Assessment of Practicum Project

Assessment of Practicum Project

Introduction

The practicum project sought to put into practice the major lesson learned and expertise instilled as it pertains to using evidence-based practice (EBP) to propagate change in the care setting. EBP relies on evidence-based research (EBR), which means that every endeavor has to be reinforced by credible use and application in prior settings to satisfactory levels of success because a facility adopts it. This paper is an assessment of the experience presented by the project, covering a wide variety of major taking points such as focus, project needs, barriers, outcomes, and project success.

Focus, Goals, and Competencies of the Leadership Project

The primary focus of the leadership project was to instigate operational changes in the neonates’ intensive care unit (NICU) of Levine Children’s Hospital (LCH). The project identified a bundle of practices that underpinned the formulation of the PICOT question to enhance health via the reduction of rates of unplanned extubations (UE).  According to an article by Galiote et al. (2019), UE leads to increased morbidity and mortality in neonates, which is why quality improvement interventions are critical to reducing risk factors. This article further propounded that unintended extubations occur due to a myriad of factors, which include, but not limited to, the environment, machines, and people. The project recognized that safeguarding the future generation and creating a healthier population is only possible if the healthcare sector could dedicate more efforts to protecting the health of the neonates. Perhaps most important is the fact that adoption of the bundle of practices was underpinned by the identification of the different elements that increase the risk for UE.

The clarity of the project was evident in the way it was formulated around specific and measurable goals, as well as competencies that the project sought to enhance. The fundamental purpose of the project was to reduce EU by a statistically significant margin, expressed as a function a hundred ventilations per day.  By adopting practices that reduce respiratory-related adverse events, the project would have made one step closer to attain the goal of reducing incidences (Hewitt, Sproul, & Emberley, 2015). To accomplish this overarching objective, the project was guided by several specific objects, which can be categorized according to the individual approaches contained in the practice bundle. These elements were adequate securing and standardization of the ETT using Y-tapping, X-ray after insertion, and checklist for overseeing efficient tube placement. Further reduction of risk factors was deemed possible via two-person handling, proper documentation, management of positioning, and focus on tube location. Throughout the project, the main competencies to improve included teamwork and leadership, problem identification, and acquisition of expertise to transcend organization and social barriers in a bid to succeed.

Discovering the Need for the Project

One factor that led to the discovery of the need for this project was seeing a friend undergo the pain of losing a child. Every female has a vision of becoming a mother someday, and the bond between the mother and the newborn strengthens even more when the baby is born. Seeing Mary suffer from child loss was devastating, which instilled a desire to pursue and solve a problem that snatches children of numbers mothers within the country and abroad. I ventured into literature and consulted my Mentor Thomas Calabro at Levine Children’s Hospital about the extent of the problem and discovered that UE was a preventable NICU occurrence that leads to loss of lives that should never be lost. This information was further supported by data from the LCH’s database, and thus, comprised a problem worth researching and solving.

The need further aligned with the vision, mission, and philosophy of the organization, which enhanced its viability. With a mission to not only improve health but also promote hope through healing for every individual, the facility has a mandate to help every child pursue wellbeing, Support for evidence-based practice is strengthened by the philosophy of valuing all persons within the origination. The facility, thus, was supportive of these efforts because the management was intent on working to minimize this menace facing children in American society.

Barriers encountered during the Practicum Project

The project was marred by obstacles that were not only linked to planning but also operations. One significant hurdle was time. The plan was to begin ad complete the project in time, which was barely impossible due to difficulties in time management. The project required extensive consultations with the various heads of departments in efforts to collect firsthand information from team leaders. However, it was complicated to schedule meetings due to their busy schedules and limited availability. Some sessions would be scheduled but later postponed due to unforeseen occurrences, influencing the entire program of the project based on the criticality of the specific event and stage of research. The difficulties in scheduling meetings threatened my goal of beginning and completing this project with a practice change.

Another barrier was in selecting change in practice using PDSA measurements for UE in NICU. Practice change is not easy to implement while one is required to not only select a change that brings positive results but also one that practitioners are comfortable with (Hatch et al., 2019). The underlying principle to every practice change has to align with the cultural preferences of the caregivers in a professional that has become very diverse. Numerous options of practice change existed, and gathering adequate data to support the selected interventions over others in the vast array of possibilities was complicated.

Outcomes of the Project

The outcome of the project will be measured through month analysis and in phases that comprise the independent implementation of the practices contained in the bundle. The monthly analysis will ascertain whether, indeed, the practices are contributing to the reduction of EU rates. At every single instance or month, one PDSA will be implemented, beginning with the securement method, then proceeding to tape brand and two-person handling. Implementation of PDSA will be followed by outcome measurement and analysis before moving to the next PDSA. Continuous monitoring of reason and the establishment of protocols to address loopholes make this project sustainable and progressive (McGalliard, Cavanagh, Quinn, & Keaney, 2019).

Success of the Project

Measured outcomes are documented on a questionnaire in EMR. Time out is called until two licensed healthcare professionals are present. Upon completion, an assessment of this PDSA will be done. There is a third PDSA to be started, which was developed by the team initiated by this practicum. This portion will assess the measurement of the ETT with the radiologist writing on the x-ray in the EMR to document placement, allowing the NICU RN and RT to establish the possibility of UE. This will be measured by any change in placement noted on the EMR by the RN or RT who identifies placement. This will be implemented 1-2 weeks after PDSA 2 is complete, and analysis is done. Upon completion of the three PDSA interventions and analysis, if all three components have positive outcomes, a guideline change will be implemented throughout the organization for NICU. Data collection will continually be used as a basis for proving that indeed the selected evidence-based practice can be transferred to other settings and provide positive results.

Conclusion

The practicum project as a valuable opportunity to explore a severe clinical issue. It was a valuable research opportunity that required consultations with teams and persons within the organization at all phases, from problem identification to solution formulation and implementation. The clarity of results guided the study and made objectives concrete and attainable. As such, this project was critical to enhancing the skills of nursing leadership.