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Evidence Based Literature




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Capstone Project Change Proposal Presentation for Faculty Review and Feedback


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The capstone change proposal is effects of disproportionate nurse to patient staffing ratios on the quality of patient care. Patients can be exposed to several safety issues if proper care is not given to them. These problems include falls, hospital-acquired infection due to poor hand hygiene by the healthcare workers, medication administration errors, poor health education to the patients, and negligence in attending to the spiritual needs of the patients. Interventions includes presenting the safety concerns to the management team of the facility to enable them to hire more nurses to deliver adequate care to the patients. In-service training of the nurses on fall prevention, proper application of fall precautions and identification of patients who are at risk of falls are another important intervention. Proper hand hygiene is an intervention that will prevent hospital-acquired infections and nurses should form the culture of doing it (Sands, & Aunger, 2020). Medication errors can lead to complications or death of patients. Nurses should check the medications properly and identify the patients before administration of the medications.

Evidence Based Literature

The articles reviewed have different research aims and questions, but they are all centered into the idea of the effects of nurse-to-patient ratios on patient outcomes. The research questions of these articles are divided into three categories: definition of nursing staffing, effects of nursing-to-patient ratio on patient outcomes and nursing characteristics that hinders the delivery of care. The study by (Cho et al., 2020), defines the term nursing staffing in terms of the nursing care needs of the patients.

Nurses are essential in the provision of quality care in acute units, and their staffing levels have an impact on patient outcomes. (Cho et al., 2015), examine the link between nursing staffing and patient outcomes, specifically the mortality rate. Comparing to (Driscoll et al., 2018) and (Shin et al., 2018), the articles examine the effects of nursing staffing ratios on the patient outcomes in acute specialist units. Besides, (Needleman, 2016) reviews the studies that examine the effects of nursing skill mix on the patient outcomes such as patient ratings of hospitals, mortality, adverse health outcomes, and nurse burnout and dissatisfaction.

Some of the factors such as nursing skills, staffing methods, and working environment affects the nursing staffing ratio, which hinders the quality of care. The article by (Bridges et al., 2019), explores the relationship between nursing staffing skills and the quality and quantity of their interactions with patients in hospital wards. (Olley et al., 2019) evaluate research on nursing staffing methods and their implication to patient outcomes in acute hospitals. (Song et al., 2020) aim to find out the association of the missing essential care tasks in nursing homes and the work environment.

Objectives of the Study

The aim of the project is to determine the condition under which the impact of hospital nurse staffing is associated with patient outcome. To determine the incidence of fall associated with hospital and unit staffing. Falls-prevention programs needs to be carefully targeted to patients at greatest risk in other to achieve cost saving (Spetz et al., 2015). To determine the work environment and staffing effect on nurses. To develop evidence-based intervention to reduce the rise of hospital-acquired infections in the hospital.

Resources Needed

Resources needed in the capstone change proposal included communication, finance, leadership and management, new policies and regulations, and hospital libraries. Good communication between nurses and patients is critical for personalized nursing care of each patient (Dithole et al., 2017). The management team needs update on the project by telephone calls, email, text messages, project introduction of the seminar that requires the use of computers and projectors. Funds are needed to purchase supplies such as water, soaps, falls prevention equipment, computers, projectors, face masks, hand gloves, sanitizers, and disinfectants. Leaders and managers have the power to influence the policies that will favor my project’s implementation, so they are especially useful resources.

Anticipated Measurable Outcomes

The measurable outcomes of the capstone change proposal are reduction of nurse’s burnout. Nurse burnout is characterized by the reduction of energy which can negatively impact on work output, and lack of motivation in a nurse (Mudallal et al., 2017). Improving safety outcomes and increasing the quality of life of the patients. Implementing adequate nurse staffing ratios will help in promoting quality care, which will reduce the rate of hospital readmissions or length of stays in intensive care units, which are often expensive.

How the Intervention will be Evaluated

Evaluation of the intervention will be done through random selection of patients admitted in acute section of the facility. Assessment of fall rate and fall prevention practice before and after the implementation of the project, will enable to determine if progress is made. Checking the infection control records to determine the number of cases after the implementation of the project will determine how well hand hygiene practices are carried out by the nurses, and other health workers. Checking admission records to obtain information about the number of readmissions is another way of evaluating the intervention. Interviewing the randomly selected patients on general satisfaction of nursing care is one way to evaluating the intervention. Errors of nurses can result to safety concerns in the facility (Palteki et al., 2020). Assessment of the nurse to patient ratios will show if the management hires more nurses to take care of the patients.



Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017). Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry: A Journal of Medical Care Organization, Provision, and Financing54, 46958017724944. https://doi.org/10.1177/0046958017724944

Dithole, K. S., Thupayagale-Tshweneagae, G., Akpor, O. A., & Moleki, M. M. (2017). Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients. BMC Nursing16, 1–6. https://doi-org.lopes.idm.oclc.org/10.1186/s12912-017-0268-5

Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. Plos One15(4), 1–29. https://doi-org.lopes.idm.oclc.org/10.1371/journal.pone.0230573

Palteki, T., Sur, H., Yazıcı, G., Þimþek, E. E., & Baktýr, Y. (2020). Evaluation of the patients’ attitudes and behaviors concerning patient safety. Southern clinics of Istanbul Eurasia, 31(1), 69–74. https://doi-org.lopes.idm.oclc.org/10.14744/scie.2020.80299

Cho, E., Sloane, D. M., Kim, E.-Y., Kim, S., Choi, M., Yoo, I. Y., Lee, H. S., & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies52(2), 535–542. https://doi.org/10.1016/j.ijnurstu.2014.08.006

Cho, S.-H., Lee, J.-Y., Hong, K. J., Yoon, H.-J., Sim, W.-H., Kim, M.-S., & Huh, I. (2020). Determining nurse staffing by classifying patients based on their nursing care needs. Journal of Korean Academy of Nursing Administration26(1), 42. https://doi.org/10.11111/jkana.2020.26.1.42

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology17(1), 6–22. https://doi.org/10.1177/1474515117721561

Needleman, J. (2016). Nursing skill mix and patient outcomes. BMJ Quality & Safety26(7), 525–528. https://doi.org/10.1136/bmjqs-2016-006197

Olley, R., Edwards, I., Avery, M., & Cooper, H. (2019). Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals. Australian Health Review43(3), 288. https://doi.org/10.1071/ah16252

Shin, S., Park, J.-H., & Bae, S.-H. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook66(3), 273–282. https://doi.org/10.1016/j.outlook.2017.12.002

Song, Y., Hoben, M., Norton, P., & Estabrooks, C. A. (2020). Association of Work Environment with Missed and Rushed Care Tasks Among Care Aides in Nursing Homes. JAMA Network Open3(1), e1920092. https://doi.org/10.1001/jamanetworkopen.2019.20092

Spetz, J., Brown, D. S., & Aydin, C. (2015). The economics of preventing hospital falls: Demonstrating ROI through a simple model. The Journal of Nursing Administration45(1), 50–57. https://doi.org/10.1097/NNA.0000000000000154

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