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Benchmark - Capstone Project Change Proposal
In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

Background
Problem statement
Purpose of the change proposal
PICOT
Literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Cunningham,E.L., McGuinness,B., Herron,B., & Passmore,A.P.(2015). Dementia. The Ulster Medical Journal, 84(2), 79-87. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488926/

The strength of this article lies with its addressing the epidemiology and socioeconomic impacts and pathophysiology features o dementia as well as the processes of the clinical diagnosis. The authors conclude that that to achieve better biomarker and drug development requires an in depth understanding of the pathophysiological processes. On the other hand, the weaknesses it seems to mostly generalize on the health issue of dementia focusing on diagnosis and treatment process and not on first hand patient experiences.

Chertkow,H.,Feldman,H.H., Jacova,C., & Massoud,F.(2013). Definitions of dementia and predementia states in Alzheimer’s disease and vascular cognitive impairment: consensus from the Canadian conference on diagnosis of dementia. Alzheimer’s Research & Therapy, 5(1),2. Retrieved from https://biomedcentral.com/articles/10.1186/alzrt198

The article applies the framework of the Canadian Consensus Conference on the diagnosis and treatment of Dementia to assess new definitions of dementia and predementia states in Alzheimer’s Diseases and vascular cognitive impairment. The key strength of the article is to help guide medical professionals as well as the healthcare system in diagnosis and treatment of dementia in clinical and research settings. The weakness though is non-application of quantitative and qualitative data on real life participants as this would further strengthen research on the definitions of dementia.

Cations, M., Radisic,G., Crotty,M., & Laver,K.E.(018).What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys. PLoS One, 13(4). Retrieved from https://journals.plos.org/plosone/article?d=10.1371/journal.pone.0196085

The main strength of this article is the integration of credible studies by MEDLINE, EMBASE, Psych INFO to establish the level of public knowledge on dementia. This helps to ensure there is public awareness and thus success for policy making in healthcare to improve care for dementia patients. The weaknesses, however, lies in the fact that the literature used was not conclusive given its geographical and cultural limitations.

Kazui H., Yoshiyama, K., Kanemoto,H., Suzuki,Y., Sato.S., & Tanaka,T.(2016). Differences of behavioral and psychological symptoms of dementia in disease severity in four major dementias. PLoS ONE, 11(8).Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161092

The authors utilize the Neuropsychiatric Inventory data for patients with dementia and vascular dementia with a bid to establish the behavioral and psychological symptoms of dementia to enhance prognosis and treatment of patients. On the other hand, the weakness of this article is that it is majorly based on statistics which thus require expert interpretation inaccessible to the general public.

Shaji, K.S., Sivakumar, P.T.,Rao,P., & Paul,N.(2018).Clinical practice guidelines for management of dementia. Indian Journal of Psychiatry, 60(3), 312-328. Retrieved from https://www.ncbi.nlm.nih,gov/pmc/articles/PMC5840907/#_ffn_sectitle

Shaji et al.,(2018) capitalizes on the framework on the assessment and follow up of older people with dementia with the aim of promoting the clinical needs of the patient. However, its weakness as affirmed by the authors is that the framework only addresses a specific population of dementia patients given that each patient is different in diagnosis and environmental conditions thus it cannot be used as a medical standard.

Sabayan, B., Sorond, F.,(2017).Reducing the risk of dementia in older age. JAMA, 317(19).Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2626575

The authors provide invaluable information regarding how dementia can be treated and focus on three areas including lifestyle habits, medical conditions and mental and social wellbeing. This goes towards engaging the public to take first approach in preventing the disease since there is no definite cure. Their weakness, though, is that the article offers more recommendations on generalized views and ideas of dementia and would have been useful if it used statistics of real life examples of people who have beaten dementia.

References

Cunningham,E.L., McGuinness,B., Herron,B., & Passmore,A.P.(2015). Dementia. The Ulster Medical Journal, 84(2), 79-87. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488926/

Chertkow,H.,Feldman,H.H., Jacova,C., 7 Massoud,F.(2013). Definitions of dementia and predementia states in Alzheimer’s disease and vascular cognitive impairment: consensus from the Canadian conference on diagnosis of dementia. Alzheimer’s Research & Therapy, 5(1),2. Retrieved from https://biomedcentral.com/articles/10.1186/alzrt198

Cations, M., Radisic,G., Crotty,M., & Laver,K.E.(018).What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys. PLoS One, 13(4). Retrieved from https://journals.plos.org/plosone/article?d=10.1371/journal.pone.0196085

Kazui H., Yoshiyama, K., Kanemoto,H., Suzuki,Y., Sato.S., & Tanaka,T.(2016). Differences of behavioral and psychological symptoms of dementia in disease severity in four major dementias. PLoS ONE, 11(8).Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161092

Shaji, K.S., Sivakumar, P.T.,Rao,P., & Paul,N.(2017).Clinical practice guidelines for management of dementia. Indian Journal of Psychiatry, 60(3), 312-328. Retrieved from https://www.ncbi.nlm.nih,gov/pmc/articles/PMC5840907/#_ffn_sectitle

Sabayan, B., Sorond, F.,(2017).Reducing the risk of dementia in older age. JAMA, 317(19).Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2626575

Re: Topic 3 DQ 2

Methods for Evaluating Evidence

It is imperative to appreciate the fact that what constitutes high-quality evidence varies depending on the questions asked and should be aligned with the needs and interests of the user or users. However, once evidence has been gathered, it must be evaluated against the outcome that could either be long-term or short-term (Jonas, Ferrari, Wines, Vuong, Cotter & Harris, 2018). The quality of every piece of evidence that is needed to provide answers to particular questions must be evaluated on the basis of established criteria for evaluating evidence. There are two methods of evaluating evidence. They are symmetric review and meta-analysis.

The symmetric review entails assessment and evaluation of research studies that address a particular topic under consideration. By using this method, a researcher a well-organized method to locate, assemble, and evaluate a body of literature regarding a particular topic by using a set of specific criteria. This method typically includes describing the findings of the research conducted (Jonas et al., 2018). Elsewhere, meta-analysis combines data from different studies. In other words, it is a statistical process of combining the findings from different individual studies. From example, when effects of treating a particular disease are consistent from one research to the next, meta-analysis is used to identify the common effects.

There are several similarities between symmetric review and meta-analysis. For example, both of them are methods used in evaluating the evidence before it can be used in decision making. On the other hand, the difference between the two methods is that symmetric review seeks to answer a defined research question and this is achieved through collecting and summarizing all the evidence that fit in the eligibility criteria (Kelly, Vaughn & Anderson, 2016). , on the other hand, uses statistical methods to summarize the findings of the findings. Equally, when inconsistencies are identified under symmetric studies, meta-analysis can be used to identify the reasons for the variations.

Reference

Jonas, D. E., Ferrari, R. M., Wines, R. C., Vuong, K. T., Cotter, A., & Harris, R. P. (2018). Evaluating evidence on intermediate outcomes: considerations for groups making healthcare recommendations. American journal of preventive medicine, 54(1), S38-S52.

Kelly, M. P., Vaughn, O. L. A., & Anderson, P. A. (2016). Systematic review and meta-analysis of recombinant human bone morphogenetic protein-2 in the localized alveolar ridge and maxillary sinus augmentation. Journal of Oral and Maxillofacial Surgery, 74(5), 928-939.

4 posts

Re: Topic 6 DQ 1

Alzheimer's Disease

After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based practice project. Explain how your proposal will, directly and indirectly, impact each of the aspects.

The project being handled in this course is about Alzheimer's Disease. This is a disease that has been researched widely and there is a lot of information available out there regarding the disease some of which is true, some of which is false and some of which is unverified. For this reason very important I need to consider in developing an evidence-based project is the quality aspect. As I go about doing my project, there will be a great need to make sure that the sources of my evidence are credible and reliable to make sure that I offer accurate fact since accuracy is a great measure of quality in research (Taber, 2013). This further brings in the financial aspect. To access some of the most credible journals in help there will be need to set a budget to buy some documents or access places such as the library (Lindsay, 2017). The final aspect that I will need to greatly consider is the clinical aspect. It will be very important for me to have accurate information in regards to what is happening on the ground to inform some very critical parts of the project such as the recommendations.

The overall proposal will also have a great impact on each of the above aspects both directly and indirectly. The proposal will directly impact the clinical aspect by advancing knowledge on the disease and further serving as a source of more evidence about the disease. The result of the research if applied in the health care facilities will be better quality for patients suffering from this disease and this way impact the quality aspect. Finally, the impact on the financial aspect is rather indirect because this will result from better care and management of the disease such that hospitals and individuals will not have to spend as much to handle it.

References

Lindsay, B. (2017). Understanding research and evidence-based practice. Exeter: Reflect Press Ltd.

Taber, K. (2013). Classroom-based research and evidence-based practice: an introduction. London: SAGE.

4 posts

Re: Topic 6 DQ 2

Alzheimer's Disease

Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?

One of the most important components of the EBP project is the stakeholders. As mentioned in my previous discussion, there are two types of stakeholders; internal and external stakeholders. However, I have noticed that my analysis of possible stakeholders who will be involved in the project is not as comprehensive and specific as it should be. I have noticed that it is important to identify the specific stakeholders who will be involved in the project as well as outline the role of each stakeholder. Besides this, it is important to design an approach of how the different stakeholders, both internal and external, will interact in the health care environment (Muller, 2017). Some of the important stakeholders include health care professionals, patients, managers and leaders, other health institutions, and the community in general.

There are different factors which have influenced me to develop my current perspectives. One is because I have realized that having first-hand information or primary data from the health care professionals will contribute to addressing some of the data gaps cases that I may experience. For example, using electronic sources and other resources may not provide me with population and institution-specific information concerning Alzheimer disease. As such, having direct consultation with health care professionals such as physicians, nurses, and nurse assistants will improve access to adequate information concerning EBP. Secondly, I have noticed that the interaction of different stakeholders is important in determining the success of the project (Hyseni et al. 2018). For example, effective participation and collaboration between health care professionals and patients will indicate certain limitations and success of the project.

References

Hyseni, L., Guzman-Castillo, M., Kypridemos, C., Collins, B., Schwaller, E., Capewell, C., & Lloyd-Williams, F. (2018). P31 Engaging with stakeholders to inform the development of a computer model for the NHS health check programme: workHORSE project.

Muller, R. (2017). Project governance. Routledge.

PICOT Statement

The paper will put into focus the aspect associated with the shortage of nursing staff in the healthcare system of the United States of America. It is evident that the shortage of nursing professionals in the country has resulted in an escalation of LTAC that is Long Term Acute Care patients who are of forty years and above. It is evident that the shortage has resulted in such patients staying in the health facilities for a prolonged period of time of about five months. Staying in a health facility for that prolonged period of time has not had a positive effect on the health of the patients and instead, it has resulted in their health decrementing to low levels. Comment by Vicki Swaney: What is your PICOT statement?

Population Problem

The shortage of nurses in the USA has had drastic effects on the healthcare system. Additionally, the ratio of nursing professionals to that of the patients is not equivalent as per the set legal, policy and management standards needed to ensure that the quality of healthcare disseminated to the patients is sufficient. The shortage has been contributed by the increase in demand for better healthcare, a decline in the number of experienced nurses’ professionals and also a decline in the number of registered nurses. The high rate of nurses’ turnover has also led to a decline in the number of nurses. Research indicates that in every three nurses one drops out of the profession after working for an estimated period of two years (Burns, & Grove, 2011). Additionally, it is also evident that one out of five nurses drop out of the profession in cases where the nurses work under stressful environments. Forecasts have indicated that the problem may escalate in years to come especially due to the fact that the demand for better healthcare will not be met by the supply of nursing professionals. The problem has affected a number of healthcare facilities that have seen them being closed due to a decline in nature and the quality of the services being offered. This has led to a decline in the ratio of nurses to the patients. The problem has also led to overworking of nurses especially in facilities that focus mainly on chronic illnesses (Burns, & Grove, 2011). Comment by Vicki Swaney: List a specific setting here and specific population you are working with to decrease the nursing shortage. How does affect your specifically to your facility and Patient Care, Health Care Agency, and Nursing Practice?

Intervention

In the case, an evidence-based approach can be used in finding an intervention. The research will put into consideration six hospitals and the data will be collected based on a random sampling of the respondents. The respondents will be chosen from the nurses' population in the highlighted facilities and will be used in trying to come up with solutions for the problem (Marć, Bartosiewicz, Burzyńska, Chmiel, & Januszewicz, 2019). Comment by Vicki Swaney: This part of the PICOT question needs to have specific interventions with support from the evidence to your specific health care organization such as workplace working with specific interventions that apply to the facility

Comparison

In the case, the research will put into consideration LTCA patients in the selected facilities. The management and the nurses will also participate in the research. Nurses will be provided with a platform where they will be able to respond to various questions touching on, turnovers, workloads, work schedules and the quality of services offered in the facilities. Comment by Vicki Swaney: Write out fully the first time then use acronyms. The comparison is comparing current practice or policy to the specific intervention you propose based on the research

Outcome

The outcome will focus on trying to determine the effect on nurses’ shortage especially when it comes to the management of LTCA patients in the USA. Additionally, the outcome will focus on the effects of turnovers, workloads and work schedules among the nursing staff. Comment by Vicki Swaney: Limit the outcome to your specific facility and not nationally. This is too broad and needs to be specific

Time

The outcome will be monitored after every four months in order to come up with a comprehensive report on the subject matter. The prolonged period of analyzing the outcomes will ensure that a conclusive report on the matter is established and at the same time determined. Comment by Vicki Swaney: The time frame needs to be a specific time frame related to specific outcomes you have set according the research evidence.

References

Burns, N., & Grove, S. (2011). Understanding nursing research (5th Ed.). St. Louis, MO: Elsevier.

Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage–a prospect of global and local policies. International Nursing Review, 66(1), 9-16.