Benchmark – Capstone Project Change Proposal my topic is: the

Benchmark – Capstone Project Change Proposal my topic is: the prevention of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) through the help of oral care. In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Develop a 2,500-3,000-word written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background of clinical problem Clinical problem statement (Topic 3 assignment) Purpose of the change proposal in relation to providing patient care in the changing health care system (Topic 2 assignment) PICOT question (Topic 3 assignment) Literature search strategy employed (Topic 4 assignment) Synthesis of literature review (Topic 6 assignment) Applicable change or nursing theory utilized (Topic 4 DQ 2) Proposed implementation plan with outcome measures (Topic 5 assignment) Plan for evaluating the proposed nursing intervention (Topic 6 assignment) Identification of potential barriers to plan implementation, and a discussion of how these could be overcome (Topic 5 DQ 2 and any other barriers that have not yet been considered) Appendix section: Update the Capstone Change Project Evaluation plan developed in Topic 7 as needed. Include it as Appendix A. Additional items developed for your capstone project (i.e., patient or staff education materials, etc.) can also be attached but are optional. Review the feedback from your instructor on the Capstone Project assignments submitted throughout the course and referenced above. Use this feedback to make appropriate revisions to these before submitting. You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. some of the resources created by me for your help so you can relate according to my previous topic, Background of Clinical Problem The capstone project focuses on the prevention of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP), a significant issue in healthcare settings. NV-HAP, a type of hospital-acquired infection (HAI), poses a considerable risk to patient safety, contributing to increased morbidity, mortality, and healthcare costs. Unlike Ventilator-Associated Pneumonia (VAP), which has been widely studied and addressed through evidence-based interventions, NV-HAP remains understudied and underreported, despite its prevalence. Hospital-acquired pneumonia, particularly NV-HAP, affects patients across all age groups and hospital units. According to the Centers for Disease Control and Prevention (CDC), pneumonia, which includes both ventilator-associated and non-ventilator-associated cases, is the most common infection among healthcare-associated infections in acute care hospitals in the United States (CDC, 2024). A study conducted in 2015 revealed that NV-HAP accounts for 60% of all hospital-acquired pneumonia cases, with a prevalence rate of 25% in acute care hospitals (Klompas et al., 2022). This data underscores the need for targeted interventions to prevent NV-HAP and improve patient outcomes. The effects of NV-HAP on patient outcomes are severe. Patients who develop NV-HAP are at a higher risk of prolonged hospital stays, increased need for post-discharge care, and transfers to other healthcare facilities. NV-HAP is also associated with higher morbidity and mortality rates compared to other HAIs (Munro et al., 2021). The financial burden of NV-HAP is substantial, as it leads to increased healthcare costs for both patients and the healthcare system. Moreover, the underreporting of NV-HAP as a hospital complication further exacerbates the issue, as it hinders the development and implementation of effective prevention strategies. Given the significant impact of NV-HAP on patient safety and healthcare costs, addressing this issue is critical. Basic nursing practices, such as elevating the head of the bed, maintaining good oral hygiene, encouraging patient mobility, and performing chest physiotherapy, have been shown to be effective in preventing NV-HAP (Jones et al., 2023). However, these practices are often not consistently implemented, leading to preventable cases of NV-HAP. The proposed capstone project aims to address this gap by implementing evidence-based interventions to prevent NV-HAP in adult patients at St. Mary Medical Center. This 389-bed hospital, where the author’s preceptor works, has a high incidence of hospital-acquired infections, including NV-HAP. The project will focus on improving oral hygiene practices, proper patient positioning, and enhancing patient support through adequate nutrition and appropriate pharmacological interventions. By implementing these strategies, the project aims to reduce the incidence of NV-HAP, improve patient outcomes, and decrease healthcare costs. In conclusion, the prevention of NV-HAP is a critical issue in healthcare that requires targeted interventions and a multidisciplinary approach. The proposed capstone project will address this issue by implementing evidence-based practices at St. Mary Medical Center, ultimately aiming to improve patient safety and reduce healthcare costs. Clinical Problem Statement The clinical problem addressed in the capstone project is the prevention of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) in adult patients. NV-HAP is a significant, yet often overlooked, healthcare-associated infection (HAI) that affects patients across various hospital units. Unlike Ventilator-Associated Pneumonia (VAP), which has been extensively studied and managed through evidence-based bundles of care, NV-HAP lacks the same level of attention and preventive strategies, leading to higher morbidity, mortality, prolonged hospital stays, and increased healthcare costs. The prevalence of NV-HAP is alarmingly high, with studies indicating that it constitutes the majority of hospital-acquired pneumonia cases. Despite its prevalence, NV-HAP is frequently underreported and understudied, resulting in insufficient preventive measures in clinical settings. The lack of standardized preventive protocols for NV-HAP contributes to the ongoing challenges in managing this condition, which ultimately affects patient outcomes and the overall quality of care provided. The capstone project focuses on implementing basic nursing interventions, such as improving oral hygiene, ensuring proper patient positioning, promoting mobility, and providing adequate nutrition, to reduce the incidence of NV-HAP. These interventions are critical in mitigating the risk factors associated with NV-HAP and improving patient safety. The project’s goal is to establish a comprehensive preventive approach that can be integrated into daily nursing practice, thereby reducing the occurrence of NV-HAP and enhancing patient outcomes in the clinical setting. Purpose of the Change Proposal in Relation to Providing Patient Care in the Changing Healthcare System The purpose of the change proposal to prevent Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) is to enhance patient care by implementing evidence-based interventions that address a significant, yet often neglected, aspect of hospital-acquired infections. In the evolving healthcare landscape, there is a growing emphasis on patient safety, quality improvement, and the reduction of healthcare-associated infections (HAIs). NV-HAP is a critical area of concern because it leads to high morbidity, mortality, and increased healthcare costs, yet it remains underreported and understudied. By focusing on basic yet effective nursing interventions—such as improving oral hygiene, ensuring proper patient positioning, and promoting mobility—the proposal aims to reduce the incidence of NV-HAP. This aligns with the broader goals of the changing healthcare system, which prioritizes preventive care, the reduction of HAIs, and the implementation of cost-effective, patient-centered care strategies. The proposal supports the shift towards value-based care, where outcomes and patient satisfaction are key metrics of success, and it contributes to the creation of safer hospital environments by addressing a preventable cause of prolonged hospital stays and readmissions. The change proposal also reflects the healthcare system’s emphasis on interprofessional collaboration and the integration of evidence-based practices. By ensuring that all members of the healthcare team are engaged in the prevention of NV-HAP, the proposal fosters a culture of teamwork and continuous improvement, which is essential for adapting to the demands of modern healthcare delivery. Ultimately, the proposal aims to improve patient outcomes, reduce the burden of NV-HAP on both patients and healthcare facilities, and align with the evolving priorities of the healthcare system. PICOT Question (Topic 3 Assignment) PICOT Question: In adult patients who are hospitalized and non-ventilated (P), how does routine oral care and patient monitoring (I) compared to those who do not receive routine oral care (C) affect the incidence of non-ventilator hospital-acquired infections (O) during the duration of the hospital stay (T)? Population (P): Adult hospitalized non-ventilated patients. Intervention (I): Routine oral care and patient monitoring. Comparison (C): Patients who do not receive routine oral care. Outcome (O): Decrease in the incidence of non-ventilator hospital-acquired infections (NV-HAP). Timeline (T): August 19 to September 1. Complete PICOT Question: In adult hospitalized non-ventilated patients, how does routine oral care and patient monitoring compared to patients who do not receive routine oral care affect the incidence of non-ventilator hospital-acquired infections within August 19 to September 1? Explanation of the PICOT Question The PICOT question seeks to evaluate whether the implementation of routine oral care and consistent patient monitoring can reduce the incidence of NV-HAP among hospitalized non-ventilated adult patients. NV-HAP is a preventable yet increasingly prevalent healthcare-associated infection that leads to extended hospital stays, higher morbidity, and increased healthcare costs. This clinical inquiry is grounded in evidence-based practice, aiming to establish whether a targeted intervention—routine oral care—can effectively prevent NV-HAP and improve patient outcomes. By comparing the incidence of NV-HAP in patients who receive routine oral care and monitoring with those who do not, this question addresses a critical gap in current patient care practices. The focus on a specific timeline (August 19 to September 1) ensures that the intervention’s impact can be assessed within a defined period, allowing for measurable outcomes that can inform future care protocols. The PICOT question aligns with broader healthcare goals of enhancing patient safety, reducing healthcare costs, and improving the overall quality of care. The findings from this inquiry could lead to the development of standardized care practices that are more effective in preventing NV-HAP, thereby contributing to better health outcomes for hospitalized patients. Literature Review Strategy The capstone project in the nursing field focuses on the “Prevention of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) in hospitalized adult patients.” In conducting the literature search, the primary consideration was identifying the appropriate research design or methodology, such as cross-sectional study, randomized study, quantitative design, quasi-experimental, non-randomized, meta-analysis etc. The literature review utilized the GCU library, specifically CINAHL and PubMed databases, to ensure the inclusion of reputable, peer-reviewed, and English-language publications relevant to the PICOT question. The search was restricted to studies published between 2019 and 2024, and all materials were required to be in English. The search strategy involved using related keywords and thoroughly examining full-text articles pertinent to the capstone project’s focus. Synthesis of the literature review: The reviewed studies collectively affirm that oral care interventions can effectively reduce the incidence of non-ventilator hospital-acquired pneumonia (NV-HAP). Research by Baker et al. (2019) and Giuliano et al. (2021) demonstrates that structured oral care protocols lead to significant and sustained reductions in NV-HAP rates, indicating the effectiveness of well-implemented and standardized practices. However, McNally et al. (2019) found that merely increasing toothbrushing frequency without proper adherence and implementation did not significantly impact NV-HAP rates, underscoring the need for quality execution. Satheeshkumar et al. (2020) reported mixed results on the involvement of dental professionals, suggesting varied effectiveness across settings and a need for further exploration of their role. Additionally, Wolfensberger et al. (2023) and Baker et al. (2019) stressed the importance of strong departmental strategies and continuous monitoring to ensure protocol adherence. Tehan et al. (2024) identified practical barriers such as staffing shortages and patient resistance that can hinder implementation. Johnny et al. (2021) and Giuliano et al. (2021) called for standardized oral care protocols and further research to develop uniform guidelines applicable across healthcare settings. Overall, while structured oral care interventions show promise, challenges related to adherence, implementation quality, and integration of dental expertise highlight the need for further research and standardized approaches to enhance NV-HAP prevention. Applicable Change or Nursing Theory Utilized Kurt Lewin’s change theory is utilized, which identifies both driving and resisting forces, along with strategies to address resistance. According to Oguejiofo (2018), the initial stage, unfreezing, involves helping individuals abandon outdated practices that are no longer relevant. This is followed by the change stage, where new behaviors and ideas are introduced and consistently practiced. The final stage, refreezing, focuses on solidifying these changes into standard practice. Successful application of this theory relies on proactive nurses who are committed to implementing the change. Providing education to nurses will support their transition from old practices to adopting new routine oral care practices for hospitalized adult patients, aimed at preventing NV-HAP. Implementation Plan with Proposed Outcomes For the capstone change project, the first step is to create a training session for all nurses to review the importance of oral hygiene in preventing NV-HAP. To reinforce this training, relevant resources will be sent to the nurses via email or text, allowing them to access the information at their convenience. The next step involves discussing the implementation of a monitoring system using the electronic health record (EHR), which will include tracking the signs and symptoms of pneumonia, as well as ensuring that the necessary resources for patient care are readily available and accessible. The anticipated outcomes include increased nurse awareness of the importance of routine oral care for preventing NV-HAP, demonstrated by their ability to explain its significance. Additionally, nursing staff will be able to identify early signs and symptoms of pneumonia, as evidenced by a reduction in the progression to severe pneumonia and sepsis in patients. Finally, nurses will receive skill-based refresher training on oral care using standardized supplies, evidenced by the consistent provision of routine oral care to patients. Evaluation plan The implementation plan for the capstone change project involves developing a teaching session for nurses to emphasize the importance of oral hygiene in preventing NV-HAP. This session will be supported by sending related resources via email or text, allowing nurses to access the information at their convenience. Additionally, the plan includes integrating a monitoring system into the electronic health record (EHR) to track signs and symptoms of pneumonia and ensuring that the necessary resources for patient care are available and accessible. The evaluation plan for the proposed nursing intervention includes several key steps. First, gathering feedback from hospital staff regarding the change project and its impact will provide valuable insights into its effectiveness and the perceptions of those directly involved in its implementation. This feedback will help identify areas that may require adjustments to enhance the project’s efficiency and effectiveness. Additionally, the evaluation will focus on patient outcomes, specifically monitoring records for a reduction in NV-HAP incidences and related health consequences. This outcome-based evaluation will help determine the success of the intervention in improving patient care and preventing NV-HAP. Identification of potential barriers to plan implementation and methods to overcome Them: The implementation of the capstone change project may encounter several obstacles, even though the project is relatively simple and requires few resources. A key challenge could be the current organizational culture and team dynamics, particularly in relation to the established care routines that nurses follow. The success of the project depends largely on the nurses’ readiness and willingness to embrace changes in their daily routines. To address these barriers, the author intends to organize educational sessions for nurses, highlighting the significance of evidence-based practice (EBP) and demonstrating how the proposed changes can improve patient outcomes and reduce the financial burden on both the organization and the community. Additionally, ongoing supervision and guidance will be provided to ensure compliance with the new protocols, along with continuous support to motivate and encourage the nurses. This strategy is aimed at easing the transition and enhancing the likelihood of successful implementation. Conclusion: Nurses, as central figures in patient care, should take the lead in guiding and motivating their teams to implement strategies for preventing hospital-acquired pneumonia (HAP). While the mortality rate associated with non-ventilator-associated hospital-acquired pneumonia (NV-HAP) may be low, the morbidity is significant, leading to higher costs, longer hospital stays, and extended care durations (Meehan & McKenna, 2020). Therefore, healthcare organizations should establish effective protocols to prevent and reduce the incidence of NV-HAP. Research also emphasizes the importance of educating nurses on routine oral care, ensuring that necessary resources are readily available to enhance the frequency and quality of care, and developing systems for monitoring and reporting NV-HAP cases within healthcare settings. Appendix A: Part I: Evaluation Plan Project Objective (Goal) Measurable Project Outcome What data will be collected to measure this outcome? What tool will be used to collect the data? Who will be responsible for collecting data? 1. Improve the frequency of oral care provided to patients at risk for NV-HAP Increase the percentage of patients receiving routine oral care by 85% within the first month of implementation Patient records will be accessed to obtain information on the number of oral care sessions documented in patient records The Electronic Health Record (EHR) auditing tool maintained by the practicum site will be used to get the information Nursing staff and quality improvement team 2. Reduce the incidence of NV-HAP in the patient population Decrease NV-HAP rates by 20% within six months post-implementation My practicum site collects and maintains information on patient diagnosis so such information will be accessed to get information on the number of NV-HAP cases reported within the hospital Infection control data tracking software maintained by the practicum site will be used to get the information Infection control nurse and data analyst 3. Enhance staff knowledge and compliance regarding oral care protocols Achieve 90% staff compliance with oral care training and protocols A survey will be conducted before and after the intervention to assess if the staff are following the standard oral care protocols. The questions will include the following: Question 1: Did you receive training on oral care protocols? Response: Yes or No Question 2: Do you follow the standard oral care practices taught during the training in your day-to-day work? Response: Yes or No Question 3: What are the standard oral care practices that you follow to prevent NV-HAP? Response: At least 5 practices A pre- and post-survey will be administered by the nurse educators and unit managers before and after the intervention Nurse educators and unit managers 4. Increase patient satisfaction related to oral care. Improve patient satisfaction regarding oral care by 90% within three months. A survey will be conducted before and after the intervention to assess if the patients are satisfied with the oral care practices at the practicum site. The questions will include the following: Question 1: Did you receive oral care during your stay? Response: Yes or No Question 2: What oral care services were provided to you? Response: Open-ended response Question 3: Were you satisfied with the oral care services provided by the staff? Response: Yes or No A pre- and post-survey will be administered by the nurse educators and unit managers before and after the intervention Patient experience team Part II: Communication Plan How will the data collected be communicated to the team? Data Collection and Reporting: Data collected will be compiled into a comprehensive report after each evaluation period (monthly for the first three months, then quarterly). The report will include a summary of findings, comparisons to baseline data, and any trends observed. Communication Methods: Monthly meetings will be held with the nursing staff and leadership to present findings and discuss progress. An email newsletter will be distributed to all staff members, summarizing key outcomes and encouraging ongoing participation in oral care practices. A dashboard will be created and made accessible to all stakeholders, providing real-time updates on the outcomes related to oral care and NV-HAP rates. Feedback Mechanism: Open forums will be scheduled for staff to provide feedback on the oral care intervention and suggest improvements. Surveys will be distributed to staff to gauge their perceptions of the intervention and its impact on patient care. Plan for Evaluating Outcomes Short-term Evaluation: Assess training completion rates and immediate feedback from staff regarding the oral care protocols. Monitor oral care frequency and document any immediate changes in NV-HAP rates. Long-term Evaluation: Conduct follow-up evaluations at six months and one year to assess the sustainability of the intervention. Review NV-HAP rates and patient satisfaction scores to determine the long-term impact of the oral care routine. This evaluation plan provides a structured approach to assess the effectiveness of routine oral care in preventing NV-HAP, ensuring continuous improvement and alignment with patient care goals. By monitoring and analyzing the outcomes, the team can make data-driven decisions to enhance the quality of care and patient outcomes.

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