Ineffective transitional care programs for ensuring the continuation of care from the hospital setting to the home setting often result in rehospitalization for elderly heart failure patients age 65 and older. The purpose of this project was to develop a home health transitional care program for elderly patients transitioning from inpatient settings to home settings using care bundles consisting of evidence-based practices to reduce preventable rehospitalizations within 30 days of discharge. The home-based chronic care model, which provides a foundation for home health's integral role in chronic disease management by ensuring patient-centered evidence-based care, guided the development of this program. The developmental process elicited feedback from a team of home health advisory members, 3 home health experts, and 2 health care consumers who may use this program in the future. The readability of the program was at a 5th grade level for easy comprehension. A 3-item survey was given to 2 members from the target population, and a 5-item survey was given to 3 content experts to evaluate the transitional program. The advisory members were asked to read and provide feedback on the transitional care program. Data were analyzed using descriptive statistics to obtain a content validity ratio score of 1.00. Findings suggested universal agreement on the content of the transitional care program, which was developed as a resource tool to provide evidence-based care bundle interventions from scholarly literature. Implications for social change include improving the outcomes of elderly heart failure patient by providing home health care agencies with a comprehensive transitional care program to prevent avoidable rehospitalizations and help patients effectively manage the disease.

The literature supports that a Unit Safety Champion (USC) may reduce falls among hospitalized patients. The purpose of this project was to determine if the implementation of a USC would assist in reducing falls on an acute unit in an urban hospital environment. The frequency of patient falls on the unit was collected from the hospital's quality department 3 months before and 3 months after the implementation of the USC. The average number of falls for 3 months before implementation was 5.0 per month (SD = 2.65) and involved a total of 15 individual patients. The average number of falls for 3 months after implementation was 5.33 (SD = 1.53) and involved a total of 16 individual patients. Although the average number of falls increased, there was no statistically significant difference in the average number of falls between these time periods. Upon further investigation, it was discovered that the unit experienced an increase in nursing turnover while implementing the USC. Although this confounding variable was not examined as part of this project, the results demonstrate the importance of nursing turnover on adverse patient events. The literature suggests that front-line workers may contribute to a quality change in the acute environment. Using Lewin's change model as a foundation, an action plan was submitted to the fall committee emphasizing the relational importance of nurse staffing management and adverse events. It is recommended that a longitudinal project be conducted to fully understand the contribution of the USC to the unit.

As primary care providers in correctional facilities, correctional nurses are expected to balance inmates' healthcare needs with the security demands of the facility. This project explored whether an evidence-based education program could provide strategies for promoting health, a healthy work environment, and a sense of well-being to improve the knowledge, coping skills, and well-being of nurses working in a correctional occupational setting. Twenty nurses participated in an educational intervention project that was guided by the transactional theory of stress. Using a pretest/posttest design, data were collected over a 2-week period and calculated using means and percentages. The descriptive statistics using the 6 items in the pre- and posttest showed an average gain of 48% in knowledge compared to the pretest scores. Using the World Health Organization Well-Being Index scale, participants' sense of well-being also improved with an average score of 21% to 40% following the intervention. Findings indicate that effective management of work-related stress could result in positive social change by improving the health of nurses, the health outcomes of inmates, their families, and the community at large. With knowledge from this project, leadership might provide support and create opportunities for nurses to improve their skills.

A Policy Guide to Decrease the Use of Continuous Passive Motion Machines by Rosa M. Cooper MSN, Walden University, 2009 BSN, Immaculata University, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2015 This project was conducted at a post-acute rehabilitation hospital that served post-acute orthopedic, stroke, brain injury, cardiac, and skilled nursing patients. On the orthopedic unit, there were 5 practicing physicians, 3 of whom consistently used continuous passive motion (CPM) therapy on total knee arthroplasty (TKA) and 2 of whom did not. As a result of discussions with physicians who did and did not utilize CPM therapy, a practice problem was identified that CPM use may not be consistent with current literature and practice evidence. Scholarly literary reviews were done on current CPM evidence- based research. Observational data were collected on patients' ambulatory function, knee range of motion, and pain durance. This information was then presented by the interdisciplinary team (IDT), which consisted of the physical therapist, occupational therapist, and nurses. The physicians input along with the observational data obtained by the IDT all supported the hypothesis that CPM usage did not promote faster healing nor added a benefit to patient outcomes. A project to revise the existing CPM policy and develop a guide decreasing CPM usage was implemented and guided by the theories of organization change and a total quality management model. The purpose of this quality assurance project is to promote a cost-effective practice change that would be beneficial to the TKA population as it relates to care and treatment. As the increase in TKA continues to rise in the United States due to such co-morbidities as obesity causing an increase in disabilities, implementing the best practice as it relates to patient outcomes brings about a positive social change.

The Centers for Disease Control and Prevention, the Joint Commission, and the Agency for Healthcare Research and Quality recognized the importance of reducing health-care-associated infections (HAIs) and catheter-associated urinary tract infections (CAUTIs) for the safety of all patients. The U.S Department of Health and Human Services has focused on approving a plan to address HAIs in the health care setting with an emphasis on CAUTIs. The purpose of this project was to decrease CAUTI rates on a long-term care and rehab unit by educating staff about using the CAUTI bundle and CAUTI maintenance tool kit. The theoretical framework that guided this project was Knowles's assumption of adult learning. The practice-focused questions addressed the effects of staff education on CAUTI prevention using a CAUTI bundle approach. Pretest and posttest data were collected from all current primary care nursing staff providers at the study site. CAUTI rates were also obtained from the infection prevention and control nurse at the study facility. Implementation of education related to the CAUTI bundle approach led to 2 consecutive months of no CAUTIs in 2019. Findings from the CAUTI project may bring about positive social change by improving patients' quality of life by ensuring they do not develop HAIs. Use of the CAUTI bundle approach may be implemented in long-term care facilities throughout the United States to ensure patients do not acquire HAIs.

Statistics show a high prevalence of metabolic syndrome (MetS) in patients with mental illness receiving second-generation antipsychotic medications. MetS is associated with elevation of obesity, truncal obesity, blood pressure, cholesterol, and fasting glucose. The purpose of this project was to educate psychiatric providers about the importance of MetS screening, early detection, management, and referral for better treatment and management. The project was guided by Lewin's theory of change model. The project inquired if educational intervention on MetS improved providers' knowledge and intent to adopt MetS guidelines. A literature review and established guidelines of the American Psychiatric Association and American Diabetic Association about MetS in psychiatric patients directed the educational content. Five expert panelists with over 10 years of experience in psychiatric mental health reviewed the educational content using a Likert-type questionnaire. Findings resulted in the acceptance of the educational content without further recommendation. Twelve staff attended the educational session presented on MetS. Comparison of the pretest and posttest questionnaires that has 5 multiple choice questions indicated some positive effects. The good knowledge of MetS, how to screen for MetS, health promotion activities with consumers, metabolic profile of different neuroleptic medications, providers' roles in MetS. The participants' overall knowledge about MetS screening improved from 8.3% pretest to 83.3% after receiving the educational program. The educational project for MetS screening might foster positive social change by improving continuity and quality of care, which will lead to better patient outcomes, reduce healthcare cost, and impact positive patient outcomes.

The goal of this project was to evaluate a hospital acquired pressure ulcer (HAPU) prevention program implemented in a New York City hospital in 2012. The program objective was to encourage collaboration of team members to prevent HAPUs in order to reduce prevalence rates to national target benchmarks. The program provided caregivers information about epidemiology, etiology, prevention, and treatment of HAPUs, and presented HAPU prevention as a collaborative process in order to foster greater awareness in each participant's role as an agent of change by emphasizing the importance of communication between members of the health care team. This project evaluated that program by exploring changes in the incidence of HAPUs following implementation of the HAPU prevention program. This study was retrospective in nature and used a backdated analysis of archival data collected as a separate-sample, pretest-posttest, and quasi-experimental design to assess the relationship of the frequency of HAPUs to the implementation of a skin safety program. The data collected was between July 2012 and December 2013 from 2 medical/surgical units in a metropolitan hospital in New York City. Data were analyzed using descriptive statistics and t tests for independent samples. Incidence of HAPUs fell on both units, with t tests demonstrating statistically significant differences and large effect sizes on both units, suggesting clinical and practical significance of the findings. While this project does not establish improved HAPU incidence as a direct consequence of the skin health education program, findings of the project provide insight for hospital leaders in their efforts to reduce HAPU rates. Results of the project suggest a HAPU prevention program emphasizing development of knowledge and skills as well as the promotion of collaboration between health care team members may be effective in reducing HAPU incidence rates. This project also provides a low cost educational option to reduce healthcare disparities and promote positive social change. Further research in similar contexts is recommended for future study.

Hospital-acquired infections such as nonventilated hospital-acquired pneumonia (NV-HAP) are significant patient safety concerns. The lack of oral care in the nonventilated acute care patient population is a major contributor to NV-HAP. Nursing staff are on the frontline in the provision of oral care to hospitalized patients, but a lack of knowledge regarding the relationship between oral care and NV-HAP was identified as a gap in practice at the project site. The purpose of the project was to develop a staff education program on oral care of the nonventilated patient population. The practice-focused question addressed whether an evidence-based education for nurses regarding oral care for nonventilated patients could be developed and validated. Knowles's adult learning theory guided the use of evidence-based practice literature to develop the staff education program. The project team of 2 infection prevention specialists, a nursing professional specialist, and a nurse educator evaluated the education program, plan for delivery, and plan for evaluation of learning through an anonymous Likert-style evaluation survey. The 4 team members also completed program evaluation surveys, and results revealed a 100% score of agreed or strongly agreed that the program objectives were met. A descriptive analysis of the data provided information that supported the evidence-based education on oral care of nonventilated patients as a means of nurse education. When implemented, the project education will be part of a standardized oral care program to reduce barriers in delivering oral care. Social change implications are related to decreasing patients' risk of NV-HAP, increasing quality of life, and decreasing length of hospital stay.

Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey results from 2013 revealed a need for improvement in nurse-patient communication at the unit level. In response, nursing administrators at an acute-care hospital asked bedside nurses to develop a protocol for bedside shift report according to best practices. The protocol was implemented in May 2014. Three months later, a postimplementation survey was distributed. Work from Lewin and Kotter theoretical concepts were used to evaluate this organizational change. The purpose of this study was to determine whether re-educating staff nurses on the bedside shift report protocol increased compliance with evidence-based practice performance standards for bedside shift reporting. In the initial phase of this project, a review of a 3-month postimplementation survey revealed consensus that bedside shift report had not been universally accepted and implemented. Based on these findings, a re-education program was developed and implemented. A 2-week post re-education survey elicited 89 respondents' perspectives on bedside shift report. Analysis of the survey results revealed that nurses had strong perceptions of this significant change to their practice. The re-education revealed that nurses could show commitment to performing daily bedside shift report if specific conditions are supported, such as nurses understanding that the process improves satisfaction levels, and if nurses' misconceptions are addressed. Social change of this magnitude indicated that the voices of bedside nurses must be heard. To make this goal a reality ongoing evaluation is required to promote patient safety, improve patient outcomes, and improve HCAHPS results related to nurse-patient communication. Positive social change results in this project impacting patients by providing a better quality of care in this facility.

The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, increase staff satisfaction, and increase compliance with best practices. The diffusion of innovation theory was used to bring about successful change among team members in the ICU. The Focus Plan, Do, Study, Act methodology was used to determine what improvements were needed in the ICU. The evaluation of the telemedicine unit demonstrated early signs of positive progress. Actual length of stay (3.25 days) from the hospital's telemedicine dashboard was less than the predicted length of stay (3.8 days), and adherence to best practice was at or above target (95%) when compared to all telemedicine units across the nation, as provided by the telemedicine dashboard. Implementing a telemedicine unit will bring about a transparency and standardization of Intensive Care services, leading to positive social change in the organization. This social change, combined with the success of the unit, can influence other non-academic healthcare institutions to pursue telemedicine technology.