Discussion: Continuation of Capstone
Discussion: Continuation of Capstone
Discussion: Continuation of Capstone ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Continuation of Capstone I dont understand this Writing question and need help to study. Discussion: Continuation of Capstone Continuation of the Capstone Part 1 Scholarly Activities Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally. You are required to post at least one documented scholarly activity by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis. Discussion: Continuation of Capstone Submit, by way of this assignment, a summary report of the scholarly activity, including who, what, where, when, and any relevant take-home points. Include the appropriate program competencies associated with the scholarly activity as well as future professional goals related to this activity. You may use the Scholarly Activity Summary resource to help guide this assignment. Part 2 Capstone Project Change Proposal Presentation for Faculty Review and Feedback ( Topic) Preventing Fall Using Video Monitoring Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor. Discussion: Continuation of Capstone nrs_493_rs_scholarlyactivities__6_.docx video_monitoring_proposal.docx sample_scholarly_activity.docx Scholarly Activities This document describes the scholarly activity elements that should be included in a five paragraph summary. You may use this resource to help guide the preparation of the Scholarly Activities assignment, due in Topic 10. Overview This section consists of a single paragraph that succinctly describes the scholarly activity that you attended/participated in, the target market for the activity, and the benefit of the activity to you. Problem This section consists of either a short narrative or a list of bullet points that concisely identifies the problems the scholarly activity is designed to solve. Educate: What is the current state of the activity topic? Explain why this is a problem, and for whom is it a problem? Inspire: What could a nurse achieve by participating in the scholarly activity? Use declarative sentences with simple words to communicate each point. Less is more. Solution This section consists of either a short paragraph or a list of bullet points that concisely describes the solution to a proposed practice problem that the scholarly activity addressed and how it addresses the problem outlined in the previous section. Opportunity This section consists of short paragraphs that define the opportunity that the scholarly activity is designed to capture. It is important to cover the objectives and goals that were met. How will attending/participating in this scholarly activity help you grow as a nurse? Program Competencies Addressed This section consists of a list of program competencies that were addressed in this scholarly activity. Please use the list from the ISP. © 2017. Grand Canyon University. Discussion: Continuation of Capstone All Rights Reserved. Video Monitoring: An Effective Fall Prevention for Inpatients Background Older adults fall risks increases in the hospital because of unfamiliarity of the environment, medications that affects mentation or blood pressure, and disease process. Klymko, Etcher, Munchiando, & Royce (2016) found that, Approximately 1 million falls occur annually in acute care settings in the United States, with incidence of 2.3-7 falls per 1,000 patient days. Also, an estimated additional cost of $3,500 for a fall without injury, with costs increasing to $16,500-$27,500 for additional falls without injury or when serious injury occurs (p. 329). Falls are very costly to hospitals and likewise to the patients. Prevention of fall has been an ongoing battle even with the sophistication of equipment and fall interventions from nurses. Problem statement Fall is the most common preventable accident for older adults (65 and older) in the United States. According to The Joint Commission (2015), Every year in the United States, 30-50 percent of falls resulting in injury. Injured patients require additional treatment and sometimes prolonged hospital stays. In one study, a fall with injury added 6.3 days to the hospital stay (p. 1). Fall can result to mortalities, increased healthcare costs to the hospital, poor patient outcomes, and post-traumatic stress to nurses. Fall can have direct and indirect costs to hospitals and patients. Bed/body alarms, side rails, fall risk bands, and assessment tools helps in reducing fall rates. But, the high acuity of our patients, staffing issues, and no certified nursing assistants (CNAs) to help with patient care, fall prevention has been challenging in our facility. Discussion: Continuation of Capstone In my experience, most falls happens when a nurse is on a break, change of shifts, at night, and the times when nurses are busy like passing medications. Moreover, a fall can cause distress to a nurse whose patient fell during their shift. Patient safety is a priority in nursing and if the safety was compromised it will cause stress to nurses. According to a study, nurses felt horrible and guilt that they let their patients fall under their care (Bok, Pierce, Gies, & Steiner, 2016). The purpose of this paper is to propose an evidence based study with the use of remote video monitoring (VM) system to fall prevention in our facility. This study includes; purpose of the change proposal, PICOT, literature search strategy employed, evaluation of the literature, applicable change or nursing theory utilized, proposed implementation plan with outcome measures, identification of potential barriers to plan implementation, and a discussion of how these could be overcome, and an appendix section. Purpose of the change proposal It is imperative to find a solution to lower the incidence of fall because of the rising cost of healthcare and the negative consequences of fall to patients and nurses. The Proposed solution to help with fall prevention is video monitoring. VM can monitor patients twenty-four hours a day. Since our hospital does not employ CNAs and sitters, video monitoring can be used to monitor a patient for safety reasons like fall. Monitors can be used to monitor patients in the dark and the video monitoring system can pay for itself for 3-6 months with the reduction in falls (Healthcare Risk Management, 2015, p. 80). Video monitoring can also create a peace of mind to nurses coupled with the other fall interventions. Discussion: Continuation of Capstone This will make the nurse stay focused on the other tasks at hand and will create a sense of security that their patients who are at fall risked are monitored. PICOT For high fall risk inpatients, how does the use of remote video monitoring compared to patients who does not use video monitoring improve falls rates during inpatient stay? P= For high fall risk inpatients, I= how does the use of remote video monitoring C= compared to patients who do not use video monitoring O= improved fall rates T= during inpatient stay? Literature search strategy employed The writer used the CINAHL and Academic Search Complete databases that provided peer-reviewed research articles and journals. The articles and journals that was used in this project is within a 5-year period. Credible journal websites were also used in this project that was peer-reviewed articles. The literature that was utilized was carefully analyzed to maintain credibility and the appropriateness to the project. The author also consulted a mentor to help with the research process Evaluation of the literature This study used multiple references for the evidenced based project to support video monitoring as an intervention to fall prevention. Video monitoring is a new intervention to fall prevention but there are multiple facilities that tested the concept wherein it has shown a positive result on fall prevention. There are eight peer reviewed research that are used for this literature review which relates to fall prevention measures. First, an article that used VM to study the antecedents of fall. VM is proven to be a safe tool to study falls and their cause because falls are mostly unwitnessed. The sample population are inpatients in an acute care facility. Discussion: Continuation of Capstone The limitation of this study is that there were 40 patients who fell that were not included while the study was ongoing (Klymko, Etcher, Munchiando, & Royce, 2016). Also, the study should have used a better assessment tool to identify fall risk patients. The study recommends the use of VM as a safe intervention for fall prevention and it can also be used to further study the antecedents of fall. Second, an article that used VM to fall prevention and reduce sitter costs. The research question is; can VM reduce fall rates and sitter cost? According to Votruba, Graham, Wisinski, & Syed (2016), There was a 35% reduction in falls when comparing the baseline data from the 9 months prior to the intervention of the 9month intervention phase where video monitoring was used (p.187). The study was at a 350 bed MAGNET designated hospital. It took place in the critical care/intermediate unit, neuro, and senior adult unit. The limitation of the research is that VM technician patient ratio and training was not studied. The research showed that the use of VM showed significant results to fall prevention. Also, VM is costeffective which can reduce the hospitals fall related costs. Third, is an article that was conducted at a hospital at Denver, Colorado that used VM to prevent falls. Within the first 3 months of operation, 57 falls were prevented with a potential minimum savings of $24,225 (Jeffers et al., 2013). The limitation is that the research was not able to explore on ways to prevent falls who have language and hearing deficits. The study recommends that use of VM to fall prevention and to reduce costs of falls. Fourth, is an article that incorporates VM in an Epilepsy Monitoring Unit (EMU) at a hospital. Discussion: Continuation of Capstone The research question is, do a non-restrictive setting safe for patients in high fall risk patients like EMU? The limitations of the study are; the population is very specific to epileptic patients. Another, the portable EEG machine and equipment like helmets are variables that are unique to the study. The study suggest that tight surveillance is more important than restricting patients (Craciun et al., 2017). A restrictive environment can lead to complications (e.g. DVT, increased falls due to inactivity, pneumonia, etc.). Fifth, is a study that compared the use of sitters to VM in fall prevention. The research question is, can VM be used to improve fall rates, reduce cost, and avoid self-harm? The study was done in a hospital at a cardiology and neuroscience unit. The limitation of the study is that the result for fall rates using the VM is not significant during the duration of the study. The study should have been done longer since there was a downward trend in the fall rate. Video monitoring is less expensive than sitters and does not impose a patient safety risk for falls or self-harm (Davis, Kutash, & Whyte, 2016). Sixth, is another article that used VM to prevent falls. The research question is, Does the use of VM reduce patient falls and injuries associated with falls and reduce the use of observational sitters for fall prevention? (Sand-Jecklin, Johnson, & Tylka, 2016). The study was conducted at an academic medical center in Mid-Atlantic Region. The limitations of the study were; the data for falls is lacking at the time when VM was not in use, there was no data regarding the nurses response time to the VM technician warning them, and the amount of education provided to patients and families to fall prevention measures.Discussion: Continuation of Capstone According to Sand-Jecklin, Johnson, & Tylka, (2016), Total of 74 falls occurred in the pre-study. Compared to only 15 with the monitored units for post study. Also, there were a total of 34 falls that were unmonitored in the post study (p.135). The study suggests that VM as a cost-effective tool to prevent fall. Further studies or standardized training should be done to VM technicians to be able to prevent fall from happening. Seventh, is an article that integrates technology with VM to prevent falls. The research question is can we use technology to improve fall rates and costs for falls? (Westle, Burkert, & Paulus, 2017). The study was done at a hospital in a neuroscience unit. The limitation of the study is the technology that was used in the research to the facilities is specific. It can create a problem with compatibility to other facilities who do not use the same technology. The research was able to use an algorithm to categorize patients who are fall risk and needed VM. The research was a success and the health system are thinking of expanding it to other units in the hospital and to other facilities. The study also suggests that a faster and more reliable means of communication should be used between the VM tech and the nurses. Lastly, is an article that studied the feelings of nurses about fall prevention and whose patients fell during their watch. The research question is; what is the meaning of fall prevention to nurses? The sample population are Association of Rehabilitation Nurses (ARN) members. One limitation of the study is, there is a low number of turnout sample. Discussion: Continuation of Capstone There was a total of 747 potential participants but only 53 responded and 43 completed the questionnaire. The study suggests that it is important to know about nurses feelings regarding fall. Nurses needs debriefing regarding the fall should be implemented. Investigators must be nonthreatening to encourage open dialog and improved learning experiences when falls occur (Bok, Pierce, Gies, & Steiner, 2015). Applicable change or nursing theory utilized A person who is admitted to a hospital are prone to falling because of weakness, unfamiliarity of the room, certain medications that they take, and equipments in the room. According to Roy Adaptation Model, the individual and the environment are sources of stimuli that require modification to promote adaptation (Friberg and Cresia, 2016). Health and Illness will be a part of persons life. Nurses are responsible in modifying the environment of a patient to promote adaptation which can lead to well-being. Safety is the priority of nursing which is the foundation of most of the policies in place. The nurse can modify the environment of the patient by introducing video monitoring to prevent fall because of the vulnerability of the patient due to external forces mentioned above. The patient can adapt to this tweak of safety measure which can lead to continued healing which is the aim of Roy Adaptation Theory. Proposed implementation plan with outcome measures Centralized video monitoring can reform fall prevention measures. Our patients can now be monitored 24 hours a day and seven days a week. VM is used to prevent falls by setting up a camera with audio system to communicate to patients who are at risk for fall and alert nurses for imminent fall. VM can also be used to study the factors that caused falls to patients because most falls happened unwitnessed. Fall interventions like bed/body alarms, bed rails, and risk assessment tools helps in preventing fall but, evidence have shown that it is not enough to solving fall prevention. VM is closely monitored by a trained medical person at a remote place where privacy of the patients is maintained. A remote camera with audio is placed at bedside to allow a two-way communication between the Video monitoring technician (VMT) and patient or the nurse. Discussion: Continuation of Capstone For example, a VMT can try to convince a confused patient who is trying to get off the bed to stay on the bed while waiting for the nurse for help. The audible voice of the VM technician can alert nurses to check on the patient or the VM tech can make a phone call to alert the staff or the primary nurse for safety concerns. A remote portable camera device will be installed in the room to an identified patient who is at risk for fall. A standard assessment tool will be used to assess a patient who will be placed into the central video monitoring. The virtual sitter patient fall risk tool that was used at Mission Hospital will be used to evaluate a patient to qualify for a VM. The tool is found at appendix D. The nurse will give report to the VMTs about the safety precautions and the indication of VM. A standard Central Video Monitoring Technician SBAR and Work Log sheet will be used to document outcomes, handoffs to from VMT to another VMT, and documentation. The worksheet is found at appendix A. A training will be conducted to a selected secretary who has preferably a certified nursing assistant certificate. Training will take about 8 hours and will monitor about 8 patients at a time. The study will be conducted in a telemetry neuro floor and will start for 16 patients. A consent will be signed by the patient or the primary decision maker if the patient is unable to make decisions. A survey will be given to patients that is detailed in appendix B to inform us about their experience under VM. The number of falls will be documented and the interventions that was used during the study. The EBP project will use a pre and a post study in a 12-month period for each study. Appendix C will show the comparison for both studies. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome Change makes most of nurses uncomfortable let alone sustaining the change. In healthcare, the landscape is always changing wherein nurses as the frontline of patient care are mostly affected to changes. A barrier of the EBP proposal is the acceptance of nurses to changes since it can affect their workflow in adapting this change. According to Shute et. al., (2012),Discussion: Continuation of Capstone Although many employees in healthcare settings may have gone through changes in their careers they may not have the skills, knowledge and expertise to adapt to new challenges, develop practice and adopt new ways of working (p. 639). I can overcome this barrier by constantly communicating to nurses and hearing out their suggestions and concerns. I can hear their concerns and will modify the plan or workflow to accommodate their concerns. A survey will be solicited to nurses to evaluate the EBP change at the end of the study using the SurveyMonkey website. Another barrier that I can think of is the unwillingness of the patient or the family to consent for the project. Patient privacy is a concern for patients or families because of the stigma attached to video monitoring. Some people do not want the feeling of being watched. My solution is to educate patients about the statistics of fall in the hospital because there is a strong evidence that remote video monitoring has lowered falls in the acute care settings. I can also educate them that privacy will be maintained, and everything is confidential. At any time, they can ask that video monitoring can be temporarily or permanently turned off if they wish to. Privacy will be implemented when changing diapers, bed baths, and anytime the patient feels like he/she needs to have privacy. A patient experience survey will also be filled out at discharge wherein they can mail it back using a pre-stamped envelope or hand it to the staff before leaving. The survey is found at appendix B. Appendix Appendix A Central Video Monitoring Technician SBAR and Work Log Appendix B Survey for Patients How Satisfied are you with the Central Video Monitoring? Satisfied Somewhat Satisfied Dissatisfied Did the staff provide enough education about the Central Video Monitoring? Very thorough Somewhat thorough Not so thorough Do you think that your privacy was maintained in your stay? Very well Somewhat well Not very well How likely are you to use Central Video Monitoring in the future? Very likely Somewhat likely Not likely Will you recommend using Central Video Monitoring to your friends and family? Very likely Somewhat likely Not likely How did the staff and the team respond to your safety? Very prompt Somewhat prompt Not responsive How do you rate your overall stay with the use of Central Video Monitoring? Excellent Above average Average Below Average Poor Can you provide us suggestions, comments, questions, and concerns regarding your stay with the use of Central Video MonitoringDiscussion: Continuation of Capstone ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ __________________________________________ Thank you for filling out the survey! Wishing you the best of health! Appendix C Pre and Post CVM intervention Total n= Total n= Fall Prevention Interventions Number of patients who used Fall Prevention Intervention at 12 Months Baseline Number of patients who used Fall Prevention Intervention at 12 Months with CVM Bed Alarm High Risk Band Bed a Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
Discussion: Continuation of Capstone
Discussion: Continuation of Capstone ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Continuation of Capstone I dont understand this Writing question and need help to study. Discussion: Continuation of Capstone Continuation of the Capstone Part 1 Scholarly Activities Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally. You are required to post at least one documented scholarly activity by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis. Discussion: Continuation of Capstone Submit, by way of this assignment, a summary report of the scholarly activity, including who, what, where, when, and any relevant take-home points. Include the appropriate program competencies associated with the scholarly activity as well as future professional goals related to this activity. You may use the Scholarly Activity Summary resource to help guide this assignment. Part 2 Capstone Project Change Proposal Presentation for Faculty Review and Feedback ( Topic) Preventing Fall Using Video Monitoring Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor. Discussion: Continuation of Capstone nrs_493_rs_scholarlyactivities__6_.docx video_monitoring_proposal.docx sample_scholarly_activity.docx Scholarly Activities This document describes the scholarly activity elements that should be included in a five paragraph summary. You may use this resource to help guide the preparation of the Scholarly Activities assignment, due in Topic 10. Overview This section consists of a single paragraph that succinctly describes the scholarly activity that you attended/participated in, the target market for the activity, and the benefit of the activity to you. Problem This section consists of either a short narrative or a list of bullet points that concisely identifies the problems the scholarly activity is designed to solve. Educate: What is the current state of the activity topic? Explain why this is a problem, and for whom is it a problem? Inspire: What could a nurse achieve by participating in the scholarly activity? Use declarative sentences with simple words to communicate each point. Less is more. Solution This section consists of either a short paragraph or a list of bullet points that concisely describes the solution to a proposed practice problem that the scholarly activity addressed and how it addresses the problem outlined in the previous section. Opportunity This section consists of short paragraphs that define the opportunity that the scholarly activity is designed to capture. It is important to cover the objectives and goals that were met. How will attending/participating in this scholarly activity help you grow as a nurse? Program Competencies Addressed This section consists of a list of program competencies that were addressed in this scholarly activity. Please use the list from the ISP. © 2017. Grand Canyon University. Discussion: Continuation of Capstone All Rights Reserved. Video Monitoring: An Effective Fall Prevention for Inpatients Background Older adults fall risks increases in the hospital because of unfamiliarity of the environment, medications that affects mentation or blood pressure, and disease process. Klymko, Etcher, Munchiando, & Royce (2016) found that, Approximately 1 million falls occur annually in acute care settings in the United States, with incidence of 2.3-7 falls per 1,000 patient days. Also, an estimated additional cost of $3,500 for a fall without injury, with costs increasing to $16,500-$27,500 for additional falls without injury or when serious injury occurs (p. 329). Falls are very costly to hospitals and likewise to the patients. Prevention of fall has been an ongoing battle even with the sophistication of equipment and fall interventions from nurses. Problem statement Fall is the most common preventable accident for older adults (65 and older) in the United States. According to The Joint Commission (2015), Every year in the United States, 30-50 percent of falls resulting in injury. Injured patients require additional treatment and sometimes prolonged hospital stays. In one study, a fall with injury added 6.3 days to the hospital stay (p. 1). Fall can result to mortalities, increased healthcare costs to the hospital, poor patient outcomes, and post-traumatic stress to nurses. Fall can have direct and indirect costs to hospitals and patients. Bed/body alarms, side rails, fall risk bands, and assessment tools helps in reducing fall rates. But, the high acuity of our patients, staffing issues, and no certified nursing assistants (CNAs) to help with patient care, fall prevention has been challenging in our facility. Discussion: Continuation of Capstone In my experience, most falls happens when a nurse is on a break, change of shifts, at night, and the times when nurses are busy like passing medications. Moreover, a fall can cause distress to a nurse whose patient fell during their shift. Patient safety is a priority in nursing and if the safety was compromised it will cause stress to nurses. According to a study, nurses felt horrible and guilt that they let their patients fall under their care (Bok, Pierce, Gies, & Steiner, 2016). The purpose of this paper is to propose an evidence based study with the use of remote video monitoring (VM) system to fall prevention in our facility. This study includes; purpose of the change proposal, PICOT, literature search strategy employed, evaluation of the literature, applicable change or nursing theory utilized, proposed implementation plan with outcome measures, identification of potential barriers to plan implementation, and a discussion of how these could be overcome, and an appendix section. Purpose of the change proposal It is imperative to find a solution to lower the incidence of fall because of the rising cost of healthcare and the negative consequences of fall to patients and nurses. The Proposed solution to help with fall prevention is video monitoring. VM can monitor patients twenty-four hours a day. Since our hospital does not employ CNAs and sitters, video monitoring can be used to monitor a patient for safety reasons like fall. Monitors can be used to monitor patients in the dark and the video monitoring system can pay for itself for 3-6 months with the reduction in falls (Healthcare Risk Management, 2015, p. 80). Video monitoring can also create a peace of mind to nurses coupled with the other fall interventions. Discussion: Continuation of Capstone This will make the nurse stay focused on the other tasks at hand and will create a sense of security that their patients who are at fall risked are monitored. PICOT For high fall risk inpatients, how does the use of remote video monitoring compared to patients who does not use video monitoring improve falls rates during inpatient stay? P= For high fall risk inpatients, I= how does the use of remote video monitoring C= compared to patients who do not use video monitoring O= improved fall rates T= during inpatient stay? Literature search strategy employed The writer used the CINAHL and Academic Search Complete databases that provided peer-reviewed research articles and journals. The articles and journals that was used in this project is within a 5-year period. Credible journal websites were also used in this project that was peer-reviewed articles. The literature that was utilized was carefully analyzed to maintain credibility and the appropriateness to the project. The author also consulted a mentor to help with the research process Evaluation of the literature This study used multiple references for the evidenced based project to support video monitoring as an intervention to fall prevention. Video monitoring is a new intervention to fall prevention but there are multiple facilities that tested the concept wherein it has shown a positive result on fall prevention. There are eight peer reviewed research that are used for this literature review which relates to fall prevention measures. First, an article that used VM to study the antecedents of fall. VM is proven to be a safe tool to study falls and their cause because falls are mostly unwitnessed. The sample population are inpatients in an acute care facility. Discussion: Continuation of Capstone The limitation of this study is that there were 40 patients who fell that were not included while the study was ongoing (Klymko, Etcher, Munchiando, & Royce, 2016). Also, the study should have used a better assessment tool to identify fall risk patients. The study recommends the use of VM as a safe intervention for fall prevention and it can also be used to further study the antecedents of fall. Second, an article that used VM to fall prevention and reduce sitter costs. The research question is; can VM reduce fall rates and sitter cost? According to Votruba, Graham, Wisinski, & Syed (2016), There was a 35% reduction in falls when comparing the baseline data from the 9 months prior to the intervention of the 9month intervention phase where video monitoring was used (p.187). The study was at a 350 bed MAGNET designated hospital. It took place in the critical care/intermediate unit, neuro, and senior adult unit. The limitation of the research is that VM technician patient ratio and training was not studied. The research showed that the use of VM showed significant results to fall prevention. Also, VM is costeffective which can reduce the hospitals fall related costs. Third, is an article that was conducted at a hospital at Denver, Colorado that used VM to prevent falls. Within the first 3 months of operation, 57 falls were prevented with a potential minimum savings of $24,225 (Jeffers et al., 2013). The limitation is that the research was not able to explore on ways to prevent falls who have language and hearing deficits. The study recommends that use of VM to fall prevention and to reduce costs of falls. Fourth, is an article that incorporates VM in an Epilepsy Monitoring Unit (EMU) at a hospital. Discussion: Continuation of Capstone The research question is, do a non-restrictive setting safe for patients in high fall risk patients like EMU? The limitations of the study are; the population is very specific to epileptic patients. Another, the portable EEG machine and equipment like helmets are variables that are unique to the study. The study suggest that tight surveillance is more important than restricting patients (Craciun et al., 2017). A restrictive environment can lead to complications (e.g. DVT, increased falls due to inactivity, pneumonia, etc.). Fifth, is a study that compared the use of sitters to VM in fall prevention. The research question is, can VM be used to improve fall rates, reduce cost, and avoid self-harm? The study was done in a hospital at a cardiology and neuroscience unit. The limitation of the study is that the result for fall rates using the VM is not significant during the duration of the study. The study should have been done longer since there was a downward trend in the fall rate. Video monitoring is less expensive than sitters and does not impose a patient safety risk for falls or self-harm (Davis, Kutash, & Whyte, 2016). Sixth, is another article that used VM to prevent falls. The research question is, Does the use of VM reduce patient falls and injuries associated with falls and reduce the use of observational sitters for fall prevention? (Sand-Jecklin, Johnson, & Tylka, 2016). The study was conducted at an academic medical center in Mid-Atlantic Region. The limitations of the study were; the data for falls is lacking at the time when VM was not in use, there was no data regarding the nurses response time to the VM technician warning them, and the amount of education provided to patients and families to fall prevention measures.Discussion: Continuation of Capstone According to Sand-Jecklin, Johnson, & Tylka, (2016), Total of 74 falls occurred in the pre-study. Compared to only 15 with the monitored units for post study. Also, there were a total of 34 falls that were unmonitored in the post study (p.135). The study suggests that VM as a cost-effective tool to prevent fall. Further studies or standardized training should be done to VM technicians to be able to prevent fall from happening. Seventh, is an article that integrates technology with VM to prevent falls. The research question is can we use technology to improve fall rates and costs for falls? (Westle, Burkert, & Paulus, 2017). The study was done at a hospital in a neuroscience unit. The limitation of the study is the technology that was used in the research to the facilities is specific. It can create a problem with compatibility to other facilities who do not use the same technology. The research was able to use an algorithm to categorize patients who are fall risk and needed VM. The research was a success and the health system are thinking of expanding it to other units in the hospital and to other facilities. The study also suggests that a faster and more reliable means of communication should be used between the VM tech and the nurses. Lastly, is an article that studied the feelings of nurses about fall prevention and whose patients fell during their watch. The research question is; what is the meaning of fall prevention to nurses? The sample population are Association of Rehabilitation Nurses (ARN) members. One limitation of the study is, there is a low number of turnout sample. Discussion: Continuation of Capstone There was a total of 747 potential participants but only 53 responded and 43 completed the questionnaire. The study suggests that it is important to know about nurses feelings regarding fall. Nurses needs debriefing regarding the fall should be implemented. Investigators must be nonthreatening to encourage open dialog and improved learning experiences when falls occur (Bok, Pierce, Gies, & Steiner, 2015). Applicable change or nursing theory utilized A person who is admitted to a hospital are prone to falling because of weakness, unfamiliarity of the room, certain medications that they take, and equipments in the room. According to Roy Adaptation Model, the individual and the environment are sources of stimuli that require modification to promote adaptation (Friberg and Cresia, 2016). Health and Illness will be a part of persons life. Nurses are responsible in modifying the environment of a patient to promote adaptation which can lead to well-being. Safety is the priority of nursing which is the foundation of most of the policies in place. The nurse can modify the environment of the patient by introducing video monitoring to prevent fall because of the vulnerability of the patient due to external forces mentioned above. The patient can adapt to this tweak of safety measure which can lead to continued healing which is the aim of Roy Adaptation Theory. Proposed implementation plan with outcome measures Centralized video monitoring can reform fall prevention measures. Our patients can now be monitored 24 hours a day and seven days a week. VM is used to prevent falls by setting up a camera with audio system to communicate to patients who are at risk for fall and alert nurses for imminent fall. VM can also be used to study the factors that caused falls to patients because most falls happened unwitnessed. Fall interventions like bed/body alarms, bed rails, and risk assessment tools helps in preventing fall but, evidence have shown that it is not enough to solving fall prevention. VM is closely monitored by a trained medical person at a remote place where privacy of the patients is maintained. A remote camera with audio is placed at bedside to allow a two-way communication between the Video monitoring technician (VMT) and patient or the nurse. Discussion: Continuation of Capstone For example, a VMT can try to convince a confused patient who is trying to get off the bed to stay on the bed while waiting for the nurse for help. The audible voice of the VM technician can alert nurses to check on the patient or the VM tech can make a phone call to alert the staff or the primary nurse for safety concerns. A remote portable camera device will be installed in the room to an identified patient who is at risk for fall. A standard assessment tool will be used to assess a patient who will be placed into the central video monitoring. The virtual sitter patient fall risk tool that was used at Mission Hospital will be used to evaluate a patient to qualify for a VM. The tool is found at appendix D. The nurse will give report to the VMTs about the safety precautions and the indication of VM. A standard Central Video Monitoring Technician SBAR and Work Log sheet will be used to document outcomes, handoffs to from VMT to another VMT, and documentation. The worksheet is found at appendix A. A training will be conducted to a selected secretary who has preferably a certified nursing assistant certificate. Training will take about 8 hours and will monitor about 8 patients at a time. The study will be conducted in a telemetry neuro floor and will start for 16 patients. A consent will be signed by the patient or the primary decision maker if the patient is unable to make decisions. A survey will be given to patients that is detailed in appendix B to inform us about their experience under VM. The number of falls will be documented and the interventions that was used during the study. The EBP project will use a pre and a post study in a 12-month period for each study. Appendix C will show the comparison for both studies. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome Change makes most of nurses uncomfortable let alone sustaining the change. In healthcare, the landscape is always changing wherein nurses as the frontline of patient care are mostly affected to changes. A barrier of the EBP proposal is the acceptance of nurses to changes since it can affect their workflow in adapting this change. According to Shute et. al., (2012),Discussion: Continuation of Capstone Although many employees in healthcare settings may have gone through changes in their careers they may not have the skills, knowledge and expertise to adapt to new challenges, develop practice and adopt new ways of working (p. 639). I can overcome this barrier by constantly communicating to nurses and hearing out their suggestions and concerns. I can hear their concerns and will modify the plan or workflow to accommodate their concerns. A survey will be solicited to nurses to evaluate the EBP change at the end of the study using the SurveyMonkey website. Another barrier that I can think of is the unwillingness of the patient or the family to consent for the project. Patient privacy is a concern for patients or families because of the stigma attached to video monitoring. Some people do not want the feeling of being watched. My solution is to educate patients about the statistics of fall in the hospital because there is a strong evidence that remote video monitoring has lowered falls in the acute care settings. I can also educate them that privacy will be maintained, and everything is confidential. At any time, they can ask that video monitoring can be temporarily or permanently turned off if they wish to. Privacy will be implemented when changing diapers, bed baths, and anytime the patient feels like he/she needs to have privacy. A patient experience survey will also be filled out at discharge wherein they can mail it back using a pre-stamped envelope or hand it to the staff before leaving. The survey is found at appendix B. Appendix Appendix A Central Video Monitoring Technician SBAR and Work Log Appendix B Survey for Patients How Satisfied are you with the Central Video Monitoring? Satisfied Somewhat Satisfied Dissatisfied Did the staff provide enough education about the Central Video Monitoring? Very thorough Somewhat thorough Not so thorough Do you think that your privacy was maintained in your stay? Very well Somewhat well Not very well How likely are you to use Central Video Monitoring in the future? Very likely Somewhat likely Not likely Will you recommend using Central Video Monitoring to your friends and family? Very likely Somewhat likely Not likely How did the staff and the team respond to your safety? Very prompt Somewhat prompt Not responsive How do you rate your overall stay with the use of Central Video Monitoring? Excellent Above average Average Below Average Poor Can you provide us suggestions, comments, questions, and concerns regarding your stay with the use of Central Video MonitoringDiscussion: Continuation of Capstone ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ __________________________________________ Thank you for filling out the survey! Wishing you the best of health! Appendix C Pre and Post CVM intervention Total n= Total n= Fall Prevention Interventions Number of patients who used Fall Prevention Intervention at 12 Months Baseline Number of patients who used Fall Prevention Intervention at 12 Months with CVM Bed Alarm High Risk Band Bed a Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
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