Pressure ulcers, or bedsores, are among the major health problems affecting limited-mobility patients worldwide. As defined by Kottner et al. (2018), this condition refers to localized soft tissue necrosis that results from prolonged pressure on the skin, particularly in bony areas of the body. Poor nutrition and inadequate care provide a basis for bedsores to develop, leading to serious pain and potentially purulent inflammation and sepsis. Therefore, it is critical to create and implement an evidence-based checklist to enhance the overall quality of care in patients and reduce pressure ulcer rates in hospitals. The purpose of this paper is to discuss the outcomes, approach, and budget of the capstone project, aiming to educate the nursing staff about an evidence-based checklist for managing and preventing bedsores.
The project suggests the evaluation and measurement of the following five outcomes of the training program for nursing staff:
- Healthcare Staff will demonstrate retention knowledge of pressure ulcer prevention methods as evident by the 80% passing rate on the post-test among 100% of the staff.
- The in-service will show effectiveness in training healthcare staff, evidenced by 80% compliance noted in the self-assessment questionnaire among 100% of the staff at the end of week six.
- Healthcare staff will demonstrate effective training on the usage of the evidence-based checklist by using the show-me method and showing 80% compliance with the procedure by the end of week five.
- Healthcare staff will demonstrate knowledge on proper patient and family teaching of pressure injury prevention as evident by the verbal teach-back method and 80% compliance with the checklist.
- The incidence rate of bedsores in the skilled nursing home in California will reduce by 5% within six months after the application of an evidence-based checklist.
To address the first objective, it is crucial to measure the connection between the use of the pressure ulcer risk assessment tool in a clinical setting and the incidence rate of bedsore development. Pressure ulcer prevention involves multiple factors, and an efficient assessment tool can minimize negative outcomes (Sayilan, 2019). The effectiveness of risk assessment in practice can be measured in several ways. In particular, the frequency and incidence rates of bedsores in the nursing home must be evaluated before and after the checklist use. Furthermore, nurses can be interviewed about their opinions on the tool’s effectiveness, impact on the quality of patient care, and key issues.
To achieve the second outcome, it is essential to assess the efficacy of the proposed in-service training on the checklist implementation. In this regard, self-assessment questionaries should be utilized to assess the compliance of the acquired knowledge with the learning objectives. Specific KPIs can be determined to measure the employees’ performance. Furthermore, the perception of the nursing staff must be considered, along with the difficulties associated with educational outcomes. Such an approach will allow for identifying ways to improve of the training program and addressing gaps that prevent effective risk assessment tool implementation.
To measure the third desired outcome, the proposed budget requirements will be assessed. In particular, it is essential to compare the predicted cost of the project with the actual expenditures. Since there are several stages involved in the training program, the expenses associated with each of them should be measured. Along with the effectiveness assessment, this measure will indicate how relevant the project is to implement in the clinical setting. Furthermore, it will provide data for other health care facilities that aim to introduce evidence-based risk assessment tools for bedsore prevention.
The fourth outcome will evaluate whether the designed training program ensures that the staff utilizes the evidence-based checklist correctly. It is critical that further research is conducted with regard to the monitoring and improvement of the existing practice (Etafa et al., 2018). The training provided will aim to ensure the staff’s competency with the tool. Nevertheless, a follow-up evaluation should be conducted to measure whether the employees retain the information provided and implement the risk-assessment tool correctly. Such an approach will ensure the consistency of the evidence-based checklist use in the nursing home.
Finally, it is critical to establish the major issues in providing training and implementing the evidence-based checklist for pressure ulcer prevention for nursing staff. In doing so, the researcher can identify and address the gaps in project design (Shi et al., 2018). The complexity of the bedsore problem in limited-mobility patients implies numerous factors affecting patient outcomes. While the use of the pressure ulcer prevention checklist aims to minimize the negative impacts, health care facilities can face additional problems such as understaffing and lack of resources for effective tool implementation. A survey would obtain the necessary data on the primary issues and provide a basis for developing solutions.
The proposed budget requirements and allocation are presented in Table 1. As can be seen, the project involves the use of pre-and post-test to assess the risk of bedsores in senior patients. Therefore, the total cost of the training and tools required for its implementation accounts for $100. In addition, the in-service training will be conducted, with the overtime paid according to an individualized paid rate.
Table 1: Budget Requirements
|Pre-Test on Pressure ulcer Prevention
Other Supply store
|Teaching on how to use evidence-based checklist for the prevention of pressure ulcers-Will need a printout
Other Supply store
|Post-test on Pressure Ulcer Prevention
Other Supply store
|Set 3 days for Inservice Training and split staff into three groups. First, the group stays on the floor while group two receives the in-service. The next day group two will receive training while Group One stays on the floor. The third day and the third group will be designated for those who missed the in-service for any reason.
In-service will be done before the end of shift time (approximately 45min) approved by the director of Nursing. Any overtime will be paid according to an individualized paid rate.
|PowerPoint-Monitor for display
|Available in Facility Sunroom
|Tools for implementation
Other Supply store
Note. This table represents the budget requirements for the Preventing Pressure Ulcers project.
To conclude, pressure ulcer bedsores are listed among the major health problems affecting limited-mobility patients worldwide. It is essential to educate nurses on the implementation of a structured bedsore risk assessment tool. As noted by Dalvand et al. (2018), preventive tools provide highly positive outcomes when used appropriately. The implementation of the proposed training program will allow for evaluating the effects of the bedsore risk assessment tool in a skilled nursing home in California on the occurrence of pressure ulcer development. Furthermore, the effectiveness of the training and the associated issues will be determined to improve the prevention project and patient outcomes.
Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: A systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clinical, Cosmetic and Investigational Dermatology, 11, 613-620. Web.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(14). Web.
Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018). Microclimate: a critical review in the context of pressure ulcer prevention. Clinical Biomechanics, 59, 62-70. Web.
Sayilan, A. A. (2019). Evidence-based practices for the prevention of pressure ulcers. Journal of Health Services and Education, 3(1), 7-10. Web.
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLOS ONE, 13(2). Web.
Endgame Structure: The Structure Of The Play
In the first act, a room with two windows is substituted, in the center of which there is a blind man in a wheelchair covered with a sheet. In the corner are also two trash bins covered with sheets. Clov, the servant of the house, enters the room; he opens the curtains and removes the sheets from both the man and the trash bins. After that, Clov leaves for the kitchen until Hamm, the blind man, awakens. After waking up, Hamm calls Clov and they discuss why the servant would not kill the man or leave him. A short time later, Hamm’s parents, Nagg and Nell, emerge from the trash bins and have a brief interaction between them. Nagg wants to kiss Nell and also cheers her up with a joke, but the woman is unenthusiastic. After that, they both return to the trash bins.
Later, Hamm calls Clov again to give him a ride around the room. Upon returning to the seat in the center, he demands to be placed exactly in his original position. After that, Hamm asks Clov to look out the window and report what he sees there, to which the servant replies that he sees nothing. Clov then discovers a flea on himself and kills it with an insecticide. Hamm then asks Clov to fetch a stuffed dog for him and seat him behind the wheelchair, which the servant does. All this time between the two characters, there are disputes. Clov begins to wonder why he cannot refuse to do Hamm’s orders. Then the servant threatens Hamm to leave him and set an alarm so that Hamm will understand that Clov did not die in the kitchen.
Hamm orders Nagg to be awakened to tell him the story of how he got into Clov’s servant. After the story ends, Nagg returns to his trash bin. Clov then starts to tidy up the room and remarks that order is his dream. Later, the servant checks the trash bins with Hamm’s parents and finds that Nell is dead and Nagg is crying. However, none of the characters show compassion and pity for what happened.
Hamm asks Clov if he was happy, to which he gets a negative response. He then asks the servant to take him under the window to enjoy the light, but there is none. Hamm asks Clov to kiss him, which the servant refuses. Then the blind man tells the story of the end of the world and asks to check the situation outside the window again. These events upset and frustrate Clov and he hits Hamm with the stuffed dog.
Clov looks out the window and it seems to him that he notices a boy whom he decides to go to. Hamm says that he no longer needs the servant but asks him to say a few kind words in the end. Clov goes to the kitchen and no longer answers the blind man’s calls. Hamm calls for his father, but he does not answer either, and Hamm remarks that this is good. The man covers his face with a handkerchief while Clov stands in the doorway all the while, ready to leave, but he stands motionless.
The structure of the play reflects the main events and also introduces the viewer to the conditions of the world of the play and its characters. The first parts of the play make it possible to understand the relationship between the characters, while in the fourth part, the central conflict is already revealed, which is the unwillingness of Clov to be tied to a blind man and legless old people (Beckett 18-21). The last part of the play allows the viewer to uncover the motivations of the characters and understand that their lives as a whole have no connection with the outside world. Thus, the structure allows you to trace the relationship between the characters, as well as their position in the world of the play.
Beckett, Samuel. Endgame. 1957. Disciplinas. Web.
Stare Decisis And The Principle’s Role In Court Cases
To avoid the effects of bias and prejudice, lawyers often rely on objective established set of principles. Stare decisis is a doctrine that is based on courts following previously covered cases with the aim of increasing efficiency throughout the process (Cross & Miller, 2021). Overall, this system allows for stability and consistency in the way certain cases are treated, lowering the probability of a judge resolving one unethically or illegally. Furthermore, the principle of stare decisis is considerably dependent on the concept of a legal precedent. The term refers to an exemplar court case decision that is acknowledged in similar instances (Cross & Miller, 2021). Binding, or controlling precedents, are sources that act as a compulsory legal foundation to consider when reviewing a case. In that way, many controversial court cases can be viewed from the perspective of stare decisis to obtain a reliable and objective outcome.
In the instance of abortions, a similar system of principles can be applied. According to stare decisis, all court decisions must be based on a court’s own precedents. Additionally, the decisions of lower courts are completely based on the justifications of higher courts. Consequently, recent cases of anti-abortion laws and the contrasting pro-abortion proceedings illustrate the way courts handle such controversial issues. Since the Supreme Court legalized abortion several decades ago, most cases regarding the law relied on the Court’s decision. However, anti-abortion advocates have brought up arguments against the strict utilization of past court rulings. Referring to the outdated nature of past abortion procedures, anti-abortion supporters emphasize the importance of reforming the settled laws. In this way, lower courts may appeal to reconsider the value of precedents and modify the role of the stare decisis principle. On the other hand, adhering to credible law sources when resolving such debatable matters will undoubtedly increase the validity of the jurisdictional outcomes.
Cross, F.B., and Miller, R.L. (2021). West’s legal environment of business (11th ed.). Cengage Learning.