Designing and Sustaining the Designing and Sustaining the Capstone ProjectCapstone Project

Linda Roussel, RN, DSN, NEA-BC, Professor, USA Linda Roussel, RN, DSN, NEA-BC, Professor, USA College of NursingCollege of Nursing

Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center

Terilee Gerry, BSN, RN, CNL Student, Maine Medical Terilee Gerry, BSN, RN, CNL Student, Maine Medical CenterCenter

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)

CNL Academic ExperienceCNL Academic Experience

CNL White paper Roles

Competencies

End of Program Expectations

CNL Academic ExperienceCNL Academic Experience

Assignments: Needs Assessment Work Flow Gap Analysis

Clinical Experience Role Socialization

CNL Academic ExperienceCNL Academic Experience

Clinical Experience Making the Case Cost-Benefit IOM Aims Outcomes Management Evaluation

The Student PerspectiveThe Student Perspective

Major Aspects of Project Major Aspects of Project Management and the Clinical Management and the Clinical Immersion ExperienceImmersion Experience

Terilee Gerry, BSN, RN, CNL Student, Maine Medical CenterTerilee Gerry, BSN, RN, CNL Student, Maine Medical Center

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

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

Student Clinical ResourcesStudent Clinical Resources

Staff Development Specialist coordinated student experiences

8 CNLs Nursing Director Student colleagues

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

Nursing DirectorNursing Director

Project approval Weekly meetings Close communication Leadership mentor

The Capstone ProjectThe Capstone Project

Preliminary discussion in 1st semester Establish a time line Unit based Needs Assessment Director approved Prepare for IRB submission

My ProjectMy Project

Assigned unit in 3rd semester Unit issues/needs unknown Director meeting-input important Possible project suggestions Decision made Began making contacts

Project BeginsProject Begins

Literature Search Begin contact/meetings with stakeholders Communication with physicians Work with faculty Input from Nursing Research Dept.

Project ContinuesProject Continues

Paper written Hospital and Univ. IRB approval obtained Data collection now underway

Director’s InputDirector’s Input

Inform staff of project to demonstrate leadership

Attend staff meetings Involvement on various committees Meet key personnel

Continued SupportContinued Support

CNL monthly meetings Quarterly meetings with CNS group Support of each other as needed

Innovative Role of the CNLInnovative Role of the CNL

Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Tammy Lee, MSN, RN, CNL, Clinical Nurse Leader Coordinator, Carolinas Medical CenterCoordinator, Carolinas Medical Center

The CNL Perspective

Innovative Role of CNLInnovative Role of CNL

“We cannot solve our problems with the same thinking that created them.”

Albert Einstein

ProjectsProjects

Simplistic to Difficult Small to Enormous Microsystem changes to House-wide

changes

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.

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

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

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

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

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

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.

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

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

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

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

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