this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le

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this assignment is referring the ABCDEF bundle –

the template pages is attached

– add info of the ABCDEF bundle in a long-term acute hospital.

PICOT: will implementing the ABCDEF bundle decrease length of stay in a long-term acute care hospital

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Must

discuss complications from prolonged hospitalizations increase length of hospital stay, must include some history of type of patients admitted to a long-term acute care hospital and most importantly how the bundle can reduce length of stay. Please read the template – see attachment to help with the writing

include:

1. introduction (complete contents)

2. abstract 100 words – follow template

3. dedication 100 words- dedicate to patients hospitalized ( be creative with the verbiage)

4. Acknowledgment 100 words ( see word doc on who to acknowledge)

5. separate references page – use references in “Implementation into practice” any article outside of that must be within 7 years

this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
Abstract The abstract is an accurate, nonevaluative, concise summary or synopsis of the direct practice improvement (DPI) project. It is not an introduction and is usually the last thing written. The purpose of the abstract is to assist future investigators in accessing the evidence-based materials and other vital information contained in the practice improvement project. Although only a relatively few people typically read the full practice improvement project after publication, the abstract will be read by many scholars and investigators. Consequently, great care must be taken in writing this section of the practice improvement project. The abstract is a concise statement of the nature of the project and the content of the practice improvement project. The content of the abstract covers the problem statement, evidence-based question(s), methodology, design, data analysis procedures, location, sample, theoretical foundations, results, and implications. The abstract does not appear in the Table of Contents and has no page number. Abstracts must be one paragraph, double-spaced, and no longer than 1 page. The abstract should be left justified with no indentions and no citations. Refer to the current APA Publication Manual, for additional guidelines for the development of the practice improvement project abstract. Make sure to add the keywords at the bottom of the abstract to assist future investigators. Examples and recommendations for writing this Abstract are offered in the DC Network. Keywords : Abstract, assist future investigators, limited to one page in length, vital information, include theories used, include outcomes and quality improvement
this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
Acknowledgments An optional acknowledgments page can be included here. This is another place to use the first person. If it applies, acknowledge and identify grants and other means of financial support. Also, acknowledge supportive colleagues who rendered assistance. The acknowledgments page has no page numbers and does not appear in the Table of Contents. This page provides a formal opportunity to thank family, friends, and faculty members who have been helpful and supportive. The acknowledgments page is only completed in the final practice improvement project and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below. If you cannot see the page break, click on the ¶Show/Hide button (go to the Home tab and then to the Paragraph toolbar).
this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
Dedication An optional dedication may be included here. While a practice improvement project is an objective, scientific document, this is the place to use the first person and to be subjective. The dedication page has no page numbers and does not appear in the Table of Contents. It is only completed in the final practice improvement project and this page is a placeholder. If this page is not to be included in the final project, delete the heading, the body text, and the section break below. If you cannot see the section break, click on the ¶Show/Hide button (go to the Home tab and then ¶ Show/Hide on the Paragraph toolbar).
this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
Chapter 1: Introduction to the Project The introduction of Chapter 1 provides a brief overview of (a) the project focus or practice problem, (b) states why the project is worth conducting, and (c) describes how the project will be completed. The introduction develops the significance of the project by describing how the project translates existing knowledge into practice, is new or different from other works, and how it will benefit patients at your clinical site. This section should also briefly describe the basic nature of the project and provide an overview of the contents of Chapter 1. This section should be three or four paragraphs long. Do not use single-sentence paragraphs or paragraphs longer than one double-spaced page. Keep in mind that you will write Chapters 1 through 3 as your direct practice improvement (DPI) project proposal and Chapters 1 through 5 for your final project manuscript. As you progress, changes will need to be made to the initial three chapters to enrich the content or to improve the readability of the final DPI project manuscript. In particular, after data analysis is complete, the first three chapters will need revisions to reflect a more in-depth understanding of the topic, to change the tense to past tense where appropriate, and to ensure consistency. To ensure the quality of both your proposal and your final practice improvement project and reduce the time for Academic Quality Reviews (AQR), your writing needs to reflect standards of scholarly writing from your very first draft. Each section should be well-organized, uniform, and logically presented. Each paragraph should be short, clear, and focused. A paragraph should (a) be three to eight sentences in length and (b) focus on one point, topic, or argument. If you have difficulty writing, it is recommended that you outline your paragraphs prior to writing the first draft of each chapter. Outlines should include the topic of each paragraph, evidence you would use to support this topic, explanations that connect the evidence to the topic, and a link or transition to the next paragraph. Outlining your paragraphs saves time when you’re writing and ensures coherence in your writing. In the final drafts, there should be no grammatical, punctuation, sentence structure, or American Psychological Association (APA) formatting errors. Be sure to use the check document feature in the Microsoft Word Review Menu. This feature will check for spelling errors and grammatical issues. Taking the time to put quality into each draft will save you time in all the steps of the development and review phases of the practice improvement project process. It will pay to do it right the first time. Verb tense is an important consideration throughout the manuscript drafting process. For the proposal, the learner (project manager) uses present tense (e.g., “The purpose of this project is to…”), whereas in the practice improvement final project, the chapters are revised into past tense (e.g., “The purpose of this project was to…”). However, when considering tense, you’ll want to pay attention to the conventions of grammar and APA style. For instance, when you signal the structure of a chapter, it should be written in the present or the future tense. Similarly, current or general problems should be written in the present tense. However, APA conventions stipulate referring to research studies in the past tense (i.e., “the research showed” vs. “the research shows). As a doctoral scholar, it is your responsibility to ensure the clarity, quality, and correctness of your writing and APA formatting. The DC Network provides various resources to help you improve your writing. Neither your chairperson nor your committee members will edit your documents nor will the AQR reviewers edit your documents. If you do not have outstanding writing skills, you will need to identify a writing coach, editor, or other resources, such as GrammarlyTM or ThinkingstormTM (GCU service), to help you with your writing and to edit your documents. The most important outcome is a scholarly product. Prior to submitting a draft of your proposal or practice improvement project or a single chapter to your chairperson, it is recommended that you have met previously with your Chair. Background of the Project The background section explains both (a) the history of and (b) the present state of the problem at the project site. This section should be two or three paragraphs in length. In this section, you should include your baseline data (see “Chapter 4: Using Data” in Clinical Analytics and Data Management). How many occurrences or current percentage of the problem compared to the industry have occurred over the 60 days prior to project implementation? Articulate how this “problem” has impacted or affected patient outcomes and nursing care (a) at the site, (b) the local level, (c) the national level, and (d) the global level. The section should close with a paragraph that ties these four concepts together, starting with the facility level and then adding the significance of the local, national, and global levels. Organizational Needs Assessment This section is one paragraph in length and should define what an organizational assessment is, why it is done, and that you did so utilizing a strengths, weakness, opportunities, and threats (SWOT) analysis. Explain why the SWOT analysis was appropriate for your quality improvement project. Present how you noted the gap between the current practice and the desired practice change that would improve patient outcomes at the project site. Use a transitional statement that takes you from describing the organization into the SWOT analysis. SWOT Analysis Introduce this section in one paragraph by briefly outlining the objective of performing a strengths, weaknesses, opportunities, and threats (SWOT) analysis. The SWOT analysis was created in DNP-840A. Within the weaknesses and threat, you will have barriers that emerge, so you will need to address how you mitigate them. Your SWOT should focus on the organization and the unit on which the project will be implemented (see Appendix A; see Figure 1). Strengths Concisely synthesize three to four strengths of the project site and unit that impact the successful implementation and ability to sustain this practice change. Do not implicate the site by name, be very general. Please refer to your scholarly readings and textbooks for examples. Weaknesse s Concisely synthesize three to four weaknesses, or challenges, of the project site that could negatively impact the successful implementation and ability to sustain this practice change. Again, do not implicate the site by name, be very general. Please refer to your scholarly readings and textbooks for examples. In addition, discuss the identified barriers and how you will mitigate them. Opportunities Concisely synthesize three to four potential opportunities for the organization and unit especially those to be gained from the implementation of this project. Do not implicate the site by name, be very general. Please refer to your scholarly readings and textbooks for examples. Threats Concisely synthesize three to four potential internal and external threats to the organization and unit that could impact the project’s implementation and sustainability. For instance, the COVID-19 pandemic may decrease staffing on the unit or lead to uneven patient populations seen at the project site. There may also be threats related to geographic location (urban vs. rural), patient population, or other facilities. Discuss the identified barriers and how you will mitigate them. Please refer to your scholarly readings and textbooks for examples. Problem Description This section should be two or three paragraphs long. It clearly states the problem or project focus, the problem statement, the patient population affected by the problem, the significance of the practice problem, and how the project will contribute to solving the problem. You will explain why you and your committee (project mentor/content expert) chose this problem. This section should be supported with literature and multiple examples that support why this problem was chosen and why it is both significant to the site and to current nursing practice. This section of Chapter 1 should be comprehensive, yet simple, providing the context for the practice project. A well-written problem statement begins with the big picture of the issue (macro) and works to the narrower, more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem that will transition into the “Purpose of the Project.” The problem should be written as a declarative statement, such as “It is not known if the implementation of the ABCDEF bundle would impact length of stay among adult patients in a long-term acute care hospital in a high observation unit in Virginia over a period of eight-weeks. Definition of Terms The “Definition of Terms” section provides an understanding of the project constructs and a common understanding of the technical terms, jargon, variables, concepts, and other terminology used within the scope of the project. Terms should be defined in lay terms and discussed according to the context that they are used within the project. Each definition may be a few sentences to a paragraph in length. This section includes any words that may be unknown to a lay-person and taken from the evidence or literature. This section is also a good place to operationally define unique phrases specific to the project. Definitions must be supported with citations from scholarly sources. Do not use Wikipedia or general dictionaries (i.e., Merriam-Webster, Dictionary.com) to define terms. All definitions should be written in complete sentences. A lead-in paragraph is needed to introduce this section and should end with something like: “The following terms were used operationally in this project.” Project Manager Please refer do not refer yourself at all in the manuscript. It should be written in 3rd person. This term is for your reference only. Please remove this term from the Definition of Terms when writing up the project. Term Write the definition of the word. Make sure the definition is properly cited (Author, 2010). Terms often use abbreviations. According to APA (2019), abbreviations are best used only when they allow for clear communication with the audience. Standard abbreviations, such as units of measurement and names of states, do not need to be written out. Only certain units of time should be abbreviated. Abbreviate hr (hour), min (minute), ms (millisecond), ns (nanosecond), or s (second). However, do not abbreviate day, week, month, and year (APA, 2019). To form the plural of abbreviations, add “s” alone without apostrophe or italicization (e.g., vols., IQs, Eds.). The exception to this rule is not to add “s” to pluralize units of measurement (12 m not 12 ms) (APA, 2019). Besides abbreviations, the terms which may need to be defined include the outcome, the type of intervention, the sampling of data, special terminology, instruments, tool, and sources of data. Summary This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion Chapter 2 followed by a description of the remaining chapters. This section should be two to three paragraphs.
this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
10 Implementation Into Practice: The ABCDEF Bundle Cathy Jones Doctor of Nursing Practice Grand Canyon University DNP-820A: Translational Research and Evidence-Based Practice Dr. Carolyn Boiman March 16, 2022 Implementation Into Practice: The ABCDEF Bundle In 2013 the Society of Critical Care Medicine initiated the ICU Liberation campaign from the PAD Clinical Practice Guideline. The guideline was updated in 2018, now known as the ICU Liberation-ABCDEF bundle. This learner’s DPI Project aims to decrease the length of stay in a long-term acute care hospital of adult patients in the high observation unit implementing the ABCDEF bundle. The ABCDE (Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Exercise and Mobility) bundle, a validated evidence-based protocol, was initially created to improve outcomes of patients in the intensive care unit (ICU). The bundle consists of spontaneous awakening trials (SATs) to decrease the use of sedation, spontaneous breathing trials (SBTs) to wean patients off mechanical ventilation faster, coordination of awakening and breathing trials to maximize benefits of SATs and SBTs, delirium screening and treatment, and early progressive mobility to decrease ICU–acquired muscle weakness (Collingsworth et al., 2021). The F for a family was added later, further redefining the bundle (Delvin et al., 2018). Individually these interventions have been associated with reductions in incidence and duration of delirium and improved patient outcomes such as shorter duration of mechanical ventilation, shorter ICU and hospital length of stay, improved functional outcomes and improved survival (Collingsworth et al., 2021). Pain may be a contributing factor in up to 50% of cases of agitation or delirium, a significant contributor in more extended hospitalization (Sosnowski et al., 2021). During the last decade, researchers have produced strong evidence demonstrating the hazards of delirium and the benefits of particular interventions, such as the individual components of the ABCDE bundle, in preventing and mediating this condition.  The Extent to Which the Practice is Being Implemented Several studies across the country published their findings on its implementation. Pun et al. (2019) published the results of its study, which included over 15,000 adults that showed significant and clinically meaningful outcomes, including survival, mechanical ventilation use, coma, delirium, restraint-free care, reduction in ICU admissions, and alterations in post-ICU discharge destinations. A study by Sosnowski et al. (2021) assessed the implementation of the ABCDEF bundle in 5 ICUs in the United States. A study by Hsieh et al. (2019) demonstrates that the complex ABCDE bundle can be successfully implemented into routine care showing the addition of early mobilization and bundle coordination to an established targeted sedation and delirium management program led to substantial reductions in mechanical ventilation duration, length of stay, and hospital cost, liberated patients from restraints, and reduced iatrogenic complications. A meta-analysis was conducted by Zhang et al. (2021) of 26,384 participants evaluating the impact of the bundle interventions on ICU delirium prevalence, duration, and other adverse outcomes. More recently, in a study conducted in Spain, Frade-Mera et al. (2022) identified patients who had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components patients had shorter ICU stays days on mechanical ventilation.   Evaluation of Possible Barriers Unfortunately, the ABCDEF bundle is not widely implemented in practice despite the bundle’s significant clinical outcomes. There are several potential barriers to the implementation of the ABCDEF bundle. The first barrier is the lack of familiarity with the guideline among healthcare providers. Many providers may be unaware of the guideline or its recommendations. A second barrier is that many healthcare facilities do not have the resources to implement all six interventions of the ABCDEF bundle. Resources needed to implement the ABCDEF bundle effectively include personnel (e.g., nurses, pharmacists, physical therapists), equipment (e.g., patient monitors), and funding for additional staff and equipment (AHRQ, 2017). A third barrier is that some healthcare facilities may not have standardized protocols for implementing the ABCDEF bundle. Without standardized protocols, care may be inconsistent across different units within a facility. Last, the culture of a healthcare facility can also be a barrier to implementing the ABCDEF bundle. The culture of a healthcare facility is defined by its values and norms, and it can be challenging to change the culture of a healthcare facility. Ways to Overcome the Barriers There are several ways to overcome the barriers to implementing the ABCDEF bundle. The first way is to increase awareness of the guideline among healthcare providers. Many providers may not be aware of the guideline or its recommendations. Educational programs can increase awareness of the guideline among healthcare providers. A second way is to provide resources (e.g., personnel, equipment, funding) to healthcare facilities to implement all six interventions of the ABCDEF bundle (Loberg et al., 2022). Many healthcare facilities do not have the resources to implement all six interventions of the ABCDEF bundle. Resources needed to implement the ABCDEF bundle effectively include personnel (e.g., nurses, pharmacists, physical therapists), equipment (e.g., patient monitors), and funding for additional staff and equipment. A third way is to develop standardized protocols for implementing the ABCDEF bundle (Loberg et al., 2022). Without standardized protocols, care may be inconsistent across different units within a facility. Standardized protocols can help ensure that care is delivered consistently across different units within a facility. Last, the culture of a healthcare facility can be changed by introducing new values and norms that support the implementation of the ABCDEF bundle. The culture of a healthcare facility can be challenging to change, but it is not impossible (AHRQ, 2017). Discussion of the Resources Available on the Selected Site The AHRQ website provides several resources to help healthcare facilities implement the ABCDEF bundle. The website includes an evidence report, clinical practice guidelines, and toolkits for healthcare providers. The evidence report summarizes the evidence supporting the use of the ABCDEF bundle. The clinical practice guideline provides specific recommendations for implementing the ABCDEF bundle (AHRQ, 2017a). The toolkits provide tools and resources that healthcare providers can use to implement the ABCDEF bundle in their facility. The AHRQ website also includes a database of quality improvement programs that healthcare facilities can use to improve the quality of care. The AHRQ website is a valuable resource for healthcare providers looking to improve the quality of care (AHRQ, 2017a). Conclusion There is evidence that the ABCDEF bundle effectively reduces pain, agitation, and delirium in elderly patients. However, the bundle is not widely implemented in practice. There are several ways to overcome the barriers to implementing the ABCDEF bundle, including increasing awareness, introducing standardized protocols, and increasing funding. The AHRQ website provides resources to help hospitals overcome the barriers to implementing the ABCDEF bundle.  References Agency for Healthcare Research and Quality. [AHRQ]. (2017). Evidence behind Pain, Agitation, and Delirium: Assessments and Sedation Management: Facilitator Guide. Ahrq.gov. https://www.ahrq.gov/hai/tools/mvp/modules/technical/pain-mgmt-slides.html. Agency for Healthcare Research and Quality. [AHRQ]. (2017a). Evidence behind Pain, Agitation, and Delirium: Assessments and Sedation Management: Slide Presentation: Overview. https://www.ahrq.gov/hai/tools/mvp/modules/technical/pain-mgmt-slides.html Collinsworth, A. W., Brown, R., Cole, L., Jungeblut, C., Kouznetsova, M., Qiu, T., Richter, K. M., Smith, S., & Masica, A. L. (2021). Implementation and Routinization of the ABCDE Bundle: A Mixed Methods Evaluation. Dimensions of Critical Care Nursing : DCCN, 40(6), 333–344. https://doi-org.lopes.idm.oclc.org/10.1097/DCC.0000000000000495 Devlin, J. W. Skrobik, Y., Gélinas, C., Needham, D.M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G.L., Nunnally, M.E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N.E., Chanques, G., Denehy, L., Drouot, X., Fraser, G.L., Harris, J. E,. Joffe, A. M, Kho, M. E., Kress, J.P., Lanphere, J.A., McKinley, S. Neufeld, K.J., Pisani, M.A., Payen, J., Pun, B. T.,Puntillo, K.A., Riker, R.R., Robinson, B.R. H., Shehabi, Y., Szumita, P.M., Winkelman, C., Centofanti, J.E., Price, C., Nikayin, S., Misak, C. J., Flood, P. D., Kiedrowski, K., Alhazzani, W. (2018) Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep Disruption in adult patients in the ICU. Critical Care Medicine: (46) 9, e825-e873.doi: 10.1097/CCM.0000000000003299 Frade-Mera, M. J., Arias-Rivera, S., Zaragoza-García, I., Martí, J. D., Gallart, E., San José-Arribas, A., Velasco-Sanz, T. R., Blazquez-Martínez, E., & Raurell-Torredà, M. (2022). The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study. Nursing in Critical Care. https://doi-org.lopes.idm.oclc.org/10.1111/nicc.12740 Hsieh, S. J., Otusanya, O., Gershengorn, H. B., Hope, A. A., Dayton, C., Levi, D., Garcia, M., Prince, D., Mills, M., Fein, D., Colman, S., & Gong, M. N. (2019). Staged implementation of awakening and breathing, coordination, delirium monitoring and management, and early mobilization bundle improves patient outcomes and reduces hospital costs. Critical Care Medicine, 47(7), 885–893. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000003765 Loberg, R., Smallheer, B., & Thompson, J. (2022). A Quality Improvement Initiative to Evaluate the Effectiveness of the ABCDEF Bundle on Sepsis Outcomes. Critical Care Nursing Quarterly, 45(1), 42-53. https://doi.org/10.1097/cnq.0000000000000387. Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., … Ely, E. W. (2018). Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in Over 15,000 adults. Critical Care Medicine. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000003482 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsovi&AN=edsovi.10.1097.CCM.0000000000003482&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 Sosnowski, K., Mitchell, M., Cooke, M., White, H., Morrison, L., & Lin, F. (2021). Effectiveness of the ABCDEF bundle on delirium, functional outcomes and quality of life in intensive care patients: a study protocol for a randomized controlled trial with embedded process evaluation. BMJ Open, 11(7), e044814. https://doi.org/10.1136/bmjopen-2020-044814 Zhang, S., Han, Y., Xiao, Q., Li, H., & Wu, Y. (2021). Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis. Critical Care Medicine, 49(2), 335–346. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000004773
this assignment is referring the ABCDEF bundle – the template pages is attached – add info of the ABCDEF bundle in a long-term acute hospital. PICOT: will implementing the ABCDEF bundle decrease le
Abstract The firsts sentence or two outlines the problem, why is this being addressed? Do not make statements that require a citation as there are no citations in an abstract! (Smoking is a known risk factor for patients with type two diabetes (DMT2) making it essential for providers to address smoking cessation consistently. At the project site there is no tobacco cessation protocol in use). The next sentence outlines the purpose of the project. Use this full template for best success: The purpose of this quantitative quasi-experimental quality improvement project was to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to _______________________ among ___________(population) in a ________ (setting ie: primary care clinic, ER, OR) in ________ (state) over four-weeks . (The purpose of this quantitative, quasi-experimental quality improvement (QI) project was to determine if or to what degree the implementation of a tobacco cessation protocol using XYZ’s Five A’s mode l would impact the patient’s motivation, nicotine dependence, and healthcare provider compliance with assessing tobacco use in adult diabetic smokers in a podiatry clinic for four weeks in the northeastern United States) . Next is nursing theory and change model! State the model or theory using the author and how it applies to the project ONE SENTENCE! (James Prochaska’s transtheoretical model (TTM) and Dorothea Orem’s self-care deficit theory were utilize to guide the theoretical (both are theories) or scientific (one theory, one model) underpinnings of the project). Data analysis and sample size is next – DO NOT SAY p> 0.05 or p<0.05 Must say p= VALUE (Data on the motivation to quit was measured by TTM and nicotine dependence was measured by the Fagerstrom Test for Nicotine Dependence (FTND) questionnaire in diabetic adult smokers aged 18 years and older, (n=16) were compared at baseline, two weeks, and four weeks post-implementation of the Five A’s model. A paired t-test showed that there was a statistical and clinically significant improvement in patient’s motivation to quit smoking (M=-2.86; SD=1.29; p=0.003), a substantial decrease in nicotine dependence (M= -1.86; SD=1.41; p=0.001), and 100% of the healthcare providers (n=6) were compliant in assessing tobacco use p=0.000). WRAP IT UP – Now you want to state how the results impacted the practice at the site and recommendations for what should be done in the future based on the project findings (Based on the results, the Five A’s model may result in increased patient motivation to quit smoking as well as a decrease in nicotine dependence. Recommendations include continuation of the program and possible repetition of the project at another clinical site over an extended monitoring period as well as with a larger sample size.) or maybe if there was no significance (Even though statistical significance was not found STATS, the INTERVENTION provided needed areas for reinforcement measurement and enhanced nursing staff awareness. Therefore, the findings suggest that continuous utilization of INTERVENTION may DO WHAT to IMPROVE WHAT. Replication of the project is needed in larger settings and over a longer period of time.) The simplest way to state recommendations for both statistical and clinical significance are: Recommendations include continuing the project at the site and dissemination of the results. Keywords: Five A’s model, brief counseling, health promotion, motivational counseling, James Prochaska’s transtheoretical model (TTM), and Type 2 Diabetes (DMT2) Fagerstrom Test for Nicotine Dependence (FTND) questionnaire, Dorothea Orem self-care deficit theory. Abstract Example I Smoking is known to place patients at high risk for or exacerbate chronic health conditions. The project site noted a gap in the use of an evidence-based practice protocol to encourage tobacco abstinence. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the translation of Martinez et al.’s research on a targeted smoking cessation program using the If You Vape: Guide to Quitting Smoking Program and the “My Story” pamphlets would improve the rate of smoking abstinence among adult users of combustible and electronic cigarettes. The project was piloted over 12 weeks in an urban Ohio primary care practice. Dorothea Orem’s self-care deficit theory and the Iowa model’s revised evidence-based practice to promote excellence in health care were the scientific underpinnings of the project. Data on smoking abstinence were measured using the Smoking Abstinence Questionnaire (SAQ) among a total sample size of 16 participants compared at baseline and every two weeks for 12 weeks. A paired t-test showed that there was a statistically and clinically significant improvement in smoking abstinence (M = -2.86; SD = 1.29; p = 0.003). Based on the results, the targeted smoking cessation using the If You Vape: Guide to Quitting Smoking booklets and the “My Story” pamphlets may improve smoking abstinence rates in this population and setting. Therefore, recommendations include continuation of the program, dissemination of results, and that researchers develop tools that reflect exclusive use of vaping pens. Keywords: Targeted smoking cessation, If You Vape: Guide to Quitting Smoking Program, “My Story” pamphlet, evidence-based practice, health promotion, Smoking Abstinence Questionnaire (SAQ), Dorothea Orem’s self-care deficit theory, Iowa model’s revised: evidence-based practice to promote excellence in health care. Abstract Example II Reducing pneumonia among older adult residents of skilled nursing facilities (SNF) may be mitigated with proper oral hygiene. The project site noted there was no standardized practice for oral hygiene which increased the risk of pneumonia for their patients. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the translation of Sutter’s research on the use of Sutter’s oral hygiene protocol would impact pneumonia rates and nursing compliance to the protocol among adult residents. The project was piloted over an eight-week period in a rural New Jersey SNF. The theoretical foundations of the project utilized Kathrine Kolcaba’s comfort theory and John Kotter’s 8-step model of change. The total sample size was 112, n = 55 in the comparative group and n = 57 in the implementation group. Data were extrapolated from the facility’s electronic health record. To analyze the comparison and implementation group data, a chi-square test was used. The results indicated there was no statistically significant improvement in reducing pneumonia X2 (1, N = 112) = 0.007, p =. 932. An independent t-test was run to analyze the compliance rates which revealed a clinical and statistically significant improvement in compliance with the protocol t (110) = -17.101, p =.0001. Despite the lack of statistical significance in reducing rates of pneumonia, there is clinical significance in reducing pneumonia from n = 6; 10.9% in the comparative to n = 0; 0% occurrences in the implementation group. Therefore, the implementation of Sutter’s oral hygiene protocol may reduce pneumonia rates and improve nursing compliance in this setting. Recommendations include sustaining the project at the project site and further analysis of data due to the small sample size and short implementation period. Keywords: Sutter’s oral hygiene, aspiration pneumonia prevention, pneumonia, evidence-based practice, skilled nursing, older adults, oral care, comfort theory, 8-step model of change. Abstract Example III An essential, routine procedure performed by nurses in the emergency room (ER) is obtaining peripheral intravascular access (PIVA). The project site noted that this routine procedure had become increasingly challenging so an evidence-based approach was sought. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the Emergency Nurse Association’s (ENA) clinical practice guidelines on Ultrasound-Guided Peripheral Venous Access (UGPVA) would improve the nurses’ self-efficacy (SE) and reduce the number of PIVA attempts for adult ER patients. The project was piloted over 12 weeks at a Northeastern United States Veterans Affairs Hospital. Albert Bandura’s self-efficacy theory and Kurt Lewin’s 8-step change theory were the project’s theoretical underpinnings. Data on nursing SE (N = 33) were analyzed using a paired t-test resulting in a clinical and statistically significant increase from pre (M = 67.81, SD = 14.84) to post (M = 95.85, SD = 3.48), p = .001. The total sample size of PIVA attempts was 398, n = 175 in the comparative group and n = 223 in the implementation group. Data were acquired through the electronic medical record. A chi-square test was used and results revealed that X2 (1, N = 398) = 0.007, p = .000, showing a statistical and clinically significant improvement in reducing the PIVA attempts. The results affirm that the implementation of the ENA’s clinical practice guidelines on UGPIVA may improve nursing SE and reduce the number of PIVA attempts in the respective populations. Therefore, the project remains in full implementation in the ER with recommendations to expand UGPIVA to the critical care units. Keywords: Intravenous access, difficult IV access, Emergency Nurse Association CPG on ultrasound-guided peripheral venous access, Bandura, nursing self-efficacy, Lewin’s change theory, evidence-based practice, reducing needle sticks, vascular access, ER procedure.

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