of the stakeholders, particularly the management to allocate resources regularly for effective implementation of the project.

References

Bernheim, S. M., Grady, J. N., Lin, Z., Wang, Y., Wang, Y., Savage, S. V., … & Han, L. F. (2010). National patterns of risk-standardized mortality and readmission for acute myocardial infarction and heart failure: update on publicly reported outcomes measures based on the 2010 release. Circulation: Cardiovascular Quality and Outcomes, 3(5), 459-467.
Berry, J. G., Toomey, S. L., Zaslavsky, A. M., Jha, A. K., Nakamura, M. M., Klein, D. J., … & Hall, M. (2013). Pediatric readmission prevalence and variability across hospitals. Jama, 309(4), 372-380.
Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360(14), 1418-1428.
Joynt, K. E., & Jha, A. K. (2012). Thirty-day readmissions—truth and consequences. New England Journal of Medicine, 366(15), 1366-1369.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.
Vloothuis, J. D., van Wegen, E. E., Veerbeek, J. M., Konijnenbelt, M., Visser-Meily, J. M., & Kwakkel, G. (2014). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst. Rev.

Rubric