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Designing and Sustaining the Designing and Sustaining the Capstone ProjectCapstone Project
Linda Roussel, RN, DSN, NEA-BC, Professor, USA Linda Roussel, RN, DSN, NEA-BC, Professor, USA College of NursingCollege of Nursing
Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center
Terilee Gerry, BSN, RN, CNL Student, Maine Medical Terilee Gerry, BSN, RN, CNL Student, Maine Medical CenterCenter
ObjectivesObjectives
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)
CNL Academic ExperienceCNL Academic Experience
CNL White paper Roles
Competencies
End of Program Expectations
CNL Academic ExperienceCNL Academic Experience
Assignments: Needs Assessment Work Flow Gap Analysis
Clinical Experience Role Socialization
CNL Academic ExperienceCNL Academic Experience
Clinical Experience Making the Case Cost-Benefit IOM Aims Outcomes Management Evaluation
The Student PerspectiveThe Student Perspective
Major Aspects of Project Major Aspects of Project Management and the Clinical Management and the Clinical Immersion ExperienceImmersion Experience
Terilee Gerry, BSN, RN, CNL Student, Maine Medical CenterTerilee Gerry, BSN, RN, CNL Student, Maine Medical Center
Academic PreparationAcademic 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
Clinical PreparationClinical 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
Student Clinical ResourcesStudent Clinical Resources
Staff Development Specialist coordinated student experiences
8 CNLs Nursing Director Student colleagues
CNL PreceptorCNL 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
Nursing DirectorNursing Director
Project approval Weekly meetings Close communication Leadership mentor
The Capstone ProjectThe Capstone Project
Preliminary discussion in 1st semester Establish a time line Unit based Needs Assessment Director approved Prepare for IRB submission
My ProjectMy Project
Assigned unit in 3rd semester Unit issues/needs unknown Director meeting-input important Possible project suggestions Decision made Began making contacts
Project BeginsProject Begins
Literature Search Begin contact/meetings with stakeholders Communication with physicians Work with faculty Input from Nursing Research Dept.
Project ContinuesProject Continues
Paper written Hospital and Univ. IRB approval obtained Data collection now underway
Director’s InputDirector’s Input
Inform staff of project to demonstrate leadership
Attend staff meetings Involvement on various committees Meet key personnel
Continued SupportContinued Support
CNL monthly meetings Quarterly meetings with CNS group Support of each other as needed
Innovative Role of the CNLInnovative Role of the CNL
Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center
The CNL Perspective
Innovative Role of CNLInnovative Role of CNL
“We cannot solve our problems with the same thinking that created them.”
Albert Einstein
ProjectsProjects
Simplistic to Difficult Small to Enormous Microsystem changes to House-wide
changes
My Capstone ProjectMy Capstone Project
As the result of my Capstone project an entire process was changed.
It’s benefits: decreased catheter related-blood stream infections and decrease number of healthcare dollars spent.
Other benefits was streamlining care for the nurses.
Capstone Project OverviewCapstone 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
Capstone Project OverviewCapstone 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
OutcomesOutcomes
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
Summary of ProjectSummary 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
ResultsResults
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
Examples of Other ProjectsExamples 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.
Here and NowHere 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
Here and NowHere 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
Here and NowHere and Now
PCL Model To move toward CNL model as nurses
complete education & certification Must be enrolled in the CNL Masters curriculum
Here and NowHere 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
Looking to the FutureLooking 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