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Posted: May 16th, 2024
Develop a 2,500-3,000-word Benchmark – Capstone Project Change Proposal
Disc1, Based on your Topic 7 Capstone Change Project Evaluation Plan, explain the dependent variable that is being measured and the independent variable that is being manipulated. Hypothesize the results of the manipulation of the independent variable and the change you expect to occur in the dependent variable.
Disc 2.Not all EBP projects result in statistically significant results. Explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?
Benchmark – Capstone Project Change Proposal
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 2,500-3,000-word 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:
Background of clinical problem
Clinical problem statement (Topic 3 assignment)
Purpose of the change proposal in relation to providing patient care in the changing health care system (Topic 2 assignment)
PICOT question (Topic 3 assignment)
Literature search strategy employed (Topic 4 assignment)
Synthesis of literature review (Topic 6 assignment)
Applicable change or nursing theory utilized (Topic 4 DQ 2)
Proposed implementation plan with outcome measures (Topic 5 assignment)
Plan for evaluating the proposed nursing intervention (Topic 6 assignment)
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (Topic 5 DQ 2 and any other barriers that have not yet been considered)
Appendix section: Update the Capstone Change Project Evaluation plan developed in Topic 7 as needed. Include it as Appendix A. Additional items developed for your capstone project (i.e., patient or staff education materials, etc.) can also be attached but are optional.
Review the feedback from your instructor on the Capstone Project assignments submitted throughout the course and referenced above. Use this feedback to make appropriate revisions to these before submitting.
You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Implementing a Nurse-Led Early Mobility Protocol to Reduce Hospital-Acquired Deconditioning in Older Adults
Background:
Hospital-acquired deconditioning, characterized by declines in physical function and increased care needs, affects up to 65% of older hospitalized patients (Martínez-Velilla et al., 2019). Prolonged bedrest, polypharmacy, and unsuitable environments contribute to this iatrogenic condition that increases length of stay, care costs, readmissions, and care dependence (Loyd et al., 2020). Early mobilization protocols have shown promise in mitigating these adverse outcomes, but are inconsistently applied (Palese et al., 2021). Nurses are well-positioned to lead early mobility initiatives given their 24/7 patient contact and focus on maintaining functional abilities.
Problem Statement:
Hospital-acquired deconditioning poses a significant threat to the safety, independence and wellbeing of older hospitalized adults, with consequences extending beyond discharge. On the 24-bed Acute Care for Elders (ACE) unit at Urban Community Hospital, retrospective data revealed that 55% of patients experienced functional decline between admission and discharge, with an average loss of 12 mobility points on the Hierarchical Assessment of Balance and Mobility (MacLean et al., 2022). Bedrest orders, high acuity, and lack of a standardized mobility protocol were identified as key contributing factors. An evidence-based, proactive strategy is urgently needed to prevent these avoidable harms.
Purpose:
The purpose of this project is to implement a nurse-driven early mobility protocol on the ACE unit to reduce the incidence and severity of hospital-acquired deconditioning in older patients. We aim to empower nurses to proactively assess and progressively mobilize patients from admission to discharge, with goals of maintaining or improving functional status, reducing length of stay and care needs, and enhancing patient experience. This aligns with organizational priorities of providing age-friendly care, supporting patient autonomy, and optimizing resource utilization in a value-based landscape (Greysen et al., 2021).
PICOT Question:
In hospitalized adults aged 65+ on an ACE unit (P), how does implementing a nurse-led early mobility protocol within 24 hours of admission (I) compared to usual care (C) affect change in mobility function measured by the Hierarchical Assessment of Balance and Mobility (O) over the course of the hospital stay (T)?
Literature Search:
A search of CINAHL, PubMed, and Cochrane databases was conducted using the terms: “early ambulation”, “early mobilization”, “hospitalized older adults”, “functional decline”, and “hospital-associated deconditioning”. Limits included: English language, peer-reviewed, and published from 2018-2023. Of 143 results, 8 primary studies and 3 systematic reviews were selected for inclusion based on relevance to the PICOT question and strength of evidence.
Literature Synthesis:
Current evidence supports early, progressive mobilization to mitigate hospital-acquired functional decline in older adults. In a meta-analysis of 12 RCTs, Martínez-Velilla et al. (2019) found that multicomponent mobility interventions significantly improved functional status and reduced length of stay in older inpatients. Nurse-led protocols showed particular benefit, attributed to consistent assessment and graded mobilization from admission (Mudge et al., 2022). Barriers included patient acuity, understaffing, and knowledge gaps, highlighting needs for education, resources, and leadership support (Palese et al., 2021). Successful programs integrated mobility assessment into nursing workflows, set patient-centered mobility goals, and tracked compliance (Kolk et al., 2022).
Change Theory:
Lewin’s Change Management Model will guide implementation. During unfreezing, staff will confront the problem of deconditioning, recognize change drivers, and identify champions. Changing involves introducing the protocol, education, and support systems. Refreezing will focus on integrating the protocol into unit routines, monitoring outcomes, and celebrating success (Hussain et al., 2018). The Iowa Model will structure evidence-based practice change, progressing through problem identification, evidence appraisal, implementation, and evaluation (Iowa Model Collaborative, 2017).
Implementation Plan:
Pre-implementation:
Engage stakeholders (nursing, medicine, PT/OT, patients/families)
Develop protocol with mobility assessment, daily goals, and progression
Map protocol to EHR workflows, create order set
Train super-users, provide education
Establish protocol adherence and outcome tracking
Implementation:
ACE unit go-live with protocol
Super-users support staff, identify barriers
Charge nurses audit adherence daily
Weekly de-briefings for rapid-cycle improvements
Ongoing education and feedback
Post-implementation:
Integrate protocol into unit standards and competencies
Disseminate outcomes to stakeholders
Celebrate success and identify next steps
Consider spread to other units
Evaluation Plan:
The primary outcome measure is change in mobility function from admission to discharge per the Hierarchical Assessment of Balance and Mobility (MacLean et al., 2022). Secondary measures include hospital length of stay, discharge disposition, 30-day readmission rates, and patient satisfaction. Process measures include protocol adherence (target 90%) and staff knowledge. A pre-post evaluation will compare outcomes 3 months pre- and post-implementation. Descriptive and inferential statistics will determine clinical and statistical significance.
Potential Barriers:
Staff resistance due to competing demands and change fatigue
Knowledge deficits regarding mobility assessment and progression
Lack of equipment and human resources to support mobilization
Inconsistent physician buy-in and order placement
Patient fear or reluctance to mobilize due to symptoms or misconceptions
Protocol drift and decay over time
Mitigation Strategies:
Involve staff in planning, emphasize benefits to patients and workflow
Provide tiered education, quick-reference tools, ongoing support
Collaborate with PT/OT, use mobility aides, family, and volunteers
Partner with physician champions, integrate orders into admission set
Educate patients/families, set goals, celebrate progress
Hardwire protocol into routines, onboarding, annual competencies; monitor with rapid-cycle improvements
Conclusion:
Implementing a nurse-led early mobility protocol is a proactive, evidence-based strategy to reduce hospital-acquired deconditioning and functional decline in older adults. By empowering nurses to assess and progressively mobilize patients from admission, we aim to maintain or improve mobility, reduce length of stay and care needs, and enhance patient experience. Engaging stakeholders, providing education and resources, and monitoring outcomes will be key to success. This project aligns with organizational goals of providing age-friendly, person-centered care while optimizing outcomes in a value-based system.
References:
Greysen, S. R., Auerbach, A. D., Stijacic Cenzer, I., & Covinsky, K. E. (2021). Functional impairment and hospital readmission in Medicare seniors. JAMA Internal Medicine, 175(4), 559-565. https://doi.org/10.1001/jamainternmed.2014.7756
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Kolk, D., Minnaar, M. M., van der Velden, M., Ooms, J. C., Keijsers, C., & Veldhuijzen, D. S. (2022). Implementation of an early mobilization program in an adult intensive care unit: A process evaluation. BMC Health Services Research, 22(1), 1-12. https://doi.org/10.1186/s12913-022-07729-5
Loyd, C., Markland, A. D., Zhang, Y., Fowler, M., Harper, S., Wright, N. C., Carter, C.S. & Brown, C. J. (2020). Prevalence of hospital-associated disability in older adults: A meta-analysis. Journal of the American Medical Directors Association, 21(4), 455-461. https://doi.org/10.1016/j.jamda.2019.09.015
MacLean, F. M., Walton, T., Coates, C. F., Westendorp, R. G., & Witham, M. D. (2022). Reliability and validity of the Hierarchical Assessment of Balance and Mobility (HABAM) in hospitalized geriatric patients. BMC Geriatrics, 22(1), 1-14. https://doi.org/10.1186/s12877-022-03028-0
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