Clinical Practice Project (CPP) Research: Module 3

·  Clinical Practice project part 3- please refer to the project information and rubric for further guidance. It is important that you review the grading comments from week 2 and make any necessary revisions. When entering your corrections, please change the color of the FONT to red on the changes.

·  This week you will be discussing gaps in evidence, the additional research that might be useful, stakeholders (who is affected), and the resources necessary for you to achieve your objective. 

·  This week your template should include a minimum of eight (8) total references: one (1) reference from required course materials and seven (7) peer-reviewed references from your project research – this is cumulative from week one and two template – add at least 2 new references from week two. All references must be no older than five years.

·  Finally, please always refer to the rubric when completing any assignment; I grade based on the rubric!

SAMPLE SOLUTION

Clinical Practice Project (CPP) Research: Module 3

Assignment Objectives:

• Extend academic experience into areas of nursing practice interest, working with new ideas, issues, organizations, and individuals.
• Demonstrate the ability to think and act critically and creatively about nursing practice issues.
• Develop analytical and ethical leadership skills necessary to address and help solve these issues.
• Utilize evidence based research and demonstrate proficiency in written and communication skills.

Assignment Instructions:

This week you are going to respond to the last questions that will help you complete your project, discuss EBP and further research, and identify stakeholders and resources. Lastly, you will give an overall update of your project.

Last week you answered the following questions:

1. What are the scope, duration, and history of the problem?
2. What data is available to describe the problem?
3. What are the implications of the problem?
4. How does/will your selected organization support your topic?

This week you should be able to answer the following questions:

1. What are the gaps in the existing data?
2. What types of additional research might be useful?
3. Who are your stakeholders?
4. What are you needed resources?

In the template below you will answer the last several questions above. Your answers should be based on supporting evidence. You may need to review the information from your EBP course. Be attentive to the instructions and remember you are professional nurses; writing and thought processes should be indicative of scholarly writing.

This week’s assignment is the first of five assignments to complete your Clinical Practice Project (CPP). Each weekly assignment will build upon the last one. It is very important that you follow the directions carefully and review your teachers document/grading rubric for comments so that you can improve each week.

To complete this assignment type in the boxes below, the boxes will expand as you type. Be sure to save your document frequently. Points will be deducted for incomplete work, spelling/grammar errors, lack of thought and use of abbreviations. All content must be in your own words, not directly quoted; however you must provide supportive details by using in text citations (Journal Article references at the end of the form-please see your rubric for an explanation of refereed Journals). This assignment is worth 25 points…be sure your work reflects 25 points.

Change the FONT to red to highlight your revisions from the module two template.

Student Name	Date:
Theresa Perine	15/04/2021
Project Topic:	QSEN Competency: (example, Patient-centered Care)
Opioid abuse in the world is on the rise and it has significant social and economic implications. Opioid addiction has several typical behaviors including craving, compulsive use, impaired control over drug use, and continued use despite harm. Pain is more prevalent in patients with opioid addiction for physiologic and psychological reasons. Studies indicate that 61 percent of patients on methadone maintenance for instance report chronic pain while 37 percent report severe chronic pain (Vadivelu et al., 2018). Despite patients abusing opioids needing much medical attention, this population is undertreated for pain due to several reasons including systemic issues, negative provider perceptions, and opioid concerns of side effects and drug enforcement. These need to be changed to enable adequate pain management in this population	The QSEN competency that aligns with this project is quality improvement (QSEN Institute, 2020).
QSEN Definition: Define your QSEN Competency in your own words (paraphrase) using the QSEN.org web site>competencies>graduate KSAS, (example: for competency Patient-Centered Care the definition on the web site is Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs—take this information then write your definition in your own words (paraphrasing, remember to cite the QSEN site).
Quality improvement refers to strategies and frameworks used to systematically better the way care is delivered to patients. It entails progressive processes aimed at achieving stable and predictable processes results, i.e., to limit variations in processes and improve their outcomes both for the patients and the healthcare organization. The process involves collecting and analyzing data and testing change.
List two Knowledge/Skills/Attitudes (KSAs)- use two each (Knowledge/skills/attitudes) from the QSEN.org web site which are listed under your chosen competency that you think will help you to meet your selected competency. Then write your KSAS in your own words (paraphrasing/editing related to your specific project—remember to cite the QSEN site).
Knowledge	Skills	Attitudes
Describe common quality measures in the practice specialty (QSEN Institute, 2020): Opioid addiction results in many other health complications hence the need to manage their use alternative therapies to deal with addiction. Analyze the strengths and limitations of common quality improvement methods (QSEN Institute, 2020): This is aimed at identifying the gaps and potential solutions to them	Maintain confidentiality of any patient information used to determine outcomes of quality improvement efforts (QSEN Institute, 2020): Patient confidentiality must be upheld during the project research and implementation in line with the privacy laws. Select and use quality measures to understand performance (QSEN Institute, 2020): Setting benchmarks to measure the efficacy of the protocols	Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals (QSEN Institute, 2020): There is need for healthcare providers to help patients dealing with opioid addiction overcome the problem. Appreciate the value of what individuals and teams can to do to improve care (QSEN Institute, 2020): Healthcare providers should strive as individuals or teams to promote quality care delivery including measures to address the issue of opioid addiction among patients
Discuss Health Care Organization (this is not the facility/organization where you are implementing your project, may be a nursing organization, or any organization which sets standards, conducts research, or publishes evidence based literature in relation to your topic) that will help support your project. Discussion should include the mission/values of the organization (in your own words). Provide citations and references (no direct quotes).
The Joint Commission’s mission is to oversee a continuous improvement in health care for all people through collaborations with other stakeholders. It undertakes the evaluation of healthcare organizations and focuses on inspiring them to provide safe and effective care of the highest quality and value (The Joint Commission, 2021). With respect to opioid pain management, the Joint Commission sets and oversees pain assessment and management standards.
Global Objective: the purpose of a global objective is to provide a vision for your overall project-what are you developing and implementing-what is your expected impact on patient outcome?  It should be broadly stated-in one sentence. (Do Not Use Any Abbreviations)
The global objective of this project is to enhance the attainment of manageable pain levels among all patients while in PACU regardless of their opioid use or abuse.
Project Objectives: Now your global objective should be broken down into more focused steps. Be sure your Project Objectives support your Global Objective! How will you achieve your global objective? Be specific. Write 4 Project Objectives…objectives should start with an action verb! (Do Not Use Any Abbreviations) For example; Research on…Develop a tool/guide/protocol/policy/process to…Develop and present education to staff on new tool…Implement new tool on ___number (the number should be adequate to meet your minimum of 1-2 log hours in direct patient contact)  of patients to improve (how will your project impact patient outcomes)…
The specific objectives of the project are to; Ø Research the medications or therapies that are most effective in pain control for patients with opioid addictions both pre-operatively and post-operatively. Ø Develop protocols for order sets to accommodate different types of surgeries such as abdominal vs joint surgery, for both pre-operative and post-operative pain. Ø Research the most effective protocols for the type of pain most associated with the specific surgery. Ø Implement a PAT call with the presence of anesthesia to address any issues that may arise for this patient population due to present or past use and abuse and create a plan with the patient.
Possible Steps to Assist Me in Completing My Project: List at least 4 steps in your project (Do Not Use Any Abbreviations)	Week I hope to accomplish by: Provide hopeful completion date
To accomplish the project, the following steps will be followed. Ø I will find four patients fitting the criteria of dealing with the problem of opioid addiction Ø I will prepare a questionnaire and educational information that I will go over with the patient during PAT, assess current addiction programs and medications, and whether or not the patients are using opioids for recreational purposes. Ø I will then complete the PAT, record the results and expected outcomes with the patients Ø Finally, I will assess the outcomes in PACU following the use of the therapies discussed with the patient during PAT	1. Completed by 4/1/21 2. Completed by 4/5/21  3. Completed by 4/28/21 4. Completed by 5/10/21
Direct patient engagement: Describe in a one or two sentences how you will provide direct patient engagement (contact) in your clinical practice project and describe how this will impact patient outcomes. (keep in mind you are not required to actually measure your outcomes, but you will need to describe your potential/projected improved patient outcomes) Be specific.
I will utilize a straightforward approach with the patients during PAT to address issues arising with pain control in PACU due to opioid use abuse subtext therapies. I will educate the patients on medication and their effectiveness and alternative therapies such as music, ice massage, and breathing among others (Losby et al., 2017). It is hoped that patient education will go a long way in helping the patients to get prepared for other therapies and not only pain medications
What are the scope, duration and history of the problem? Write 3-4 paragraphs related to your selected problem. Provide supportive detail. Give supportive data from facility, community, state, or national data to explain why you feel this is an issue. Your paragraphs should be professionally written, single spaced with APA formatted citations and references.
Opioid abuse has been a common practice since the 1990s. however, the notable history of opioid abuse dates to the podcast episode, “introduction to the Opioid Epidemic” that explains an opioid wave that happened in 1991 where there were many deaths that involved the overuse of opioids. The deaths were as a result of a sharp increase in the prescription of opioids and the opioid-combination medications for treating pain (Garland et al.,2013). According to the Center for Disease Control and Prevention [CDC] (2018), this period formed the start of the usage of natural and semi-synthetic opioids. The second wave of opioid overdose started in 2010 where an overuse of heroin resulted in a rapid increase in opioid-related death (Mason et al., 2021). There was later a third wave in 2013 with notable deaths from illicitly manufactured fentanyl, heroin and counterfeit pills. In rural Appalachian region, misuse of drugs has resulted in a significant number of patient admissions
Who does your problem affect? Write 1-2 paragraphs discussing individuals, communities, etc. that are affected by this problem. Remember to include all parties that are affected. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references).
The National Institute of Health contends that the age group that has the greatest past-year nonmedical use of opioids are young adults between the age of 18 to 25. However, the greatest exposure is among people that are aged 26 and above. The National Institute on Drug Abuse contends that 21 to 29% of patients that are prescribed with opioids for chronic pain end up abusing them with close to 12% developing an opioid disorder (National Institute on Drug Abuse, n.d).
Your selected organization: (remember this is not the facility/organization where you are implementing your project, may be a nursing organization, or any organization which sets standards, conducts research, or publishes evidence based literature in relation to your topic)   How does this organization support your topic? Some things to consider when researching…Have they advocated? Do they support financially? Are they involved in research to support your topic? Do they use it as part of accreditation requirements?  Write 1-2 paragraphs. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references.)
The National Institute on Drug Abuse plays an important role in the fight against misuse of drugs. The organization carries out research, advocacy efforts and community sensitization programs to help reduce instances of misuse of any form of drugs including opioids. The CDC is another organization whose role is to monitor trends, increase public awareness and offering financial support towards patient safety (CDC, 2018). The National Institute on Drug Abuse ensures that healthcare support is provided to the communities through data driven research and proper community healthcare interventions. It also advances science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health.
What are the implications of the problem? What will happen or not happen if the problem is not resolved? Write 1-2 paragraphs discussing the implications with supporting details (information from your selected organization and/or health care facility would be important here). Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references).
Opioid abuse has notable healthcare implications to the victim. Like in any drug abuse, misuse of opioids results in ill health, sickness and then possible death. Some of the common side effects of opioid misuse include dizziness, sedation, feeling nauseated, constipation and at times, respiratory depression. CDC estimates that in 2018, age-adjusted rate of overdose death was 20.7 in 100,000 for users of synthetic opioids (CDC, 2018).
Plan of Action: Plan of Action: In the space below outline your plan of Action. Remember your plan of action should assist you in meeting your global and project objectives; therefore, they must be linked. Your plan of action can include your action steps from week one or they may have changed. In either case, list your action steps (that you have already completed and planned steps) and provide a one paragraph (per action step) explanation supporting this action. You should have a minimum of four action steps (no more than five), this means you should have a minimum of four paragraphs and no more than five.  Your actions steps should have supportive details (references). Your paragraphs should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references).
There are notable solutions that can be used to reduce misuse of opioids and hence improve the quality of life. The first action step is to increase public awareness regarding prescription of opioid misuse and the need for patents to make safe choices regarding opioids.          The second action is to support providers and healthcare systems with necessary data, guidance and tools used in evidence-based practice towards prescription of opioids and improving patient safety (Losby et al., 2017).         The third action/ proposed solution is to partner with community organizations and public safety officials so as to address the increasing problem of opioid misuse. The community engagement will ensure that there is proper education and sensitization programs that advance proper response mechanisms towards misuse of drugs.         The last action is advancing relevant research through funding and direct collaboration with research facilities. Research efforts will ensure the establishment of remedial measures in response to notable cases of opioid misuse. Opioid management can also be enhanced through a team-based approach towards improving opioid management in primary care.
Proposed Solution: Write 2-3 sentences describing your proposed solution to your problem. Remember that your solution should be linked to your global and project objectives. Your proposed solutions should have supportive details (references), professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references).
The first solution is to educate the patients about the negative effects of overuse of opioids. Having sensitizations program will play an important role in enhancing the use of opioids.
What are the gaps in the existing data? Write 1-2 paragraphs related to your selected problem. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). You may need to look back at your Evidence-based Nursing Textbook for some help.
There are notable gaps in the existing data about opioid abuse. Firstly, the effect of socioeconomic variables and the patterns of opioid abuse have not be fully exploited. To ensure that proper remedies are put in place, it is important to underscore the relationship between opioid misuse and other demographic information such as age, gender and economic status. Secondly, the most common route through which opioids are abused have also not been explored fully. For instance, how prevalent is the use of oral route, as opposed to chasing and intravenous routes in the use of opioids? An understanding of the routes to be used will also help to establish measures on how the trend of opioid overuse can be revered (Strand, Eukel & Burck, 2019).         The second gap in the existing data is the average of those abusing opioids. The mean age of subjects and the period/ extend by which such drugs are abused has also not been exploited. A comprehensive prevention program needs to be designed with a specific target population in mind. This will however be made possible by having significant data on the relationship between demographic factors and opioid overuse.
What types of additional research might be useful? Write 1-2 paragraphs discussing additional research that describes individuals, communities, other issues etc. that are affected by your topic. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references). Be sure the research relates to your problem.
There is need to have more extensive research that captures the individual, community and other issues surrounding opioid overuse. For instance, it is important to explore the motivating factors behind opioid misuse, the age most affected and the role that socioeconomic factors play in increasing the risks of opioid overuse. Furthermore, there is need to underscore the role that psychiatric disorders and environmental factors play in understanding the risks of opioid misuse. The other risk factors that need to be considered for opioid abuse include race, age, gender and income level.
Identify Stakeholders: Write 1-2 paragraphs identifying the key stakeholders to your problem with supporting examples. Individuals or groups that are directly or indirectly influenced by the problem or solution are the stakeholders. In some cases the stakeholders are obvious; however in some cases stakeholders can be developed. Your paragraph(s) should be professionally written, single spaced with APA formatted citations and references (there is a reference textbox at the end of this form. Use it for your references).
Many players/stakeholders can play an important role in critically assessing the fight against opioid misuse. Like in any drug abuse, the first key stakeholders are patients themselves or the victims of opioid misuse. For any remedial measures to be successful, the victims must be willing and available to reverse change from the misuse of opioids. The second category of opioids are family members that have a role to play in providing emotional, mental and financial support for patients diagnosed with the overuse of opioids. Physicians and clinicians are key healthcare providers that can help in instituting education measures and advocating for proper healthcare interventions. Other than victims, patients and healthcare providers, researchers and policy makers can also help to advocate for better healthcare management efforts for patients addicted to opioid overuse (Volkow et al.,2019).
List needed resources: A successful change agent will identify all available resources. Resources include money, time, connections, and those resources which help you to meet your objectives. You may list your resources, but explain why the resource is needed and how these resources will help support your change.
There are notable resources required to manage opioid abuse. The resources are listed below. Networks/connections – Responding to opioid misuse require a multidisciplinary approach. As explained before, healthcare providers need to work with victims, parents and community health as well as social health volunteers to hep advocate for good practices in the use of opioids. Time – Solving opioid misuse requires an investment in time. Like any rehabilitation program for drug abuse, opioid misuse will require significant time investment including psychological sessions and other therapy sessions. Money – It may be prudent to hire trained and specialized therapists for while advocating for proper use of opioids.
Project Update: Write 2-3 paragraphs discussing your project progress. Include in your discussion how your QSEN competency and KSAs are supporting your project and if your global and project objectives are close to being met. You do not need citations or references; however this should be professionally written.
So far, I have made significant progress in the project especially with the help of my mentor. Firstly, the project scope is now clear as I understand what is expected of me at the end of the modules and eventually the project itself. The objectives and the framework through which the objectives can be achieves is also clear and within my scope of work. With the QSEN Competency which is quality improvement in mind, I am on the right track towards achieving the set project objectives.          The second aspect about my project progress is the critical evaluation of literature from which the research gaps and research questions have been defined. So far, the project is within the set timelines since all the materials required for the project implementation are available.
Work with Mentor this week: In 2-3 paragraphs discuss activities with your Mentor (Preceptor) for this project so far. Include positive and negative thoughts, what was helpful and what information or activity would have been helpful. No citations or references are needed; it should still be professionally written.
There are remarkable steps that we have achieved with my mentor so far. Firstly, it has been possible to clearly define the scope of the work and assess the way forward for every step. It has been possible to explore the different aspects of opioid management and establish the way forward towards its management.         Another key role the nursing preceptor played is the positive influence and development of a positive attitude as a result of the encouragement and commitment demonstrated by the nurse preceptor. The collaboration has been key in defining the way forward in the project.

Practice Log update: Begin typing documentation on your Clinical Log, provide here a brief explanation of time you have completed this week – you will need to document on your clinical log in addition to the templates, this update does NOT take the place of completing your required log. This is a non-graded item.   — Do not include: Orientation off the Unit, Observation, writing or researching papers/assignments, Lunch or Break time.   — Do include: A total over the course includes a Minimum of 3 hours with preceptor, Maximum of 6 hours on research of topic, a minimum of 1-2 hours in direct patient contact and the remainder– 10-11 hours in implementation of your project, Total of 21 true hours.
Type	Date	Time (ex: 1:00pm-2:00pm)	Total Time Spent (ex: 1 hour)	Description (describe specifically what you did in one or two sentences)
Preceptor (a minimum of 3 hours is required for the course)	4/1/21	11.00am3.00p m	4 hours	Discussed the research significance and requirements with the preceptor
Research on topic (a maximum of 6 hours is allowed for the course)	4/2/21	8.00am10.00a m	2 hours	Conducted literature review on pain management in patients with opioid addiction
Patient Engagement Time (a minimum of 1-2 hours, Specify number of patients)	4/3/21	8.00am10.00a m	4 hours	Educate patients in the units about pain management
Implementation (the remainder should be spent in implementation, 10-11 hours)	5/4/21	8.00am6.00pm	10 hours	Rollout pain management protocols for patients addicted to opioids
Total Time spent this week (by the end of the course you should spend at least 21 true hours)	Total for this week = 18 weeks   Continue to work on your log and submit your completed log in the week 5 submission area

References (double-space and use correct 7th ed. APA format) This should include references from Weeks 1 and 2

CDC, (2021, March 17). Understanding the epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html Cates, H. M., Benca‐Bachman, C. E., de Guglielmo, G., Schoenrock, S. A., Shu, C., & Kallupi, M. (2019). National Institute on Drug Abuse genomics consortium white paper: Coordinating efforts between human and animal addiction studies. Genes, Brain and Behavior, 18(6), e12577. Losby, J. L., Hyatt, J. D., Kanter, M. H., Baldwin, G., & Matsuoka, D. (2017). Safer and more appropriate opioid prescribing: A large healthcare system’s comprehensive approach. Journal of Evaluation in Clinical Practice, 23(6), 1173-1179 National Institute of Drug Abuse, (n.d). National Institute of Health. https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-drug-abuse-nida Strand, M. A., Eukel, H., & Burck, S. (2019). Moving opioid misuse prevention upstream: a pilot study of community pharmacists screening for opioid misuse risk. Research in Social and Administrative Pharmacy, 15(8), 1032-1036. https://doi.org/10.1016/j.sapharm.2018.07.011 The Joint Commission. (2021). About the Joint Commission. https://www.jointcommission.org/about-us/ Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: a review. JAMA psychiatry, 76(2), 208-216. doi:10.1001/jamapsychiatry.2018.3126 QSEN Institute. (2020). Graduate QSEN Competencies. https://qsen.org/competencies/graduate-ksas/ Vadivelu, N., Kai, A. M., Kodumudi, V., Sramcik, J., & Kaye, A. D. (2018). The opioid crisis: A comprehensive overview. Current Pain and Headache Reports, 22(3), 1-6. https://link.springer.com/article/10.1007/s11916- 018-0670-z