NRS 493 Capstone Project Change Proposal Example
NRS 493 Capstone Project Change Proposal Example
Background
Falls are a reoccurring and expensive issue in healthcare. According to the Centers for Disease Control and Prevention, each year $50 billion is spent as a result of non-injury falls, and $754 million is spent as a result of fatal falls (CDC, 2020 NRS 493 Capstone Project Change Proposal Example). It is crucial for healthcare facilities to take the appropriate and necessary measures in hopes of minimizing these occurrences. The topic of falls is one that should concern all healthcare workers, as each and every one plays a role in prevention. Many facilities have fall policies and procedures in place that focus solely on a single fall contributing factor. The current literature, however, suggests that the most effective way to prevent falls is through the implementation of multifactorial fall prevention intervention. This paper will discuss the effectiveness of multifactorial fall prevention interventions and provide some examples of these interventions.
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Problem Statement
Falls are accompanied with a significant financial cost, as well as physical and psychological costs to the patient. Falls can lead to fractures, loss of independence, increased length of stays, quality of life changes, and even death to the patient (Wallis, A., 2021). When asked, staff members have also reported feeling helpless and frustrated about their inability to control falls (Vlaeyen, E., 2017). There are numerous and varying causes of falls, therefore the efforts to prevent falls should also vary. Falls can occur as a result of improper or lack of use of mobility aids, changes in mentation or coordination, weakness, impaired vision, side effects of medication, and/or chronic diseases. A decrease in frequency of falls would result in a decrease in fall related injuries, costs and deaths, improved patient outcomes and safety, improved quality of life, and decrease in length of patient stays. Due to the above, there is a dire need to promote increased fall prevention practices in healthcare. The use of multifactorial fall approaches is identified by the Joint Commission as a evidence-based tool (Arrah, 2020 NRS 493 Capstone Project Change Proposal Example).
Purpose of Change Proposal
The purpose of this change proposal project is to decrease the frequency of falls through the implementation of multifactorial fall prevention interventions, specifically for patients residing either short-term or long-term in long-term care facilities. This change proposal aims at implementing various fall prevention interventions on a patient specific basis. By identifying the patient specific fall risk and implementing prevention measures based on that patient’s risk factors patient safety is being promoted for each individual.
PICOT Question
The PICOT question being focused on in this capstone project is as follow: For residents at Crossroads Care Center in Sun Prairie, WI (P) does the use of multifactorial fall risk interventions (I) reduce the future risk of falls (C) compared to single fall risk interventions (O)?
Literature Search
In order to discover relevant literature, the writer first identified reliable databases to search for said literature. The databases utilized in this paper were found through the Grand Canyon University (GCU) library website resources. The databases chosen from the GCU library were EBSCOhost, CINAHL, and PubMed. Another database utilized was Google Scholar. These databases were searched using combinations of the keywords “fall interventions”, “long-term care facility”, “eldery or geriatric”, and “multifactorial or multicomponent or multi-interventional”. The search excluded articles that did not fit the criteria of being peer-reviewed and published within the last five years.
Evaluation of Literature
All of the articles chosen for this project were related to the PICOT question above, as well as peer-reviewed and published within the last five years. The research questions in the articles were all centered around multifactorial fall preventions interventions, but the specific focus of each article chosen varied. The focuses include the effectiveness, costs and benefits, barriers and facilitators, and the long-term effects of multifactorial fall prevention. Two of the articles focused more specifically on the number of falls and reducing this number, while one article focused on the use of patient safety agreements in combination with other interventions to form a multifactorial fall prevention program.
The sample populations identified in each of the articles also large variability. The populations include residents in nursing homes and or long-term care facilities or rehabilitation units in the Netherlands, large southeastern metropolitan areas, Wisconsin, North Caroline, Virginia, Maryland and Texas, Quebec, Ontario and other mid-size Canadian cities, and New South Wales. Another group of articles focuses specifically on those 65 years or older in an acute hospital setting, in Europe, North America, Oceania, and Asia, and one study includes the study of over 19,000 older adults living in the community.
Change Theory
The nursing change theory identified and chosen by the writer in this proposal project is the nudge theory. Instead of steps, the nudge theory identifies seven principles. These principles include defining changes, consider employee point of view, provide evidence to show the best options, present change as a choice, listen to employee feedback, limit options, solidify change with short-term wins. This change theory is the most effective for this change proposal because it educates those effected by the practice change with the evidence that supports the change, as well as gives them an opportunity to provide their feedback, voice their concerns and ask questions. This also allows the management that is implementing he proposal to make any needed changes based on that feedback prior to fulling implementing the change.
Implementation Plan and Outcome Measures
The change proposal will be presented to the department heads and upon approval will be implemented beginning with current residents that have endured a fall within the last month, and further extending to any new admissions. These residents will be evaluated using a Morse fall risk scale. Based on this result, specific fall risk factors will be determined and fall prevention interventions will be implemented to prevent future falls. Each individual fall prevent plan will include medication review and a form of physical activity a minimum of 3 times a week. This physical activity may include physical and/or occupational therapy, independent or accompanied walking for leisure, or facility organized activities. Facility organized activities may include chair exercise, bowling, balloon volleyball, ping-pong, and pool noodle strength training. Other interventions may include patient safety agreements, low bed, placement near nurses’ station, non-slid socks, education of patient, staff, and or family, increased frequency of rounding, and proper instruction of use of mobility aids. The outcomes of the change would be assessed by comparing the number of falls in the facility before and after the change, as well as the number of falls per specific resident in a month time period before and after the change.
Use of Evidence-Based Practice in Implementation
There are countless evidence-based studies based on falls, with many of those studies identifying that the use of multicomponent is effective in preventing and/or decreasing the occurrences of falls, as well as decreasing fall related costs overtime. In evaluation of the articles there was multiple common themes. Each of the articles concluded that the use of multifactorial fall prevention interventions were effective at either preventing and reducing falls or decreasing fall related costs. In relation to the specific interventions identified, exercise and medication review were identified in six of eight articles. Therefore, each patient that is identified as a high fall risk, or that has a history of falls, must have both of these interventions initiated.
Potential Barrier
As with all change, there is the potential for some barriers to arise. Some potential barriers include determination from management that a change is not indicated or noncompliance from staff or residents. Although a need for new procedure in order to decrease the frequency of falls has been identified by the Director of Nursing for Crossroads Care Center, this does not ultimately determine that the department heads will identify this change project as the desired new procedure. If approved and implemented by management, staff and/or residents may be noncompliant with the new practice. A change in practice my cause resistance from either of the above. It is the goal that since staff are being included in the implementation through the nudge change theory that they will be compliant. The residents, however, are mostly elderly and may not be willing to following the changes.
Conclusion
Falls in healthcare are financially, physically, and psychologically costly. Falls can increase cost, lengthen stays, cause injury, and even death. Not all falls are preventable, but it is the responsibility of the nurses and other healthcare workers to take the necessary steps to control factors that may lead to falls. Through the implementation of multifactorial fall prevention intervention protocol, staff have the ability to prevent falls as a result of varying causes.
NRS 493 Capstone Project Change Proposal Example Resources
Arrah L Bargmann, BSN, RN, Stacey M Brundrett, MSN, RN, AGCNS-BC, Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety, Military Medicine, Volume 185, Issue Supplement_2, May-June 2020, Pages 28–34, https://doi.org/10.1093/milmed/usz411
Cost of Older Adult Falls. (2020, July 9). Centers for Disease Control and Prevention. https://www.cdc.gov/falls/data/fall-cost.html
Jackson, Karen. (2016). Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention. Journal of Nursing Education and Practice. 6. 10.5430/jnep.v6n6p84.
7 Hopewell S, Copsey B, Nicolson P, et alMultifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants. British Journal of Sports Medicine 2020;54:1340-1350.
4 Lee, S. H., & Yu, S. (2020). Effectiveness of multifactorial interventions in preventing falls among older adults in the community: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES, 106. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2020.103564
Ma, C. L. K., & Morrissey, R. A. (2020). Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward. Australian Journal of Rural Health, 28(4), 408–https://doi-org.lopes.idm.oclc.org/10.1111/ajr.12646
Panneman, M. J. M., Sterke, C. S., Eilering, M. J., Blatter, B. M., Polinder, S., & Van Beeck, E. F. (2021). Costs and benefits of multifactorial falls prevention in nursing homes in the Netherlands. Experimental Gerontology, 143. https://doi-org.lopes.idm.oclc.org/10.1016/j.exger.2020.111173
Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., Dobbels, F., & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International Journal of Nursing Studies, 70, 110–121. https://doi- org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2017.02.002
1 Wallis, A., Aggar, C., & Massey, D. (2021). Multifactorial falls interventions for people over 65 years in the acute hospital setting: An integrative review. Collegian. https://doi- org.lopes.idm.oclc.org/10.1016/j.colegn.2021.05.003
Assignment Instructions
Description

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
1.Background
2.Clinical problem statement.
3.Purpose of the change proposal in relation to providing patient care in the changing health care system.
4.PICOT question.
5.Literature search strategy employed.
6.Evaluation of the literature.
7.Applicable change or nursing theory utilized.
8.Proposed implementation plan with outcome measures.
9.Discussion of how evidence-based practice was used in creating the intervention plan.
10.Plan for evaluating the proposed nursing intervention.
11.Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
12.Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.1:     Exemplify professionalism in diverse health care settings.
2.2:     Comprehend nursing concepts and health theories.
3.2:     Implement patient care decisions based on evidence-based practice.

1.Produce a written comprehensive evidence-based capstone project change proposal using components developed in prior topics of the course.
2.Integrate a plan for evaluating the nursing intervention in the written comprehensive evidence-based capstone project change proposal.
3.Integrate a change or nursing theory into the written comprehensive evidence-based capstone project change proposal.
4.Identify potential barriers to the implementation of the change proposal.
5.Integrate how the identified potential barriers will be overcome.
6.Integrate reflective practice into the practicum reflective journal.
7.Demonstrate interprofessional collaboration during the creation of the capstone project change proposal.
PICOT Question
Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.
The PICOT question will provide a framework for your capstone project change proposal.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Describe the problem in the PICOT question as it relates to the following:

Evidence-based solution
Nursing intervention
Patient care
Health care agency
Nursing practice

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