Change Proposal Topic: Re-implementation of Bedside Shift Report
NUR 490 Capstone Project Guidelines
Overview As the final stop in your journey toward your Bachelor of Science in Nursing degree, you will complete a capstone that integrates the knowledge and skills you have developed in previous coursework. Over the duration of the capstone course, you will create a proposal for change designed to address a specific healthcare-related need in the organization where you currently work or a place where you have previously worked, or an issue of local, state, or national importance, subject to instructor approval. You will also reflect on your journey through the Bachelor of Science in Nursing program and how you plan to position yourself professionally by developing a brief philosophy of nursing statement. This statement will be an important tool for discussing the knowledge, skills, and abilities that you have gained from the RN-BSN program and your own nursing values with potential employers or graduate school admissions officers.
Together, these capstone artifacts will set you apart from other workforce and/or graduate school applicants by showcasing your unique abilities and talents. The artifacts will demonstrate your current knowledge, theoretical foundations, and expertise in the nursing profession and your ability to improve your own performance and that of your organization through thoughtful reflection on your own practice.
Evaluation of Capstone This capstone will be assessed somewhat differently than other courses you have taken online at SNHU. There are two separate components that operate together to comprise the whole capstone experience and are not assessed separately. You will be evaluated on both artifacts as a one cohesive unit in determining whether you have demonstrated proficiency in each outcome. Your instructor will guide you through this process and will maintain a running narrative of your strengths and areas for development in relation to the outcomes as you progress through the class. Your work is expected to meet the highest professional standards.
This assessment will evaluate your mastery with respect to the following outcomes:
• Apply skills in using patient care technologies, information systems, and clinical decision support tools to promote safe nursing practice and quality
patient outcomes
• Utilize evidence-based practice in planning, implementing, and evaluating outcomes of care
• Formulate strategies to promote health and prevent disease in individuals and populations across the life span
• Implement patient safety and quality initiatives within the complex clinical microsystem using leadership and communication skills
• Analyze trends in healthcare policy, finance, and regulatory environments and their implications for healthcare access, equity, and affordability
• Evaluate life-long learning and nursing engagement to promote personal and professional transformation
Prompt Your capstone assessment will consist of two components. The first component consists of a change proposal that comprehensively addresses a nursing- related concern—either in an organization where you work or have worked, or more broadly at the local, state, or national level. Your instructor should approve
your change proposal topic early in the course. Because change does not happen in isolation and often has far-reaching impacts, your proposal will need to incorporate multiple aspects of health practice in suggesting strategies to improve the target populations’ health. You will need to address patient and nurse safety; appropriate use of technology; health literacy; policy, regulatory, and financial constraints; and strategies for building support for proposed changes.
In addition to the change proposal, you will also create a brief statement that expresses your philosophy of nursing practice. To do this, you will reflect on what you have learned, relevant theories of nursing practice, and the importance of professional integrity, ethics, and self-reflection in caring for patients. Your goal is to articulate how your philosophy of nursing has evolved as a result of the experiences and knowledge you gained in the RN-BSN program.
Change Proposal In first portion of your capstone, you will create a comprehensive change proposal designed to promote health and to prevent disease in your selected health care environment (current employer, previous employer, or within the broader nursing community, subject to instructor approval). This artifact will showcase your abilities as a nursing professional capable of leading change in a complex healthcare environment.
As a practicing RN-BSN, you will be expected to bring clinical expertise to your work and take on a leadership role in continually improving patient care. Your change proposal should be geared toward convincing an audience of administrative decision-makers that change is needed and that your plan is desirable and viable. It should clearly and concisely lay out the problem you are seeking to address and suggest specific evidence-based changes, including a plan for implementing and evaluating those changes. You should also specify and approximate a timeframe for carrying out your plan and the resources you will need. (Note: You do not need to actually implement the change and evaluate it, just create a plan for how you would do so.)
Remember that in order for you to gain support for your proposal, it will need to be succinct, clear, and well-supported throughout by credible research and evidence.
Your proposal should contain the following sections:
I. Introduction
A. Identify a clinical or nonclinical problem that is relevant to nurses in your workplace or former workplace or is a recognized issue in the local, state, or national nursing community from which you can act as a change agent and propose a change.
B. Explain why you selected the issue, identifying the significance to nursing practice and the expected outcomes from the change.
II. Justification of Need A. Explain the current situation of the targeted organization for your proposed change. B. Develop arguments with evidence that support this need for change.
III. Pre-Implementation Plan
A. Identify a specific change theory that will assist you with planning stages of your change proposal B. Identify activities needed prior to implementing your change, making theory-to-practice connections with each key element and impact of
change to the element C. Discuss a plan for activities needed to leverage this element to promote change and identify the stakeholders that may be involved in these
activities. The activities you propose must cover multiple aspects of health practice surrounding the problem, including but not limited to:
a. Patient and Nurse Safety b. Information Management Systems c. Health Literacy d. Administrative Policies e. Ethical Considerations (i.e.; equity of access and treatment, etc.)
IV. Implementation Plan
A. Assess the factors that are likely to affect the implementation of your recommended activities B. Identify evidence-based rationales to propose how you will address them, incorporating your identified change theory. Your plan should
encompass the following with evidence to support your rationale: a. Technological challenges b. Institutional structures c. Strategies for building buy-in among different stakeholders, including nurses d. Financial trends and anticipation of the availability of human resource and project funding e. Hospital or governmental policy constraints f. Regulatory requirements g. Patient diversity
V. Evaluation plan:
A. Propose steps for evaluating your suggested changes based on your change theory and evidence on existing best practices. Include the indicators that you will use to measure success, both in implementing the change itself and in ensuring quality outcomes for diverse patients.
B. Identify appropriate benchmarks from which to measure the effectiveness of the change. C. Discuss the processes you will use for gathering feedback from relevant stakeholders—including nurses, patients, and their families—on what is
and is not working in order to support continuous improvement.
VI. Time and resource allocation: A. Give an approximate timeframe for the different stages and activities in your proposal
B. Estimate the human and other resources that will be needed to carry out your proposal. You do not need to include specific dollar amounts, but you
should anticipate what each activity requires in terms of resources in general terms. For example, you might need a certain number of full- or part-time
staff or the services of a contracted firm, specific software, hospital supplies, laptops, publicity materials, and so forth. You may find it useful to use an
Excel spreadsheet or other table for presenting this information.
VII. Conclusion
A. Summarize the proposed change, its significance, and expected outcomes as a result of implementing the proposed change.
Change Proposal Timeline:
Draft Deliverable Module Due Grading 1 Rough draft of Introduction section One Draft graded; receive feedback from
instructor and peers 2 Rough draft of Justification of Need and
Pre-Implementation plus revisions from Module One
Two Draft graded; receive feedback from instructor and peers
3 Rough draft of implementation plan plus revisions from previous weeks
Three Draft graded; receive feedback from instructor and peers
4 Rough draft of evaluation plan plus revisions from previous weeks
Four Draft graded; receive feedback from instructor and peers
5 Rough draft of time and resource allocation plan plus revisions from previous weeks
Five Draft graded; receive feedback from instructor and peers for final submission in Module Seven
Philosophy of Nursing Statement For the second and final component of your capstone, you will write a 3–5-page statement in which you construct your own philosophy of nursing practice. This philosophy should include, but is not limited to, a discussion of the theoretical foundations and assumptions that are foundational to your practice, as well as how your coursework and capstone project impacted your own philosophy of nursing and contributed to your personal and professional transformation. This reflection is a professional, yet personal, statement of why you think being a nurse is important and the principles that guide your practice. It is also a valuable tool for sharing the knowledge, skills, and abilities that you have gained from the RN-BSN program and your own nursing values with potential employers or graduate school admissions officers.
Your philosophy of nursing statement should include the following:
1. Introduction: Open your statement with a few sentences about the importance of a philosophy of nursing practice. How does such a philosophy shape
your identity and role as a nurse?
2. Assumptions: Discuss your assumptions about patients, health, environment, and nursing and the relationships among these variables. How does your
nursing philosophy guide your interaction with patients, their families, and other healthcare professionals? How do professional integrity, equity, ethics, and the potential for bias factor into your assumptions?
3. Theoretical Foundation(s): Highlight the theoretical foundations that are important in your philosophy of nursing practice. You may have one or several.
How do these foundations translate into your practice?
4. Experiences: Evaluate how new experiences and knowledge shape your nursing philosophy. Specifically, you should address how your RN-BSN coursework, this capstone, and other experiences have influenced how you view your nursing practice. What role does self-reflection play in personal and professional transformation? How do activities like the change proposal help you develop as a lifelong learner and act as an agent of change in improving both personal and professional practice? In addition, you may want to discuss challenges that you have faced and what you would change or do differently in addressing those challenges, since the ability to effectively and creatively solve problems is a highly valued job skill.
5. Conclusion: Reflect on how your nursing philosophy and experiences at SNHU relate to your plans for further education and how this will impact your
future nursing practice.
Philosophy of Nursing Timeline: To help you develop your philosophy of nursing, you will collaborate with your instructor through a series of reflection journals in which you will reflect on your learning and create drafts related to the sections of philosophy outlines above.
Draft Deliverable Module Due Grading
1 Introduction and Assumptions rough draft
One Graded separately; Reflection Journal Rubric
2 Theoretical Foundation(s) and Experiences rough draft
Three Graded separately; Reflection Journal Rubric
3 Revised draft of previous sections and Conclusion rough draft
Six Graded separately; Reflection Journal Rubric
Final Project Rubric This rubric will be applied to both the Change Proposal and the Philosophy of Nursing assignments as a whole, and neither component will be assessed on its own.
The “Possible Indicators of Success†are examples for you and the instructor of the types of concepts to look for to demonstrate proficiency. They are neither exhaustive nor proscriptive and should be used as guides for illustrating how your capstone embodies the outcome. All outcomes are weighted equally.
Guidelines for Submission: Your change proposal should include a title page and table of contents and should conform to the latest APA writing conventions and citations. It should be approximately 10–15 pages, not including the reference list or optional appendices, double-spaced, and in 12-point Times New Roman font. Your references must include at least 3 peer-reviewed nursing sources. You may include optional illustrations, photographs, graphs and charts, and other non- textual materials as needed to support your proposal.
Your nursing philosophy should be approximately 3–5 pages, double-spaced, and in 12-point Times New Roman font. You will submit both components in one document.
NUR-490-01: Apply skills in using patient care technologies, information systems, and clinical decision support tools to promote safe nursing practice and quality patient outcomes
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to assess technological and information infrastructures for their contribution to patient safety and outcomes? Does the capstone demonstrate the student’s ability to propose appropriate technology and other tools to support improvements in nursing practice and patient outcomes? Does the capstone demonstrate the student’s ability to assess staff’s training, technology, and information needs to ensure quality patient-centered outcomes? Does the capstone demonstrate the student’s ability to anticipate and plan for potential technological challenges and limitations associated with change activities and propose solutions? Does the capstone demonstrate the student’s ability to suggest appropriate procedures for collecting, recording, and analyzing information to evaluate the effectiveness of change activities? Does the capstone demonstrate the student’s ability to select appropriate clinical decision support tools in addressing a specified health problem?
NUR-490-02: Utilize evidence-based practice in planning, implementing, and evaluating outcomes of care
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to justify the need for change in the identified area based on clinical and research-based evidence? Does the capstone demonstrate the student’s ability to apply a change theory in planning, implementing, and evaluating activities to improve a targeted aspect of care? Does the capstone demonstrate the student’s ability to support proposed change proposal activities from planning through evaluation with credible research and evidence? Does the capstone demonstrate the student’s ability to draw connections between activities proposed and quality patient outcomes?
Does the capstone demonstrate the student’s ability to propose appropriate indicators for measuring the effectiveness of change activities and their impact on patient outcomes based on existing best practices? Does the capstone demonstrate the student’s ability to describe the underlying theoretical foundation(s) in his or her nursing practice?
NUR-490-03: Formulate strategies to promote health and prevent disease in individuals and populations across the life span
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to propose clinical and/or nonclinical strategies that address an identified concern in meeting the health needs of individuals or target populations? Does the capstone demonstrate the student’s ability to plan appropriate health literacy activities for diverse populations and age groups? Does the capstone demonstrate the student’s ability to assess how differences in health needs across individuals from different age groups and backgrounds may affect the effectiveness of planned interventions?
Does the capstone demonstrate the student’s ability to support continuous improvement in health promotion and disease prevention by incorporating patient/family feedback in designing, implementing, and evaluating health initiatives? Does the capstone demonstrate the student’s ability to specify appropriate resources needed to effectively carry out health improvement activities? Does the capstone demonstrate the student’s ability to assess how assumptions and potential for bias may affect care in different populations?
NUR-490-04: Implement patient safety and quality initiatives within the complex clinical microsystem using leadership and communication skills
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to identify relevant clinical guidelines or institutional policies and procedures in designing quality improvement projects?
Does the capstone demonstrate the student’s ability to exercise leadership by proposing improvements to policy and procedures designed to ensure safety and promote quality? Does the capstone demonstrate the student’s ability to accurately identify direct and indirect stakeholders in proposing safety and/or quality improvements? Does the capstone demonstrate the student’s ability to navigate complex stakeholder relationships in suggesting potential strategies for building buy-in?
Does the capstone demonstrate the student’s ability to address stakeholder concerns in communicating the necessity and feasibility of proposed activities? Does the capstone demonstrate the student’s ability to identify institutional structures that help or hinder proposed change? Does the capstone demonstrate the student’s ability to analyze how relationships between patients, health, environment, and nursing interact in complex systems to affect care?
NUR-490-05: Analyze trends in healthcare policy, finance, and regulatory environments and their implications for healthcare access, equity, and affordability
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to assess how the policy environment affects a healthcare organization’s ability to provide quality care to underserved populations? Does the capstone demonstrate the student’s ability to analyze complex healthcare environments in identifying opportunities for improved care? Does the capstone demonstrate the student’s ability to suggest procedures for guaranteeing affordable and equitable care for diverse patient groups within the current healthcare context? Does the capstone demonstrate the student’s ability to anticipate financial trends in the organization and/or the broader healthcare context that may impact available resources? Does the capstone demonstrate the student’s ability to analyze how institutional and/or government policy can constrain what changes are feasible in addressing identified healthcare needs? Does the capstone demonstrate the student’s ability to suggest changes for improving healthcare access, safety, and delivery that comply with relevant regulatory requirements?
Does the capstone demonstrate the student’s ability to designate time frames for carrying out activities that comply with institutional and regulatory requirements?
NUR-490-06: Evaluate life-long learning and nursing engagement to promote personal and professional transformation
Proficient 100%
Not Proficient 0%
Possible Indicators of Success Does the capstone demonstrate the student’s ability to promote personal and professional improvement by working to engage nurses in developing and carrying out change activities? Does the capstone demonstrate the student’s ability to incorporate nurse and patient/family feedback in evaluating change and improving professional care? Does the capstone demonstrate the student’s ability to articulate ways in which self-reflection contributes to personal and professional transformation?
Does the capstone demonstrate the student’s ability to distinguish between underlying core values and ideas that evolve with experience in developing a philosophy of nursing? Does the capstone demonstrate the student’s ability to promote his or her own future development based on a clearly stated philosophy of nursing practice? Does the capstone demonstrate the student’s ability to assess the role of the nurse as an agent of change in improving professional practice?
CHANGE PROPOSAL OUTLINE 2
Change Proposal Outline
Time and Resource Allocation
Several factors must be considered in the process of implementing the proposed change of bedside shift report (BSR). Time and availability of resources are the most important factors that should be considered. The success of implementing BSR as per the change proposal depends on customized planning and the resources available for use. Selecting the appropriate timeline allows the change management teams to pull together the necessary resources. It also promotes the participation of key stakeholders in the change implementation process.
The resources required for the implementation of the proposed change include digital telehealth equipment, additional manpower, as well as financial resources. Resources to facilitate extensive research are also required for the change implementation process. Financial resources are the most crucial in this process because everything else depends on the availability of sufficient funds. However, the required resources must be verified and approved by the board of directors at the facility before the change implementation process is officiated. For this reason, the timeframe must be designed to accommodate consultation with key stakeholders. The most appropriate timeframe, therefore, is six months beginning from the approval date for the change implementation project. Below is a detailed schedule of the activities to be undertaken, the resources and the time allocated for each activity.
Stage
Activity
Resources
Timeframe
Unfreezing
Planning
3 specialists
1 week
Research to identify the appropriate implementation strategy.
2 specialists
5 nurse leaders
2 weeks
Nurse and Patient education
3 nurse leaders
4 trainers
4 weeks
Changing
Policy Formulation to accommodate BSR.
5 contracted specialists.
1 week
Acquisitions for the required digital devices and contracting.
10 laptops
50 telehealth devices
2 weeks
Pilot Project; testing the proposed BSR reimplementation change on a small population.
2 Nurse leadership teams.
10 Volunteers (Patients and relatives).
5 weeks
Change implementation; implementing BSR in the entire facility.
5 Nurse leadership teams.
50 Volunteers (Patients and relatives).
8 weeks
Refreezing
Policy formulation to prevent reverting to old habits.
4 contracted specialists.
2 board members
5 nurse leaders.
1 week
Monitoring and evaluation to ascertain the effectiveness of BSR.
Financial resources
5 nurse leaders
2 weeks
Policy adjustments to promote the effectiveness of the re-implemented BSR.
3 nurse leaders
4 contracted specialists
1 healthcare manager
1 week
Project closing.
5 nurse leaders
2 Healthcare managers
1 board member.
1 week
Conclusion
In conclusion, the proposed change concerns the re-implementation of bedside shift reporting to enhance the quality of services offered to patients. The proposed change is consistent with modern nurse informatics systems thus it’s very relevant. Also, the proposed change will be implemented as per Lewin’s theory of change management to ensure that the process runs smoothly. The anticipated outcome is an improvement in the communication between nurses, patients, and their relatives. The implementation process is scheduled to be completed by the end of 6 six months from the approval date.
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