Capstone Project Blog

Capstone Project Blog

Introduction/overview

In the last three weeks of implementing the program, three primary goals were attained. The first goal was educating the patients on predisposing factors and mitigating interventions for falls using the American and British Geriatrics Societies (AGS/BGS) framework for fall prevention (Panel on Prevention of Falls in Older Persons, American Geriatrics Society, and British Geriatrics Society, 2011). The second goal involved nurses assessing whether the participants in the intervention goal had implemented the recommended interventions such as consulting an optician, improving lighting, and other home modification solutions (Centers for Disease Control and Prevention, n.d.). The goal was achieved by visiting the patients in their home in the second week, observing their home environment, and conducting interviews. According to Roussel et al. (2020), one of the crucial roles of managers and leaders is to perform regular performance evaluations against objectives (p. 24). Subsequently, in the third week the project leader directed nurses to conduct interviews with the patients to determine how they had benefited from the implementation of the program that was held in the third week.

Challenges

In delivering education to patients and evaluating the effectiveness of the program, I encountered three primary challenges. The first challenge that I encountered is that some of the intervention group participants underestimated their risk of falling. Subsequently, they felt that implementing the recommended interventions was unnecessary. I coached the nurses who encountered the problem to convince the reluctant participants about the prevalence and the burden of falls. In particular, I instructed them to inform the patients that falls was the leading cause of injuries and deaths among adults aged 65 years or older (Centers for Disease Control and Prevention, n.d.). Additionally, according to the Centers for Disease Control and Prevention (CDC) (n.d.), falls contributed to over 800,000 hospitalization cases, 3 million emergency visits, 28,000 deaths, and a $31 billion increase in Medicare costs. Subsequently, after helping the patient to conduct the cost-benefit analysis of implementing the recommended interventions, they were motivated to implement the program. The second problem that the interprofessional team encountered is that some of the patients were from different cultures and had a low English command. The problem was mitigated by the use of translators, who facilitated communication between nurses and patients in the education and evaluation phases. The final challenge was that some members of the interprofessional teams disagreed on some of the recommended interventions. For example, some of the nurses complained that doctors and pharmacists refused to prescribe vitamin D to frail patients. In such cases, I relied on transformational leadership by holding group discussions where evidence-based practices were used to attain an amicable consensus that could benefit the patient the most and enhance the relationship among the teammates (Roussel et al., 2020, p. 32).

Utilization of Coaching and/or Mentoring

I utilized coaching as a nurse leader, to enhance the competence of nurses in using the AGS/BGS framework and enabling the participants in the control group to implement the recommended interventions. The five main coaching activities that were utilized in the implementation of the program are observing, creating a discussion plan for the coaching session, initiating, providing, and eliciting feedback, and having follow-up meetings (Roussel et al., 2020, p. 32).  I mainly observed nurses as they were educating the patients since some of the educational sessions were recorded to identify their weaknesses. Moreover, the results obtained from the SurveyMonkey survey regarding the issues that nurses found hard to understand, was used to create a discussion program for the coaching session that could address the areas that nurses felt they required additional training. In some of the areas that I felt that I was not yet competent such as analyzing data to evaluate the effectiveness of the educational program, I initiated the coaching session by approaching a clinician who I knew had evaluated the success of similar programs in the past, who could educate and train me on the issue. Finally, follow-up meetings between the coach that I had selected and me involved the verification of whether I had evaluated the performance of the program appropriately. Finally, follow-up meetings were also conducted with nurses and patients to determine if they had understood the issues that were identified as challenging in the SurveyMonkey survey.

Capstone Project Plan Progress

In the last three weeks, the capstone project has progressed according to the established timeline. For example, in the first week, nurses managed to educate the patients on the predisposing factors for falls and mitigating interventions as planned. Additionally, in the second week, nurses verified that patients in the intervention had implemented the recommended intervention measures, such as consulting the appropriate specialist and making the proposed home modification. Finally, in the final week, nurses collected data that could be used to evaluate the success of the program, such as the incidence of falls that is summarized in table 1. Subsequently, the implementation of the program has progressed as planned.

 Table 1: incidence of falls among 30 patients before and after the intervention

Leadership lessons learned

The main leadership lessons that I learned is that the use of an appropriate leadership style and change model are pivotal in enhancing the success of a given quality improvement incentive due to two primary reasons. First, a major discerning character of transformational leaders is that they are curious, which motivates them to learn about new things that can enhance their ability to implement a given project successfully (Roussel et al., 2020, p. 31). Curiosity enabled me to seek the assistance of a coach who trained and educated me on performing data analysis to determine the effectiveness of the educational program. Additionally, curiosity made me aware of my inner world, such as the weakness that I had, and seek assistance from more accomplished peers. Secondly, transformational leadership entails the use of coaching that provides an opportunity to facilitate the growth and development of peers and less competent peers. Finally, transformational leaders facilitate consensus building that can improve the collaboration among interprofessional teams by enabling amicable group discussions.

I also learned that the use of the Schein (2004) change model could enhance the success of quality improvement incentives by creating change and sustaining it due to two primary reasons ( as cited in Roussel et al., 2020, p. 49). First, change occurs at all levels of the organization where the leaders campaign for the change address the attitude, beliefs, skills requirements, and behaviors that can lead to the desired change. For example, I ensured that the nurses had the necessary skills by training them through Zoom on using the AGS/BGS checklists to ensure that they addressed the multiple predisposing factors and appropriate interventions. Additionally, I created a safety culture essential to sustain change by informing both the nurses and the participants in the intervention groups about the prevalence and burden of falls among older adults that motivated them to use the selected fall framework tool that had higher effectiveness in preventing falls.

Outcomes Achieved

In the three weeks, I managed to achieve three substantial results that could be used to assess the success of the educational program. The first outcome that I achieved is that there was a considerable reduction in the occurrence of falls after implementing the program, as indicated in table 1 and figure 1. The primary reason for this is that the goal for reduction of the number of falls per 30 older adults was achieved in the third week. Secondly, all the patients in the intervention group managed to implement the recommended intervention by the second week, which enhanced the effectiveness of the program by substantially reducing the risk of falling. The final outcome is that all the nurses involved in the quality improvement program reported using the SurveyMonkey survey that they were competent in using the AGS/BGS framework.  Moreover, nurses reported a substantial increase in the knowledge of the patients regarding falls, especially among those who had low command of English due to effective interpreters (Eklöf et al. 2014, p. 243). Subsequently, since the program successfully attained the desired goal, it is recommended that it be extended to more home care for older adults.

Figure 1: Run chart of the incidence of falls per 30 older adults in the intervention group.

References

Centers for Disease Control and Prevention. (n.d.). Take a Stand on Falls. Centers for Disease Control and Prevention. Retrieved 12 November 2020, from https://www.cdc.gov/features/older-adult-falls/index.html.

Eklöf, N., Hupli, M., & Leino-Kilpi, H. (2014). Nurses’ perceptions of working with immigrant patients and interpreters in Finland. Public Health Nursing, 32(2), 143–150. doi:10.1111/phn.12120.

Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148-157.

Roussel, L. Harris, J., Thomas, T. (2020). Management and leadership for nurse administrators (8^th ed.). Burlington, MA. Jones & Bartlett Learning.