Two Unit’s Experience with Nursing Students Capstone Projects ...

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Two Unit’s Experience with Nursing Students Capstone Projects ...

Two Unit’s Experience with Senior

Nursing Students Capstone Projects

and Implementation of

Evidence-Based Practice

Presented by

Cheryl Anema PhD, RN

Patti Wilson MA, RN, ONC

Phyllis Lawlor-Klean RNC, MS, APN/CNS

Cheryl Anema PhD, RN

Purdue University Calumet

School of Nursing

Assistant Professor of Nursing


Engage in activities that promote the

importance of nursing and professional

nursing roles in creating change in health care

environments.


Nursing Roles in Project Development

Team Leader

Committee skills

Working with nursing professionals

Researcher


Design, implement, and disseminate

knowledge of an evidence based practice

project relevant to nursing in a complex health

care environment.

Assessor / Explorer

Data Collector

Analyzer

Disseminator - New knowledge


Identification of Need / Problem


Prepare students in the process of project

management, teamwork, and timelines.

Project Management

Timeline of project

Team member roles & responsibilities

Communication team strategies

Team meetings


Teamwork

Communication styles

Negotiation

Identification of talents / skills of each team member

Openness to constructive criticism

Honesty

Responsibility

Prepare students in professional communication,

accountability, team meeting planning – agenda

development


How to run a Committee meeting

Creation of Agenda

Coordination of schedules


Professional Communication & Presentation

Addressing professionals

Email vs phone vs texting

Notifications of meetings and change of meetings

Dress professionally

Time management (start & finish on time)

Arrive early – never late

Bring copies of agenda & items to be discussed (or

provide by email at least a day ahead of meeting)

Stay focused, yet be flexible to needs of group


Design –




PICO development (Guides research)

ROL (Review of Literature)

Transparency of search

Multidisciplinary

Methodology

Implementation –




Further ROL and resources

Hospital interactions, collaborative data collection

Analysis / Statistical analysis (as appropriate)

P – Problem

I – Intervention

C – Comparison

O - Outcome

Dissemination –



Student presentation of results to cooperating

nursing units.

Development and implementation of Poster

Presentation

www.makesigns.com

Poster specifications

Highlight key points

Bullet information

Suprapubic Catheter Protocol

Brad Foster, Caitlyn Schalich, & Lauren Skewis

School of Nursing, BSN Capstone Students

o

o

Introduction

Urinary catheterization occurs in up to 25% of all

hospitalized patients.

Suprapubic catheters (SPC) make up 4% of these

Methods

PROCESS:

Relevant evidence-based research reviewed.

Critical appraisal of each article was completed using the

Joanna Briggs Rapid Appraisal Tools.

catheterizations.


Committee meetings with Project Team were held.

o

SPC are used most commonly in patient requiring long


Supplies and kits from Medical Center were used to create

term catheterization.

the equipment list for the protocol.

DATABASES SEARCHED:

o

Care and exchange of SPC are within the scope of

o CINAHL Database

o The Joanna Briggs Institute

practice of a nurse (IL Nurse Practice Act - 2008).

o Cochrane Database

o Medline Database

o Google Scholar

o Wiley Interscience Database

o

Background

A Tertiary Medical Center in the Midwest is changing the

SPC exchange procedure from a physician task to a

nursing task.

Conclusions

An evidence based protocol for the care and exchange of a

hospitalized adult patient with a SPC was created.

EQUIPMENT:

o Silicone catheters are correlated with higher complications of

o

This Medical Center currently does not have a hospitalbased

nursing protocol for the care and exchange of a

cuffing than latex coated catheters.

o Personal protective equipment (PPE) is necessary for potential

Recommendations

SPC.

exposure to bodily fluids.

o

Submit protocol to clinical directors and policy committee

o Dressings are used per patient/doctor preference.

of partnering Medical Center.

o According to the Guidelines for Use of Medical Protocols

o Dressing may indicate recent SPC insertion (4-6 weeks).

o

Provide training and education sessions about SPC care

(2004) protocols are needed to promote uniformity of

Purpose

care, and provide expectations of health care staff.

CARE:

o Assessment and site care should be done every shift.

o

and exchange for nurses.

Offer SPC care education for patients and family

Our goal was to develop a protocol that provides guidelines for care

and exchange of an adult patient with a suprapubic catheter.

o Normal saline is comparable to tap water for cleaning incision sites.

o Normal saline is preferred over tap water in a hospital setting.

o Providing troubleshooting solutions decreases further

complications.

o

o

members.

Implement protocol into practice in all adult units.

Evaluate protocol within one year of implementation for

EXCHANGE:

modifications and evidence based practice updates.

o SPC exchange occurs every 6 to 8 weeks as ordered.

Acknowledgments

o First exchange after insertion is done by physician.

o Sutured SPC are not to be exchanged by a nurse.

o No more than 5 to 10 minutes should elapse between removal and

reinsertion of SPC.

This project was completed in partnership with Advocate Christ Medical Center. We would like to thank:

Cheryl Anema PhD, RN (Faculty Preceptor)

Laura Hogan BSN, RN (ACMC Project Director)

Patricia Wilson BSN, RN, ONC (ACMC Project Team Member)

Cheryl Lefaiver PhD, RN (ACMC Project Team Member)

Elizabeth Kupczyk MSN, RN (ACMC Project Team Member)


WIN – WIN!

Evidence-Based Practice:

Manager Assisted in the Project Director Role

Patti Wilson, MA, RN, ONC

Advocate Christ Medical Center

Manager of Clinical Operations –

Bone & Joint Institute

Manager - Physician rounding

revealed the need for a closer look

at suprapubic catheter (SPC) exchange Investigation by manager revealed no policy

available to nursing.

Inpatient nurses consult Urology

Potential increase in length of stay

Patient dissatisfier


Team met to discuss current practice

in reference to SPC exchange.




Revealed Home Health Nurses routinely

exchange SPC

Inpatient nurses rarely exchange SPC

Compiled literature from Evidence Based

Research on SPC use and exchange.

Students search for evidence based practice

involving SPC exchange.

Included:

Supplies

Step by Step Process

Precautions

Limitations





Discussed findings in comparison to current

practice

Discussion surrounding change in nurse

practice

Reviewed Advocate process for creating NEW

policy

Team began to develop a policy to address SPC

exchange performed by nursing

Developed and Approved

Suprapubic Catheter Care and Exchange

Policy #01.118.514


Plan for next group of students to assist in the

roll out of education on new policy

Monitoring of outcomes

Include: Patient Satisfaction

Case Studies

Reduction in Length Of Stay

Student awareness of safe implementation

of new procedures developed from

Evidence Based Practice prepares the

new graduate nurse to focus on

positive patient outcomes.

Education on new practice is paramount to

successful implementation.

• Neonatal ICU experiencing an increase in DD

• Prior products/protocols no longer working


Evaluation of all products interfacing with the

diaper area was requested (diapers, diaper

wipes, soap, lotion, diaper rash products).

Diaper rash product list provided by unit PharmD


Reviewed the EBP literature, both nursing and

other disciplines, and Skin Care Standards

related to DD.

This activity was time intensive (literature and

product review) and saved the APN a lot of time.


Hospital Laundry consulted for product or

process change and Facilities for temperature

and humidity numbers for the patient care pods.


Each student spent time in the Neonatal ICU

with the Unit Skin Care Committee Chair to get

a feel for patient care related to DD.





DD concern outlined with the Capstone Team

Protocols, standards, and literature were

accessed and reviewed

Ongoing guidance provided to the team

Liaison between students and interdisciplinary

team



The students developed a Performance

Improvement data collection tool.

The data collection was facilitated over a three

week time frame and collected by our Assistant

Clinical Managers and Charge Nurses.


Students entered and reviewed the data

Concurrently, the data related to patients with

DD was evaluated

presence of DD, products / feeding used, type of

bed, with or without humidity, if in open crib when

did DD occur



Data analysis showed varying nursing practices

and products related to DD were used.

Data review lead us to look closer at our bed

humidity guidelines and the actual relative

humidity in the rooms.


Some of the humidity evidence-based literature

was reviewed, but not in depth, as we were far

into the semester.


According to Guidelines of Perinatal Care

(2007) room temperature should be 72-78

degrees Fahrenheit and room humidity should

be 30-60%.


Our Facilities staff educated us on temperature

and humidity readings with a “Fluke”.

The fluke is a hand held device to record temperature and

humidity.


They also showed us how our pods were divided

into zones by the placement of the thermostats.


With this information, we explored the pod

location of the babies with DD.


The interfacing skin products were appropriate

and evidence-based.


Provided an evidence-based literature review

on DD and premature and newborn skin care.


No standard DD prevention protocol was found

in the literature.


They thought outside the box regarding other

impacting factors.


Impact of room humidity needs more investigation.


Their findings were presented to the Neonatal

ICU staff.


A new student Capstone Team is in place focusing on

humidity and diaper dermatitis.


Facilities placed a system in place to provide us with

historical data on temperature and relative humidity in the

unit pods.

They also repaired a thermostat issue in Pod 2.

School of Nursing


The Unit Skin Care Team is working on a DD prevention

protocol.

They are evaluating different diaper rash products.


All of this is thanks to the Student Capstone Team’s

evidence-based investigation.

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