1 13 DNP Prospectus Comment by Cynthia Fletcher: This is a good beginning Ann Marie. There are many areas that we will discuss at our meeting to improve clarity and congruence with a DNP Project. Educating Inpatient Nurses to use Standardized Care Plans Anne Marie Wouapet Doctor of Nursing Practice – Nursing Informatics A00505587 Prospectus: Educating Inpatient Nurses to use Standardized Care Plans Problem Statement Standardized care plans can be described as the pre-determined menu of interventions which are used for different patient situations (Monsen, Swenson & Kerr, 2016). Evidence-based care is the conscientious use of the most recent evidence to make decisions on the care of individual patients or in the delivery of health care services (Murdaugh, Parsons & Pender, 2018). The current best evidence is the most recent information which has been obtained from valid and relevant research about the effects of different types of healthcare, the accuracy of diagnostic tests, the potential for harm from exposure to different agents, or predictive power of prognostic factor (Schmidt & Brown, 2017). Standardized care plans form the main basis for the implementation of evidence-based care directly in practice and for the improvement of patient outcomes (Nussbaum et al., 2015; Yehuda & Hoge, 2016). A health care facility recently transitioned to the use of a new and better electronic health record system. The facility also purchased standardized care plans to increase efficiency in their operations. However, the compliance with using the standardized care plans was only 40 percent among the inpatient nurses. Comment by Cynthia Fletcher: ?Comment by Cynthia Fletcher: Questionable purpose.Comment by Cynthia Fletcher: Was it different for those who were not inpatient nurses? Accordingly, the facility recently had a visit from the Joint Commission on Accreditation of Healthcare Organizations and received a negative rating because the nurses were not adding care plans based on the patients' primary problem or diagnosis in the patients' charts upon admission. This presents several specific problems in the healthcare facility. There is poor compliance from the nurses concerning the addition of standardized care plans to the charts of patients based on their diagnosis or primary problem(s). The system which the facility invested in was not being used for the improvement of patient outcomes and quality of care delivered. The focus of this project is the failure of inpatient nurses to make use of standardized care plans. The gap in nursing is the failure of delivery of evidence-based practice using the standardized care plans which result in poor patient outcomes and quality of life. One of the areas of knowledge that has not yet been explored is the cause of low rates of adoption of standardized care plans by nurses. Another gap is the lack of studies on nurses’ perception of the standardized care plans and how they affect their use in .

1. 1
13
DNP Prospectus Comment by Cynthia Fletcher: This is a good
beginning Ann Marie. There are many areas that we will discuss
at our meeting to improve clarity and congruence with a DNP
Project.
Educating Inpatient Nurses to use Standardized Care Plans
Anne Marie Wouapet
Doctor of Nursing Practice – Nursing Informatics
A00505587
Prospectus: Educating Inpatient Nurses to use Standardized
Care Plans
Problem Statement
Standardized care plans can be described as the pre-determined
menu of interventions which are used for different patient
situations (Monsen, Swenson & Kerr, 2016). Evidence-based

2. care is the conscientious use of the most recent evidence to
make decisions on the care of individual patients or in the
delivery of health care services (Murdaugh, Parsons & Pender,
2018). The current best evidence is the most recent information
which has been obtained from valid and relevant research about
the effects of different types of healthcare, the accuracy of
diagnostic tests, the potential for harm from exposure to
different agents, or predictive power of prognostic factor
(Schmidt & Brown, 2017). Standardized care plans form the
main basis for the implementation of evidence-based care
directly in practice and for the improvement of patient outcomes
(Nussbaum et al., 2015; Yehuda & Hoge, 2016). A health care
facility recently transitioned to the use of a new and better
electronic health record system. The facility also purchased
standardized care plans to increase efficiency in their
operations. However, the compliance with using the
standardized care plans was only 40 percent among the inpatient
nurses. Comment by Cynthia Fletcher: ?Comment by Cynthia
Fletcher: Questionable purpose.Comment by Cynthia Fletcher:
Was it different for those who were not inpatient nurses?
Accordingly, the facility recently had a visit from the Joint
Commission on Accreditation of Healthcare Organizations and
received a negative rating because the nurses were not adding
care plans based on the patients' primary problem or diagnosis
in the patients' charts upon admission. This presents several
specific problems in the healthcare facility. There is poor
compliance from the nurses concerning the addition of
standardized care plans to the charts of patients based on their
diagnosis or primary problem(s). The system which the facility
invested in was not being used for the improvement of patient
outcomes and quality of care delivered. The focus of this
project is the failure of inpatient nurses to make use of
standardized care plans. The gap in nursing is the failure of
delivery of evidence-based practice using the standardized care
plans which result in poor patient outcomes and quality of life.
One of the areas of knowledge that has not yet been explored is

3. the cause of low rates of adoption of standardized care plans by
nurses. Another gap is the lack of studies on nurses’ perception
of the standardized care plans and how they affect their use in
inpatient care setting. Further, the study also seeks to explore
the effectiveness of a training program on the implementation of
standardized care plans.Comment by Cynthia Fletcher: Why is
this a reason to cite the facility?Comment by Cynthia Fletcher:
What the negative rating?Comment by Cynthia Fletcher:
Rephrase: the policy requires the use of ….
The compliance rate is low.Comment by Cynthia Fletcher: This
is what should be included when you first identify this
program.Comment by Cynthia Fletcher: You have not identified
that this is a problem and validation for a gap was not
presented. Comment by Cynthia Fletcher: Where is your
evidence for this statement?Comment by Cynthia Fletcher:
?Comment by Cynthia Fletcher: You are not conducting a study;
you are implementing a teaching program to increase knowledge
aboutComment by Cynthia Fletcher: You do not train
professionals to perform a professional function; they are
educated.
Practice-Focused Question
The guiding practice-focused questions which is the focus for
this study is as follow:
1. What are the causes of low use of standardized care plans by
in-patient nurses?
2. What are the nurses’ perceptions of the standardized care
plans?
3. Can the nurses’ training andWill an education program to
teach nurses how to use on standardized care plans increase
their use of in the inpatients’ settings for their patients
according to the establish guidelines, increase their knowledge
about the use of the plans?
The practice-focused questions are relevant to the
practice and identified gaps in various ways. While standardized
care plans are increasingly being embraced in inpatient care
settings, there is scarcity of knowledge about ways of

4. successfully implement them. Jansson et al. (2010) observed
that nNurses’ understanding of how to use standardized care
plans is critical to their successful implementation (Jansson et
al., 2010). Therefore, these research questions can guide inquiry
into the factors that influence the successful adoption of
standardized care plans by inpatient nurses in hospital
settings.Comment by Cynthia Fletcher: referenceComment by
Cynthia Fletcher: referenceComment by Cynthia Fletcher: this
reference is not on the reference listComment by Cynthia
Fletcher: this is outside the scope of the project.
Social Change Comment by Cynthia Fletcher: Ann Marie, this is
a beginning; we can review at our meeting.
Social change involves alteration of the social order of the
society including changes in the social relations, behaviors, and
institutions (Yanicki, Kushner & Reutter, 2015). The project
will impact the social change for healthcare consumers and
professionals in several ways. There would be appropriately
developed care plans from which nurses can select reducing the
need for nurses to develop them from scratch for every patient
(Altman & Brinker, 2016). The selection and addition of a care
plan by a nurse would lead to the automatic population of the
chart of an individual patient. Furthermore, the educational
tablets of the patients would be dependent on the completion of
the nurses adding the care plan to the patients’ chart. There
would also be a decrease in workflow time of nurses because of
the presence of a preset care plan. Finally, there would be no
need for nurses to do any follow up teaching on the care plan.
The mission of Walden University is to develop a diverse
community of career professionals with the chance to change
themselves as scholar-practitioners so that they can promote
positive change. This project seeks to meet this mission by
exploring providing knowledge on implementation of
standardized care plans (Monsen et al., 2011). Such knowledge
can be integrated into practice in order to improve patient
outcomes and nurses’ productivity in health settings. Also, a
positive social is any deliberate process of creating ideas,

5. strategies, and actions which are aimed at promoting the work,
development, and dignity of people, communities,
organizations, cultures, and societies (Yob et al., 2016).
The parties that might benefit from the project include
the nurses and the patients. Standardized care plans make it
possible for all patients to receive good care irrespective of who
is caring. This project improves the works of nurses and also
leads to an improvement in the quality of care delivered to
patients. Patient safety increases as a result of implementation
of standardized care plans (Andreae, Ekstedt, Snellman, 2011).
Nurses also benefit from standardized care plans in terms of
ease of work since they can easily access a rich body of
evidence to integrate into practice. In addition, nurses benefit in
terms of the ease of access and the documentation of medical
records.Comment by Cynthia Fletcher: ?
Context for Doctoral Change
The intended setting for the project is a community small
teaching hospital where the inpatient nurses deliver care to
patients. The main foundation of the project is the education of
the inpatient to educate the nurses on the benefits and use of
standardized care plans and the need for the nurses to make use
of these care planswhen planning patient care. Comment by
Cynthia Fletcher: This is not clear
The research design that will be used for the study is a
descriptive design. Stratified random sampling procedure will
be used to select participants, who will mainly be inpatient
nurses. The interviews will be administered on the nurses to
explore the causes of poor use of the standardized care plans
and their perceptions on the health institution’s standardized
care plans.Comment by Cynthia Fletcher: ?
Sources of Evidence Comment by Cynthia Fletcher: Ann Marie,
please use the Checklist to identify what is required in this area.
The main source of evidence is the Joint Commission's standard
for a care plan which details the information which should be
considered for standardized care plans (Baker, 2017). The
medical records of patients contain numerous clinical

6. information (Garrett, 2016). They contain the reason for
admission, initial diagnosis or diagnostic impression, findings
of assessments, food allergies, medication allergies, and
conclusions from the medical history and physical examination.
The records also have information on complications, hospital-
acquired infections, consultation reports, observations that are
relevant to care, noted progress, all orders, a medication which
have been administered, adverse drug reactions, treatment
goals, and discharge plan (Carter, 2015). The records should
guide standardized care plans formulation. The use of the
electronic system enables the selection of the appropriate care
plan based on the patient medical record as the system is
automatic and integrates the different patient information. This
makes it necessary to educate the nurses on the use of the
standardized care plan as a way of improving patient care. Also,
standardization is an aspect of clinical practice that has been
emphasized by different healthcare stakeholders for the purpose
of improving the quality of patient care. For instance, the World
Health Organization emphasizes the need for consistence in
clinical procedures through standardization to minimize
confusion among healthcare workers as provided in the EBP
guidelines (World Health Organization, 2017). Furthermore,
standardization increases effectiveness of communication
among healthcare workers when sharing patient information
across different healthcare units and among different healthcare
facilities (Adelson et al., 2017). Also, standardization has been
found to reduce the likelihood of misinterpretation of data
among different healthcare workers, which increases patients’
quality of life through administration of accurate treatment
processes, and also reduces the number of hospital readmissions
(Adelson et al., 2017). Further afield, standardization of
healthcare procedures reinforces a safety and accuracy
organizational culture in which high quality patient care is part
of healthcare values. As a result, the quality of patient care will
be high hence high patient satisfaction with healthcare services
provided by healthcare organizations (Kasiri, Cheng,

7. Sambasivan & Sidin, 2017). Standardization of clinical
procedures has also been shown to minimize cases of
misdiagnoses, which in turn reduces health risks to patients and
expenses associated with continued treatment (Douketis et al.,
2016). Lack of standardized procedures is often associated with
high risks of misdiagnoses and other medical errors since some
healthcare procedures such as administration of anticoagulants
in perioperative units can cause serious health effects or even
fatalities. As such, there is a need to introduce education on
standardization to minimize errors thereby increasing the
quality of patient care and the efficiency and effectiveness of
clinicians when performing medical procedures.
Lack of standardization of medical procedures is
associated with high likelihood of errors when treating or
handling patients. For instance, the manner in which patient
details such as medical history is entered can cause confusion
when being analyzed by other hospital units if the data has not
been entered in a standardized manner (Badano et al., 2015).
Furthermore, the use of different standards for interpreting the
same information such as the use of different color codes when
interpreting images can cause confusion when the same
information is being interpreted using a different color in a
different healthcare facility, which can lead to misinterpretation
of images, which can lead to misdiagnoses and prescription
errors (Badano et al., 2015). It is thus necessary for clinical
practitioners to use standardized criteria for interpreting data
that have been provided in different modes in order to ensure
consistency in interpretations, and to enhance interoperability
of clinical equipment (Wager, Lee & Glaser, 2017). Lack of
standardization also has negative implications on healthcare
workers. Confusion and miscommunication often occur in
clinical settings that lack standardized operating procedures.
The confusion leads to significant wastage of time and effort,
which significantly slows down activities and increases anxiety
and depression among healthcare workers (Wager et al., 2017).
Such situations occur when nurses start to develop the

8. perception that they are less competent than expected thereby
lowering their self-esteem and increases negative perception of
their work and overall job satisfaction.
Procedural Steps
In order to successfully complete the project, data will be
gathered from different sources using different approaches. One
way of sourcing relevant information that can be applied for the
project is to search in scholarly databases for information on the
approaches of implementing standardization in practical clinical
settings. Secondly, I would use questionnaires with open-ended
questions to inquire from the inpatient nurses in the hospital
that the program is to be implemented about the challenges that
they encounter as a result of lack of standardization of clinical
procedures. The questionnaires will be issued to willing
participants who will respond to the questions in their own free
time, and in privacy settings. Questionnaires answered in
private settings have the potential to yield genuine and detailed
information since they give respondents a sense of anonymity
and limiting factors such as influence from the management is
not experienced (Corr, 2016). The third approach will involve
physical assessments of the clinical procedures used in the
hospital to check the degree of standardization in the healthcare
institution. Comment by Cynthia Fletcher: This is the
information required in the previous section.
In order to succeed in such an assessment, it will be necessary
to seek for permission from the management in advance, and to
request the management to provide information on the levels of
standardization in the hospital, the challenges faced due to
ineffective or lack of standardized procedures. Information will
also be gathered from the management concerning the level or
lack of educational programs on standardization so as to have a
clear view of how to introduce the program (Corr, 2016).
Lastly, it is also necessary to consult other stakeholders such as
patients to give their views on the quality of care with relation
to standardized clinical procedures in order to have a clear
understanding of the effects of lack of standardization on the

9. quality of patient care.
This project on education on standardization is supported by the
DNP resources page. The project falls under evidence-based
approaches that can be used to improve the quality of patient
care. This project takes the educational approach on
standardization to improve the quality of patient care.
Ethical Considerations
Several ethical considerations will be put in place. The first
consideration is that the project has a favorable risk to benefit
ratio with the benefits outnumbering the risks involved
(Ketefian, 2015). The selection of nurses for the project will be
fair based on the scientific objectives and not vulnerability. The
nurses will also be required to sign consent forms which will be
voluntary after being informed of all that is required of them
and risks involved in the program (Hoyland, Hollund & Olsen,
2015). The subjects will also be accorded with respect in the
lines of privacy, confidentiality and an opportunity to withdraw
from the study (Oye, Sørensen & Glasdam, 2016).
The regions of data sources will be inpatient units in
the hospital. Data will also be sourced from the admissions unit,
in wards, and from the hospital’s inventory.
Data will only be collected after receiving full
approval from the committee and the IRB. Finally, the project
will obtain approval from an independent review organization
before the collection of information.
The potential ethical issues that can arise include
psychological and emotional harm to some inpatient nurses in
units that perform the poorest with regards to the use of
standardized care plans, and negative ratings of the hospital’s
use of standardized procedures. Comment by Cynthia Fletcher:
?
AlignmentComment by Cynthia Fletcher: ?
All the aspects of the project from the data-gathering phase to
planning and implementation are in harmony and follow a
systematic and sequential order.

10. The use of a standardized care plan is supported by different
organizations both locally and internationally as they have been
found to contribute to an improvement of patient outcomes and
the quality of care. The practice-focused question and the
procedural steps will help in addressing the practice problem by
revealing the importance of using standardized care plans.
Credible sources that support the practice problem
include but not limited to healthcare organizations such as the
Joint Commission, WHO, and scholarly researches. They will
help to convince inpatient nurses in the affected units to make
use of the standardized care plans which will see an
improvement from the current 40% compliance and positive
rating from the Joint Commission for Accreditation of
Healthcare Organizations.
The practice-focused questions will address the lack of
standardization by inquiring about the levels of standardization,
barriers and reinforcing factors, and the best approaches to
implement the project. The feedback will be used to align
project activities to specific needs and conditions of the
healthcare workers in the hospital.
References
Adelson, K., Paris, J., Horton, J. R., Hernandez-Tellez, L.,
Ricks, D., Morrison, R. S., & Smith, C. B. (2017). Standardized
criteria for palliative care consultation on a solid tumor
oncology service reduces downstream health care use. Journal
of oncology practice, 13(5), 431-440.

11. Altman, M., & Brinker, D. (2016). Nursing social
entrepreneurship leads to positive change. Nursing
Management, 47(7), 28-32.
Baker, D. W. (2017). History of The Joint Commission’s pain
standards: lessons for today’s prescription opioid
epidemic. Jama, 317(11), 1117-1118.
Carter, J. T. (2015). Electronic medical records and quality
improvement. Neurosurgery Clinics, 26(2), 245-251.
Corr, P. J. (2016). Reinforcement sensitivity theory of
personality questionnaires: structural survey with
recommendations. Personality and Individual Differences, 89,
60-64.
Garrett Jr, J. H. (2016). Effective perioperative communication
to enhance patient care. AORN journal, 104(2), 111-120.
Høyland, S., Hollund, J. G., & Olsen, O. E. (2015). Gaining
access to a research site and participants in medical and nursing
research: A synthesis of accounts. Medical Education, 49(2),
224-232.
Ketefian, S. (2015). Ethical considerations in research. Focus
on vulnerable groups. Investigación y Educación en
Enfermería, 33(1), 164-172.
Martin, S. A., & Sinsky, C. A. (2016). The map is not the
territory: medical records and 21st-century practice. The
Lancet, 388(10055), 2053-2056.
Monsen, K. A., Swenson, S. M., & Kerr, M. J. (2016). The
perceptions of public health nurses using standardized care
plans to translate evidence-based guidelines into family home
visiting practice. Kontakt, 18(2), e75-e83.
Murdaugh, C. L., Parsons, M. A., & Pender, N. J.
(2018). Health promotion in nursing practice. Pearson
Education Canada.
Nussbaum, D. P., Penne, K., Stinnett, S. S., Speicher, P. J.,
Cocieru, A., Blazer III, D. G., ... & White, R. R. (2015). A
standardized care plan is associated with a shorter hospital
length of stay in patients undergoing
pancreaticoduodenectomy. journal of surgical research, 193(1),

12. 237-245.
Øye, C., Sørensen, N. Ø., & Glasdam, S. (2016). Qualitative
research ethics on the spot: Not only on the desktop. Nursing
Ethics, 23(4), 455-464.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based
practice for nurses. Jones & Bartlett Learning.
Sowan, A. K., Leibas, M., Tarriela, A., & Reed, C. (2019).
Nurses’ Perceptions of a Care Plan Information Technology
Solution
with Hundreds of Clinical Practice Guidelines in Adult
Intensive Care Units: Survey Study. JMIR human factors, 6(1),
e11846.
Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care
information systems: a practical approach for health care
management. New Jersey: John Wiley & Sons.
World Health Organization. (2017). Facilitating evidence-based
practice in nursing and midwifery in the WHO European
Region. WHO. Retrieved from
http://www.euro.who.int/_data/assets/pdf_file/0017/348020/WH
06_EBP_report_complete.pdf?ua=1
Yanicki, S. M., Kushner, K. E., & Reutter, L. (2015). Social
inclusion/exclusion as matters of social (in) justice: a call for
nursing action. Nursing Inquiry, 22(2), 121-133.
Yehuda, R., & Hoge, C. W. (2016). The meaning of evidence-
based treatments for veterans with posttraumatic stress

13. disorder. JAMA Psychiatry, 73(5), 433-434.
Yob, I. M., Danver, S. L., Kristensen, S., Schulz, W., Simmons,
K., Brashen, H. M., ... & Penland, D. R. (2016). Curriculum
alignment with a mission of social change in higher
education. Innovative higher education, 41(3), 203-219.
Problem Statement must include:
· Why it’s necessary to have standardized care plans (their
importance and benefit, why are care plans necessary). Why do
nurses need to have care plans for the patients
· How will the standardized care plans affect patients care.
b) Summarize preliminary, supporting evidence that provides
justification that this problem is meaningful and relevant to the
local setting as well as the broader field of nursing practice,
citing key scholarly sources.
· The facility recently upgraded their system to include
standardized care plans. Unfortunately, since the
implementation of the standardized care plans, the nurses
compliance with adding care plans to the patients’ chart upon

14. admission based on the patients’ diagnosis decreased from 90%
compliance to 40% which was supported by the findings of the
Joint Commission who recently paid a visit to the facility and
had penalized the facility for poor compliance by the nurses in
adding the standardized care plans to the patients’ charts.
· Why are the nurses not utilizing the standardized care plans?
The nurses stated that the facility had not provided them with
the proper training on how to use the new standardized care
plans.
· Some nurses also expressed their concern on the standardized
care plans being time consuming and impede the workflow.
c) Explicitly state the gap in nursing practice or problem that
will be the focus of this doctoral project
· Implementing a teaching tool to educate the nurses on how to
use the standardized care plans.
· The importance of standardized care plans.
· Also, to increase the nurses’ knowledge on using the
standardized care plans
The Practice Focus Question
a) Describe the meaningful gap-in-practice that this doctoral
project addresses.
b) State the guiding practice-focused question(s) for this
doctoral project.
Will an educational tool increase the inpatient nurses’

15. compliance in using the standardized care plans from 40% to
90% as compared to non-standardized care plans.
c) Briefly explain the practice focused question as it is relevant
to the identified gap in practice.
Social Change
a) Discuss how the healthcare consumers support positive social
change in the community.
b) Discuss how Walden University support social change and be
specific (google “Walden University social change).
c) Specify who might benefit from the project and in what ways
the information from the project might result in positive social
change.
Context for Doctoral Change
a) Briefly describe the intended setting for the doctoral project.
Inpatients hospital
b) Explain how this project can be accomplished in the
identified setting or context.
· Approval from the institution. I need to speak to the facility to
get their approval to build a teaching tool for the inpatients’
nurses.
· Approval from the stakeholders, the nurses and anyone
involved in the project.
· The research design is pre presentation questionnaire and post

16. presentation questionnaire
Sources of Evidence
· The library
· Joint Commission
· Literature search, review and appraisal
Ethical Considerations
This section should include how do you protect the involved
parties. Also reassure the involved parties that the follow-up
test would be done anonymously. Also, how do you protect the
involve parties from not reporting their Get consent for all
those who will participate in the teaching program ( example:
by continuing to complete this questionnaire, you are giving
your agreement to participate in this questionnaire).