ESSAY: Capstone milestone 1

Summary Guidelines

Updated 5/2018

Purpose

Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star Model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

• CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO4)
• CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO8)

Due Dates

Milestone 1 consists of the completion of ONE form with two worksheets. Complete both worksheets and submit the form by Sunday, 11:59 p.m. MT at the end of Week 3.

Points

Milestone 1 is worth 175 points (75 points for the Practice Issue and 100 points for the Evidence Summary).

You are required to use the assignment specific item(s) (article/systematic review/topic/form/templates) or you will earn a “0” for the assignment. In addition, assignments that do not follow the current guidelines or use the required item, as defined above, will be evaluated for evidence of an academic integrity violation.

After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. This includes blank, incomplete, incorrect file, and/or incorrect file format documents. It is your responsibility to submit the correct completed assignment in the correct format to the correct submission area. Your last submission before the due date will be graded. You may not resubmit after the due date with a different file and incur a late deduction per the Late Assignment policy.

Practice Issue Worksheet Directions

1. Below is a video tutorial with tips for completing this assignment. Click to view an audio transcript (Links to an external site.)
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Closed Captions

1. Choose the ONE systematic review topic that is of most interest to you, or most relevant to your practice situation, from the required List of Approved Systematic Reviews (Links to an external site.)
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2. Follow the grading criteria below to formulate your practice issue, which must be based on the topic of the systematic review you have selected.
3. Download the required Milestone 1 Practice Issue and Evidence Summary Worksheets (Links to an external site.)
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(both worksheets appear in ONE form) to document the practice issue presented and approved by your instructor in the Week 2 Discussions.
4. You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the “.docx” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)
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. Click on the envelope at the top of the page.
5. Your practice issue will be the same for all three Milestone assignments in this course.
6. Please type your answers directly into the worksheet.

Evidence Summary Worksheet Directions

1. Develop an evidence summary by following the grading criteria below.
2. Document this on the evidence summary portion of the worksheet.
3. You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment.
4. Please type your answers directly into the worksheet.

**Academic Integrity Reminder**

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment.

Please see the grading criteria and rubrics on this page.

NOTE: Please use your browser’s File setting to save or print this page.

Rubric

NR451_Milestone1_3

NR451_Milestone1_3

NR451_Milestone1_3
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomePractice Issue Statement, Scope of Practice, Practice Area Identifies a Practice issue statement that is an independent nursing decision, and is relevant to the systematic review topic chosen from among the approved list provided in the course. Describes the scope of practice issues. Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminate the falls? This is where you begin your initial search into the problem or practice issue identified. Identifies the practice area.	20.0 pts Practice issue is identified based on the approved systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is fully described. Practice area identified. 18.0 pts Practice issue is identified but is not clear, however it is based on the approved systematic review topic chosen. Practice issue is an independent nursing decision. Scope of practice issue is described in simple terms. Practice area identified. 16.0 pts Practice issue is identified but is not clearly related to a nursing practice issue, however it is based on the approved systematic review topic chosen. Practice issue is not an independent nursing decision. Scope of practice issue is described but is not clear. Practice area identified. 8.0 pts Practice issue is unclear. Practice issue is not based on the approved systematic review topic. Practice Issue is not an independent nursing decision. Scope of practice issue is not described. Practice area identified. 0.0 pts Practice issue is not identified; practice issue is not an independent nursing decision; scope of practice issue is not described; practice area is not identified.	20.0 pts
This criterion is linked to a Learning OutcomePractice Issue-Rationale for Selections Identifies how rationale behind how the practice issue was selected as a practice issue/problem. Documents the practice issue in a logical manner.	35.0 pts Documents how the practice issue was identified. Rationale for responses is logical and described thoroughly. 33.0 pts Documents how the practice issue was identified. Rationale for responses is logical and briefly described. 30.0 pts Documents how the practice issue was identified. Rationale for responses is somewhat logical and vaguely described. 15.0 pts Vaguely describes how the practice issue was identified. Rationale for responses is somewhat logical and vaguely described. 0.0 pts Does not document how the practice issue was identified. Rationale is not completed. This section of the form is blank	35.0 pts
This criterion is linked to a Learning OutcomeTypes of Evidence Gathered-Rationale for Selections Identifies and documents types of evidence that must be gathered for review of the Practice Issue. Describes rationale for each type of evidence that is selected.	20.0 pts Identifies and documents what types of evidence is needed for review. Thoroughly describes rationale for all checked types of evidence selected. 18.0 pts Identifies and documents what types of evidence is needed for review. Briefly describes rationale for all checked types of evidence selected. 16.0 pts Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence. 8.0 pts Does not document more than one type of evidence that is needed for review and does not include rationale for selected type of evidence. 0.0 pts Does not document types of evidence or rationale.	20.0 pts
This criterion is linked to a Learning OutcomePractice Problem Description States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms. Describes practice setting in measureable terms. Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?	10.0 pts -Practice problem is in own words, with reference to the population of interest. -Setting of the problem is identified -Magnitude of problem is discussed. -The practice issue is stated in measurable terms. 9.0 pts -Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is discussed. -The practice issue is stated in measurable terms. 8.0 pts Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated in measurable terms. 4.0 pts -Practice problem is in own words, with reference to the population of interest. -Setting of the problem is not discussed. -Magnitude of problem is not discussed. -The practice issue is stated but not measurable. 0.0 pts -Practice problem is not in own words -There are no references to the population of interest. -Setting and magnitude of problem is not discussed -The practice issue is not stated in measurable terms.	10.0 pts
This criterion is linked to a Learning OutcomeSource(s) of Evidence Identifies a source of evidence that is a nursing topic and is the subject of a systematic review article. Provides a complete reference for the systematic review article that was chosen from the list, as well as any optional scholarly source in support of the project topic.	20.0 pts -Source is a Systematic Review article chosen from the approved list (plus optional scholarly article of support). Complete APA formatted reference(s) is given for with no errors. The source (s) must be relevant to the practice issue identified. 18.0 pts -Source is a Systematic Review article chosen from the approved list (plus optional scholarly article of support). -A reference is given, but it has APA formatting errors. -The source must be relevant to the practice issue identified. 16.0 pts -Source is a Systematic Review article chosen from the approved list. (plus optional scholarly article of support). -No reference is provided. -The source must be relevant to the practice issue identified. 8.0 pts -Source of evidence is a research article or systematic review not on the approved list. -A reference for the article or systematic review is given. -The source is not relevant to the practice issue identified. 0.0 pts -Source of evidence is not provided, or is not a research article or systematic review. -Reference is missing.	20.0 pts
This criterion is linked to a Learning OutcomeArticle Objectives/Statement of Questions Identifies the objectives of the article. Identifies questions being addressed by author/s. Explains relationship to the chosen practice issue.	20.0 pts -Objectives of article are identified. -Questions addressed by author/s are thorough. -Relationship to your practice issue is explained. 18.0 pts -Objectives of article are identified. -Questions addressed by author/s are explained but not thorough. -Relationship to your practice issue is explained. 16.0 pts -Objectives of article are identified. -Questions addressed by author/s are not thorough. -Relationship to your practice issue is vague. 8.0 pts -Objectives of article are identified. -Questions addressed by author/s is missing. -Relationship to your practice issue is not explained. 0.0 pts -Objectives of article are not identified. -Questions addressed in article and relationship to own practice is not identified.	20.0 pts
This criterion is linked to a Learning OutcomeInterventions/Main Findings Summary Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes. Summarizes main findings of the author/s including strength of evidence for each main outcome. Describes the relevance to the Milestone 2 paper.	30.0 pts -Thoroughly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Thoroughly summarized main findings of the author/s. -Included strength of evidence for each main outcome. 26.0 pts -Briefly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Briefly summarized main findings of the author/s. -Included strength of evidence for each main outcome. 24.0 pts -Vaguely summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes. -Vaguely summarized main findings of the author/s. -Included strength of evidence for most of main outcomes. 11.0 pts -Summary of interventions is not in own words. -Summarized main findings of the author/s is not apparent. -Did not include strength of evidence for any of the main outcomes. 0.0 pts -Summary of the interventions the author(s) suggest to improve patient outcomes is missing. -Summary of the main findings of the author is missing. -The strength of the evidence for outcomes are missing.	30.0 pts
This criterion is linked to a Learning OutcomeEvidence-based Solutions and Limitations Outlines evidence-based solutions to consider for the capstone project. Discusses any limitations to the studies included in the systematic review that he/she believes may impact use of the evidence provided in their project.	20.0 pts -Outline of evidence-based solutions considered for project is documented and clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project. 18.0 pts -Outline of evidence-based solutions being considered for project is documented but not clear. Discussed any limitations to the studies performed. Documents limitations believed may impact use in project. 16.0 pts -Outline of evidence-based solutions considered for project is documented but not clear. Discussed most limitations to the studies performed. Documents limitations believed may impact use in project. 8.0 pts -Outline of evidence-based solutions being considered for project is not documented. -Discussed most limitations to the studies performed. Documents limitations believed may impact use in project. 0.0 pts -Outline of evidence-based solutions, limitations of studies and potential impact to project is missing.	20.0 pts
Total Points: 175.0

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TOPIC: Health care associated infections P – Population ( Hospital acquired Infection) I – Intervention (Hand Washing) C- Comparison of intervention (washing hands with antiseptic solutions; No hand washing) O –Outcome( Reduce Infection) T- Time Frame.(3-6 months) PICOT question therefore will be: does hand washing among health care professionals reduce hospital acquired infections? ANSWER Health Care Associated Infections Name: Institution Affiliation: Date:   Capstone Project Milestone 1: Practice Issue and Evidence Summary Worksheets   Student Name: Cynthia Tei                                       Date: 5/21/2018   Practice Issue Worksheet   List the topic and include the citation for the systematic review you have selected: TITLE: Hand Washing with Antiseptic to Reduce Surgical Site Infection.  By Tanner (2016), surgical hand antiseptic to reduce surgical site infection. Cochrane Database of Systematic reviews, Issue 1. Art . No.: CD004288.DOI: 10.1002/14651858.CD004288.pub3. retrieved from, http://onlinelibrary.Wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1002/14651858 What is the practice issue you have identified related to the topic you have chosen? The issue has been identified as a result of increased cases of surgical site infections from health providers to patients and also from patient to patient that results in patient complications. Define the scope of the practice issue: The “scope of practice” will be used to describe who, what, where, when, why, and how of nursing practice especially in relation to surgical hygiene. The PICOT question will be used to define the action, processes and procedures that majorly results to patient complications due to surgical hygiene and especially hand washing or lack of it and the intervention process. This practice issue will be a discussion of why hand washing is important and also address the key players of the surgical department in as far as safety is concerned. A survey based on literature will also bring out the voice of relevant stakeholders over what they feel needs to be done to ensure hand washing succeeds. A conclusion put in place outlines what needs to be considered in general medical practice in as far as ensuring pathogens are not transmitted through negligent issues of clinical practice.   Describe the rationale for your checked selections: Safety/risk management concerns- Failure by a health professional to wash hands with an antiseptic under clean running water will imply that surgical equipment will be contaminated. This will be a health risk not only to the patient but the health professional. Clinical practice issue is a concern- Improving the cleanliness of a surgical operating area and surgical equipment will automatically improve the health concern of health professionals. Hand washing won’t be hard to implement. What evidence must be gathered? (check all that apply) _X__ Literature search __X_ Guidelines ___ Expert Opinion ___ Patient Preferences ___ Clinical Expertise ___ Financial Analysis ___ Standards (Regulatory, professional, community) ___ Other   Describe the rationale for your checked selections: Literature search- Is important in identifying, appraising and synthesizing the research. It identifies the available evidence and statistical facts on dangers of lack of hand washing practice as well as provide an informed decision on what to change in order to ensure safety is adhered to. It also helps learn what policy says and how to implement it. Guidelines- There is a standard safety procedure in every health facility. Different states have also there guidelines as far as health facility safety is concerned. Federal, state, local and other regulatory actions are necessary for EBP adoption. Directions: Please type your answers directly into the worksheet.   Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms: Hand washing or hand hygiene is one of the most crucial steps that can help avoid spread of germs and eventually one falling sick not only for older people but also to the young especially with the advent of many viral diseases such as Ebola (Kelly, 2016). Many diseases and micro-organism related conditions are spread when hand washing is not taken seriously. This activity should be undertaken using soap and clean running water. The practice of hand washing continuous to be encouraged especially among health care professionals. However, this can be a debate as to whether their hand washing can really reduce hospital acquired infections. Type the complete APA reference for the systematic review article you chose from the list provided, It must be relevant to the practice issue you described above. By Tanner (2016), surgical hand antiseptic to reduce surgical site infection. Cochrane Database of Systematic reviews, Issue 1. Art. No.: CD004288.DOI: 10.1002/14651858.CD004288.pub3. Identify the objectives of the article. The objectives of the article is to describe the need for hand washing using antiseptic to reduce surgical cite infections. Provide a statement of the questions being addressed in the work and how they relate to your practice issue: The high number of deaths in surgical operations are as a result of negligence on the use of clear procedures on cleanliness and safety of surgical equipment as well as the cleanliness of the health professionals concerned. Among these risks, failure to wash hands with antiseptic soap under clean running water is one of the basic practices that is neglected yet causes many deaths. As a basic practice, hand washing will ensure that other clinical and surgical safety measures are automatically adhered to as per any facilities operating standards.   Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes. The authors suggest that hand washing should always be part of all operational procedures in a surgical set up. An antiseptic soap should always be used as it ensures that all germs are removed and hence no transmission. Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper. The main findings showed that hand washing practice can save up to 60% of lives that are lost due to transmission of pathogens from professionals to patients or from patient to patient. If a health facility employs hand washing practice, it will take a very short time for safety measures to be restored in a health facility. However, cleanliness should not be limited to health professionals but also to the patients and even surgical equipment. Outline evidence-based solutions that you will consider for your project. Advice the cleaning team to fast ensure the environment around the health facility is clean Engage all members of surgical team in ensuring that they clean their hands with anti-septic at all times Surgical equipment to be cleaned well and those in doubt to be disposed and replaced Execute the research plan Evaluate the outcome of readmissions. Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project. The limitation that may impact the ability to utilize the research would be having nurses that are only dedicated to ensuring that all surgical operation procedures (including hand washing) are adhered to. Secondly, all disposed surgical tools may not be easily replaced due to budget constraints.                               References Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305-315. Aziz, A. M. (2014). Supporting infection prevention in the operating room. Journal of Operating Department Practitioners, 2(3), 121-129. Kelly, R. (2016). Protecting your patients and staff from infection. Practice Management, 26(7), 20-23. Wakawa, A. M., Abdu, P. A., Oladele, S. B., Sa’idu, L., & Mohammed, S. B. (2012). Risk factors for the occurrence and spread of highly pathogenic avian influenza H5N1 in commercial poultry farms in Kano, Nigeria. Sokoto Journal of Veterinary Sciences, 10(2), 40-51.