Nursing 710 Scholarly Project Proposal Plan



Nursing 710 Scholarly Project Proposal Plan

Cheryl Miller

Ferris State University

Abstract

The paper describes in detail my project proposal plan to review, revise and standardize the nurse-to-nurse report process for patients being admitted from the emergency department to an in-patient setting at Munson Medical Center during the fall of 2013. The purpose is to support the role of nursing in providing care for these patients. The identified goals and objectives are to perform a gap analysis to identify barriers in the current nurse-to-nurse report process, meet and collaborate with nursing staff from the emergency department and in-patient settings to discover possible solutions to these barriers, and to utilize research findings to validate those solutions. Watson’s nursing theory will be used for implementation this project plan. The premise is a caring environment which includes principles of open communication, a mutual respect for positive and negative feelings, and a collaborative spirit in order to foster an exchange of ideas and possible solutions (Watson, 2008). Overall success of this project plan will be measured by my self-assessment, verbal and written feedback from my preceptors, and results of a nursing satisfaction survey.

Nursing 710 Scholarly Project Proposal Plan

The purpose of this project is to review, revise and standardize the nurse-to-nurse report process for patients being admitted from the emergency department (ED) to an in-patient setting at Munson Medical Center. The need for this project was identified at a recent meeting attended by key nursing leadership members from the ED and in-patient units. The current nurse-to-nurse report process, established in 2011, is deemed ineffective as it does not support the nursing staff in their role to promote safe and effective care for patients. Ultimately, patient safety and staff morale are at risk. Nursing staff from the ED identified the following challenges with the current process: the need for the ED to make multiple calls in order to give notification of the patient’s arrival on the in-patient unit. Nursing staff from the in-patient units identified the following challenges: staff not following the established fifteen minute rule, insufficient information in the ED handoff report, and no notification to receiving bedside registered nurse (RN) of the patient’s impending arrival. Based upon these findings, it is clear that revision and re-examination of the nurse-to-nurse report process is needed.

This project plan utilizes Jean Watson's Philosophy and Science of Caring (2008) which is based upon the foundational theory of a caring environment. Promotion of a caring environment includes principles of open communication, a mutual respect for both positive and negative feelings, and a collaborative spirit. These principles of communication are critical to the success of the project proposal. Applying these principles during the phases of this project proposal will support a spirit of collaboration amongst the nursing staff, as well as, promote understanding of the nursing care needs unique to the ED and in-patient units. This understanding will help to foster a positive supportive relationship between nursing staff. In addition, it will allow for further collaboration and synergistic energy for developing effective solutions to the present barriers of the nurse-to-nurse report process. The purpose of this proposal is to standardize the nurse-to-nurse report process in order to promote safe and effective care for patients being admitted from the ED to an in-patient setting. This project plan supports the mission and vision statement of Munson Medical Center (2013) to provide comprehensive quality care, to protect patients and advocate for their safety. The goal, objectives, and activities of this project plan are based upon research findings of Mei-Sing Ong, Biomed, and Enrico Coiera (2011) who found that having a standardized verbal and written process for patient handoff contributed to nursing’s ability to protect the safety of patients, especially when the handoff communication occurred between units with distinct clinical settings. The development and implementation of this project plan is consistent with the Nursing Administration Scope and Standards of Practice (ANA, 2009) as it enhances nurses’ ability to provide optimum patient care, improves communication, and promotes patient safety. Additionally, Tomajan (2012) found that professional nursing leadership has a responsibility to advocate for desired changes in the workplace setting that are realistic and meet the needs of nursing staff and patients. The identified skills of advocacy require problem solving, communication, influence, and collaboration; which are included throughout this project proposal plan.

Setting

The setting for this project will be Munson Medical Center, a 391 bed acute care hospital and regional referral center serving the health care needs of twenty-two counties in the northern Michigan area. Munson Medical Center is nationally recognized for providing superior patient care. (2013). There are more than 300,000 annual patient visits for services such as neurology, oncology, cardiology, and orthopedics. Key stakeholders of this project include ED and in-patient nursing staff, nursing leadership, patients being admitted from the emergency department to an in-patient setting, and other project team members who may be assisting in this endeavor to standardize the nurse-to-nurse report process.

Project Goal and Objectives

The goal of my scholarly project will be to review, revise and standardize the nurse-to-nurse report process for patients being admitted from the emergency room to an in-patient bed at Munson Medical Center during the 2013 fall semester at Ferris State University. The purpose of this project is to support the nursing role in caring for patients who are being admitted from the emergency department to the in-patient setting by providing a standardized, agreed upon format for nurse-to-nurse communication. This standardized communication can help improve patient care, promote patient safety, and provide a tool to support the role of nursing. Mei-Sing Ong, Biomed, and Enrico Coiera (2011) found that poor handoff between the emergency department and in-patient setting can result in delayed treatment and increased risk of patient safety. Therefore, the importance of having an effective nurse-to-nurse handoff process is imperative to the promotion of safe and effective patient care.

The objectives of this project are to obtain literature and other data sources by September 5, 2013 related to the threat to patient safety from ineffective handoff communication when transferring patients between units in an acute care hospital setting. A gap analysis was performed using a style of round table discussion at the initial meeting with both ED and in-patient nursing staff to identify barriers in the nurse-to-nurse report process. I plan to utilize a similar approach going forward on this project. Kempnich (2011) found that accelerated decision making is a proven gap analysis approach to problem solving in the healthcare arena. The process involves collaboration between the right stakeholders with the right tools at the right place, in order to make the right decision based upon a shared group vision (Kempnich, 2011). The benefits are that team members are engaged in working toward a common purpose, it is collaborative, and encourages a free exchange of ideas (Kempnich, 2011). These principles support relationship building and problem solving and complement my plan to apply Watson’s (2008) nursing theory. Therefore, this approach will be implemented at the project proposal meeting tentatively planned for September 15, 2013 to help clarify and further identify additional barriers. In addition, I plan to foster an environment of open communication by allowing all viewpoints to be shared, heard, and respected. This is also consistent with Watson’s (2008) nursing theory which encourages an exchange of both positive and negative ideas. I plan to further consult with key nursing leadership staff from the emergency department and in-patient units to discover possible solutions to the identified barriers of having a standardized, agreeable process for nurse-to-nurse report by September 30, 2013. I plan to develop and formalize an agreed upon process for nurse-to-nurse report for patients being admitted from the emergency room to an in-patient setting by October 30, 2013 through collaborative meetings and joint decision making with key leadership and shift coordinators from the ED and in-patient units. I plan to include nursing staff from the education department so that a formal computer based education plan can be developed by November 30, 2013. I hope to have this education included in the 2014 annual Health Stream assignment for nursing staff from the ED and in-patient units. I will evaluate my performance through a self-assessment process based upon my perceptions of what went well during implementation of the project proposal plan, what did not go well, and insights gained as a result. It includes short and long term goals. Desjarlais and Smith (2011) found that the process of self-assessment promotes self-growth, is proactive and is meaningful when evaluating the results of a well thought out action plan. I will also seek verbal feedback from my preceptors throughout each phase of this proposal, as well as, final written feedback at project completion in December 2013. This written feedback will focus upon my preceptors evaluation of my strengths, weaknesses, and possible suggestions for improvement. I will evaluate the effectiveness of the revised nurse-to-nurse report process using a nursing staff satisfaction survey by December 15, 2013. The proposal plan is listed in Appendix A.

Project Activities

In order to obtain relevant research articles to support this project, my first activity will include searching Cinahl, PubMed, ERIC, and other data bases related to best practice for nurse-to-nurse report when transferring patients between units in an acute care setting, compilation of a literature reference list, and review of current literature for relevance to this project plan by September 5, 2013 (see Appendices A & B). Secondly, I will meet with key nursing leadership from the emergency department and in-patient nursing units to perform a decision acceleration gap analysis in order to fully understand the challenges in the current report process by September 15, 2013. My third project activity will be to meet every other week with nursing leadership and shift coordinators from the emergency room and in-patient units to brainstorm and share ideas of possible solutions that are agreeable to all parties by September 30, 2013. My fourth project activity will be to develop and formalize the new process for nurse to nurse report and present to all stakeholders for their approval by October 30, 2013. Once approved, my fifth project activity will be to contact staff development to seek assistance in the development of on-line education for nursing staff by November 15, 2013. I anticipate that this education will be part of the 2014 annual education program via Health Stream for nurses in the emergency room and in-patient setting. These activities are included in the proposal plan listed in Appendix A.

Evaluation of the nurse-to-nurse report process will be completed utilizing a nursing satisfaction survey. This tool will be based on a Likert scale and distributed via intra company mail to both ED and in-patient nursing staff by December 15, 2013. Survey results will be measured using participant responses of strongly agree, agree, neutral, disagree and strongly disagree. I plan to include a section for written comments or suggestions which will offer additional feedback for review. This survey is included in Appendix C. Final survey results will be used to determine the overall success of this project and will provide a guide for making improvements to the future nurse-to-nurse report processes. I plan to gauge my personal performance using a self-assessment tool and direct verbal and written feedback from my preceptors during implementation of this project. Desjarlais and Smith (2011) found that performing a self-assessment can help one to discover their own strengths and weaknesses, it can be used in the future to sharpen performance skills, it can be shared with a mentor, and it can help to develop short and long term action plans. This assessment tool is included in Appendix D.

Identification of Preceptors

Ann Holmes, MS, RN, Director of Nursing Operations and Throughput and Nursing Administration will be my preceptor for this project because of her experience as an emergency department manager, in-patient unit manager, and her current leadership role in relation to patient admissions and throughput operations at Munson Medical Center. Based upon her experience, she will provide expert leadership guidance in the development and completion of this project. Marianne Cornellier, MSN, RN, Manager Nursing Services will be my preceptor for this project because of her advanced educational experience, professionalism, and for her ability to give fair and honest feedback. I have obtained signed agreements from both preceptors for implementation of this project plan which are included in Appendix E.

Proposed Date and Timeline

The timeline for my project will be September 5, 2013 to December 15, 2013 which is consistent with the timeline for the fall semester at Ferris State University. This can be found in Appendix A. The overall success of this project will be based upon an ED and in-patient nursing satisfaction survey, a self-assessment evaluation, and verbal and written evaluation by my preceptors.

References

American Nurses Association (2009). Nursing administration scope and standards of practice.

Silver Spring, MD: .

Desjarlais, M. & Smith, P. (2011). A comparative analysis of reflection and self assessment.

International Journal of Process Education. Lisle, IL: Pacific Crest.

Kempnich, J. (2011). Utilizing decision acceleration for Magnet gap analysis. Nursing

Management 42(2), 43-45.

Mei-Sing Ong, M., Biomed, E., & Enrico Coiera, M. B. (2011). A systematic review of failures

in handoff communication during intrahospital transfers. The Joint Commission Journal

on Quality and Patient Safety 37(6), 274-283.

Munson Medical Center (2013). Mission Statement. Retrieved from



Tomajan, J., (2012). Advocating for nurses and nursing. The Online Journal of Issues in Nursing

(17)1. doi:10.3912/OJIN.Vol17No01Man04

Watson, J. (2008). Nursing: The philosophy and science of caring (Revised ed.) Boulder:

University Press of CO.

Appendix A

Nursing 710 Project Proposal Planning Guide

Title of Project: Revision of Nurse to Nurse Report for ED Admission Process

|Goals |Objectives |Activities |Timeline |

|1. To review, revise, and |1.1 Obtain literature and other |1.1a Search Cinahl, PubMed, ERIC, |1.1a To be completed by September |

|standardize the nurse to nurse |data sources related to the threat |and other databases for literature.|5, 2013. |

|report process for patients being |to patient safety due to an |1.1b Compile literature reference | |

|admitted from the emergency |ineffective nurse to nurse report |list and bibliography. |1.1b To be completed by September |

|department to an in-patient unit. |process when transferring patients |1.1c Review literature for |5, 2013 |

| |between units in an acute care |relevance to proposed project. | |

| |hospital setting. | |1.1c To be completed by September |

| | |1.2 Schedule and meet with key |5, 2013. |

| | |nursing leadership from the | |

| |1.2 Perform a gap analysis to |emergency department and in-patient|1.2 To be completed by September |

| |identify barriers in the nurse to |nursing units to identify barriers |15, 2013. |

| |nurse report process. |of current report process. | |

| | | | |

| | | | |

| | |1.3 Schedule and meet every other | |

| | |week with key nursing leadership | |

| |1.3 Collaborate with key leadership|and staff to brainstorm possible |1.3 To be completed by September |

| |and nursing staff from the |solutions to identified barriers. |30, 2013 |

| |emergency room and in-patient units| | |

| |in order to develop evidence based |1.4 Schedule and attend meetings | |

| |solutions. |every other week with key | |

| | |leadership and nursing staff from |1.4 To be completed by October 30, |

| |1.4 Develop and formalize an agreed|the emergency room and in-patient |2013. |

| |upon evidenced based process for |units. | |

| |nurse to nurse report. | | |

| | |1.5 Meet with staff development re | |

| | |2014 plan for Health Stream on-line| |

| |1.5 Educate nursing staff on the |education of nursing staff. |1.5 To be completed by November 15,|

| |new process for ED to in-patient | |2013. |

| |nurse to nurse report. |1.6 Develop and distribute nursing | |

| | |satisfaction survey of emergency | |

| |1.6 Evaluate the effectiveness of |room to in-patient nurse to nurse |1.6 To be completed by December 15,|

| |the new nurse to nurse report |report process. |2013. |

| |process using a staff satisfaction | | |

| |survey. | | |

Appendix B

Bibliography

American Nurses Association (2009). Nursing administration scope and standards of practice.

Silver Spring, MD: .

Cheung, D.S., Kelly, J. J., Beach, C., Berkeley, R. P., Bitterman, R. A., Broida, R. I.,…White,

M. L. (2009). Improving Handoffs in the Emergency Department. Annals of Emergency

Medicine XX(X), 2-10.

Desjarlais, M. & Smith, P. (2011). A comparative analysis of reflection and self assessment.

International Journal of Process Education. Lisle, IL: Pacific Crest.

Friesen, M., White, S. & Byers, J. (2008). Handoffs: Implications for nurses. In R. G. Hughes

(eds.), Patient Safety and Quality: An Evidence Based Handbook For Nurses (pp. 1-48).

Rockville, MD: Agency for Healthcare and Quality.

Kennan, G. M., Tschannen, D., & Wesley, M. L. (2008). Standardized nursing terminologies can

transform practice. JONA, 38(3), 103-106.

Kempnich, J. (2011). Utilizing decision acceleration for Magnet gap analysis. Nursing

Management 42(2), 43-45.

Mascasoli, S., Laskowski-Jones, L., Urban, S. & Moran, S. (2009). Improving Handoff

Communication. Nursing, 39(2), 268-271.

Mei-Sing Ong, M., Biomed, E., & Enrico Coiera, M. B. (2011). A systematic review of failures

in handoff communication during intrahospital transfers. The Joint Commission Journal

on Quality and Patient Safety 37(6), 274-283.

Munson Medical Center (2013). Mission Statement. Retrieved from



Patterson, E. S., Wears, R. L., (2010). Patient Handoffs: Standardized and Reliable Measurement

Tools Remain Elusive. The Joint Commission Journal on Quality and Patient Safety

36(2), 52-61.

Tomajan, J., (2012). Advocating for nurses and nursing. The Online Journal of Issues in Nursing

(17)1. doi:10.3912/OJIN.Vol17No01Man04

Van Eaton, E. (2010). Handoff Improvement: We Need to Understand What We Are

Trying to Fix. The Joint Commission Journal on Quality and Patient Safety 36(2), 51.

Wakefield, D., Ragan, R., Brandt, J. & Tregnago, M., (2012). Making the transition to nursing

bedside shift reports. The Joint Commission Journal on Quality and Patient Safety38(6),

243-253.

Watson, J. (2008).Nursing: The philosophy and science of caring (Revised ed.) Boulder:

University Press of CO.

Appendix C

Nursing Satisfaction Survey--Draft

ED to In-Patient Nurse to Nurse Hand off/Report Process

1. Strongly Agree 2. Agree 3. Neutral 4. Disagree 5. Strongly Disagree

Please answer the following questions using the number scale provided above.

1. The nurse to nurse report process for patient admissions from the emergency department to an in-patient setting is clearly defined. _____________

2. The nurse to nurse report process for patient admissions from the emergency department to an in-patient setting is consistently followed.____________

3. The nurse to nurse report process for patient admissions from the emergency department to the in-patient setting helps me provide safe and effective care to my patients. ____________

4. Suggestions for improvement _________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

5. Additional comments________________________________________________________

_____________________________________________________________________________

Appendix D

Self-Assessment Tool Draft

Standardized Nurse-To-Nurse Report Process

1. Project Planning and Preparation

Identified Strengths___________________________________________________________

Identified Weaknesses_________________________________________________________

Short Term Action Plan________________________________________________________

____________________________________________________________________________

Long Term Action Plan________________________________________________________

____________________________________________________________________________

2. Timeline of project activities and objectives

Identified Strengths____________________________________________________________

Identified Weaknesses__________________________________________________________

Short Term Action Plan_________________________________________________________

_____________________________________________________________________________

Long Term Action Plan_________________________________________________________

_____________________________________________________________________________

3. Overall Project Completion

Identified Strengths_____________________________________________________________

Identified Weaknesses___________________________________________________________

Short Term Action Plan__________________________________________________________

_____________________________________________________________________________Long Term Action Plan________________________________________________________________________________________________________________________________________________________

Appendix E

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