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Designing and Sustaining the Capstone Project


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Designing and Sustaining the Capstone Project

  1. 1. Designing and Sustaining theDesigning and Sustaining the Capstone ProjectCapstone Project Linda Roussel, RN, DSN, NEA-BC, Professor, USALinda Roussel, RN, DSN, NEA-BC, Professor, USA College of NursingCollege of Nursing Tammy Lee, MSN, RN, CNL, Clinical Nurse LeaderTammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center Terilee Gerry, BSN, RN, CNL Student, Maine MedicalTerilee Gerry, BSN, RN, CNL Student, Maine Medical CenterCenter
  2. 2. 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)
  3. 3. CNL Academic ExperienceCNL Academic Experience  CNL White paper  Roles  Competencies  End of Program Expectations
  4. 4. CNL Academic ExperienceCNL Academic Experience  Assignments:  Needs Assessment  Work Flow  Gap Analysis  Clinical Experience  Role Socialization
  5. 5. CNL Academic ExperienceCNL Academic Experience  Clinical Experience  Making the Case  Cost-Benefit  IOM Aims  Outcomes Management  Evaluation
  6. 6. The Student PerspectiveThe Student Perspective Major Aspects of ProjectMajor Aspects of Project Management and the ClinicalManagement and the Clinical Immersion ExperienceImmersion Experience Terilee Gerry, BSN, RN, CNL Student, Maine Medical CenterTerilee Gerry, BSN, RN, CNL Student, Maine Medical Center
  7. 7. 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
  8. 8. 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
  9. 9. Student Clinical ResourcesStudent Clinical Resources  Staff Development Specialist coordinated student experiences  8 CNLs  Nursing Director  Student colleagues
  10. 10. 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
  11. 11. Nursing DirectorNursing Director  Project approval  Weekly meetings  Close communication  Leadership mentor
  12. 12. The Capstone ProjectThe Capstone Project  Preliminary discussion in 1st semester  Establish a time line  Unit based  Needs Assessment  Director approved  Prepare for IRB submission
  13. 13. My ProjectMy Project  Assigned unit in 3rd semester  Unit issues/needs unknown  Director meeting-input important  Possible project suggestions  Decision made  Began making contacts
  14. 14. Project BeginsProject Begins  Literature Search  Begin contact/meetings with stakeholders  Communication with physicians  Work with faculty  Input from Nursing Research Dept.
  15. 15. Project ContinuesProject Continues  Paper written  Hospital and Univ. IRB approval obtained  Data collection now underway
  16. 16. Director’s InputDirector’s Input  Inform staff of project to demonstrate leadership  Attend staff meetings  Involvement on various committees  Meet key personnel
  17. 17. Continued SupportContinued Support  CNL monthly meetings  Quarterly meetings with CNS group  Support of each other as needed
  18. 18. Innovative Role of the CNLInnovative Role of the CNL Tammy Lee, MSN, RN, CNL, Clinical Nurse LeaderTammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center The CNL Perspective
  19. 19. Innovative Role of CNLInnovative Role of CNL “We cannot solve our problems with the same thinking that created them.” Albert Einstein
  20. 20. ProjectsProjects  Simplistic to Difficult  Small to Enormous  Microsystem changes to House-wide changes
  21. 21. 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.
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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.
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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