Capstone discussion 6

please respond to the main discussion DQ1 and DQ2 with reference and also respond to the peer discussions


After discussion with your mentor, name one financial aspect, one
quality aspect, and one clinical aspect that need to be taken into
account for developing the evidence-based practice project. Explain
how your proposal will directly and indirectly impact each of the aspects.


Now that you have completed a series of assignments that have led you
into the active project planning and development stage for your
project, briefly describe your proposed solution to address the
problem, issue, suggestion, initiative, or educational need and how it
has changed since you first envisioned it. What led to your current
perspective and direction?

Peer DQ1

As per conversation with my mentor, one financial aspect that needs to
be taken into account for developing the evidence-based project is the
estimated budget that has to be approved by the management of the
organization. While a quality aspect should always be to improve
the current organizational rate. The clinical aspect is the
improvement of patient care that is the main reason behind this
evidence-based project. According to Sipes (2016), one of the
primary responsibilities of a project manager is to successfully
execute a project within the estimated budget, time, and quality
standards. The budget is that backbone of every project.
If the project manager does not have the necessary amount of money and
a properly estimated budget, then the project will result in a
failure. My mentor has taught me that a project manager has to
fully understand the importance of cost estimation and budgeting from
the initiation phases of the project. The amount of financial
resources will dictate the duration and type of available operation
and activities in the realm of a project. My project proposal
will include an estimated budget, will be free of miscalculations, and
will have a complete breakdown of the necessary budget.

One quality aspect of my hand hygiene compliance improvement project
is to increase the compliance rate of proper hand hygiene techniques
in the department. According to my mentor, even though all the
healthcare providers are aware that they have to wash and sanitize
their hands throughout the shift, many of them do not use proper hand
hygiene techniques or forget to wash their hands. Currently, the
hand hygiene compliance rate in my healthcare organization is
decreasing, as the rate of healthcare-associated infections has
increased. In observational studies conducted in local city
hospitals, direct healthcare providers washed or sanitized (with
alcohol-based sanitizer) their hands on average from 5 to as many as
42 times per shift (World Health Organization, 2018). If the
average shift is 8-12 hours that means that many direct care providers
only washed/sanitized their hands between 1 and four times.
These numbers are very low for a healthcare facility. The
average shift of the direct patient care provider in my healthcare
facility is 8 hours, and the average number of hand washing procedures
performed during the shift has decreased from 5 per shift to 2.5 in
the past year, which is half of the previous numbers.

One clinical aspect that needs to be taken into account when
developing the evidence-based project is how the project will affect
the delivery of patient care. The introduction of hand hygiene
compliance monitoring badges is meant to improve the hand hygiene of
the healthcare providers, but will it negatively impact the patient
care? As a project manager, it is imperative to understand and
try to predict the positive and negative clinical aspect that these
monitoring badges will have on the delivery of patient care.
Will it take time away from patient care? Will it decrease the
number of hospital-acquired infections? My proposal of the
hand-hygiene monitoring badges will not take time away from patient
care because proper hand washing takes one minute, but the number of
hospital-acquired infections can be significantly decreased. In
American hospitals alone, the Centers for Disease Control (CDC)
estimates that healthcare-associated infections (HAI) account for an
estimated 1.7 million infections and 99,000 associated
deaths each year (2018). Using proper hand washing and hand
sanitizing techniques throughout the shift can decrease the number of
HAIs in the healthcare organization. Hand washing is the
fundamental way to prevent and reduce HAIs in hospital patients
(McCalla, Reilly, Thomas, McSpedon-Rai,


Centers for Disease Control and Prevention. (2018). Hand hygiene
in healthcare settings.
Retrieved from

McCalla, S., Reilly, M., Thomas, R., & McSpedon-Rai, D. (2017).
Major Article: An automated hand hygiene compliance system is
associated with improved monitoring of hand hygiene. AJIC:
American Journal of Infection Control
, 45(1),

Sipes, C. (2016). Project management for the advanced practice
nurse. Retrieved from

World Health Organization. (2018). WHO guidelines on hand hygiene in
health care: First Global Patient Safety Challenge. Clean
Care is Safer Care
. Retrieved from…

Peer DQ2

Evidence based health practices are often available for a
various condition like asthma, heart failure, and diabetes. The
practices are not always implemented in any care delivery. It is a
problem-solving approach which incorporates the careful use of up to
date, quality data in decisions regarding care of patients (Vaidya
et al., 2017).

Financial aspect

Evidence based practice is an approach which involves many
stages that require thorough check and finances to function well. A
financial manager makes a detailed budget of how the method will
work. Everything should be planned within the budget made by the
financial manager. Every step is taken keenly for the practice to
function well. Public authorities and professional organizations
have tried to promote evidence-based practice to provide standard
health services not leaving out national and international
organizations (Melnyk et al., 2017).

my project is on staffs or nurse turnover in nursing home or a long
term care facility, the finances of the evidence-based practice will
be very high. A lot of money is needed to set up a facility which is
conducive for the patients and nurses who use the area. The finances
may come from donors, well-wishers, investors and the government.
Also, the place will be a nursing home for those patients with
diabetes especially type two diabetes. It will provide kits for the
patients to measure their blood glucose level even at the comforts
of their homes. Nurse turnover is an undesirable trend for health
care employers since it is expensive, disruptive and threatens the
quality of care and patients safety (Vaidya et al., 2017). The
nurses who are not performing well are assessed and released, and
new ones who act are hired. It also requires the nurses’
satisfaction with the salary paid and the environment they work in.
Finances for the nurse’s payroll and finances for hiring them are
provided too (Vaidya et al., 2017).

One quality aspect

Evidence-based practice project requires a high percentage of
quality for it to perform correctly. It is considered as a one
quality point of developing the practice. Every step should be
designed correctly to avoid non quality practice. Nurse turnover is
one problem that can threaten the quality of care and patient safety
in the facility. It should be taken care of since it is a sensitive
matter (Melnyk et al., 2017). The quality of the nursing facility
depends on the services the patients receive since t is the main
agenda of the program. The practice should work to improve the
quality of the nursing care facility every time for the patients to
receive high standard services with high quality.

Clinical aspect

My project on staffs or nurse turnover in nursing home or
long term care facility, clinical matters, and care will be handled
with a lot of keenness. The patients will be taken care of in a
right way and ensured proper services for them. The facility will be
clean every time to avoid infections and diseases, have medical
equipment that will help in testing and treat patients. They will be
there to prevent issues of patients coming to the facility and
don’t receive any medication. It will directly have an impact
on the practice because providing evidence before diagnosis, and the
patients will be treated well (Melnyk et al., 2017).


B. M., Fineout‐Overholt, E., Giggleman, M., & Choy, K. (2017). A
Test of the ARCC© Model Improves Implementation of
Evidence‐Based Practice, Healthcare Culture, and Patient
Outcomes. Worldviews on Evidence

Based Nursing, 14(1), 5-9.

N., Thota, A. B., Proia, K. K., Jamieson, S., Mercer, S. L., Elder,
R. W., … & Zaza, S. (2017). Practice-Based Evidence in
Community Guide Systematic Reviews. American journal of
public health
, 107(3), 413-420.

Peer DQ3

Evidence-based practice has become an important tool for enhancing
healthcare outcomes. My topic is more concerned with the development
of an evidence-based practice project aimed at reducing staff turnover
rates in health care settings. Statistics have indicated that an
estimated 15 to 36% turnover rate is experienced each year in
hospitals across the United States (Stone, Hughes & Dailey, 2008).

Increased turnover cause increases the cost of hiring and poor
health outcomes. The process of developing an evidence-based project
requires putting into consideration factors such as finances, quality
and clinical factors. Financial factors indicate that the project
should reduce the cost incurred by the health care systems in addition
to requiring low implementation cost. For this project, the
evidence-based practice will help to reduce the turnover rates hence
saving on the finances of the health care system, which are incurred
even by the patients. The project will make sure that the
implementation does not exceed the expected cost-benefit of
implementing the project.

Evidence-based practice should also be able to improve the quality
of care or services offered to the people. It can be identified that
having an adequate number of motivated staffs will help provide
high-quality care to the patients. The provision of quality care plays
an essential role in improving the wellbeing, promoting
patient’s satisfaction and outcomes. Additionally, it is
important to put clinical considerations in place when designing
evidence-based practice. The project should meet the clinical needs
and improve the overall healthcare outcomes. The nursing care homes
have increased the need to have an adequate number of employees to
provide quality acre thereby improving the health care outcomes of the
people. Increased turnover reduces the clinical competence of
promoting the safety of patients, which results in increased cost for
insurers, family, care providers, and the patients thus should be
avoided (Stone et al., 2008).


Stone, P. W., Hughes, R., & Dailey, M. (2008). Creating a safe
and high-quality health care environment.

Peer DQ4

Direct expenses are those that directly effect the operation of the
hospital. Examples of direct expenses would be Nursing; staffing
nurses are completely dependent upon the number of patients on the
unit. Other examples of direct expenditures would be supplies needed
to care for said number of patients. Indirect expenses are not a
direct increase or decreasing item combined with patient count, things
like facility monthly rent, salaries for upper management, and
maintenance (Gartenstein, Devra., 2018, June 26).

My capstone project is correctly utilizing the CIWA-ar scale and
alcohol withdraw protocol to reduce morbidity/mortality and shorten
length of stay. Education will be the primary way of implementing this
evidence-based project (EBP) through having volunteer nurse
“champions” to help educate staff, educational poster
boards placed in staff rooms, and 2-minute presentation with
educational fliers given at all huddles for a 7-10 period. Secondary
execution would be to create a mandatory educational computer-based
program, part of an e-learning video and quiz.

Financial Aspects

We hear the term value equation in our work area whether it
be in cost control concerning staffing or proper utilization of the
many different items needed for patient care (lines, iv start kits,
products for ADL’s, dressing materials, etc.). Improving our
patient’s health by providing the best care through EBP is all
healthcare providers goal. The cost of providing EBP must be
considered in the value equation to be implemented. The steps for
implementation start with; 1) determining the cost avoided 2)
determining the cost of implementation 3) examining the return on
investment (ROI) (Cullen, Laura, DNP, RN, and Hanrahan, Kirsten, DNP,
ARNP, Jan. 9, 2018). My primary method of implementation requires the
volunteered time by staff nurses to be champions for education
presentations. These nurses would also be resources for staff to ask
questions of while on shift. This primary method to help reduce
morbidity/mortality and shorten length of stay would not negatively
affect the financial aspects for the corporation, it would help it
through shortened hospital stays. This EVP does not affect the
indirect financial aspect to any degree as it is education driven. If
my secondary method for implementation was to move forward that would
affect the direct financial aspect through time and money put forward
for the creation of my e-learning video and for all nursing staff to
take. Indirectly it would affect the IT department and electricity
expenditure for implementation.

Quality Aspect

Quality improvement utilizes systematic-reviews and data-guided
methods to improve patient outcomes or processes. Clear definition of
the processes or outcome need to be clearly defined, identify the
measurement technique used, develop a plan for execution of said
intervention while incorporating data collection before and after
(Conner, Brian, T., June, 2014). My EBP has the potential to affect
quality directly through correctly utilizing the CIWA-ar protocol
which would improve the quality at which patients withdrawing from
alcohol by experiencing better controlled symptoms and shortening
length of stay. This can be measured through electronic health records
of previous adult patients admitted to the hospital as primary or
secondary diagnosis of alcohol withdraw assessing the average length
of stay before implementation and 3-month period after implementation
to determine average length of stay and any adverse effects of
treatment. The indirect aspect of this proposal could affect patient
satisfaction scores from those patients that were correctly treated
under the CIWA-ar protocol.

Clinical Aspects

One major clinical aspect to be considered is finding the support
staff to become the champions for the implementation of
educating staff nurses. The desire to best address this type of
patient will further the cause for additional help. I will present
this EBP to the clinical directors and charge nurses for each floor
and explain I am looking for volunteers to learn the importance of
this EBP and further educate staff. I will also post education fliers
with my contact information explaining the need for further support.
The direct impact would be the time the clinical director and charge
nurses will spend listening to the proposal. Staff nurses assisting
this project will be volunteer basis and this will clinically advance
all staff to properly apply the CIWA-ar protocol. This project in its
primary function does not impact the company from the indirect aspect.


Conner, Brian, T., (June, 2014), Differentiating research,
evidence-based practice, and quality improvement. Retrieved from:…

Cullen, Laura, DNP, RN, and Hanrahan, Kirsten, DNP, ARNP, (Jan. 9,
2018), Evidence-Based Practice and the Bottom Line: An Issue of Cost,
Retrieved from:

Gartenstein, Devra. (2018, June 26). Examples of Direct and Indirect
Costs. Small Business – Retrieved from…

Peer DQ5

In the initiation phase of the project, it is imperative to plan the
project and include the proposed solution to the identified
issue. Direct patient care providers in the surgical department
will be required to wear and activate their hand hygiene monitoring
badges at the beginning of their shifts. The data will be
analyzed on a daily, weekly and monthly basis for the first six months
in a specific department. The data collected will be for each
employee and will need to be statistically analyzed using a computer
software program. When the staff member uses the hand washing
station, the monitoring badges records the event and sends it to the
computer software for analysis (Hygreen, 2011). Each staff
member will have a unique identification number which will be recorded
in the computer application, so that data for each staff member in the
department is collected separately. ID number, time and date
will be recorded and sent for analysis. Mandatory training sessions on
proper hand hygiene procedures will be created and presented for the
nursing staff of the surgical department. Posters on the
proper hand hygiene techniques will be clearly displayed in all the
patient rooms and hallways of the surgical department.

The statistical analysis program will review the collected data and
create plot charts, graphs and descriptive statistical data such as
mode, median and mean for each staff member’s hand washing compliance
and the overall compliance for that specific department.
Compliance reports can be reviewed to see if the improvement project
is working, whether or not there are any problems with equipment, if
any employee has a high non-compliance with hand hygiene (so they can
be interviewed) techniques. The data collected will allow the
healthcare facility to determine if the hand hygiene monitoring
systems should be implemented throughout the entire facility.

My proposed solution to the poor hand hygiene compliance in the
organization did not change over the course of this semester.
Evidence shows that direct observation is not the most effective
method to monitor hand hygiene compliance in the organization.
However, scholarly literature shows that automatic monitoring badges
are a much more effective than direct observations.


Hygreen. (2011). Hand Hygiene Recording and Reminding System.
Retrieved from

Peer DQ6

The increased challenge of hospital readmission of patients with
heart failure has become a topic of concern. Prevention of hospital
admission for heart failure patients has become a priority for
clinicians, researchers, and stakeholders in the systems. According
to Bergethon et al. (2014), the issue is sensitive because one in
four heart failure patients is hospitalized thirty days following
the discharge. The topic attracted me because if not controlled it
will continue to affect the people and contributed to increased cost
for the providers, insurers and the patients. Therefore, the primary
purpose of my study was to identify the intervention that can be
used to reduce the readmission rates. The interventions suggested
may include planning for discharge and scheduling for follow up to
keep track of the medical progress of these patients

Additionally, it is important to offer patient education to
allow the patients to beware of their condition and encourage them
to take an active role in self-care, which may help reduce the
readmission rates.The increased readmission has
been attributed to lack of proper link up of the patients with the
outpatient providers. The outpatient providers should be provided
with adequate information regarding the discharged patients to
ensure a good transition from inpatient to outpatient care.
Therefore, it will become possible to administer the required
medication and help to the patients, which reduces the risk of
readmission. From the studies, it has been observed that although
the reduction of admission rates can be hard to achieve, it is
attainable. Development of effective strategies will greatly
contribute to the reduction of readmission rates. Therefore, all the stakeholders in the healthcare system
should collaborate to establish an evidence-based practice that will
eliminate the issue. Nursing practitioners will need to conduct more
research to come up with more strategies that can be utilized to
solve the issue.


Bergethon, K. E., Ju, C., DeVore, A. D., Hardy, N. C., Fonarow,
G. C., Yancy, C. W., … & Hernandez, A. F. (2016). Trends in
30-day readmission rates for patients hospitalized with heart
failure: findings from the Get With the Guidelines-Heart Failure
Registry. Circulation: Heart Failure, 9(6),

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