1/16/2015
CNL Capstone Project: Scope and Considerations Joanne G. Samuels, PhD, RN, CNL Jill M. Berg, PhD, RN, FAHA
Objectives Upon completion of this session, participants will gain broader understanding of AACN Revised Competencies and Curricular Expectations for the Clinical Nurse LeaderSM Education and Practice that are important for the Capstone Project Appropriate scope for the CNL Capstone Project Human subject considerations for the CNL Capstone Project
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Capstone: Defined Multifaceted assignment that serves as a culminating academic and intellectual experience for students
Generally completed at the end of a program Opportunity for students to provide evidence of meeting program/degree/course requirements
Many Forms
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Project Scope
Considerations Quality improvement Represents the entire QI process steps (1 PDSA cycle) Moves beyond description to intervention Completed within a semester Obtain some measure of baseline and comparative results for analysis Provides a basis for further improvement – i.e., “giveback” for the host unit
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Potential content areas of interest Hand off
Noise reduction
Pain Management
Purposeful rounding
Intravenous therapy policies and procedures
Skin breakdown prevention CAUTI reduction
Risk assessment tool implementation
Glucose monitoring improvements
Patient education programs
AIM
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Too big Aim: Decrease noise levels at night Aim: to design and trial a formalized evaluation to assess the quality of a hospital sponsored program. Aim: Implement a sustainable system of purposeful rounding
Too small Aim: To identify the average patient throughput time in ED Aim: To describe the current education needs of staff regarding existing pain assessment tools. Aim: Staff nurses’ barriers to providing consistent and effective diabetes education
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Just right Aim: Promote IV cap use by 90% in 2 months Aim: Implement an educational mnemonic tool emphasizing therapeutic communication strategies for pain management Aim: Implement Hendrick's Fall Risk assessment tool
CNL Competencies Essential 1: Background for Practice from Sciences and Humanities Interpret patterns and trends in quantitative and qualitative data to evaluate outcomes of care within a microsystem and compare to other recognized benchmarks or outcomes, e.g., national, regional, state, or institutional data
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Essential 2: Organizational and Systems Leadership Evaluate the efficacy and utility of evidence-based care delivery approaches and their outcomes at the microsystem level Collaborate with healthcare professionals, including physicians, advanced practice nurses, nurse managers, and others, to plan, implement, and evaluate an improvement opportunity
Essential 3: Quality Improvement and Safety Use performance measures to asses and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of higher-value care Perform a comprehensive microsystem assessment to provide the context for problem identification and action
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Use evidence to design and direct system improvements that address trends in safety and quality Implement quality improvement strategies based on current evidence, analytics, and risk anticipation Demonstrate professional and effective communication skills, including verbal, non-verbal, written, and virtual abilities
Essential 4: Translating and Integrating Scholarship into Practice Facilitate practice change based on best available evidence that results in quality, safety, and fiscally responsible outcomes Disseminate changes in practice and improvements in care outcomes to internal and external audiences
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Evaluation Rigorous analysis of completed or ongoing activities that determine or support meeting prescribed objectives Determination of the significance, value, or worth of a piece of work in a careful and thoughtful way Rubrics A standard of performance for a defined population A set of criteria and standards typically linked to learning objectives
Rubrics Scales Exceeds, Meets, Does Not Meet Exceeds, Meets, Needs Improvement, Inadequate (failed) Likert-type scale Clear expectations for each delineation are imperative
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Capstone Rubric Title Abstract Background and Significance Local Problem Defined Was a comprehensive microsystem assessment performed to provide the context for problem identification and action?
Intended Improvement Primary Improvement-Related Question Was there evidence of collaboration with healthcare professionals, including physicians, advanced practice nurses, nurse managers, and others, to plan, implement, and evaluate the improvement opportunity? Ethical Issues Setting Described
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Intervention Description Was evidence used to design and direct system improvements that address trends in safety and quality? Were quality improvement strategies implemented, based on current evidence, analytics, and risk anticipation? Were practice changes facilitated by using best available evidence that the intervention would result in quality, safety, and fiscally responsible outcomes?
Study Design How were professional and effective communication skills demonstrated, including verbal, non-verbal, written, and virtual abilities? Methods of Evaluation Data Analysis Methods – Qualitative and Quantitative
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Results Changes in environment of care Changes in processes of care Changes in patient outcomes Cost of implementation Were the efficacy and utility of evidence-based care delivery approaches and their outcomes evaluated at the microsystem level? Were performance measures used to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of higher-value care?
Discussion Summary of most important successes and difficulties in implementing the intervention Relation of findings to previously reported studies Limitations Interpretation Why were findings different? How might the intervention be improved/strengthened (recommendations)?
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Were patterns and trends in quantitative and qualitative data used to evaluate outcomes of care within a microsystem and compare to other recognized benchmarks or outcomes, e.g., national, regional, state, or institutional data? Conclusions Were changes in practice and improvements in care outcomes disseminated to internal and external audiences?
Human subjects considerations
Federal Policy for the Protection of Human Subjects – 1991
Requires covered entities to implement specific measures to safeguard the privacy PHI
Defines protected populations
Informed consent
The Common Rule 45 CRF 46.102(f)
"Human subject means a living individual about whom an investigator (whether professional or student) conducting research obtains (1) Data through intervention or interaction with the individual, or (2) Identifiable private information.
HIPAA Privacy Rule 2013
Regulates covered entities’ use of PHI
Calls for data sharing agreements
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Human subjects considerations: Project typology Element
Research
QI
Program development
Purpose
New knowledge
Improve LOCAL practice
Apply evidence
Significance
Unanswered question
Clinical imperative
Clinical or social imperative
Background info
Other research or theory
Evidence from current practice (baseline data)
Evidence from current practice, literature and theory
Statement of results
Hypothesis
Aims
Goals and objectives
Intervention
Experimental, descriptive, or qualitative
Trail change, PDSA
Structured program initiative
Measures
Variables
Processes and outcomes
Processes and outcomes
Adapted with permission – Kathleen Thies, 2014
Human Subjects Considerations Protecting the rights of the employees and staff when conducting surveys Insure the right to refuse without penalty Provide for anonymity of the respondent
University of Wisconsin KnowledgeBase
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The debate remains….IRB or no IRB for student projects? Pro
Facilitate positive academic/practice partnerships by insuring the covered entity complies with regulations
Con
Provides a learning experience for the student by assuring the student follows confidentiality and data security procedures
Adding a checklist......to “cement minimum standards and ensure they are followed, not to discover new therapies”
Stops critical improvement work
Minimal risk
Enables the publication and dissemination of findings
Practice interventions are already evidence based
Unclear lines between research and QI
Many projects use identifiable staff and patient data
Commercial IRBs More than 45 available Typically much faster turnaround Many meet twice each week Typically costly
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Closing Thoughts Many ways to approach capstone experiences Many ways to assess performance Questions remain as to need for IRB approval Where do we draw the line between Evidence-Based Practice Projects and Clinical Research? Who do we need to protect when disseminating findings?
Questions
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