– discuss change strategies and how to implement them in the work environment to help promote change. 

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Sep 23, 2022

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I need an 8-12 page research proposal paper, excluding title and reference page, in APA format for a nursing research course. 
Paper must cover:
– Discuss the PICOT question, in detail, and explain why this research is important to the nursing profession. 
– Analyze the literature review, and determine how the current research supports the PICOT question, discussing all of the articles from the literature review. 
– Analyze possible evaluation and measurement strategies and potential outcomes. 
– Provide insight on how personal experience affects evidence-based practice. 
– Discuss change strategies and how to implement them in the work environment to help promote change. 
– Determine potential barriers in the workplace to consider when implementing change.
Supporting information:
– Part I: The PICOT question and explanation of the selected population (from Unit 2 Discussion Board). PICOT question is: In ambulatory infusion clinics, does adequate nurse staffing ratios improve patient care in three months 
– Part II: The intervention—what is the intervention, and why it is selected? see below
– Part III: The comparison—what is currently being done or what are other possible interventions to consider? Currently being done are nurses working overtime, supervisors providing staff coverage, supervisor tasks not being completed when supervisor is working as a staff nurse, reschedule patient appointments when staffing is inappropriate, and nurse burnout.
– Part IV: The outcome(s) and time frame—what is the anticipated outcome from the change in intervention? And, over what period of time? see below
My recent discussion:
I work in a military health facility which is the only level 1 trauma center in the Department of Defense and one of two level 1 trauma centers in San Antonio, Texas. The issues surrounding nursing shortages and appropriate nurse-patient ratios have been a concern in numerous healthcare facilities of both military and civilian organizations. It is highly understood that nursing shortages and inappropriate nurse-patient ratios contribute to high rates of staff turnover and job dissatisfaction (Helfrich et al., 2017, p. 764). There are many nursing and support positions within my organization that were victims to a hiring freeze. The hiring freeze has been lifted, and the news brought a lot of joy, excitement, and relief to the staff who, for over a year, have been doing the job they were hired for along with additional tasks to cover the hole left by open positions. Unfortunately, the joy of receiving this news was short lived. Although the hiring freeze has been lifted, the hiring process that was created during the hiring freeze is still in place. Supervisors cannot post vacant job positions and hire qualified candidates. Instead, supervisors must write an exception to policy stating why this vacant position needs to be filled. The exception to policy must be sent to higher decision makers who will determine which positions will be filled throughout the organization.
This requires supervisors to be creative when developing interventions to decrease the heavy workload felt by staff since nothing has changed with the nursing shortage in our organization (Chan, Wong, Cheung, & Lam, 2018, p. 6). Patient and staff safety are always the priority when implementing interventions. As a nursing manager of an infusion clinic, our patients are referred to us from other services to receive treatment. Most patients are referred from gastroenterology, rheumatology, or neurology services. One intervention is to transfer some infusions to other clinics who have trained staff to administer certain medications. Instead of having a centralized infusion clinic for the facility, this will allow us to utilize the resources of other clinics since the Infusion Clinic’s patient census is increasing. The second intervention is to revise our scheduling practices by scheduling more time for patient appointments to allow time for administrative tasks and infusion chair turnover between patients. The third intervention is to cross-train a nurse from another area to be an Infusion Clinic float nurse in the event of staff illness or call out. 
The outcomes to be measured are the number of missed administrative tasks, staff receiving uninterrupted lunches, the number of documentation errors, difference between patients’ appointment and check-in times, and the difference between patients’ appointment times and infusion start times. These outcomes will be measured by doing daily rounding and daily chart audits. The outcomes will be measured monthly over a period of six months to determine success or areas still needing improvement. If the outcomes are successful, this will be tremendous benefit to the outpatient clinics involved. Inpatient wards may have more staff overall, but they also have float nurses and similar systems in place to meet patient demands and staff call outs. 
References:
Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9), 2086-2097. doi:10_1111/jan.12976 
Chan, E. A., Wong, F., Cheung, M. Y., & Lam, W. (2018). Patients’ perceptions of their experiences with nurse-patient communication in oncology settings: a focused ethnographic study. PLOS ONE, 13(6). doi:10.1371/journal.pone.0199183 
Frith, K. H., Anderson, E. F., Tsdng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing   Economics, 30(5), 288-294.
Griffiths, P., Ball, J., Drennan, J., Dall’Ora, C., Jones, J., Maruottis, A., …Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitation of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies, 63, 213-225. Retrieved from http://dx.doi.org/10/1016/j.ijnurstu.2016.03.012
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., …Ball, J. (2018). The association between nurse staffing and omission in nursing care: A systematic review. Journal of Advanced Nursing, 74, 1474-2487. doi:10.1111/jan.13564
Helfrich, C. D.,   Simonetti, J. A., Clinton, W. L., Wood, G. B., Taylor, L., Schectman, G., …Nelson, K. M. (2017). The association of team-specific workload and staffing with odds of burnout among VA primary care team members. Journal of General Internal Medicine, 32(7), 760-766. doi:10.1007/s11606-017-4011-4
Kouatly, I. A., Nassar, N., Nizam, M., & Badr, L. K., (2018). Evidence on nurse   staffing ratios and patient outcomes in a low-income country: Implications for   future research and practice. Worldviews on Evidence-Based Nursing, 15(5),   353-360. doi:10.1111/wvn.12316
Nelson, B. A., (2011). Healthcare team members’ perception of staffing adequacy in a comprehensive cancer center. Oncology Nursing Forum, 38(1), 52-59

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