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Designing and Sustaining the Capstone Project

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Designing and Sustaining the Capstone Project Linda Roussel, RN, DSN, NEA-BC, Professor, USA College of Nursing Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader ... – PowerPoint PPT presentation

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Title: Designing and Sustaining the Capstone Project


1
Designing and Sustaining the Capstone Project
  • Linda Roussel, RN, DSN, NEA-BC, Professor, USA
    College of Nursing
  • Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader
    Coordinator, Carolinas Medical Center
  • Terilee Gerry, BSN, RN, CNL Student, Maine
    Medical Center

2
Objectives
  • Describe overall expectations for the Clinical
    Immersion Experience, including the Capstone
    Project. (Linda)
  • Identify major aspects of planning a Capstone
    Project, including a doing a Needs Assessment,
    developing an evidence-base for practice change
    and outcome measures. (Terilee)
  • Review innovative role of CNL and how the CNL
    immersion experience and completed project help
    advance CNL skill set (Tammy)

3
CNL Academic Experience
  • CNL White paper
  • Roles
  • Competencies
  • End of Program Expectations

4
CNL Academic Experience
  • Assignments
  • Needs Assessment
  • Work Flow
  • Gap Analysis
  • Clinical Experience
  • Role Socialization

5
CNL Academic Experience
  • Clinical Experience
  • Making the Case
  • Cost-Benefit
  • IOM Aims
  • Outcomes Management
  • Evaluation

6
The Student Perspective
Major Aspects of Project Management and the
Clinical Immersion Experience
  • Terilee Gerry, BSN, RN, CNL Student, Maine
    Medical Center

7
Academic Preparation
  • BS in Nursing
  • 2 yrs clinical experience
  • 5 semesters
  • Semester 1,2 course work
  • Semester 3,4 continue course work and begin
    clinical experience
  • Last semester course work and full clinical
    immersion

8
Clinical Preparation
  • 3rd semester and the 40,000 ft view
  • Met people behind the scenes
  • Met future resources
  • 8 hrs clinical time/wk in 4th semester
  • Weekly meetings with CNL preceptor
  • Full clinical immersion during last semester

9
Student Clinical Resources
  • Staff Development Specialist coordinated student
    experiences
  • 8 CNLs
  • Nursing Director
  • Student colleagues

10
CNL Preceptor
  • Shadow different CNLs
  • Eventually assigned primary preceptor
  • Weekly meetings
  • Advisors
  • Offered help with research/capstone project
  • Shared experiences with us
  • Offered support/advice/suggestions

11
Nursing Director
  • Project approval
  • Weekly meetings
  • Close communication
  • Leadership mentor

12
The Capstone Project
  • Preliminary discussion in 1st semester
  • Establish a time line
  • Unit based
  • Needs Assessment
  • Director approved
  • Prepare for IRB submission

13
My Project
  • Assigned unit in 3rd semester
  • Unit issues/needs unknown
  • Director meeting-input important
  • Possible project suggestions
  • Decision made
  • Began making contacts

14
Project Begins
  • Literature Search
  • Begin contact/meetings with stakeholders
  • Communication with physicians
  • Work with faculty
  • Input from Nursing Research Dept.

15
Project Continues
  • Paper written
  • Hospital and Univ. IRB approval obtained
  • Data collection now underway

16
Directors Input
  • Inform staff of project to demonstrate leadership
  • Attend staff meetings
  • Involvement on various committees
  • Meet key personnel

17
Continued Support
  • CNL monthly meetings
  • Quarterly meetings with CNS group
  • Support of each other as needed

18
Innovative Role of the CNL
The CNL Perspective
  • Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader
    Coordinator, Carolinas Medical Center

19
Innovative Role of CNL
  • We cannot solve our problems with the same
    thinking that created them.
  • Albert Einstein

20
Projects
  • Simplistic to Difficult
  • Small to Enormous
  • Microsystem changes to House-wide changes

21
My Capstone Project
  • As the result of my Capstone project an entire
    process was changed.
  • Its benefits decreased catheter related-blood
    stream infections and decrease number of
    healthcare dollars spent.
  • Other benefits was streamlining care for the
    nurses.

22
Capstone Project Overview
  • Identification of the problem and population
  • Utilized a systematic research
  • The Cochrane Database
  • CINAHL
  • Medline
  • Expanded research to include
  • Institute of Medicine
  • Institute of Healthcare Improvement
  • 5 Million Lives Campaign
  • CVL Bundle

23
Capstone Project Overview
  • Joint Commission
  • CDC
  • Infusion Nursing Society
  • Review literature
  • Includes searching for evidence based practice
    protocols
  • How the financial aspect impacts the hospital,
    patient, and insurance companies
  • How other facilities combated the same problem
    and their successes

24
Outcomes
  • December, 2007
  • Implementation of the dressing change kit
  • Elimination of the 24 hour dressing change
  • Nursing care was streamlined
  • Improved patient outcomes as evidenced by the
    decrease in PICC Line associated infections

25
Summary of Project
  • Lateral integration of care
  • Utilization of research and application to
    practice
  • Proposal to change protocol based on evidence
  • Implementing the BioPatch and sterile dressing
    change kits
  • Staff Education
  • Improved patient outcomes

26
Results
  • Initially,
  • September, 2007
  • 18 CR-BSIs, 4 PICC Line related
  • Implemented BioPatch
  • October, 2007
  • Noted 72 reduction in CR-BSIs with 100
    reduction in PICC Lines
  • Follow up,
  • Comparing first 6 months of 2007 (prior to
    project) to the first 6 months of 2008
  • 50 reduction in CR-BSIs

27
Examples of Other Projects
  • Development of hand-off communication tool
    between transport and nursing staff.
  • Development of dose calculation tools for
    pediatric codes.
  • Development of standardized documentation for
    nuclear medicine testing when nurses are involved.

28
Here and Now
  • Coordinating new CNL Program
  • Utilizing the 12 Bed Model
  • 6 Med-Surg units (current)
  • Planning for future adding 4 new units
  • Using Evidence Based Practice to find new and
    better ways of caring for patients
  • Utilizing the CNL White Paper

29
Here and Now
  • Identification of Nurses for Educational Support
  • Based on
  • Clinical Performance
  • Attitudes and Vision of the power of Bedside
    Nursing
  • Committed to organizational values mission

30
Here and Now
  • PCL Model
  • To move toward CNL model as nurses complete
    education certification
  • Must be enrolled in the CNL Masters curriculum

31
Here and Now
  • Metrics
  • Physician, Patient, Nurse Satisfaction
  • Decrease in falls
  • Decrease in hospital acquired
  • Pressure ulcers
  • Infections
  • PE/DVT
  • Improve D/C process
  • Other nurse sensitive indicators applicable to
    specific units

32
Looking to the Future
  • There are many ways to discover what project
    needs undertaking
  • Six Sigma
  • LEAN
  • Root Cause Analysis/ Microsystem Analysis
  • Windshield Survey
  • Consider
  • Patients quality of care and safety
  • Buy-in from administration
  • Cost vs. Savings
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