DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project– Step-By-Step Guide
This guide will demonstrate how to complete the Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
Whether one passes or fails an academic assignment such as the Grand Canyon University NUR 550 Benchmark – Evidence-Based Practice Project: Literature Review depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
The introduction for the Grand Canyon University DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
After the introduction, move into the main part of the DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for DNP 820 Benchmark – DPI Project Milestone: 10 Strategic Points for the Direct Practice Improvement Project
Ten Strategic Points
| The 10 Strategic Points | |
| Title of Project | Title of Project Utilizing preventive care bundle to reduce the incidence of pressure ulcers among elderly and debilitated patients. |
| Background Theoretical Foundation Literature Synthesis Practice Change Recommendation | Background to Chosen Evidence-Based Intervention: List the primary points for six sections. Background of the practice problem/gap at the project site The demand for quality patient care is universal across health care settings. Achieving this goal obligates nurses to identify areas where quality improvement is necessary to improve patient outcomes. Pressure ulcers are a significant health problem since they hamper care quality and safety, extend hospital stays, and increase morbidity and mortality (Darvall et al., 2018; Yap et al., 2021). In response, nurses should address such problems by implementing suitable evidence-based interventions. The current site primarily relies on standard pressure ulcer prevention strategies. Although they are somewhat effective, better interventions are needed to improve health outcomes. Significance of the practice problem/gap at the project site Pressure ulcers are among the common hospital-associated infections. Since they hamper care quality and threaten patient safety, nurses must develop appropriate and sustainable solutions. As change leaders, nurses should guide their workplace settings in implementing quality improvement projects and a similar approach is needed to reduce the incidence of pressure ulcers in the practicum site. As Darvall et al. (2018) noted, preventing pressure ulcers improve patient outcomes by reducing mortality and hospitalization. Similar outcomes will be achieved by implementing the proposed intervention to reduce the gap between the present and the desired health outcomes in the facility. Theoretical Foundations Nursing theories guide health care professionals in delivering patient care and responding to complex situations. Their primary objective is to define what nursing entails. A suitable theory for the current DPI project is Imogene King’s Goal Attainment theory. According to Butts and Rich (2021), health goals under King’s theory are achieved through transactional care. In such a care process, the nurse and patient identify the health problem together, set mutual goals, and develop mechanisms to achieve the goals. A similar approach would facilitate the effective implementation of the pressure ulcers preventive bundle. The change model appropriate for the project is Kurt Lewin’s change theory, which outlines practice change as a methodical process. Lewin described the change process as phased and achieved through three stages: unfreezing, change, and refreezing (Saleem et al., 2019). Unfreezing entails preparing people for change, while the change process entails implementing the intervention. Refreezing is primarily about solidifying the change to make it sustainable (Saleem et al., 2019). Similarly, the implementation site and patients should be prepared for the change. Appropriate mechanisms should also be implemented to solidify the change to achieve long-term benefits. Create an annotated bibliography using the “Preparing Annotated Bibliographies (APA 7th)” located in the Student Success Center. Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 While repositioning patients, health care professionals should optimize turns to achieve better outcomes. In response, Renganathan et al. (2019) assessed the beneficial outcomes of improving turn compliance in patients highly susceptible to pressure ulcers. In this prospective, multiphase, multicenter trial, Renganathan et al. (2019) optimized patient turns using a monitoring system that automated alerts in the intervention group. The primary finding was a lower incidence of pressure ulcers in the intervention group than in the control group (p < 0.001). The article supports the DPI intervention by underlining the importance of patient turns and demonstrating how they can be optimized. Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 In this study, Hassan et al. (2020) assessed the effectiveness of body repositioning in reducing pressure ulcer incidence. Through a quasi-experimental approach, Hassan et al. (2020) subjected all immobilized patients in a public hospital in Pakistan to a 2-hourly repositioning and recorded the incidence of pressure injuries. The main finding was a reduced incidence of pressure injuries after implementing the project. The article supports the DPI intervention by confirming the effectiveness of repositioning in reducing the incidence of pressure ulcers in critical care settings. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Protective dressings are a vital component of a preventive care bundle for pressure ulcers. In response, Hahnel et al. (2020) conducted a randomized controlled trial to evaluate the effectiveness of appropriate dressing in reducing pressure ulcers. In the intervention group, areas susceptible to pressure ulcers such as the sacrum and the heels were covered using protective dressing. Patients in the control group received standard care only. Hahnel et al. (2020) confirmed the effectiveness of protective dressings by finding that pressure ulcers were lower in the intervention group (2.8%) than in the control group (10.5%). The study underlines the importance of protective dressings as a component of a preventive care bundle for reducing pressure ulcers. Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 In this quasi-experimental pre-and-post intervention, Zhang et al. (2021) assessed the effectiveness of a pressure injury care bundle in reducing the incidence of pressure injuries in ICUs. Essential components include skin care, repositioning, and continuous risk assessment. The primary finding was a reduction in pressure injury incidence from 13.86% to 10.41%. These findings confirm the beneficial effects of a preventive care bundle in reducing the incidence of pressure injuries, as conjectured in the DPI intervention. Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 The purpose of this study was to evaluate the effectiveness of preventive dressings. Santamaria et al. (2018) conducted a randomized controlled trial where the intervention group (n= 138) received protective dressings (multi-layer silicone foam) besides standard care applied to the control group. The primary finding was a higher pressure ulcer incidence in the control group than intervention group (p = 0.004). The study supports the DPI intervention by confirming the importance of protective dressing as a protective care bundle component. . Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention Nurses have a professional mandate to improve patient care standards in health care facilities. Practice change through implementing quality improvement projects is instrumental in improving patient care outcomes. Similarly, the preventive care bundle for pressure ulcers will improve care standards in the practicum site by reducing the incidence of pressure ulcers. Therefore, it is an excellent opportunity for producing more desirable health outcomes than the current practices Summary of the findings written in this section. As a significant problem in critical care settings, the incidence of pressure ulcers can be reduced through a preventive care bundle. The annotated research stresses the need for a multicomponent care bundle for reducing the incidence of pressure ulcers in the practicum site. Recommended practices include repositioning, evidence-based skin care routine and protective dressings. Technology can be used to automate alerts to optimize patient turns and compliance during repositioning. The inference is that the care bundle should include different practices, and the explored research confirms such an approach effective in reducing the incidence of pressure ulcers. |
| Problem Statement | Problem Statement: It is not known if the implementation of pressure preventive bundle would impact pressure injury among the elderly and debilitated patients. |
| PICOT to Evidence-Based Question | PICOT Question Converts to Evidence-Based Question: In elderly and debilitated patients, will the implementation of a pressure preventive bundle reduce the incidence of pressure injury within 60 days? Evidence-Based Question: Provide the templated statement. To what extent will the implementation of a pressure preventive bundle reduce the incidence of pressure injury among elderly and debilitated patients in the long-term care facility? |
| Sample Setting Location Inclusion and Exclusion Criteria | Sample, Setting, Location Identify sample, needed sample size, and location (project phenomena with small numbers and variables/groups with large numbers). Sample and Sample Size: The target group is elderly and debilitated patients with pressure ulcers or at risk of their development. It is expected that 50 patients will participate and provide a reasonable sample for the DPI intervention.Setting: The setting for the study is a long-term care facility Location: suburban Maryland CityInclusion Criteria All participants should be of sound mind. Since informed consent is critical in studies involving humans, only the patients willing to participate will be included. Importantly, they should not be participating in another study. Exclusion Criteria Illiterate patients and those not meeting the inclusion criteria described above will be excluded. Besides, patients likely to leave the country during the study will also be excluded. |
| Define Variables | Define Variables:Independent Variable (Intervention): application of preventive care bundle for pressure ulcers (preventive interventions)Dependent Variable (Measurable patient outcome): incidence of pressure ulcers. |
| Project Design | Project Design: This project applies a quality improvement approach. You must be able to explain and cite the difference between research and quality improvement (one paragraph each). Quality Improvement: Quality improvement typifies the continuous strive for better health care processes and outcomes. As a result, health care professionals engaging in quality improvement seek to standardize processes to achieve better health outcomes by reducing variations (CMS.gov, 2021). In health practice, quality improvement is achieved by implementing evidence-based research.Research: Research is primarily about developing new knowledge for practice use. Generally, researchers concentrate on studying and testing phenomena to prove or disprove different hypotheses. The knowledge developed through research is the foundation of evidence-based practice. Clinicians implement such knowledge to improve health outcomes.Summarize: The current project characterizes quality improvement. The initiative seeks to reduce health variations by reducing the incidence of pressure ulcers in the long-term care facility. Findings from previous research will be implemented to improve care quality. |
| Purpose Statement | Purpose Statement: Provide the templated statement. The purpose of this quality improvement project is to determine if the implementation of a Care Bundle Intervention would impact pressure ulcer prevention among elderly and debilitated patients in a long-term-care facility. The project will be piloted over an eight-week period in a suburban Maryland city in a long term care facility. |
| Data Collection Approach | Data Collection Approach:Vital patients’ demographics like age, education level, and gender will be collected. Patients’ understanding of the pressure care bundle will also be assessed.Baseline data on the incidence of pressure ulcers in the facility will be obtained from the electronic health records (EHRs).Pre- and post-intervention data related to the incidence of pressure ulcers will be collected.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.Record the subjects’ vital demographics such as age and genderRetrieve baseline information from the electronic health recordsMeasure pre- and post-intervention incidence to compare outcomesMake the necessary inferences from the findings: a reduction of the pressure ulcers incidence by over 50% will be considered statistically significantSecure data from unauthorized access Potential ethical issues involving human subjects include their protection, informed consent to promote voluntary participation, and data privacy will be observed. All data will be treated as confidential and used primarily for the DPI intervention’s purposes.The project must adhere to ethical principles of beneficence, non-maleficence (no harm), and autonomy. It is designed to benefit the patients by improving health outcomes and presents no harm whatsoever. Human subjects will also be allowed to make independent decisions to avoid biased results. |
| Data Analysis Approach | Data Analysis Approach: Data will be analyzed through comparative data analysis. The difference between the incidence of pressure ulcers before and after the project implementation will be used to compute the percentage difference. Statistically significant outcome: a reduction of pressure ulcer incidence by 0.5 (50%) Clinically significant outcome- value above 10% reduction in pressure ulcer incidence. |
| References | CMS.gov. (2021). Quality measurement and quality improvement. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations. Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning. Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 Saleem, S., Sehar, S., Afzal, M., Jamil, A., & Gilani, S. A. (2019). Accreditation: Application of Kurt Lewin’s Theory on Private Health Care Organizationanl Change. Saudi Journal of Nursing and Health Care, 2(12), 412-415. doi: 10.36348/sjnhc.2019.v02i12.003 Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309-315. https://doi.org/10.1177/1751143718804682 Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891 Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 |
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Literature Evaluation Table – DPI Intervention
Learner Name
Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed.
PICOT-D Question: For elderly and debilitated patients [P], will the implementation of a pressure preventive bundle [I], compared to routine pressure injury care [C], reduce the incidence of pressure injury [O], within 60 days? [T].
Table 1: Primary Quantitative Research – Intervention (5 Articles)
APA Reference (Include the GCU permalink or working link used to access the article.) | Research Questions/ Hypothesis, and Purpose/Aim of Study | Type of Primary Research Design | Research Methodology
| Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) | Outcomes/ (Succinctly states all study results applicable to the DPI Project.) | Limitations of Study and Biases | Recommendations for Future Research
| Explanation of How the Article Supports Your Proposed Intervention |
Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784. | Hypothesis: changing from 5-hourly to 3-hourly turns will reduce pressure injury incidence in critically ill patients. Aim of the study: to determine the impact of changing from 5-hourly to 3-hourly turns on pressure injury incidence in critically ill patients. | A pre-post intervention evaluation study | Setting/sample: the study was conducted in an intensive care unit at the Royal Melbourne Hospital, Australia. All patients admitted during pre-intervention (1094) and post-intervention (1165) were included in the study. Methods: patient turns were conducted by the nursing staff and clinical assistants amid other interventions for reducing pressure injury incidences, such as regular skin checks, dressings, and risk assessment. Random turn audits and chart reviews were conducted monthly. Similar instruments can be applied to the DPI project. Data collection: pressure injury data were derived from the reporting database. | The incidence of decubitus injuries was markedly reduced in the post-intervention period (p < 0.001). | A change in turn frequency from 5-hourly turns to 3-hourly turns halved pressure injury incidence. As a result, older adults and critically ill patients can benefit from frequent turns. | Darvall et al. (2018) evaluated the potential detrimental effects of increased turning on patients. As a result, the findings are skewed to the positive impacts. | Researchers recommend a future studies through a prospective, multi-center trial. Future studies should also be randomized to reduce systematic errors. | The single-center study affirmed the positive impacts of repositioning to reduce pressure injury incidence, which is a core component of the DPI project’s care bundle. |
Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19. https://doi.org/10.1016/j.ijnurstu.2017.12.012
| Hypothesis; improving turning compliance with wearable sensors provides a high protective effect against developing pressure injuries. Aim of the study: assessing the effectiveness of a wearable patient sensor in improving total time with turning compliance and pressure injuries prevention in acutely ill patients. | Randomized controlled trial. | Setting/sample: the study was conducted on 1564 patients in a two ICUs in a large academic medical center in California. Among the 1564, 1312 underwent randomization. Methods: patients in the intervention group (n =659) received optimized turning practices, influenced by real-time data from wearable patient sensors while the control group (n = 653) received turning care relying on traditional turn reminders. The DPI project can use similar instruments to optimize turning during repositioning. Data collection: the wearable patient sensors relayed data to a secure SQL database every ten seconds. Position changes were then calculated to determine the degree of position change. | The primary finding relevant to the DPI project was that the intervention group had fewer pressure injuries than the control group (p =0.031) | The study demonstrates that optimizing turning compliance can reduce the incidence of pressure injuries in health care settings. | Pickham et al. (2018) highlighted that the study was not immune to the threats of internal validity due to confounding variables. Selection bias was also possible since the researchers randomized clusters instead of individuals. | A similar study in the future that randomizes individuals instead of clusters is crucial. | The study demonstrates the link between optimizing patient turns and reducing pressure injuries. The DPI project seeks to use interventions that optimize turns to reduce pressure ulcers among the elderly and debilitated patients. |
Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 | Hypothesis: dressing pressure ulcer predilection areas will significantly reduce the incidence of pressure ulcers in patients in ICUs. Aim of the study: to determine whether applying preventive dressings on pressure ulcer predilection areas, besides standard prevention, reduces the incidence of pressure ulcers in patients in ICUs. | A randomized, controlled | Setting/sample: the study was conducted on 475 patients in a tertiary care hospital in Berlin, Germany. Methods: besides standard prevention, patients in the intervention group (n = 212) had preventive dressings applied to the sacrum and heels. The dressings were renewed every 3 days and the susceptible area checked. A similar approach can be used in the DPI project, but the frequency will be different. Data collection: the risk for pressure ulcers was measured according to the hospital standard and the Braden scale. A 1-h skin inspection and pressure injury classification instruction was also used. | The cumulative pressure ulcer incidence was 2.8% in the intervention group compared to 10.5% in the control group (p =0.001). | The results affirm that preventive dressings, besides standard prevention, effectively reduce pressure ulcers on predilection (sacrum and heels) areas. | The study was associated performance and detection bias since the participants were not blinded to the study procedures and randomized allocation. A selection bias was also reported. | Future studies where participants are blinded will reduce the reported bias. | The study found preventive dressings effective in reducing the incidence of pressure injuries. Preventive dressing is among the DPI project preventive bundle’s components. |
Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1 | Hypothesis: the effectiveness of repositioning significantly varies with the intervals. Aim of the study: to determine the clinical effectiveness of three repositioning intervals (2, 3, and 4-hours) in adult nursing home residents. | A pragmatic cluster randomized controlled trial. | Setting/sample: the study was conducted in 9 nursing homes from a large proprietary system in 34 states in the U.S. 992 residents from the 9 centers participated in the study. Methods: The study was classified into three arms: each arm contained three nursing homes assigned single repositioning interval as standard care during the 4-week period. A wireless patient monitoring system notified the nursing staff by displaying residents’ repositioning need. The DPI project will not apply similar instruments due to cost implications. Data collection: the patient monitoring system was used to track events. Data were further recorded via electronic health records and the nursing homes’ risk management system for pre-post analysis. | Pressure injury during the intervention was 0.0% and 5.24% in Baseline (p =0.001). Repositioning compliance is better in 4-hour repositioning (95%) than 3-hour repositioning (90%) and 2-hour repositioning (85%). | The study confirms the effectiveness of repositioning in reducing pressure injuries. | Cluster trials in settings without extensive preliminary analyses have a large degree of uncertainty. Selection bias: the study excluded nursing homes with severe pressure injury risk. | Yap et al. (2021) recommended additional research to identify specific race and risk differences factors in pressure injury incidence. | The study explored the effectiveness of repositioning intervals, an essential component of the DPI project’s preventive bundle. |
Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621 | Hypothesis: residents in aged care facilities randomized into the intervention group using multi-layer silicone foam dressings will have a lower incidence of pressure injury development that those in the control group. Aim of the study: to determine the clinical effectiveness of multi-layer silicone foam dressings in preventing sacral and heel pressure injury development in high-risk residential aged care patients. | A randomized controlled trial | Setting/sample: the study was conducted in 40 residential aged care facilities in Australia. A total of 288 residents were enrolled in the study. Methods: residents randomized to the intervention group (n =138) had dressings applied to susceptible areas such as sacrum and heels besides receiving standard pressure injury prevention care. Residents in the control group (n =150) only received pressure injury care as recommended by international guidelines. Researchers used clinical records for data collection and analysis, and a similar approach can be used in the DPI project. Data collection: data were collected daily for both groups, and included skin assessment on the sacrum and heels for pressure injury development. Other essential information included mobility status, continence status, and injury risk score. | Pressure injuries’ incidence was higher in the control group than in the intervention group (p = 0.004) | Appropriate dressing can reduce the risk of developing pressure ulcers in older adults. The use of silicone sacrum and heel dressing offers a protective benefit to high-risk patients such as the elderly. | Santamaria et al. (2018) did not blind both the subjects and the assessor to the presence or absence of the intervention. The study also included individuals with impaired cognitive function and may have introduced a potentially unknown bias to the study. | Further research is recommended to ascertain whether aging-related tissue changes are the cause of a higher incidence of sacral pressure injuries in aged care residents compared to acute patients. | Skin care through appropriate dressing is a core component of pressure ulcers preventive bundle. The article confirms its effectiveness by demonstrating a significant difference between the intervention and control groups. |
Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)
APA Reference (Include the GCU permalink or working link used to access the article.) | Research Questions/ Hypothesis, and Purpose/Aim of Study | Type of Primary or Secondary Research Design | Research Methodology
| Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) | Outcomes/ (Succinctly states all study results applicable to the DPI Project.) | Limitations of Study and Biases | Recommendations for Future Research
| Explanation of How the Article Supports Your Proposed DPI Project |
Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579 | Hypothesis: implementing a pressure injury care bundle based on the best evidence will reduce pressure injury incidence in intensive care units significantly. The study assessed the effectiveness of pressure injury care bundle in preventing the development of pressure injuries in intensive care units and to identify how nurses’ compliance rates changed during the implementation process. | A quasi-experimental pre- and post-intervention design. | Setting/sample: the study was conducted in all critical care units in hospitals from 26 provinces in China. All adult patients admitted in the ICUs during the study were included. Methods: the researchers designed a care bundle checklist to analyze implementation and compliance. A checklist can be used in the DPI project. Data collection: the unit staff collected the number and stage of pressure injuries at three time points. A compliance checklist was used to measure the implementation compliance rate at two time points. | Implementing the pressure injury care bundle reduced pressure injury rates from 13.86% to 10.41% and the compliance increased from 55.15% to 60.15% after the care bundle implementation (p =0.00) | A standard care bundle based on the best evidence can reduce the incidence of pressure injuries significantly. The bundle’s key elements were pressure-reducing device, patient repositioning, skin care, ad risk identification. | The before and after study design was susceptible to time changes. Besides, researchers did not collect all participants’ demographic characteristics; thus, they could not analyze how different demographic characteristics impacted the interventions on patients. | Future research should explore how pressure injury prevention interventions affect patients with different characteristics such as age, gender, and disease severity. | The article confirms the effectiveness of preventive care bundle in reducing the incidence of pressure injuries. The DPI project compares the effectiveness of a preventive bundle with routine pressure injury care. |
Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543 | Hypothesis: body repositioning will reduce pressure ulcer incidence in patients admitted in intensive care units. Aim of the study: assessing the effect of body repositioning in immobilized patients to prevent pressure ulcers. | A quasi-experimental with non-equivalent control group design | Setting/sample: the study was conducted in intensive care units of neurosurgery department at a public hospital in Pakistan. All immobilized patients admitted in the ICU were enrolled in the study. Methods: the research instrument had three segments: socio-demographic data, Braden risk assessment scale, and repositioning of immobilized patients. At-risk patients were repositioned 2 hourly and the repositioning schedule attached at the bedside. A risk assessment scale will be used in the DPI project to evaluate the risk of pressure ulcers. Data collection: nurses filled the Braden risk assessment form with the help of the researcher and kept it in the nursing file. | There was a major difference between the interventional and control group mean of body repositioning. p = 0.000 (less than 0.001) showed a significant difference. | Repositioning (2-hour) patients can reduce the incidence of pressure ulcers among debilitated patients. | The sample proportion was small and from a particular confined group. Thus, the results cannot be comprehensive to the broader population. | Future research on repositioning is needed but should recruit a larger sample from a broader population to ensure that the results are generalizable. | The article confirms the effectiveness of repositioning, which is among the components of the DPI preventive bundle. |
Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial. BMC Complementary and Alternative Medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2 | Hypothesis: an evidence-based skin care routine can reduce pressure ulcers among orthopedic patients. Aim of the study: to investigate the effectiveness of Aloe Vera gel in preventing pressure ulcers in patients admitted in the orthopedic ward. | A randomized, triple-blind clinical trial. | Setting/sample: the study was conducted on 80 purposefully selected patients in an orthopedic ward in Arak town, Iran. Methods: in the intervention group, nurses rubbed pure Aloe Vera gel on the patients’ hips, sacrum, and heels while water gel and starch were used in the control group. A similar skin care routine will be applied in the DPI project but not necessarily with Aloe Vera gel. Data collection: signs of pressure ulcers on the sacral, hips, and heels were evaluated on days 3, 7, and 10. | Data analysis showed a significant difference in the incidence of pressure ulcers between the groups (p =0.047). Twelve pressure ulcer cases were recorded in the control group while only three were reported in the intervention group. | The statistical difference implied that Aloe Vera gel prevented the occurrence of pressure ulcers in the intervention group. | The sample was limited. | Researchers recommended future studies with more samples. | The study confirmed the effectiveness of skin care, which is among the components of the DPI preventive bundle. |
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Table 3: Theoretical Framework Aligning to DPI Project
Nursing Theory Selected | APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) | Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project |
Imogene King’s goal attainment theory | King, I. M. (1994). Quality of life and goal attainment. Nursing Science Quarterly, 7(1), 29-32. https://doi.org/10.1177/089431849400700110 King, I. M. (1999). A theory of goal attainment: Philosophical and ethical implications. Nursing Science Quarterly, 12(4), 292-296. https://doi.org/10.1177/08943189922107205
| Nursing theories are organized bodies of knowledge that help nurses to explain nursing phenomena. Broadly, they define what nursing entails and why nurses should do it. Imogene King’s theory of goal attainment fits the DPI project. Its fundamental principles will be used to guide the implementation process. King’s theory is established on the principle that the care process is transactional and that the nurse’s role is to help patients maintain their health (King, 1999). For better outcomes, patients should understand the care process and be actively involved in decision-making as care partners. In the DPI project, the nurse and the patient will identify the problem together, set mutual goals, and develop mechanisms to achieve the goals, as King’s goal theory recommends. The nurse and patient’s goals and functions should align with each other (King, 1994). A similar approach will be used to implement the DPI project’s preventive bundle. The nurse will ensure that patients understand the importance of the preventive bundle, targeted outcomes, and patients’ roles in every step of the process. |
Change Theory Selected | APA Reference – Seminal Research References (Include the GCU permalink or working link used to access each article.) | Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention |
Kurt Lewin’s change theory | Burnes, B. (2004). Kurt Lewin and the planned approach to change: A re‐appraisal. Journal of Management studies, 41(6), 977-1002. https://doi.org/10.1111/j.1467-6486.2004.00463.x Lorenzi, N. M., & Riley, R. T. (2000). Managing change: An overview. Journal of the American Medical Informatics Association, 7(2), 116-124. https://doi.org/10.1136/jamia.2000.0070116
| Change theories describe how to introduce positive change in patient care. They are established on the principle that change is intrusive and requires methodical implementation. Due to the complexity and sensitivity of patient care, nurses should introduce change systematically while developing effective strategies to cope with possible resistance (Hussain et al., 2018). Kurt Lewin’s change theory outlines change implementation steps that fit the proposed DPI intervention. Lewin’s theory suggests that individuals and groups are influenced by restraining and driving forces that push change in different directions. Restraining forces aim at maintaining the status quo while the driving forces push change in the direction that causes it to happen (Lorenzi & Riley, 2000). Lewin further underlined that change occurs in three phases: unfreezing, change, and refreezing. The freezing phase involves preparing for change, while the change step involves implementing the desired change (Burnes, 2004). Refreezing involves solidifying the implemented change to make it sustainable. Unfreezing is necessary for the DPI project since the organization’s management, patients, and all stakeholders should be prepared for the changes realized through the preventive bundle. As a result, they should understand its benefits and worries addressed to reduce resistance. The change phase will involve implementing the preventive pressure bundle to reduce the incidence of pressure ulcers among the elderly and debilitated patients in the long-term facility. The last step, refreezing, will involve several measures to sustain the change. Such measures include continuous evaluation of outcomes, progressive support from the management, and dissemination of results to enable other nurses to implement the preventive bundle in the future. |
Table 4: Clinical Practice Guidelines (If applicable to your project/practice)
APA Reference – (Include the GCU permalink or working link used to access the article.) | APA Reference – (Include the GCU permalink or working link used to access the article.) | Explanation for How Clinical Practice Guidelines Align to DPI Project |
N/A | Place the primary quantitative research used in the clinical practice guidelines in Table 1. This is part of the primary quantitative research used to support your intervention. | N/A |
References
Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784.
Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621
Hassan, N., & Afzal, M., Sehar, S., & Gilani, S. A. (2020). Effects of body repositioning in immobilized patients to prevent pressure ulcer in intensive care units at public hospital, Pakistan. Iris Journal of Nursing & Care- IJNC, 2(4), 2020. http://dx.doi.org/10.33552/IJNC.2020.02.000543
Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial. BMC Complementary and Alternative Medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2
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
Joseph, S. S., George, R. A., Jose, R., & Sebastian, B (2021). Application of a nursing care protocol based on King’s Theory of Goal Attainment: A pre-experimental study. PJMHS, 15(12), 3481-3484. https://doi.org/10.53350/pjmhs2115123481
King, I. M. (1994). Quality of life and goal attainment. Nursing Science Quarterly, 7(1), 29-32. https://doi.org/10.1177/089431849400700110
King, I. M. (1999). A theory of goal attainment: Philosophical and ethical implications. Nursing Science Quarterly, 12(4), 292-296. https://doi.org/10.1177/08943189922107205
Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12-19. https://doi.org/10.1016/j.ijnurstu.2017.12.012
Santamaria, N., Gerdtz, M., Kapp, S., Wilson, L., & Gefen, A. (2018). A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. International Wound Journal, 15(3), 482–490. https://doi.org/10.1111/iwj.12891
Yap, T. L., Horn, S. D., Sharkey, P. D., Zheng, T., Bergstrom, N., Colon-Emeric, C., … & Kennerly, S. M. (2021). Effect of varying repositioning frequency on prevention of pressure injuries in nursing home residents: TEAM‐UP cluster‐randomized clinical trial results. Research Square, 1-21. https://doi.org/10.21203/rs.3.rs-717425/v1
Zhang, X., Wu, Z., Zhao, B., Zhang, Q., & Li, Z. (2021). Implementing a pressure injury care bundle in Chinese intensive care units. Risk Management and Healthcare Policy, 14, 2435–2442. https://doi.org/10.2147/RMHP.S292579