DNP-835 Quality and Sustainability Paper: Part 2

Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 2  – Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 2  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-835 Quality and Sustainability Paper: Part 2          

Whether one passes or fails an academic assignment such as the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 2  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-835 Quality and Sustainability Paper: Part 2          

The introduction for the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 2    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.

How to Write the Body for DNP-835 Quality and Sustainability Paper: Part 2          

After the introduction, move into the main part of the DNP-835 Quality and Sustainability Paper: Part 2     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-835 Quality and Sustainability Paper: Part 2          

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-835 Quality and Sustainability Paper: Part 2          

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-835 Quality and Sustainability Paper: Part 2

Improved and better patient care outcomes entail the major focus of healthcare sectors and nurses. As such, nurses engage in various activities which enhance patient outcomes by improving patient care services and ensuring patient safety in the patient care environment. However, various events in hospitals and other patient care environments threaten patient safety hence the potential for patient harm (Lawati et al.,2018). As such, quality improvement and patient safety programs are used to solve such problems and improve outcomes. In the previous weeks, a healthcare entity/issue was identified and explored. In addition, a suitable solution was identified. Therefore, the purpose of this assignment is to determine the requirements for promoting a successful implementation and sustainability of the quality program.

Evaluation of The Current Evidence-Based Quality Program Designs That Can Be Implemented to Improve the Quality Outcomes

The identified quality or safety issue in the organization of choice is catheter-associated urinary tract infections (CAUTI).  CAUTIs form part of the nosocomial infections in healthcare settings which have been associated with various adverse impacts, such as enhanced rates of mortality and morbidity in the US. The majority of urinary tract infections are related to catheter use which further increases in case of prolonged use of urinary catheters. CAUTIs have been connected with higher healthcare costs and prolonged hospitalizations, hence a need to control them (Russell & Watters, 2019).

The adverse outcomes of CAUTI have led to sustained research on finding strategies that can be implemented to improve quality. One of the current EBP-based strategies is the use of nurse-driven protocols for removing indwelling urinary catheters. Such interventions involve data collection regarding catheter use, which then informs the nurses to immediately remove the urinary catheters when they are no longer needed by the patients (Zurmehly, 2018). A related intervention is the use of a hospital-wide policy on indwelling urinary catheter insertion can care. Such policies require that the nurses get trained as appropriate on how to insert the catheters appropriately and how to care for the patients when they use the indwelling catheters. The other aspect is the use of external catheters, which catheters to minimize the chances of infections. One of the most current and common strategies is the use of a CAUTI care bundle (Fritsch et al.,2019). Such care bundles contain a collection of activities geared towards reducing the rates of CAUTI. For example, a bundle may consist of using the right and recommended catheter insertion techniques, prompt removal of catheters when not needed, removal techniques, appropriate use of drainage system, and staff education, among others.

From the evaluation of the current EBP strategies, the proposed strategy for the quality improvement project is the use of the CAUTI bundle. Recent research has shown that the use of a CAUTI bundle care has a greater impact as compared to the use of a single intervention approach. Currently, the facility is using a bundle care approach with three major activities including a catheter removal protocol, an electronic checklist, and staff education. However, such an approach can be enhanced by including more activities in the care bundle. Therefore, a 5-Step care bundle is proposed. This 5-Step bundle includes various activities such as consistent staff education, the stabilization of the bladder catheter, offering patient and caregiver education, and ensuring that the collection bag is kept below the bladder and above the flow. The other activity is conducting a daily evaluation for discontinuation (Elkbuli et al.,2018).

The proposed 5-Step care bundles include more activities or action items to be used in ensuring that CAUTI rates are reduced. In place of the current three items or activities carried out in the facility, the new proposal will see an implementation of a five-step care bundle to help improve the care outcomes (Elkbuli et al.,2018). The implication is that the proposed intervention is likely to have a greater impact on CAUTI-related patient outcomes as compared to the current intervention. The nurses will be at the center stage of the intervention since they offer primary or basic care to patients who use indwelling urinary catheters.

Potential Obstacles and Ways to Overcome Them

Implementation of the proposed solution is envisioned to take the form of change efforts. Therefore, it is expected that various obstacles may exist. As such, there is a need to timeously come up with potential solutions which can be used to ensure that such obstacles are overcome. One of the expected obstacles is resistance to the proposed change (Mathieson et al.,2019). As earlier indicated, the change involves implementing the use of a five-step bundle involving additional care activities. Therefore, there is a possibility of nursing staff resisting the change for fear of having to follow increased protocols. Such a fear is understandable and the nurses should be involved in coming up with appropriate interventions. One way of overcoming such an obstacle is engaging the nurses from the onset of the program and assuring them that supporting mechanisms will be put in place to help them adapt to the demands of the new intervention.

Another potential barrier is financial constraints. The implementation of the five-step bundle may require additional financial resources, which have to be procured before implementation. In a case scenario where the financial resources are limited, then the success of the project may be compromised. The next potential barrier is the lack of sufficient support from the organization’s leaders (Mathieson et al.,2019). The success of the project heavily hinges on appropriate support from the organization’s leaders. However, a lack of support may be detrimental to the project’s success. This challenge can be overcome by aligning the project’s objectives with the organization’s vision and mission. Such a step will make the leaders have more interest in the proposed project hence better chances of success.

The Stakeholders For Collaboration

Stakeholders form an important part of a project and therefore, they should be identified in time, and if possible, meetings are conducted together with them. In addition, such meetings can also be used to assign roles and responsibilities (Dang et al.,2021). One of the stakeholders considered for the project and collaboration is the nurses offering care to the patients using indwelling urinary catheters. Nurses are at the forefront of catheterization and the removal of indwelling urinary catheters when they are no longer in use. As such, as part of the identified stakeholders, the nurses will be responsible for implementing the proposed change. The implication is that they will be at the center stage of the implementation of the five-step CAUTI care bundle.

 There are various leaders among nurses as part of the stakeholders. Among them are the nurse leaders who will be responsible for coordinating the implementation of the program and acting as a link between other staff members and the organization’s leaders (Dang et al.,2021). The unit leaders are also regarded as part of the nurse leaders as they will be responsible for availing the resources needed for implementing the project in every unit.

The other group of stakeholders is the physicians. Physicians are responsible for the treatment of various patients using indwelling urinary catheters. It will be key to collaborate with them since they are the ones who usually recommend the use of indwelling catheters and when to remove them (Dang et al.,2021). Collaboration with them will enhance nurses’ ability to identify when a patient needs to use indwelling catheters and when a patient doesn’t need any. In addition, such a collaboration will also be key to enhancing nurses’ knowledge regarding when to remove the indwelling urinary catheters, especially when the patient no longer needs the catheter. Minimization of the use of indwelling urinary catheters is part of the 5-step bundle hence it will help in reducing the incidences of CAUTI, which is one of the major aims.

The other group of stakeholders is the patients and their family members. Patients admitted to the facility for treatment and using indwelling urinary catheters. These are individuals who will receive the benefits of the program since the use of a five-step bundle will ensure that there is appropriate bundle care such as prompt removal and appropriate insertion of the catheter. The patient family members also form part of the stakeholders as they also stand to benefit (Dang et al.,2021). They are likely to spend fewer funds on the patients as incidences such as prolonged hospital stays will be reduced.

The Change Management Theory to be Used In the Implementation of the Program

Implementation of quality/safety improvement or evidence-based practice projects requires carefully formulated plans to accomplish. It is important to note that the implementation of such programs usually involves a change process. Implementing a change process or a change program requires the use of appropriate strategies since human beings are prone to resisting change since, in most cases, people prefer that things remain the way they are (Hussain et al.,2018). Therefore, for such a project to succeed, the change should appropriately be managed using change theories. Change theories offer frameworks upon which change efforts can be based and implemented. Using various theories, change can be implemented successfully by ensuring that all the stakeholders are part of the change and that they are supporting the change.

The proposed change management theory to be implemented for this project is Lewin’s change theory. This theory has widely been applied in various sectors such as healthcare to implement and manage various change initiatives. According to Lewin, change takes place in three stages or phases. The phases include unfreezing, change, and refreezing. While the phases may overlap with each other, each phase has distinct activities associated with it. According to this theory, there are forces that impact change, the driving force and restraining force (Hussain et al.,2018). While the driving force supports and enhances change, restraining forces are those forces that prevent change from taking place. As such, a change can only happen when the driving forces overcome the restraining forces.

Also Read:

DNP 835 Sustainability Worksheet 

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DNP 835 Sustainability Plan Presentation 

DNP-835 Summary of Current Course Content Knowledge

DNP 835 Topic 8 Reflective Journal 

DNP 835 DNP Reflective Journal

DNP 835 Patient Outcomes and Sustainable Change Syllabus

The unfreezing phase entails letting the stakeholders know the need to undertake a change initiative. At this stage, the change implementers create an urgent need for change implementation by letting the stakeholders know the impact of an identified problem and how it is impacting patient outcomes (Hussain et al.,2018). Therefore, the stakeholders will be informed of the need to reduce the CAUTI rates by using statistics showing the upward trends in the rates of CAUTI. Communication is key in this phase as all the stakeholders should be informed of the importance and the potential benefits of implementing the five-step bundle to control and reduce the rates of CAUTI. It is also important to create awareness and motivate individuals to be part of the change process.

The second phase is the change phase. It commences when individuals have been convinced that a change is necessary and they are ready to move (Crosby, 2020). Therefore, at this stage, the proposed intervention is implemented; in the case of this project, the five-stage CAUTI care bundle is implemented in the patient care setting to help improve patient outcomes. Since individuals may struggle with the new reality, it is important that communication remains strong. Individuals also learn new ways of thinking, processes, and new behaviors. In this project, the nursing staff will also be trained on the use of the proposed five-step CAUTI care bundle so that they become more familiar with the impending change. It is important to note that constant communication and explanation of the reasons behind making the change are key. The stakeholders are also reminded of the potential benefits of the CAUTI care bundle once the whole project has been implemented.

The last phase of change is the refreezing stage. This is the final stage of change management and is characterized by stabilizing, reinforcing, and solidifying the implemented change. The implication is that the implemented change forms part of the organization’s culture, structure, goals, and processes (Crosby, 2020). This phase is key since it is used to ensure that the staff does not revert to the old ways of doing things and ways of thinking. This phase is also characterized by acknowledging and rewarding individualized efforts made toward reinforcing the implemented change. The implemented change of the five-step CAUTI care bundle will form part of the organization’s culture and it will be used as daily care for patients who use the indwelling urinary catheters.

The Expected Outcomes and Ways of Sustaining the Expected Outcomes

As earlier highlighted, the facility has been observing an upsurge of CAUTIs hence poorer patient outcomes. As such, the use of five stages CAUTI care bundle has been proposed to help reduce the rates of CAUTI and prevent the potential occurrence of new cases (Davies et al.,2018). Therefore, it is important to identify potential outcomes and ways of sustaining the expected outcomes. One of the expected outcomes is reduced rates of CAUTI. It is expected that upon the implementation of the proposed five-step CAUTI care bundle, the organization will experience a 50% reduction in the rates of CAUTI and ensure that patients have improved outcomes.

The next expected projected outcome is the increased knowledge and efficiency of using the five-step CAUTI bundle among the nurses caring for the patient using the indwelling urinary catheters. As part of the project, the nurses are to be trained on how to use the proposed bundle (Davies et al.,2018). Such will be accomplished through an education session involving every staff member participating in offering care for patients using indwelling urinary catheters. It is expected that the nurses will have improved knowledge regarding when to use the indwelling catheters and when to remove them so that patients do not get an infection.

It is also expected that the organization will adopt the new intervention and use it as an organization-wide strategy to help reduce the rates of CAUTI cases and improve patient outcomes. The project’s results will be used to inform the organization of the next step. For example, if the results are found to be positive, then the organization will adopt the five-step CAUTI care bundle as a new patient care strategy in the organization. It is important to ensure the sustainability of the project outcomes (Davies et al.,2018). Therefore, there is a need to use effective strategies. One of the strategies is evaluation and monitoring to ensure that the nurses are following the laid down protocols and guidelines for the care bundle. Frequent staff training will be used to ensure that the staff is up to date with the current methods of CAUTI prevention.

Conclusion

Quality improvement projects are important and can be used in improving patient outcomes. Therefore, it is important to formulate an appropriate quality improvement initiative depending on the identified clinical problem. The identified problem in this project is catheter-associated urinary tract infections which have been shown to negatively impact patient outcomes. Even though the organization has been trying various strategies to reduce the rates of infection, such rates are still high. As such, the use of a five-step CAUTI care bundle has been proposed. It is expected that upon the implementation of the CAUTI care bundle, the rates of CAUTI in the organization will reduce substantially.

References

Crosby, G. (2020). Planned change: Why Kurt Lewin’s social science is still best practice for business results, change management, and human progress. Productivity Press.

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.

Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., … & Brown, C. V. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758-763. https://doi.org/10.1016/j.ajic.2017.11.032

Elkbuli, A., Miller, A., Boneva, D., Puyana, S., Bernal, E., Hai, S., & McKenney, M. (2018). Targeting catheter-associated urinary tract infections in a trauma population: a 5-S bundle preventive approach. Journal of Trauma Nursing| JTN, 25(6), 366-373. Doi: 10.1097/JTN.0000000000000403

Fritsch, P. F., Sutton, J., Roche, E., Berberi, V., Whidden, E., & Holder, C. (2019). Reinforcing a catheter-associated urinary tract infection (CAUTI) bundle compliance decreases overall catheter days and CAUTIs. American Journal of Infection Control, 47(6), S22. https://doi.org/10.1016/j.ajic.2019.04.035

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.

Lawati, M. H. A., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: a systematic review. BMC Family Practice, 19(1), 1-12. https://doi.org/10.1186/s12875-018-0793-7

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20, e6. Doi: 10.1017/S1463423618000488

Russell, J. A., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics, 54(1), 81-96. https://doi.org/10.1016/j.cnur.2018.11.001

Zurmehly, J. (2018). Implementing a nurse-driven protocol to reduce catheter-associated urinary tract infections in a long-term acute care hospital. The Journal of Continuing Education in Nursing, 49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08

DNP 835 Sustainability Worksheet Sample

Sustainability Plan Worksheet 

An improvement team needs to consider the long-term sustainability of an improvement effort. This worksheet will help you outline the elements needed for a sustainability plan for your proposed evidenced-based quality and/or safety program design by taking you through a series of questions. By answering these questions, you will be able to develop a plan to ensure the longevity of the expected improvements from your proposed quality and/or safety program stick long-term. 

For each category, use the questions provided to help you draft the necessary components that will be needed in a sustainability plan. Use one or two concise sentences to inform on each bullet point/question. Provide scholarly and peer-reviewed support accordingly.  

Adapted from “Sustainability Planning Worksheet” by the Institute for Healthcare Improvement (2019). 

 References

Carrigan, T. M., & Livesay, S. (2018). Mapping a Strategy for Success: A Case Study in Nursing Engagement as a Strategic Imperative at a Comprehensive Stroke Center. Nurse Leader, 16(2), 112-117. https://doi.org/10.1016/j.mnl.2017.12.010 

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 

Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: a feasibility study. Health & Social Care In the Community, 27(4), e417-e427. https://doi.org/10.1111/hsc.12742 

McShane, B. B., Gal, D., Gelman, A., Robert, C., & Tackett, J. L. (2019). Abandon statistical significance. The American Statistician, 73(sup1), 235-245. https://doi.org/10.1080/00031305.2018.1527253 

Palinkas, L. A., Garcia, A., Aarons, G., Finno-Velasquez, M., Fuentes, D., Holloway, I., & Chamberlain, P. (2018). Measuring collaboration and communication to increase implementation of evidence-based practices: the cultural exchange inventory. Evidence & Policy, 14(1), 35-61. https://doi.org/10.1332/174426417X15034893021530 

Tucker, S. J., & Gallagher-Ford, L. (2019). EBP 2.0: From strategy to implementation. AJN The American Journal of Nursing, 119(4), 50-52. 10.1097/01.NAJ.0000554549.01028.af