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:
- Problem statement
- Purpose of the change proposal
- 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.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Expert Answer and Explanation
Capstone Project Final
Medical errors are prone in healthcare facilities more so in pediatric care units. The problem has been associated with many factors. Davis-Coan et al. (2016) argue that medical errors are mainly caused by nurse burnout. The authors note that nurses who work for long hours are likely to perform mistakes while caring for patients because they are fatigued. Another factor that causes medical errors in pediatric care units is improper handoffs. Hannan et al. (2019) mention that nurses are required to give detailed reports about patients and their progress during handoff stages. However, some nurses omit this vital activity and withhold vital information, and this can lead to medical errors. Another cause of medical errors in care units is a nurse shortage. When there are few nurses in medical facilities and the patients are many, medical errors can occur because the nurses can be overwhelmed with their work.
Medical errors are worth solving because they negatively impact healthcare institutions and patients. Lawson et al. (2018) report that medical errors can cause financial, psychological, and emotional stress to the organization and medical provider on duty. The scenarios have caused my hospital in that the organization has used a lot of money to compensate the people affected. Also, health providers have undergone a lot of stress because of the events. Pereira- Hannan et al. (2019) argue that the medial error can cause negative publicity, and this can make the patients lack faith in the facility. My organization has suffered financial losses since the events occurred. Lastly, patients’ lives can change drastically (Hannan et al., 2019). For instance, the children involved in the events developed brain conditions that interfered with their mental health.
Clinical Problem Statement
According to Lawson et al. (2018), in 2016 alone, medical errors accounted for more than 100,000 deaths in the pediatric departments across healthcare facilities in the US, making the problem the third cause of death in pediatric departments. Another research done by Lawson et al. (2018) shows that less than 10% of medical errors occurring in hospitals are reported. Hannan et al. (2019) mention that the most common medical errors in pediatric departments include hospital-associated infections, too much oxygen for premature babies, a bad combination of drugs, and giving wrong drugs. The severity of the problem has attracted change in healthcare organizations, including my hospital.
Purpose of the Change Proposal in Relation to Providing Patient Care in the Changing Health Care System
The primary purpose of this capstone project is to reduce medical errors in pediatric care unit by training nurses about the issue and improving the number of staff in the department.
In pediatric care unit (P) does improving nurse staffing and training nurses (I) compared to not improving nurse staffing, and training nurses (C) reduce the rate of medical errors (O) during admission period (T)?
Literature Search Strategy Employed
Articles published from 2015 to 2020 were included in the literature review. The ones older than five years were excluded. The articles were searched via Canyon University online library. The databases consulted include the National Center for Biotechnology Information library (NCBI), BMC library, Wiley online library, and Institutes of Health library (NIH). Apart from the above databases, some articles were also extracted from Google Scholar database. The search teams used to identify the articles include medical errors in healthcare, medical mistakes, missed events, and medical negligence. The search was exhausted by applying a variation of the terms. The step that followed the literature search was the evaluation of the identified articles.
Evaluation of the Literature
A table was used to evaluate the literature used to support this project. Eight articles were evaluated. The literature was evaluated by looking at the purpose of the articles, the research questions that guided the studies, and the methodology. Also, the author(s) of the article and the year of publication was also the focus of the evaluation. Analysis method, data collection tools and methods, the setting of the studies, sample, recommendations, and key findings were also part of the evaluation. In the evaluation, the significance of the articles to the PICOT question has also been mentioned. The full evaluation of the articles can be found in the table in the appendix.
Applicable Change or Nursing Theory Utilized
Lewin’s Change Management Theory will be applied to this project. The theory was developed by Kurt Lewin specifically for nursing change management. This theory has been selected for this project because it has simple steps that can be easily adapted. The theory was organized in three stages, and they include unfreezing, changing, and refreezing stages (Al-Ali, Singh, Al-Nahyan & Sohal, 2017). In the first stage, people who can resist change should be identified and convinced to embrace the upcoming transition. The people can be convinced by creating awareness messages about the change. In the second step, the implementation plan should be developed, and change initiated. In other words, the change should now be made real. In the refreezing phase, the change should be reinforced, and its progress monitored ((Fatema et al., 2017). In this step, the change management team should ensure that people do not deviate from the transition.
Proposed Implementation Plan with Outcome Measures
The project will take a total of 31 days, and it will be evaluated six months after implementation, as highlighted in the table below.
|Selection of the project team members||Two days|
|Assigning roles to the project team.||A day|
|Developing a budget for the plan and presenting it to the management for approval.||Two days|
|Improving nurse staffing. Here, the following four activities will be done and they include creating a formal staffing plan, establishing a staffing committee, reducing turnover causes, and consulting with nurses on way forward as described by Hannan et al. (2019).||Ten days|
|Training nurses. In this activity, the nurses will be trained on how to avoid medical errors and deal with it in case it happens (AbuMustafa & Jaber, 2019).||Fifteen days|
|Meeting the project team members to discuss whether they have accomplished their tasks.||A day|
|Evaluating the project to determine whether it has achieved its outcomes.||Six months after the project has been implemented.|
How Evidence-Based Practice was used in Creation of the Proposal
Evidence-based practice has been key when preparing the capstone project proposal. The proposed solution has been decided upon based on the numerous data that support its application in solving the situation. The proposal presented to the management will be prepared based on the EBP findings. For instance, the articles in the literature review will be used to show the management how the problem is threatening the existence of the organization.
The evaluation method that will be used to evaluate this change project surveys. During the evaluation, a conceptual model will be developed in a move to determine primary evaluation elements. The next step will be developing inquiries that will guide the process. The questions will ensure that the process is not done out of context. The third phase will be selecting the design used in the process, which is a qualitative survey. After the selection of the design, the team will decide on the instruments to collect data. In this process, data will be collected through questionnaires. The next stage is the data gathering process. Questionnaires will be distributed among the target population for their feedback to be captured. The last stage is data analysis and presentation. The information gathered with be analyzed thematically and presented to the management. The full evaluation process will be done six months after the implementation process.
Project Barriers and How to Solve them
Some of the barriers will be faced during the implementation process. The first barrier is the lack of clarity about the project. Some of the employees and other stakeholders may not understand the objectives, goals, and purpose of the project. Also, the project team may lack clarity about their roles in the project. This barrier mitigated by communicating the project, clearly describing its purpose and objectives. The second barrier is inadequate resources. The project may lack resources to be used in the implementation. However, the barrier will be solved by procuring the resources before implementation. The last barrier is resistance to change. The management may resist to add resources to the HR for improving staffing ratios. This barrier will be solved by communicating to the management and persuading them to fully embrace the change.
The purpose of this paper was to solve the issue of medical errors in pediatric care unit by improving the number of nurses in the department and training them about how to handle medical errors in case they experience one. Eight articles were used to answer the PICOT question. The change was managed using a change theory known as Lewin’s Change Management Model. The project will be evaluated using survey approach and evaluation data collected by the help of questionnaires.
AbuMustafa, A. M., & Jaber, M. (2019). Factor affecting Medical errors Reporting among medical team in Pediatric Hospitals in Gaza governorate. Journal of Medical Research and Health Sciences, 2(11), 794-801. http://jmrhs.info/index.php/jmrhs/article/view/131
Al-Ali, A. A., Singh, S. K., Al-Nahyan, M., & Sohal, A. S. (2017). Change management through leadership: the mediating role of organizational culture. International Journal of Organizational Analysis. https://doi.org/10.1108/IJOA-01-2017-1117
Davis-Coan, C., Crawford, K., Lynch, T., Davis, R., Miller, T., & Santoro, T. J. (2016). OSF Saint Francis Medical Center and University of Illinois College of Medicine, Peoria, ILRates of Medical Errors and Adverse Events in a Medical ICU Following Implementation of a Standardized Computerized Handoff System. Ochsner Journal, 16(Spec AIAMC Iss), 38-39. http://www.ochsnerjournal.org/content/16/Spec_AIAMC_Iss/38.abstract
Fatema, K., Hadziselimovic, E., Pandit, H. J., Debruyne, C., Lewis, D., & O’Sullivan, D. (2017, October). Compliance through Informed Consent: Semantic Based Consent Permission and Data Management Model. In PrivOn@ ISWC. Retrieved from http://www.tara.tcd.ie/bitstream/handle/2262/82659/88248c5b669175f267069c3319d9ac2d3e84.pdf?sequence=1
Hannan, J., Sanchez, G., Musser, E. D., Ward-Petersen, M., Azutillo, E., Goldin, D., … & Foster, A. (2019). Role of empathy in the perception of medical errors in patient encounters: a preliminary study. BMC research notes, 12(1), 327. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4365-2
Lawson, N. D., Shanafelt, T. D., Tawfik, D. S., Morgenthaler, T. I., Satele, D. V., Sinsky, C., … & West, C. P. (2018, November). Burnout is Not Associated With Increased Medical Errors/In Reply. In Mayo Clinic Proceedings (Vol. 93, No. 11, pp. 1683-1684). Mayo Foundation for Medical Education and Research. DOI:10.1016/j.mayocp.2018.08.015
Literature Evaluation Table
|Criteria||Article 1||Article 2||Article 3||Article 4|
|Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
|AbuMustafa, A. M., & Jaber, M. (2019). Factor affecting Medical errors Reporting among medical team in Pediatric Hospitals in Gaza governorate. Journal of Medical Research and Health Sciences, 2(11), 794-801. http://jmrhs.info/index.php/jmrhs/article/view/131||Davis-Coan, C., Crawford, K., Lynch, T., Davis, R., Miller, T., & Santoro, T. J. (2016). OSF Saint Francis Medical Center and University of Illinois College of Medicine, Peoria, ILRates of Medical Errors and Adverse Events in a Medical ICU Following Implementation of a Standardized Computerized Handoff System. Ochsner Journal, 16(Spec AIAMC Iss), 38-39. http://www.ochsnerjournal.org/content/16/Spec_AIAMC_Iss/38.abstract||Hannan, J., Sanchez, G., Musser, E. D., Ward-Petersen, M., Azutillo, E., Goldin, D., … & Foster, A. (2019). Role of empathy in the perception of medical errors in patient encounters: a preliminary study. BMC research notes, 12(1), 327. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4365-2
|Pereira-Lima, K., Mata, D. A., Loureiro, S. R., Crippa, J. A., Bolsoni, L. M., & Sen, S. (2019). Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis. JAMA network open, 2(11), e1916097-e1916097. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2755851
|Article Title and Year Published
|“Factor affecting Medical errors Reporting among medical team in Pediatric Hospitals in Gaza governorate” Published in 2019||“OSF Saint Francis Medical Center and University of Illinois College of Medicine, Peoria, ILRates of Medical Errors and Adverse Events in a Medical ICU Following Implementation of a Standardized Computerized Handoff System”||“Role of empathy in the perception of medical errors in patient encounters: a preliminary study”
The article was published in 2019.
|“Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis”
The paper was published 2019.
|Research Questions (Qualitative)/Hypothesis (Quantitative)||“What are the factors affecting Medical errors Reporting among medical team in Pediatric Hospitals in Gaza governorate?”||Quality hospital handoff reduces the rate of medical errors in healthcare facilities.||“What is the relationship between patients’ perception of healthcare providers’ empathy, their intention to adhere to treatment, and their perception of medical errors?”||Hypothesis: Physicians with depression are likely to cause medical errors.|
|Purposes/Aim of Study||“The objective of the study was to identify the factors affecting medical error reporting by medical team among pediatric hospitals in Gaza Governorate, Gaza Strip (AbuMustafa & Jaber, 2019).||“The purpose of this project was to evaluate the effectiveness of and staff satisfaction with resident handoffs at baseline and then performed a reevaluation after the I-PASS handoff system was integrated with Epic in the OSF Saint Francis Medical Center (SFMC) adult ICU” (Davis-Coan et al., 2016).||“The purpose of this study was to determine the relationship between patients’ perception of healthcare providers’ empathy, their intention to adhere to treatment, and their perception of medical errors made” (Hannan et al., 2019).||The purpose of the study was “to provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors” (Pereira-Lima et al., 2019)|
|Design (Type of Quantitative, or Type of Qualitative)||A cross-sectional study design with questionnaires was used to collect data.||Randomized control trial was used as the design of the study.||Descriptive quantitative approach was used as the study design.||Systematic review was the design of the study.|
|Setting/Sample||Participants used were 90 clinical staff from El Rantisi, El Naser, and El Durra hospitals.||5 residency programs were used as the sample for this study.||195 clinical professionals were the participants of the study.||Articles involving 21 517 physicians were the samples for the study.|
|Methods: Intervention/Instruments||Questionnaires was the instrument used to collect data.||The instruments used in this study was questionnaires.||Surveys created by Qualtrics software® was used to collect data.||ERIC, PsycINFO, and Embase were databases used to collect data.
|Statistical Package for the Social Sciences software version 23 was used to analyze data.||SPSS was used to analyze data in this study.||Data was analyzed through descriptive statistics.||Meta-analysis was done in analyzing the data.|
|The findings of the study showed reporting of medical errors among pediatric nurses can be affected by insufficient staff, worry of legal implications, and work pressure.||Awareness about medical errors can help in reducing the rate of medical errors in hospitals.||The findings showed that nurses and physicians’ empathy did not affect adherence to treatment but impacted patient’s perception about medical errors.
|The key finding was that physicians who have tested positive for depression have high chances of reporting medical errors.|
|The authors recommend that nurses and doctors should be educated about how to handle medical errors so that they can know how to handle the issue when it occurs. Also, change culture should be embraced in medical organizations to help care providers report any medical error.||Medical facilities should have enough funds when they want to solve the issue of medical errors within the institution.||Further studies should be conducted to find out the impact medical errors on patients’ outcome.||The authors recommended that medical errors can be reduced by improving care givers’ mental health.|
|Explanation of How the Article Supports EBP/Capstone Project||This paper will be used to understand why nurses do not report medical errors.||This paper will provide strategies to reduce medical errors.||This paper will be used to understand empathy and its effects on medical errors.||The article will be vital when developing the background of the project.|
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