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You will need to help complete the attached document titled "The 10 Strategic Points."

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TOPIC: Measuring the Impact of Covid-19 Pandemic Among Health Care Workers: An Evidence-Based Intervention

The Direct Practice Improvement (DPI) Project incorporates 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. These 10 points are defined and instructions for completion of the DPI Project Milestone: Outline of 10 Strategic Points assignment are provided in the "10 Strategic Points" resource located in the DC Network.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • Doctoral learners are required to use the current APA style for their writing assignments. 
  • You are required to submit this assignment to LopesWrite for similarity and plagiarism

Directions:

  1. Access the DC Network and download "10 Strategic Points." (ATTACHED).
  2. Complete the table.

The 10 Strategic Points for the Prospectus and Direct Practice Improvement Project

Introduction

In the Direct Practice Improvement (DPI) Project, there are 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project. The 10 Strategic Points are defined within this document and a template provided. The ten strategic points are developed in a table format, as noted below.

The Process for Defining the 10 Strategic Points

The order of the 10 Strategic points listed below reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the purpose or focus for the project based on a clearly defined need or gap from the project site.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 Strategic points, so they are simple, clear, and correct in order to ensure that anyone who reviews them will easily understand the quality improvement project. It is important to align all of the 10 Strategic points to ensure it will be possible to conduct and complete the project.

Developing the 10 Strategic Points document begins in DNP-815A begins as a three-page document that can help ensure clarity, simplicity, correctness, and alignment of each of these 10 Strategic Points in the Direct Practice Improvement Project. This document is integral to learner success in the project courses. Therefore constant updates should be made through each course as you develop the project. Please see the table below regarding the development of the citation requirements expected per course.

Course

Minimal number of articles

DNP-801A

Begin collecting original research to support the evidence-based practice intervention found in the research or clinical practice guidelines.

MUST have 2 original research articles from the USA (or Canada if Canadian student) to support the intervention within five years of your graduation date.

DNP-815A

Must have a total of 5 original research articles:

MUST have 2 original research articles from the USA (or Canada if Canadian student)to support the intervention within five years of your graduation date. Other 3 research articles may be added from US, Canada, UK, Denmark, India, New Zealand, Germany, or Australia.

DNP-820A

Must have a total of 15 original research articles:

MUST have 2 original research articles from the USA (or Canada if Canadian student) to support the intervention within five years of your graduation date. Other 3 research articles may be added from US, Canada, UK, Denmark, India, New Zealand, Germany, or Australia.

Any other original research can come from any of the 131 countries listed in the International Compilation of Human Research Standards 2020) found here:

https://www.hhs.gov/ohrp/international/compilation-human-research-standards/index.html

DNP-830 (A)

These points should have been completed and ready for use in DNP-830A to support the drafting of the DPI project. All criteria from DNP-820A should have been met and revised.

Value of the 10 Strategic Points Document

The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their project, a critical step required before learners can implement their DPI project. The document also proves useful for communicating the DPI project focus with the Content Expert, as well as for reviewing the DPI project with the Project Chair, mentor, content expert, and academic quality review (AQR) process. (Delete all of the information above when submitting the document as to keep the GCU logo)

Example: 10 Strategic Points Document for a Quality Improvement Project

Ten Strategic Points

The 10 Strategic Points

Title of Project

1) Title of Project

List the title of the project/manuscript to include the intervention and no more than 12 words

Background

Theoretical Foundation

Literature Synthesis

Practice Change Recommendation

2) Background to Chosen Evidence-Based Intervention:

List the primary points for six sections.

i) Background of the practice problem/gap at the project site

ii) Significance of the practice problem/gap at the project site

iii) Theoretical Foundations (choose one nursing theory and one evidence-based change model to be the foundation for the project):

iv) Create an annotated bibliography using the "Preparing Annotated Bibliographies (APA 7th)" located in the Student Success Center. https://www.gcumedia.com/lms-resources/student-success-center-content/documents/writing-center/preparing-annotated-bibliographies-apa7-mla8-turabian9.pdf utilizing the five (5) original research articles that support the evidence-based intervention. This will be the foundation of the Literature Synthesis you will have to do in DNP-820A.

v) Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention

vi) Summary of the findings written in this section.

Problem Statement

3) Problem Statement:

Describe the variables/groups to project, in one sentence.

A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower, and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

It is not known if the implementation of __________________would impact_______________ among ___________ (population).

 

PICOT to Evidence-Based Question

4) PICOT Question Converts to Evidence-Based Question:

(P) Among adult patients in a rural care setting, (I) how does the implementation of a telehealth program (C) compare to traditional commute-for-care (O) impact rate of follow-up with the primary care provider (T) over a period of four weeks?

Evidence-Based Question:

Provide the templated statement

To what degree will the implementation of _______________ (intervention) impact______________(what) among _____________ (population) patients in a ______ (setting) in _______ (state)?

Sample

Setting

Location

Inclusion and Exclusion Criteria

5) Sample, Setting, Location

Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers).

i) Sample and Sample Size: Population (participants whose outcomes are measured) and number based on G*power analysis or sample size calculator. Explain potential bias and mitigation of sample size.

ii) Setting: Clinic, hospital, parish nursing, community center, medical-surgical,…..

iii) Location: urban / rural then what state:


iv) Inclusion Criteria

· Who can participate?

v) Exclusion Criteria

· Who cannot participate

Define Variables

6) Define Variables:

i) Independent Variable (Intervention):

ii) Dependent Variable (Measurable patient outcome):

Project Design

7) Project Design:

This project will use a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each).

i) Quality Improvement

ii) Research

iii) Summarize

Purpose Statement

8) Purpose Statement:

Provide the templated statement.

The purpose of this quality improvement project is to determine if the implementation of _________________ (intervention, make sure you have the evidence-base here) would impact ______________(what) _______________________ among ___________(population). The project was piloted over an eight-week period in a (rural, urban)________ (state) ________ (setting i.e.: primary care clinic, ER, OR).

Data Collection Approach

9) Data Collection Approach:

i) You will need data on your participants demographic information (example: age, gender, educational background, ethnicity…..etc.). What instrument would you use to measure this? (Will you use a pre-made Likert Scale? An Excel Spreadsheet?)

ii) You also need data on the measurable patient outcome. What instrument will you use (survey, electronic health records, instrument) to obtain this data and how is it determined to be valid and reliable.

iii) For the instruments used to measure data provide the reliability and validity (psychometric studies) for each.

iv) Describe the step -by-step process you will use to collect the data, explain where the data will come from, and how you will protect the data and participants.

1.

2.

v) Discuss potential ethical issues pertaining to your project. Ethical Considerations in Human Research Protection (i.e. confidentiality vs anonymity of the data, informed consent, and potential conflict of interest.)

vi) Discuss how you will adhere to the principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, within the theoretical framework, clinical problem, and clinical questions.

Data Analysis Approach

10) Data Analysis Approach:

How will you analyze the participants’ descriptive, demographic information? What statistical analysis will be used to prepare the results?

What type of data analysis will be needed to analyze the measurable patient outcomes? What statistical test will be used? (i.e. chi-square, paired t-test, Wilcoxon…)

Will you use Intellectus, Laerd Statistics, or a statistician?

Discuss the potential Bias and Mitigation of the data.

References

© 2020. Grand Canyon University. All Rights Reserved.

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Ten Strategic Points: Direct Practice Improvement Project

Beverly Holland

Grand Canyon University: DNP 960

Running head: TEN STRATEGIC POINTS: DIRECT PRACTICE IMPROVEMENT 1

TEN STRATEGIC POINTS: DIRECT PRACTICE IMPROVEMENT 24

September 8, 2020

Ten Strategic Points: Direct Practice Improvement Project

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Ten Strategic Points: Direct Practice Improvement Project

The 10 Strategic Points

Broad Topic Area

1. Broad Topic Area/Title of Project:

The Impact of the Implementation of Code-Blue Nurse Champions for Cardiac Arrest

Literature Review

2. Literature Review:

a. Background of the Problem/Gap:

Cardiovascular disease is the primary cause of death resulting in 840, 768 in 2017, with 379, 133 deaths due to cardiac arrest (Varini et al., 2019). The American Heart Association’s (AHA) 2020 Impact Goals are to improve the cardiovascular health (CVH) of all Americans by 20% while reducing deaths attributable to CVDs and stroke by 20% (Varani et al., 2020). An estimated 209,000 in-hospital cardiac arrests (IHCA) occur each year in the United States (US), the survival rate of 24% (Andersen, Holmberg, Berg, Donnino, & Granfeldt, 2019). Key elements of success include early identification of at-risk patients combined with timely interventions to prevent deterioration of cardiac arrest. Such identification might occur through an early warning system triggered by specific vital sign abnormalities, a scoring system based on multiple criteria, or staff concern (Andersen et al., 2019). Survival of and favorable outcomes from IHCA are highly dependent on factors such as skilled resuscitation team, prompt initiation of cardiopulmonary resuscitation and defibrillation, and organizational structures to support resuscitation care; nurses are an integral part of IHCA response (Guetterman et al., 2018). Patient survival of cardiac arrest events depends on early recognition of the event and immediate response including activation of a “Code Blue” team and initiate high quality cardiopulmonary resuscitation (CPR) (Connell et al., 2016). Code blue, for the purpose of this project, is the phrase utilized to describe a medical emergency event at the project facility in which the patient has no pulse and is not breathing in or in cardiac arrest. Cardiac arrest is defined by the AHA (2016) as a malfunction in the heart causing an irregular heartbeat and disruption of blood flow to vital organs.

Clinical nursing staff often provides suboptimal CPR during IHCA due to inadequate skills retention (Maiken, Castren, Nurmi, & Niemi-Murola, 2016; McHugh et al., 2016; Saramma, Raj, Dash, & Sarma, 2016), including a delay in the recognition of clinical deterioration with a resulting delay in the initiation of CPR (Andersen et al., 2019). Staff hesitation in initiating CPR is associated with a perceived low level of confidence in their ability to perform (Makinin et al., 2016). Numerous recent studies have reported similar findings of a connection between the confidence level of the nurse and the nurse’s performance of CPR on a patient (Adcock, Kuszajewski, Dangerfield & Muckeler, 2020; Herbers & Heaser, 2016; Makinen et al., 2016).

High-quality CPR is critical for survival from cardiac arrest. Most providers in hospital settings have infrequent opportunities to perform CPR to maintain a level of proficiency (Panchal, Norton, Gibbons, Buehler, & Kurz, 2020), leading to a hesitancy to initiate CPR (Maiken et al., 2016). Nursing education and training designed for early recognition and management of patient deterioration can improve learner outcomes by using medium to high-fidelity simulation as an educational intervention (Connell et al., 2016). Deliberate practice and integration of teamwork skills in the time-pressured clinical environment provide great realism. They are a precious resource to improve participants' confidence and knowledge and identify latent threats and system issues that compromise patient safety (Greer et al., 2019; Czekajlo & Dabrowska, 2017). Staff not working in critical care areas may not have the needed knowledge, skills and experience in treating critically ill patients. However, they are instrumental in implementing a timely and appropriate intervention to prevent further deterioration and thereby reduce mortality and morbidity, because timely deployment most often depends on staff nurses (Massey, Chaboyer, & Anderson, 2017).

Considering that early interventions could save lives, issues concerning delays in calling the rapid response team to exist. The recognition of physiological observations and response to complex processes involves knowledge and experience, and early intervention and escalation of care are essential (Guinane et al., 2014). Earlier intervention improves patient's survival (Jenkins et al., 2015). According to Massey et al. (2017), an adequate education, appropriate knowledge, and skills are required to aid in the identification of the deteriorating patient and helps provide prompt, timely, and appropriate intervention to prevent further deterioration and possibly death. Additionally, a well-planned education program aimed at making nursing staff thoroughly familiar with the purpose and process of the rapid response team, the development of clear-cut calling criteria, and the involvement of key stakeholders, including nurses, in the design and implementation of the rapid response team can alleviate issues concerning delays of activating the rapid response team (Massey et al., 2017).

The purpose of this quality improvement project is to analyze or evaluate the impact of a novel code blue nurse champion role as cardiac arrest first responder in a medical-surgical unit has on nurses’ self-efficacy and patient IHCA outcomes. The following question guides this quality improvement project: Does the implementation of a code-blue nurse champion role, as cardiac arrest first responder, improve nursing self-efficacy to initiate cardiac resuscitation and survival of IHCA patients when compared to current practice among adult medical surgical patients in a urban acute care hospital in California over four-weeks?

The following clinical questions guide this quantitative project:

Q1: Does educational training consisting of IHI rapid response education, and cardiac arrest in situ simulation for code blue nurse champion nurses’ increase self-efficacy in responding to cardiac arrest?

Q2: Does the implementation of a code blue nurse champion role increase survival of IHCA?

Theoretical Foundations (models and theories to be foundation for the project):

Bandura self-efficacy

Confidence is related to self-efficacy but is a distinct concept. Bandura (1982) defined confidence as “the perception that one is competent and capable of fulfilling particular expectations." In contrast, self-efficacy is the personal judgment of “how well one can execute courses of action required dealing with prospective situations” (p.122). Self-efficacy has been studied extensively in nursing concerning how nursing interventions can influence a patient's behavior to improve health outcomes (Lenz & Shortridge-Baggett, 2002, as cited in Van Dyk et al., 2016). The literature review that follows supports incorporating these sources as an aid in influencing self-efficacy. Education and training have been found to be successful in improving an individual’s perception of confidence in emergency situations (Forouzi, Heidarzadeh, Kazemi, Jahani, & Afeshari, 2016). Nurses’ lack of confidence in their knowledge and level of skill to handle crisis situations can play a role in their ability to intervene (Crowe, Ewart, & Derman, 2018). Modeling and training can be an effective method to demonstrate a behavior and may improve confidence. The ability to observe, practice, and debrief allows nurses to build self-efficacy (Bliss & Aiken, 2018). Providing training to improve self-efficacy can be beneficial for a variety of professionals working in the healthcare arena. In one study, internationally trained nurses who worked in the United States received simulated training to better manage complex cardiac patients. The confidence that these foreign trained nurses had to care for high-risk patients was improved after training (Babenko-Mould & Elliott, 2015). Sergeev et al. (2012) found military physicians and paramedics exhibited more self-confidence when performing procedures after they had practiced on mannequins. This simulated experience was associated with a belief of increased self-efficacy when performing the same procedures in different environments. There is a need for a program that allows nurses to actively engage in training experiences which may aid in improving one’s confidence about those skills.

Transtheoretical Model Stages of Change

The Transtheoretical Model (TTM) focuses on the individual's decision-making and is a model of intentional change. The model posits that health behavior change involves progress through six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change are identified for producing progress, decisional balance, self-efficacy, and temptations (Prochaska & Velicer, 1997). The TTM operates on the assumption that people do not change behaviors quickly and decisively; instead, change in behavior, especially habitual behavior, occurs continuously through a cyclical process (Boston University School of Public Health [BUPH], 2019). The TTM is not a theory but a model; different behavioral theories and constructs can be applied to various stages of the model where they may be most effective. The TTM offers an exemplar for the process of change to guide intervention programs, such as education, feedback, or interpretation. Consciousness-raising involves increased awareness about the causes, consequences, and cures (i.e., interventions, actions) for problem behavior (Prochaska & Velicer, 1997). Interprofessional collaboration, often a cornerstone for cardiac resuscitation teams, has been introduced as a critical factor in providing patient-centered services and improving healthcare (Keshmiri et al., 2017). Keshmiri et al. (2017) sought to evaluate the effectiveness of theory-based interprofessional collaboration education (IPE). Studies performed in the field of IPE have not been based on theory (Reeves et al., 2016 as cited in Keshmiri et al., 2016). The researchers hypothesized that an educational intervention tailored to the learners' (N=91) readiness to change for interprofessional collaboration would lead to an improvement in their interprofessional collaborative performance (Keshmiri et al., 2017).

Review of Literature with Key Organizing Themes and Sub-theme

A. Cardiopulmonary Resuscitation (CPR)

Evidence confirms the strong association between CPR quality and cardiac arrest outcomes (Brennen et al., 2016; Gonzalez et al., 2017; Lim et al., 2016; Lund-Kordahl et al., 2019; Saramma et al., 2016). Furthermore, gaps exist in the current BLS methodology, leading to poor CPR skills (Brennen et al., 2016; Makinen et al., 2016) while research also reports that nurses are delivering inadequate CPR as a result of ineffective CPR skills (Brennan et al., 2016; Halm & Crespo, 2018). Three subthemes emerged from the literature, including CPR knowledge by nurses, CPR performance and delivery by nurses, and confidence in performing CPR.

Subthemes:

a. CPR knowledge by nurses

a. A quantitative, quasi-experimental study was conducted by Rajeswaran, Cox, Moeng, and Tsima (2018) at three hospitals in Botswana. A pre-test, intervention, post-test, and a re-test after six months were utilized to determine the retention of CPR knowledge and skills. Non-probability, convenience sampling techniques were used to select 154 nurses. The study showed markedly deficient CPR knowledge and skills, concluding that poor CPR knowledge and skills among RNs may impede the survival and management of cardiac arrest victims (Rajeswaran et al., 2018).

b. Tsaloukidis et al. (2017) sought to address nurses' perceptions and preferences for how they successfully learn and apply CPR knowledge and skills. This study aimed to determine whether e-learning classes, conventional classroom learning, or a mixed program are preferable to nurses as they learn CPR using an electronic survey. The authors concluded that nurses prefer to be trained by a combination of methods (Tsaloukidis et al., 2017).

c. Dudzik et al. (2019) conducted a mixed-method study to evaluate the implementation of the Resuscitation Quality Improvement (RQI) program (N=164). The RQI program was studied at a single hospital to verify improved competence and confidence of HCPs' CPR techniques through low-dose, high-frequency training. The results suggest the potential of a new training method to create high-quality CPR skill mastery and retention (Dudzik et al., 2019).

d. Massey et al. (2015) performed an integrative review of 17 studies that described or appraised ward nurses' practice in recognizing and responding to patient deterioration. In their review, full-text articles included quantitative (n=6), mixed methods (n=2), and qualitative synthesis (n=9) (Massey et al., 2015). Recognizing patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education; and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes: (1) nontechnical skills; (2) access to support; and (3) negative emotional responses.

b. CPR performance and delivery by nurses

a. The concern remains that nurses are delivering inadequate CPR in clinical settings and identified as preventable harm (Brennan et al., 2016; Halm & Crespo, 2018). Nurses play an integral role in the initiation and delivery of CPR, and consideration of their role as the first responder is critical. Competency demonstration is the cornerstone of assuring high-quality CPR. The primary research questions seek to understand the knowledge and application of CPR principles and skill retention in nursing (Adams et al., 2016; Lin et al., 2018; Niles et al., 2017; Sullivan et al., 2015).

b. Through a cross-sectional review, McHugh et al. (2016) evaluated nursing factors impacting IHCA outcomes (i.e., the relationships between nurse staffing, workplace environment, and IHCA survival outcomes), focusing on hospital-level outcomes. Highlighted were the disparities in IHCA outcomes between hospitals, nurses as a primary feature of IHCA response, and literature related to IHCA failure to rescue. Similar studies found an association between higher nurse staffing practices and positive cardiac arrest outcomes (McHugh et al., 2016; Needleman et al., 2012).

c. Hernandez-Padilla et al. (2015) sought to understand the effects of two different retraining strategies on nursing students’ acquisition and retention of BLS skills. The study examines the impact of two retraining methods on acquisition and retention of BLS and automated external defibrillator (AED) skills among nursing students. The authors hypothesized retraining BLS/AED with student-directed training methods are superior to an instructor-directed training method. In this randomized cluster trial, 177 nursing students from universities in Spain and the United Kingdom (UK) were randomly assigned to an instructor-directed (IDG) or a student-directed (SDG) 4-hour retraining session in BLS/AED. A significant increase was observed between the pre-test and post-test periods in both groups for all variables of interest (p <0.05). Within the post-test period, significantly more SDG students successfully passed their one BLS/AED competency examination relative to the IDG students. IDG students’ skills significantly deteriorated for all but one measure; SDG students only experienced a significant decrease in mean no-flow time (p = 0.02). A significant increase was observed between the pre-test and post-test periods in both groups for all variables of interest (p <0.05). The study showed that training using peer collaboration and peer training was more effective in obtaining and retaining BLS/AED skills than an instructor-directed training method. Future research should further explore how similar student-directed training programs vary (Hernandez-Padilla et al., 2015).

d. Saramma et al. (2016) note that though many studies assess skill retention within one year, few assess longer-term retention (e.g., three to four years). Using a prospective study design, the researchers posed the question, do formal CPR training programs significantly improve knowledge and skill over the long term (Saramma et al., 2016)? Though the formal training program used provided benefits to skill and knowledge, over the long term, the program does not seem to have lasting benefits. At a minimum, annual retraining and recertification are recommended (Saramma et al., 2016). Despite these limitations, the sample size and findings suggest that the study still provides clear and relatively unambiguous findings (Saramma et al., 2016).

c. Confidence in CPR performance

CPR training helps individuals learn and apply cognitive, behavioral, and psychomotor skills then develop the self-efficacy to provide CPR when necessary (Bhanji, Finn et al., 2015; Horowitz, 2018). Many times, nurses lack the confidence to identify a deteriorating patient. When a nurse has self-confidence, recognizing and responding appropriately to an emergency is increased (Horowitz, 2018).

a. Makinen et al. (2016) posit that nurses' primary education has poorly prepared them for CPR and leadership. Despite training, nurses hesitate to begin CPR. Previous studies have demonstrated the healthcare provider's hesitance to initiate CPR. The study's purpose was to evaluate trainers' attitudes towards CPR and defibrillation (CPR-D), current guidelines, and a structured questionnaire for workplace training. . A significant association between scales of Hesitation, Nurses' Role, and Nontechnical Skills are identified. Those confident in their skills as members and leaders of a group (Nurses' Role scale) (p < 0.01) found the guidelines more useful. Those who reported their professional competence was lacking (Restrictions scale) (p < 0.01) scored higher on the scale of Hesitation (p < 0.01) and lowered on scales of Nurses’ Role (p <0.01) and Nontechnical Skills scale (p < 0.01) (Makinen et al., 2016). Findings indicate an association between competence and confidence. Nurses that

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