DNP-801A Selecting a Practice Problem

Sample Answer

Use the steps on this worksheet to outline the details for the patient practice problem at your practice site that you are proposing for your future DPI Project. Use the “PICOT-D Selection Guidelines,” located in the DC Network, to evaluate your proposed patient practice problem. If it does not meet these criteria, you must select a different topic.

Complete the licensure information. Your practice problem and intervention must fall within the scope your licensure.
Licensure APRN RN

• Is this practice change within the scope of your nursing practice?
  YES No
  
• By submitting this form, I am attesting I have read my state’s Nurse Practice Act and the project is within the scope of my practice.

Describe the type and focus of your proposed project site (e.g., Adult medical surgical unit in rural Nebraska; pediatric primary care clinic in urban Illinois). The focus for this practice problem is the prevention of pressure ulcers in a Long-Term Care Facility in suburban Maryland.

The facility of focus is my workplace, and I have chosen to focus on this practice problem because pressure ulcers have higher prevalence rates in patients in long term care facilities than hospitalized patients (Mondragon and Zito, 2021).

Pressure ulcers have consistently resisted prevention efforts in long-term care facilities across the nation and worldwide. They have adversely impacted the health, dignity, social well-being, quality of life of many Americans at the homecare setting, acute care hospitals and long-term care facilities. The financial burden of pressure ulcer treatments is enormous costing the nation $26.8 billion a year (Morse, 2019).

Moreover, the number of litigations against both acute care hospitals and long-term care facilities all over America are frightening. Residents in LTC facilities are at high risk for developing pressure ulcers due to a variety of health factors, the age, debilitative condition of majority of the patients and the overwhelming workload of nurses and nurses’ aides, and other healthcare workers.

Describe a patient practice problem occurring at your proposed project site that you would like to address for your DPI Project. Explain why this is a patient problem. Provide data that support the patient problem (e.g., heart failure readmission rates 21%). If you have not asked for these data yet, how would you go about obtaining the data needed?

For this DPI project, the practice problem of focus is Pressure Ulcers Prevention in a long-term care facility. Pressure ulcer develops when there an underlying tissue and or skin around a specific part of the skin that is often covering the bony prominence is damaged due to persistent pressure over a very long time.

These areas of the skin are most susceptible to pressure because they have the least amount of cushioning. Pressure ulcers cause 60,000 deaths annually. (Borojeny, et al., 2020). The primary aim of pressure ulcer prevention is to minimize or prevent pain/discomfort associated with the wounds., improve quality of care and life, prevent acute illness such as sepsis, and death and decrease the high cost of healthcare.

This practice problem is a patient problem at my project site because Pressure ulcers are more prevalent in the elderly population, with more emphasis on those who have chronic diseases such as cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders, and these are complicated by conditions like anemia, infectious diseases, malnutrition, incontinence, polypharmacy and debility (Jaul, et al., 2018).

These chronic conditions and co-morbidities are highly associated with a majority of long term care patients. And my practice site falls under this category, hence has high risk patients that need prevention from developing pressure ulcers. The facility has both short- and long-term patients.

• Average Age of patients is 75years.
  
• Percentage of male patients = 43%
  
• Percentage of female patients = 57%
  
• Percentage above 65 years = 80%
  
• Percentage of patients with current PU =27%
  
• Percentage of in-house acquired PU = 11%
  

The facility has a total of 38% of patients with pressure ulcers which calls for interventions to prevent further occurrence. Promedica Senior Care, 2022).

Describe the evidence-based intervention proposed for addressing the patient practice problem at your site and how the proposed intervention is different from what is currently in place for the practice problem (intervention must be a new change, not something already in place or “noncompliance” from staff). Explain why the intervention is realistic and feasible for your practice site.

The evidence-based intervention I propose to use at my Project site is a care bundle comprising support surfaces, skin inspection, and repositioning. Comprehensive skin assessment or skin inspection involves the assessment of the entire skin of every individual for any abnormalities. It requires a detailed screening of the skin from head to toe by visual tactile means focusing particularly on bony prominences (Lavallee, et al., 2019).

Comprehensive skin Assessment should not be a one-time event. It should be a regular clinical practice to determine whether there are any new skin conditions. In the case of my project site, I will make it a weekly event due to certain barriers such as shortage of clinical staff who are expected to play the major role.

Support surfaces such as air loss mattresses and powered reactive air-fluidized surfaces to reduce pressure ulcer incidence will be provided for at risk patients. (Lavallee, et al., 2019).

Describe the team that will be implementing your DPI intervention. (Remember, as the project manager, you may not have any interaction with the patients. You are 100% hands-off and require nurses, advanced practice nurses, physicians, or other interdisciplinary team members to participate in the implementation of the project.)

The project team will consist of healthcare professionals – physicians/Nurse practitioners, wound care nurse, nurses and nurses’ aides, and clinical managers, and dietician. Nurses will play the most role since they are responsible for the assessment and provision of care to patients and thus must conduct such tasks as they will ensure the promotion of patient welfare and dignity.

The wound nurse will be the project manager and leader of the team. She will have the additional responsibility of coordinating the activities of the team and acquiring resources for the project from organizational management The unit manager will supervise the RNs in the skin assessments and make notes on patients with new skin conditions including site of new skin conditions, measurements, and features.

The wound doctor/Nurse Practitioner will be responsible for giving new treatment orders if applicable. The nurses’ aides or GNAs as they are called in the State of Maryland will assist the nurses in the assessment process. The dietician will have the task of recommending supplements and reviewing/enhancing the diets of at-risk patients. This practice if carried out consistently will reduce the incidence of pressure ulcers at my project site.

Discuss the expected measurable patient outcome based on implementing the intervention and explain how the new proposed process/intervention will improve the measurable patient outcome. Include, where you will get your descriptive demographic data on your patient sample population and where will you get your measurable patient outcome data (e.g., electronic health record, quality department, evidence-based survey/measurement tool that is valid and reliable).

The expected measurable patient outcome to be realized from carrying out this implementation practice is the decrease of pressure ulcer incidence at my project site, and if any new skin conditions is observed, early detection and treatment plan will facilitate the healing process.

The timeframe for all DPI Projects is 8 weeks. Explain how your DPI Project can be implemented within that timeframe.
implemented within that timeframe.

Activity/ Week 1 2 3 4 5 6 7 8

Preparation, writing the manuscript presenting a comprehensive overview of the problem and proposed solution.

• Seeking approval from organizational leadership (management).
  
• Nurses’ education on the project and the expectations.
  
• Acquiring and preparing resources and supplies.
• Implementation
• Analysis of results and writing the report

Search for two original (primary quantitative) research articles that support your proposed intervention. Refer to the “Levels of Evidence in Research” chart, located in Class Resources, as needed for assistance in your search. If your intervention is a clinical practice guideline, or is coming from a clinical practice guideline, include the relevant original (primary quantitative) research that supports your intervention. In addition, include the clinical practice guideline as one of your references.

Using APA format, list your primary quantitative research below. Include working links for each article. Ensure each link works as your instructor will use these links to access your articles.

Supporting Primary Quantitative Research

• Lavallee, Jacqueline, F. (2019). Preventing pressure ulcers in nursing homes using a care …
  https //pubmed.ncbi.nlm.nih.gov/30919525
  
• Yilmazer, T., Tuzer, H., (2019). Pressure Ulcer Prevention Care Bundle A Cross-sectional …
  https //www.researchgate.net › publication › 334815291_…

References

• Morse, Susan. (2019). Pressure ulcers cost the health system $26.8 billion a year
  https //www.healthcarefinancenews.com › news › press…
  
• Borojeny, Lotfolah A., Albatineh, Ahmed, N., Dehkordi, Ali. H., and Gheshlagh , Reza. G. (2020). The Incidence of Pressure Ulcers and its Associations in …https //www.ncbi.nlm.nih.gov › articles › PMC7716611
  
• Jaul, E., Barron, J., Rosenzweig, Joshua P., & Menzel, J. (2018) An overview of co-morbidities and the development of pressurehttps //bmcgeriatr.biomedcentral.com › articles
  
• Lavallée, J. F., Gray, Trish A., Dumville, Jo. C., and Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care …
  https //pubmed.ncbi.nlm.nih.gov/30919525