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Step 1 Prepare a PowerPoint or poster presentation summarizing the entire quality improvement or change project. Include the following elements:

  • Title and author name
  • Introduction
  • Background (summary of interview with nurse administrator/leader)
  • Research question
  • Literature review (summary of annotated bibliography)
  • Change theory
  • Project implementation steps/details
  • Measurement of results
  • Summary

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Implementation and Measure of Results

Amisadai Mederos

Denver College of Nursing

NUR445: Capstone

Sharon Bator

December 12, 2021

Implementation and Measure of Results

The process of change implementation is necessary to bring out the best in patient care in the current and future practice. Implementing the change involving the installation of alarms and nursing education requires the systematic change implementation process and review. Within the change process, a lot of concepts are experienced. The people involved in the change are all the nursing care practitioners. The nurses are the immediate people in the patient's care (Suresh, 2018). It is also essential to involve the doctors and other clinicians since they are in the collaborative management of the patients. In the change approval, it is the role of the hospital administrator or the head of the hospital to approve it. The departmental head has a share in advising the administration regarding the change.

It is vital to select the best process to bring out convenience in plan communication. The clear concept is to communicate all the past inconveniences of the recent practices. A provision of the advantages and anticipated efficiency of the plan promotes a good understanding to the recipients of change. It is also necessary to get the people's views who will be affected by the change. In implementing the actual change, the detailed procedural approach promotes success. The first step involves the communication of the entire problem to the whole stakeholders. All the medical staff, specifically the nurses, need to understand the change. A provision of the detailed statistics on the recent falls and the direct impact to the patients is an eye-opener to accept the change and prepare psychologically and physically for the arrival of the change.

The next step is the actual installation of the alarms in the rooms. The alarms are in line and followed by specific demonstrations to the nurses in the department. There can be supervision for a little duration to assess the actual implementation and acceptance. The last step for the change is a follow-up and review. The change agents can allocate people to provide feedback and further guide on the use and response to the alarms. The collection of data will entail using a survey with the dissemination of some questionnaires to the nursing staff in the department. The questionnaires have a role in addressing the specific needs of the patients without deviation. The questionnaires can explain all the concepts of the change and the views of the staff. Validity and reliability are critical factors in the research (Aguinis et al., 2019). It is essential to use the pretest and posttest questionnaires to check if the tool will measure what is intended and provide the intended results.

The data from the survey questionnaires will be entered into the data analysis tool and represent the information in terms of digits or statistical presentations to generate the results. The results will reflect the actual need for the implementation. The overall action for the results is a provision to the hospital management. The hospital will also use the data in making decisions and planning for the needs of the patients. The hospital can also use the results to do collaborative management with other hospitals and different units like the supplies of more equipment. Results also determine the need for a workforce. The same results also define and explain the need for continuous research to improve patient care and prevent more complications and accidents consistently.

References

Aguinis, H., Hill, N. S., & Bailey, J. R. (2019). Best practices in data collection and preparation: Recommendations for reviewers, editors, and authors. Organizational Research Methods, 1094428119836485. https://journals.sagepub.com/doi/abs/10.1177/1094428119836485

Suresh, S. (2018). Nursing research and statistics. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=xsliDwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research+text+book+2018&ots=sa9h3SfBy1&sig=_PbVfQ3PH5h5vt1MWyFMD3pCkWM

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Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION

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2

Change Project

Amisadai Mederos

Denver College of Nursing

NUR445 – Capstone

Sharon Bator

November 29, 2021

Change Project

Lewin’s Change Theory would work best for the change project regarding geriatrics falls. The theory shows an interaction between individuals and the environment. Individuals have the power to implement change in an environment. It contains three steps in which change happens (Burnes, 2020). The first step is unfreezing. To implement change in an organization, there is a need to identify the need for change and how it will help the organization. In the unfreezing stage, the need for change is identified and the reasons. It involves breaking restraining forces such as poor communication (Burnes, 2020). The driving forces are training and management support. There is problem identification and ensuring support from the management.

The second step in the model is changing. It involves setting a new mindset for the members of the organization and making group decisions (Burnes, 2020). For instance, there can be a group meeting to discuss the problem and the need for change. After the discussion, decisions can be made on the area that requires change and the necessary change that is required. Efficient communication is required during that change process. It is a crucial process because new norms and standards are formulated. It helps in stepping into the final step.

The final step is refreezing. In this step, there is a need to identify how to integrate the change into the culture and any barriers to change. The barriers should be solved through communication and open discussions (Burnes, 2020). A way of sustaining change is also identified, such as a leadership system and promoting a reward system. Therefore, the model suggests that change can be implemented in any organization following the three steps. Efficient application of the theory will eliminate chaos and any instability in an organization.

Stages of Implementing the Change Project

The proposed project is about preventing geriatric falls after an anesthetic procedure. The main problem of focus is if geriatrics under anesthesia given pain medication would be at a lower risk of falls compared to those with no pain medication. From the interview, the director mentions that older adults do not process medicine quickly and are at a higher risk of falls. Aleycia suggests the need for change on the alarm system to identify the specific room where a patient requires help. The first step is unfreezing, where the problem is identified (Burnes, 2020). Communication is required to ensure the problem is well known and the need for change is established. The second step would be to implement change in the system and implement a system where the alarms are identifiable for each room. Finally, the refreezing process involves the identification of any potential errors and ensuring nurses understand the system.

Reference

Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science56(1), 32-59.

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Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION

2

1

Change Project

Amisadai Mederos

Denver College of Nursing

NUR445: Capstone

Sharon Bator

December 6, 2021

Change Project

Background

An interview with the nurse director, Aleycia, revealed vital information regarding the change project. Patients above 50 years of age are at a higher risk of falls compared to younger individuals. It is because they do not metabolize anesthesia faster like younger people. Medications take a longer time to leave the system. Generally, individuals under anesthesia within the first 24 hours are at a high risk of falls. The JHFRAT has been effective in reducing falls in the hospital. Aleycia suggests more education for nurses and the implementation of new alarms that are specific for every room to help nurses get to the rooms faster.

Research Question

Are geriatrics who have gone under anesthesia and are receiving pain medication compared with those without receiving anesthesia and pain medication at a higher risk for falls over the first 48 hours after surgery?

Literature Review

(Daoust et al., 2018) examines the risk of falls of older adults under opioid use. The article includes patients above 65 years. The results show that opioid use results in a greater risk of falls for older patients, which leads to injury or death among the patients (Daoust et al., 2018). The article by (Mazur et al., 2016) includes patients above 79 years. Patients’ advanced age and delirium history are associated with higher fall risk. Also, patients having a higher BMI are at a lower risk of geriatric falls. According to (Wu et al., 2021), polypharmacy is associated with delirium and geriatric falls. Patients hospitalized due to fall injuries currently use BZDs (Yu et al., 2017)). Therefore, anesthesia medication is associated with the risk of geriatric falls.

Stages of Project Implementation

The first step in Lewin’s change theory is unfreezing, where the problem is identified. Communication is required to ensure the problem is well known and the need for change is established. The second step would be to implement change in the system and implement a system where the alarms are identifiable for each room. Finally, the refreezing process involves the identification of any potential errors and ensuring nurses understand the system.

References

Daoust, R., Paquet, J., Moore, L., Emond, M., Gosselin, S., Lavigne, G., Choiniere, M., Boulanger, A., Mac-Thiong, J. M., & Chauny, J.-M. (2018). Recent opioid use and fall- related injury among older patients with trauma. CMAJ: Canadian Medical Association Journal, 190(16), E500+. https://link.gale.com/apps/doc/A535816357/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=fe728eb5

Mazur, K., Wilczyhski, K., & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11, 1253+. https://link.gale.com/apps/doc/A503296118/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=4876a981

Wu, H., O’Donnell, L. K., Fujita, K., Masnoon, N., & Hilmer, S. N. (2021). Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. International Journal of General Medicine, 14, 3793+. https://link.gale.com/apps/doc/A673020801/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=941ecb3a

Yu, N.-W., Chen, P.-J., Tsai, H.-J., Huang, C.-W., Chiu, Y.-W., Tsay, W.-I., Hsu, J., & Chang, C.-M. (2017). Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan. BMC Geriatrics, 17(1). https://link.gale.com/apps/doc/A511320776/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=446b7aa2