TOPIC PROPOSAL

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Topic Proposal
As a nurse practitioner, it is imperative to develop a hypothetical or applicable change project. The project must be an evidence-based practice change project. The change project discussed in this paper is hypothetical: mobilizing post-surgical joint patients. This paper shall also discuss several aspects of the change project: relevance, applicable change theory, ethical considerations, legal considerations, cultural competencies, and expected outcomes of the project. As a practitioner in the surgical orthopedic ward, the major challenge in the orthopedic department is mobilizing the patients. Through experience, I have observed that the more we mobilize the patients, the lesser the stay at the hospital and the better the patient outcome. Mobility classes were started in the past for the staff, but they never succeeded due to lack of support and interest. My interest is to reintroduce those classes.
The classes shall entail patient safety mobilization in patients with hip, knee, and spinal injuries without causing further injuries. They shall also entail skills on how to make a patient cooperative in mobilization exercises. A mobility dashboard shall be instrumental in showcasing the progress of our patients in mobility exercises. Charting of the dashboard is done three times a day and a single time of hitting their John Hopkins Highest Level of Mobility. The system can be different for different wards or across the entire Geisinger system.
Auditing/evaluation is essential in determining if nurses are not mobilizing their patients or who are not charting the mobilization exercises. My project questions are; will communication training for staff help in improving patients’ mobility scores? Shall small actions such as charge nursing and morning meetings and mobilizing our patients to improve our patient’s mobility score? I plan to use the mobility dashboard to monitor mobility scores. The change project shall involve initially monitoring the patient mobility scores and morning meetings with the in-charge nurse for at least a month. Initiation of weekly classes and patient mobilization training. I would compare the new dashboard records with the previous ones before the classes and training and see the differences, if there are any.
Discuss why the Change is Necessary
Patients in the surgical orthopedic ward often have fractures, and mobilization can be quite uncomfortable or painful. Activities can be risky without prior practice. Early mobilization has several benefits making the change project on patient mobilization very important. Patient mobilization increases blood flow in the limbs and internal organs. Increased perfusion often leads to increased nutrient supply to an area and subsequent healing (Arias et al., 2018). It also helps avoid blood clotting, like the case of deep venous thrombosis that occurs with immobility. Immobility is associated with pressure ulcers which are notorious for causing nosocomial infections and poor healing. When patients begin ambulation early, they can regain their strength early, leading to early healing (Kaye et al., 2019). Mobility prevents surgery complications such as forming of strictures (Wainwright and Burgess, 2020). Ambulation helps the gastrointestinal system to resume or increase function, thus avoiding complications such as constipation.
Mobilization promotes mental and physical stability. The patient is physically fit and has a lower level of anxiety after mobility exercises. Mobilization builds muscle strength thus helps in building self-confidence and self-care acuity. It also helps improve airway clearance relieving respiratory problems such as congestion that comes with immobility. A patient learns and prepares to rejoin society again and physically fit. A change project of improving patient mobility is thus significant. ICN requires patients who are bedridden to be turned two-hourly, which promotes patient mobility.
Patients with musculoskeletal problems often experience problems with a range of motion. Some exercises would lead to further injury, and information on the correct type of exercise for specific injury is essential in ensuring patient safety (Nydhal et al., 2017). Training during the change project is integral and indispensable. Furthermore, certain equipment must be available to exclusively address specific patient movement (Wainwright and Burgess, 2020). The change project aims to mobilize equipment, staff training and adequately prepare patients to ensure effective patient mobilization.
Change Theory Applicable To Nursing
Strauss’s evidence-based practice change model is the most applicable theory applicable to this topic in nursing (Albarqouni et al., 2018). The model is made up of five basic steps. The first step is creating a research problem, which can be answered by carrying out research. The question in perspective is about mobility and interventions that can be made to improve it. The second step is gathering information or evidence. This step involves a literature review. I would research how mobilizing patients affects the number of days one stays in the hospital. I would research the effects of mobilizing patients on their long-term health outcomes. I would also look for literature that expounds on the advantages of mobilizing patients. The model’s third step is evidence appraisal.
This step requires scrutinizing if the sources and the author are credible. Evidence is appraised only if it is from a credible source and a credible author (Scot and Thompson, 2019). The fourth step involves applying the evidence. It involves ascertaining that the gathered evidence justifies the claim or supports it. Credible sources that support your claim as a nurse practitioner are instrumental in determining the success of an actual change project. The last step involves reflection on the previous steps, reviewing areas one succeeded and those that failed. The step also involves asking questions about what could have been done better for better results. PICOT analysis tools and critical reviews are instrumental in guiding and informing future research for better results. The methods used in collecting, analyzing, and interpreting collected data are instrumental in informing future practice and future research (Albarqouni et al., 2018).
International collaboration can occur when the synthesis of data is done in a logical, organized, and systematic manner. Scientists across the globe can work harmoniously and systematically due to having a common ground. Strauss’s evidence model has several advantages. Mastery of the model quickly occurs with practice (Scott and Thompson, 2019). However, the system is not without demerits. Too much time is used in searching the evidence. Lack of knowledge and skills would lead to the inadequate formulation of EBP questions, gathering of wrong information, leading to wrong analysis and synthesis of data. There are also significant problems with the availability of databases. Scott and Thompson (2019) claim that developing research questions and gathering data can at times be very overwhelming.

Potential Obstacles, Barriers, and Challenges
Despite policies on patient mobilization and benefits accrued, patient mobilization procedures are still underutilized today. There lie significant challenges in their implementation relative to the clinical settings they require to be implemented. Potential barriers to this exercise include staff turnover, vacations, scheduling issues, refusal of participation, and financial limitations. The nursing staff is often burdened with immense workloads. Introducing another activity to their already colossal workload can pose a significant challenge. Nurses are most likely not going to cooperate. The workload limits the few who cooperate in other areas of patient care.
Some nurses would be reluctant to participate, which poses a challenge to implementing the change project. Training requires experts in mobilizing patients, and facilitating training requires monetary and other physical resources. The hospital administration may not be able to cater to the training due to a lack of necessary resources. The hospital may channel resources to other areas, such as emergency treatment. Training sessions and mobilization exercises require extra time, which is not usually available for the nurses. Nurses’ shortages may also pose a challenge to schedule as the number available might not be sufficient to execute patient mobilization effectively. Another challenge is patient cooperation. Fracture injuries are rather painful or uncomfortable, and patients may fail to cooperate in mobility exercises. The degree of patient cooperation determines the success of the change project.
Ethical Considerations
Ethical considerations are not restricted to ethical principles and the law but go beyond providing care, logical thinking, and acting in the patient’s best interest (Hadad and Geiger, 2018). Ethics is a broad topic, and ethical considerations in a change project are numerous. It involves personal moral conduct. I should tailor the research to benefit the participants on completion. All procedures should meet the requirements of the ethical guidelines. One ethical consideration applicable to this change project is the principle of beneficence. Scot and Thompson (2019) define beneficence as the strong wish to do procedures that only relay the best benefits to others. It implies kindness, charity, and mercy to others. All healthcare providers should have the moral capacity to determine and do what is right (Hadad and Geiger, 2018). All procedures carried out at least relay some benefit to the recipient.
The second ethical consideration is autonomy. It implies allowing people to make decisions regarding their bodies. Informed consent is a crucial component of autonomy. The healthcare providers are mandated to respect and uphold patient decisions both as an obligation and a moral duty (Hadad and Geiger, 2018). During the project, the participants should be allowed to sign consent forms, and those who refuse to participate should be exempted without coercion. The participants should also be fully informed of the procedures, their components, and expectations.
Legal Considerations
Conforming to the law of the land is vital to any change project. Laws applicable to a change project include HIPAA (Health Insurance Portability and Accountability Act). It is possible to violate the act. HIPAA’s Breach Notification Rule requires the patient to be informed when their information is impermissibly disclosed (Cohen and Mello, 2018). Patients are entitled to privacy, and when the information is shared, the nurse should notify the patients. When carrying out a change project, it is very easy to breach this act, and when it happens, the nurse should promptly report the act to the responsible body.
Social networking policies are a second legal consideration. The nurse is responsible for patient privacy and information confidentiality (Househ et al., 2018). Thus, they should adhere to institutional policies on social networking and be sensitive to what they post on social media. The American Nurses Association advises nurses to refrain from discussing patients’ information online (Househ et al., 2018). The nurses should aim at maintaining professional boundaries between them and their patients. They should also be aware information they post can be used against them in the future. Nurses should respect their role and refrain from online postings and discussions involving their patients.
Cultural Competency
Health and healthcare is a diversified field that involves many aspects such as culture, physiology, psychology, social, and spiritual aspects. Cultural contributions to health and well-being are indispensable. The effects of culture cannot be assumed or ignored. Studies have associated the culture of an individual with health outcomes (Liu and Aungsurich, 2018). Cultural beliefs impact the healing of an individual. Before starting any project, it is essential to ascertain the participants’ culture and the feasibility of the study with the culture. People whose cultural beliefs impede medical care interventions should be educated on the procedures and not coerced or pushed beyond their cultural beliefs (Liu and Aungsurich, 2018). When developing a change project, one should ensure it is culturally sensitive and, most importantly, culture supportive. The healthcare providers should also be informed on the different cultures and their impact on health-related outcomes. Background knowledge in culture and sociology should be a prerequisite for healthcare providers participating in the study.
Expected Outcomes
The expected outcomes are that the patients will exhibit a decreased hospital stay with the initiation of mobilization exercises. From the change project, it is expected that the prevalence of common preventable complications shall markedly decrease in the ward. The change project utilizes a quasi-experimental study where one group of patients receives the mobilization exercises while the other group is just observed. The outcomes of the two groups are then evaluated after one month of observation. From the study hypothesis, the patients who receive the mobilization exercises should have a shorter hospital stay duration. The dependent variable here is the number of days spent at the hospital, and the independent variable is the introduction of the mobilization exercises. A regression analysis test can be instrumental in determining if there is a difference between individuals who underwent mobilization exercises and those who did not. A chi-square test analysis of the number of days spent at the hospital can be used to showcase any differences between the two groups.
Self-Reflection
The change project in improving patient mobility bears several lessons. From the project, I learned that the burden of immobility on patient care is more profound than it might seem. Most of the preventable surgery complications and hospitalization problems arise from immobility. Facilities and other resources are also lacking in hospitals to cater for activities such as patient mobilization. With an adequate number of staff who are well trained, patients can be mobilized effectively and achieve a shorter stay at the hospital with better health outcomes.
As an MSN with advanced knowledge and skills, I would be instrumental in leading the change project. I would train the nurses on the importance of patient mobilization and effective mobility exercises. I would also use my knowledge to effect the change process and root it into the organizational culture. I would also greatly influence the nurse and other healthcare providers in accepting the change project. I would research, publish a report and communicate the findings to other healthcare providers to enhance collaboration and acceptance of the change project. With the necessary resources and approval, I would implement this project as evidence shows that patient mobilization has many benefits to the patients, as seen above.

References
Albarqouni, L., Hoffmann, T., Straus, S., Olsen, N. R., Young, T., Ilic, D.,Shanifelt, T., Haynes, B. R., Guyatt, G., & Glasziou, P. (2018). Core competencies in evidence-based practice for health professionals: a consensus statement based on a systematic review and Delphi survey. JAMA Network Open, 1(2) e180281e180281 https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2685621
Arias-Fernández, P., Romero-Martin, M., Gómez-Salgado, J., & Fernández-García, D. (2018). Rehabilitation and early mobilization in the critical patient: systematic review. Journal of physical therapy science, 30(9), 1193-1201. https://www.jstage.jst.go.jp/article/jpts/30/9/30_jpts-2018-155/_article/-char/ja/
Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. Jama, 320(3), 231-232. https://jamanetwork.com/journals/jama/article-abstract/2682916
Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. https://europepmc.org/article/nbk/nbk526054
Househ, M., Grainger, R., Petersen, C., Bamidis, P., & Merolli, M. (2018). Balancing between privacy and patient needs for health information in the age of participatory health and social media: a scoping review. Yearbook of medical informatics, 27(1), 29. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6115243/
Kaye, A. D., Urman, R. D., Cornett, E. M., Hart, B. M., Chami, A., Gayle, J. A., & Fox, C. J. (2019). Enhanced recovery pathways in orthopedic surgery. Journal of anaesthesiology, clinical pharmacology, 35(Suppl 1), S35.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515716/
Liu, Y., & Aungsuroch, Y. (2018). Current literature review of registered nurses’ competency in the global community. Journal of Nursing Scholarship, 50(2), 191-199. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0363-x
Nydahl, P., Sricharoenchai, T., Chandra, S., Kundt, F. S., Huang, M., Fischill, M., & Needham, D. M. (2017). Safety of patient mobilization and rehabilitation in the intensive care unit. Systematic review with meta-analysis. Annals of the American Thoracic Society, 14(5), 766-777. https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201611-843SR
Scott, B & Thompson, M. (Eds). (2019). Transitioning from RN to MSN: principles of professional role development.
Wainwright, T. W., & Burgess, L. (2020). Early Ambulation and Physiotherapy After Surgery. In Enhanced Recovery After Surgery (pp. 211-218). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-33443-7_23.