Managing a 105-bed Acute Care Hospital with more than 32 Medical Specialties

Name

Institutional Affiliation

Instructor’s Name

Due Date
Introduction

This part of the DNP project discusses all the methodological processes that

contribute to the effective execution of the project. In particular, this section aims to

examine the project's organizational context, the anticipated population it will

address, the theoretical frameworks and models employed in project management, the

implementation strategy, sustainability plans, challenges, enablers, ethical issues, and

the data collection and analysis strategy.

Organizational Setting

The practicum site is a 105-bed hospital providing acute care and featuring

over 32 medical specialties. The facility is located roughly 24 miles from a main

urban center in the Southwestern United States. In 2023, the facility recorded over

6,000 inpatients, 20,000 emergency room visits, 80,000 outpatient services, and

15,000 surgical procedures. The center has also documented 900 babies born. The

facility employs approximately 400 individuals, of which 250 are essential health care

service providers working at the center. The employees operate within the

organization's dietary, environmental, and admissions divisions. The hospital is an

acclaimed health care institution, earning the Texas Hospital Quality Improvement

Silver Award in 2022. Additionally, it has received a four-star rating from CMS.

Additional accolades consist of the Press Ganey Summit Award for Core Measures

and acknowledgment as an institution where most employees have been employed for

the last ten years. The facility has been recognized as a Level IV trauma center by the

Joint Commission.

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Population

The project was intended to involve various stakeholders. The project will

involve around 320 participants. The initial group of participants in this project

consisted of hospital personnel, including Registered Nurses, Licensed Practical

Nurses, and Certified Nursing Assistants tasked with providing care within the

facility. Everyone on the staff will be required to take part in the project. The

initiative will also involve fall prevention champion volunteers who will work

alongside other caregivers to ensure the successful execution of the project. Members

of the community will also be included in the project population. Their fall risks will

be evaluated, and solutions will be offered to meet their requirements at minimal

expense. Veterans at risk of falling are anticipated to achieve a fall risk assessment

score of 10 or more, based on the specific assessment tool used. A total of 16

participants will be involved in the project. Patients are an essential part of the

project's population. The project will involve a sample of patients aged 60 and above,

without any specific individual requirements. The majority of patients in this group

can walk and live alongside other people in the community. The patients chosen for

the project are those treated at the practicum location. Individuals under 60 years of

age will be omitted from the project. Direct contact will be used to enroll participants.

The patient's approval will also be requested. As participation in the project is

optional, only those who are willing will be involved. They will also possess the

freedom to terminate the project whenever they choose, at any point in time.

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Translation Science (or QI Model + Nursing Theory) and Project Management

Theoretical Framework:

Researchers concur that the successful conversion of scientific knowledge into

clinical practice is the most reliable and proficient method of delivering care (Curtiis

et al., 2017). Nonetheless, ineffective strategies in applying these practices can hinder

sustainability and reduce health outcomes as a result. Thus, utilizing the most efficient

theoretical theories, models, and frameworks is crucial as the healthcare system

undergoes rapid changes due to advancements in technology and the emergence of

new knowledge (Rapport et al., 2018). The theoretical framework I have chosen for

this project is the Quality Implementation Framework. This evidence-based

theoretical model would be useful in guaranteeing a suitable implementation strategy

for the chosen intervention, as it outlines all essential steps in the implementation

process and all pertinent actions linked to achieving an improved implementation

procedure (Moullin et al., 2019). The advantages of skillfully utilizing

implementation frameworks, models, and theories are extensive. Frequently, scholars

utilize this framework to assist them in designing and executing studies efficiently

(Proctor et al., 2012). The Implementation framework is also noted to guide the

empirical reasoning of research teams while assisting in the interpretation of results

(Nilsen, 2020). Within the healthcare sector, the Implementation framework offers a

reliable approach for effective planning and execution of essential processes or

initiatives. Throughout the years, the use of implementation frameworks has grown

significantly, raising concerns that they might not be sufficiently applied in advancing

implementation science and practice (Moullin et al., 2020).

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Project Implementation Plan

The implementation plan for the project is an 8-week initiative featuring a

range of activities conducted by project participants such as Registered Nurses,

Licensed Practical Nurses, Certified Nursing Assistants, and volunteers. To

effectively carry out the implementation plan for the evidence-based intervention, a

range of activities must be taken into account. The key steps would consist of the

following:

(i) Defining and understanding the problem and its causes

The project execution plan will include efforts to understand the issue and its

underlying causes. This will be accomplished during the initial week of the

implementation process. Falls among elderly patients in acute care environments are

increasingly recognized as a major public health concern that adversely affects health

outcomes across different population groups. At my practicum location, the issue has

continued, with an average of 3 falls reported each day. This project intends to assess

the efficiency of a multifaceted intervention for fall prevention while also examining

the primary causes of falls in elderly patients. The Doctor of Practice, in partnership

with Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants,

will need to identify and comprehend the issue and its origins.

(ii) Understanding the modifiable causal factors

This phase of the project execution process involves a thorough investigation

of the modifiable fall risk factors in elderly patients that can enhance their quality of

life and overall health results. This stage will be finished by the end of the second

week of the project execution process. Certain modifiable elements linked to falls in

elderly patients comprise obesity, lack of physical activity, and inadequate nutrition.

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The Registered Nurses and Licensed Practical Nurses are required to comprehend

these elements in the acute care environment and prepare a detailed report to be

presented to the Doctor of Practice.

(iii) Choosing change strategies

This phase entails the most effective theoretical approach to managing the

change plan. Theoretical frameworks and models such as the Implementation

Framework have been identified as the most effective change strategy to oversee the

project implementation process. It is estimated that this phase of the implementation

process involving evaluation and effectiveness of the approach based on available

resources will be completed within the third week of the implementation plan. The

Registered Nurses, Licensed Practical nurses, and nursing assistants will collaborate

with the Doctor of Practice to understand the most effective change strategy

addressing elderly patient falls within the acute care setting.

(iv) Explaining how the change will be delivered

This phase of the implementation process entails the mechanisms that will be

utilized to lead the change within the health care facility. It will detail all the

resources, both human and nonhuman that can be used to ensure that the intervention

model effectively addresses the issue of elderly patient falls to improve health

outcomes. This phase will be executed within the fourth week of the project

implementation process. The Doctor of Nursing will be expected to be the key

personnel responsible for explaining to patients and nursing practitioners how the

change will be delivered to address the issue of elderly patient falls within the acute

care setting.

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(v) Testing and adapting the intervention

This phase of the implementation process entails carrying out trials to assess

the intervention's effectiveness. It will also witness the complete implementation of

the multifactorial intervention designed to decrease falls among elderly patients in

acute healthcare environments. This will occur during week 5 of the project's

execution. The tasks occurring in this phase will be the joint endeavor of the Doctor

of Nursing Practice, Registered Nurses, Licensed Practical Nurses, and Nursing aides.

(vi) Conducting a thorough evaluation based on available evidence for effectiveness

The final three weeks of the project execution phase will involve evaluations

of the project's effectiveness, focusing on strengths and weaknesses in light of

feedback. This stage will also be a joint effort, integrating the contributions of all

project members to effectively tackle any weaknesses, strengths, or arising

challenges.

The pre and post-summative data collection

In the initial phase of the summative data collection, a one-on-one session will

be held with 20 practitioners chosen by the Doctor of Nursing Practice. Every

practitioner will receive a file that includes distinctly labeled elements of the project.

The key elements of the project found in the file consist of an instruction sheet, a

pretest, a worksheet, and a post-test. The respective practitioners were watched as

they performed the tasks. The documentation also featured separate remarks and

inquiries made by the practitioners. After finishing the tasks, the practitioners were

inquired about their likes and dislikes. The second phase of the summative data

gathering will include a cohort of 45 practitioners hired by the health care facility.

The identical file provided to the initial group will be allocated to this cohort. It is

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anticipated that the summative data collection before and after will yield positive

results, and the project's intervention objectives will be achieved. In general, the

practitioners are anticipated to express satisfaction with the experience and adopt

multifaceted strategies in handling falls among elderly patients in acute care

environments.

Plans for Sustainability

It is crucial to maintain and promote changes that improve the quality of care

patients obtain in different healthcare environments. As a Doctor of Nursing Practice,

attaining sustainability will enhance outcomes for patients, clients, or health

populations. The project's success will rely on how well it aligns with its established

goals and objectives. Therefore, to achieve project sustainability, I will work to foster

a positive work atmosphere by implementing various essential strategies. To begin

with, I will work towards fostering a positive atmosphere, considering the economic

and political landscape. This will guarantee that I am aware of the possible threats and

advantages of the DNP project while formulating the best responses to tackle major

challenges and preserve strengths. Similar to any other business initiative, the

economic and political contexts are key factors in a project's success and

sustainability, as they influence the policies and resources needed for effective

execution.

I will also guarantee that the project maintains a solid funding foundation to

support the majority of the ongoing activities. A solid financial foundation might be

achievable by partnering with essential federal and state government agencies, local

communities, supporters, politicians, and various non-profit organizations looking to

assist. The financial resources acquired from these organizations will be efficiently

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handled and tracked by designated project members. The sustainability of the DNP

project will rely on collaborations across different sectors to secure additional

financial and non-financial resources that can support and advance the project's

development. In my role as the Doctor of Nursing Practice overseeing the project, I

will guarantee that it upholds excellent organizational capability to secure its

longevity. In particular, I will make certain that the project participants stay informed,

resourceful, and skilled in addressing any critical matters that can benefit the project's

progress. To ensure a robust knowledge base, participants will undergo regular

training, workshops, and refresher courses to stay informed about new trends. The

initiative will remain sustainable by implementing efficient communication strategies

that consider the contributions of all stakeholders, irrespective of their roles within the

project environment. Additionally, I will make certain that the project adheres to its

objectives for lasting sustainability. Most importantly, it is crucial to uphold strategic

project planning since it serves as the unifying element for all sustainability

initiatives.

Following the successful execution of the project, there will be continuous

assessments to guarantee lasting success. In the Doctor of Nursing Project, I will

assess the effectiveness of the project outcomes using a rubric and a checklist. This

will guarantee that all project goals are achieved, and the project's activities are

properly carried out.

Barriers, Facilitators, Ethical Considerations

Although the project is anticipated to succeed, worries about obstacles that

may hinder its efficient execution persist as a major challenge. There are concerns that

the involved project participants, such as Registered Nurses, Licensed Practical

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Nurses, volunteers, and nursing assistants, might not have adequate knowledge of

evidence-based practice. This significantly affects the project deliverables and could

result in delays or the collapse of the project execution. As the Doctor of Nursing

Practice, I will thoroughly evaluate the 7 project participants and confirm that they

possess sufficient knowledge of evidence-based practice. A disagreement regarding

the DNP project is yet another possible obstacle that may hinder the project's

execution. Some participants in the project might demonstrate dissatisfaction with the

DNP project and share differing opinions on it. As the Doctor of Nursing Practice, I

will make certain that all individuals involved in the project agree, focusing on

reducing falls among elderly patients in acute care environments due to this escalating

public health concern. A crucial enabler of the project is access to both monetary and

non-monetary resources, which will ensure the successful execution of important

processes or activities tied to project delivery. The project is crafted with a focus on

ethical aspects. In the process of choosing research participants, only those who are

willing to take part in the project will be selected. Their permission will be requested,

and they will have the freedom to withdraw from the project at any point, without

conditions. All personal details acquired from the research participants will remain

confidential and inaccessible to third parties. In general, the project will be carried out

according to the guidelines established by the American Nurses Association Center

for Ethics and Human Rights.

Data Collection and Analysis Plan

Patient information will be securely recorded in a spreadsheet. The

information unnecessary for the project will remain confidential to prevent access by

unapproved individuals. The required information will solely be available to

individuals involved in the project, including the Doctor of Nursing Practice,

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Registered Nurses, Licensed Practical Nurses, and nursing assistants. After outlining

the project, the Doctor of Nursing Practice will personally hand out questionnaires

and surveys to Registered Nurses, Licensed Practical Nurses, nurse assistants, and

volunteers who are anticipated to complete them and return them to the Doctor of

Nursing Practice. The questionnaires and surveys did not contain the specific names

of the relevant participants. The answers gathered from the surveys and questionnaires

will be logged in a Word document and examined through frequency distribution.

Data Analysis

Descriptive statistics will be employed to analyze the documented patient data

quantitatively. Frequency distributions will analyze the recorded patient information

as well as the feedback from staff and patients regarding falls and the ways

multifactorial strategies can help prevent falls in elderly patients within acute care

environments. The information collected from patients and staff for the project

consists of a history of falls, the most recent fall incident, and the intervention date.

The information will also encompass the demographic details of the population

chosen as participants. The Quality Implementation Framework will be utilized in the

relevant examination of research participants' feedback, to pinpoint possible obstacles

and enablers. In my role as a Doctor of Nursing Practice, I will partner with a

specialist from the Chamberlain College of Nursing to support the statistical analysis.

Budget

The project's anticipated cost is approximately $ 5380 for the duration of 8

weeks. This expense includes all the resources necessary for the successful execution

of the project needs.

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References

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2017). Translating research

findings to clinical nursing practice. J Clin Nurs, 26(5-6), 862-872.

doi:10.1111/jocn.13586 Moullin,

J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019). Systematic

review of the exploration, preparation, implementation, and sustainment (EPIS)

framework. Implementation Science, 14(1), 1-16. Moulin,

J. C., Dickson, K. S., Stadnick, N. A., Albers, B., Nilsen, P., Broder-Fingert, S., ... &

Aarons, G. A. (2020). Ten recommendations for using implementation

frameworks in research and practice. Implementation science communications, 1,

1-12.

Nilsen, P. (2020). Making sense of implementation theories, models, and

frameworks. Implementation Science 3.0, 53-79.

Proctor, E. K., Powell, B. J., Baumann, A. A., Hamilton, A. M., & Santens, R. L.

(2012). Writing implementation research grant proposals: ten key ingredients.

Implementation Science, 7(1), 1-13.

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Rapport, F., Clay-Williams, R., Churruca, K., Shih, P., Hogden, A., & Braithwaite, J.

(2018). The struggle of translating science into action: Foundational concepts

of implementation science. J Eval Clin Pract, 24(1), 117-126.

doi:10.1111/jep.12741

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