benchmark - evidence-based practice proposal final paper
TRANSCRIPT
Running head: PROPOSAL 1
Benchmark - Evidence-Based Practice Proposal Final Paper
Student’s Name:
Institutional Affiliation:
PROPOSAL 2
Abstract
The time spent in Emergency Departments (EDs) is the most significant in a patient’s
hospital stay period. This is because this is where lifesaving emergency services are offered. This
section is the most challenging for care providers because a slight delay can result in undesirable
consequences on the patients’ health. However, in recent decades, Overcrowding in emergency
departments (EDs) resulting in delays has been a trend in many care organizations. It has now
become a global problem and has been identified as a national crisis in many states. Previous
studies have shown that the major cause of the overcrowding is the inefficiency of the nurses to
accurately carry out diagnosis on the patient within the shortest time possible after admission. With
reference to existing literature in this topic, the goal of this study is to qualify the hypothesis that
nurses who have taken a triage assessment class achieve more accurate and timely diagnosis for
patients with cardiac related chest pain within 10 minutes of patient arrival to Emergency
department compare to the nurses who have not acquired the training. The current study delivered
online triage training to nurses globally using facebook and twitter live videos, for 2 hours daily
for a period of 4 weeks. The study then applied both qualitative and quantitative methods of data
collection. The evaluation showed that nurse triage training resulted in reduced delay and
overcrowding in the emergency department.
PROPOSAL 3
Section A
Evidence Based Practice Proposal
It is important to understand an organization’s culture in order to start assessing its
readiness for EBP implementation. Organization Culture and Readiness for System-Wide
Integration of Evidence-Based Practice is a tool that can be used to assess the organizations level
of readiness. From the survey, one of the categories that scored high is the availability of the
necessary technological equipment. For the EBP to be implemented effectively various
technological equipment such as EHRs will be required which were readily available within the
organization. Another category that scored high is the availability of resources and facilities that
could enhance the efficient implementation of EBP. The organization has libraries which can be
of great significance because the team responsible can be in a better position of researching and
acquiring more knowledge about the EBP. The other resource is the easy accessibility of the
organization's research department. On the other hand, the category that scored low is
employee’s attitude and level of knowledge in regard to the EBP project and organizations
culture. The employees lacked enough knowledge on the importance of the EBP project and how
it would help increase efficiency and quality of services offered to be in line with the
organization's culture.
Project Barriers
One of the project barriers is insufficient funds cater for all the expenses incurred during
the project. Another project barrier is lack of sufficient time to carry out more research regarding
the EBP. The time constraint is facilitated by the heavy workload involved and staff shortage.
PROPOSAL 4
Facilitators
One of the facilitators of the project is appropriate management support. With the help
and support the approval of the necessary project procedures and the financial budget necessary
for the implementation of the project will be easy to achieve. The management also helps the
team in the decision-making process which facilitates the effective implementation of the
project. Another project facilitator is information availability, enabled by easy access to the
internet and also the use of the organization's library materials (Kaplan, Zeller, Damitio, Culbert,
& Bayley, 2014).
Integrating Clinical Inquiry
Clinical inquiry can be integrated into the organization through assessment, skill
building, staff engagement, building infrastructure and generating questions. Some of the weaker
areas of the organization such as lack of enough knowledge by the employees regarding the
importance of using EBP can be strengthened through the introduction of training programs and
seminars .these strategies will increase the employee’s level of knowledge and skills regarding
the use of EBP. This, in turn, can also help change their attitude towards the EBP (Fain, 2017).
Section B
Problem Description
PICOT Research Question
(P) In an Emergency Department, in regards to triage process, are nurses (I) whom have
taken a triage assessment class (C) compared to nurses whom have not participated in a triage
PROPOSAL 5
assessment class (O) more accurately diagnosing patients with cardiac related chest pain (T)
within 10 minutes of patient arrival to Emergency department?
Background
The emergency department of most healthcare organization experience overcrowding due
to the inefficiency of the nurses to accurately carry out diagnosis on the patient within the
shortest time possible. The overcrowding phenomenon in the emergency department has raised
concern in the public health field for the past ten years with several research works carried to
determine the best solution (DiSomma et al., 2015). Research studies have revealed that triage
assessment practice which calls for effective utilization of the available resources to make an
accurate decision is the most preferred solution to the overcrowding issue. However, the nursing
department in most health organizations still expresses variations in the use of the Emergency
Severity Index (ESI) triage algorithm causing the delays in the emergency departments. Majority
of the nurses tend to commit the mistriage on the patients. Nurses who have experience in
Emergency Severity Index (ESI) triage algorithm do not usually commit mistriage and finish the
patient assessment and diagnosis within average 10 minutes thus the need for ESI education in
the nursing profession.
Purpose
The pre-eminent goal of this project is to evaluate the impacts of implementing a triage
assessment process in nurses serving in the Emergency Department on time taken to handle the
patients, focusing on patients complaining of chest pain and receiving treatment within ten
minutes of arrival regardless of nature of chest pain, cardiac related or non- cardiac related.
PROPOSAL 6
Stakeholders
The stakeholders in this research include the nursing departments in all health
organizations handling emergency issues, nursing students through their organizations such as
National Student Nurses’ Association, the nursing organizations such as International Council of
Nurses, the nursing accreditation bodies and nursing training institutions.
Rationale
Most of the nurses in the emergency department misapply the existing Emergency
Service Index triage criteria causing mistriage in the patients, especially patients complaining of
chest pain. The challenge is prominent as most adults express under triage during the ESI
algorithm application. The emergency department being the leading victim of mistriage, it is
essential the nursing professionals refresh themselves on the concept of proper triage ESI
assignment to patients to eradicate the incidences of mistriage. Accurately apply the concept of
ESI triage will help to reduce overcrowding in the emergency department and providing timely
treatment for patients complaining of true (cardiac related) chest pain. There is the need to
improve the existing process of educating practicing nurses in the emergency department on the
ESI triage practice. The new training strategy should involve the establishment of simulation
environment which requires knowledge-sharing and practical high-risk skill utilization to help in
improving the competence on the nursing professionals serving in the emergency departments
(Evans & Kohl, 2014).
The DNP quality improvement educational program that involves the use of social media
platforms such as YouTube and Facebook to help the nursing professionals working in the
emergency departments across the world to share their knowledge and experiences in the
PROPOSAL 7
application of ESI triage practice would be a great program to share and include in reinforcing
the importance of proper triage. The platforms provide room for interaction allowing the
members to have enriching conversations among themselves and understand their areas of
weaknesses and strengths in handling patients with emergency needs. All these efforts aim at
reducing the amount of time taken in the assessment and diagnosis of the patients at the
emergency department thus eliminating the phenomenon of overcrowding in such places
(Fitzgeral, Radmanesh, & Hawkins, 2015). ESI triage practice is an essential aspect of the
emergency management process in a health organization.
Section C
Literature Support
Critical Appraisal of Evidence
The results of the study comprising the article are valid because they address the problem
of overcrowding in the emergency department. The study participants in the intervention and the
comparison groups are similar despite the difference in hostels. The intervention is identified into
the suggestion of ensuring more efficiency in the ED. The participants in the comparison groups
received a reasonable treatment/care based on the treatment of the exposure of interest of the
intervention group. There was no follow-up between groups. There is an appreciable use of
statistical information to enrich the authors of the article present. The use of percentages and
numbers are appropriate. The outcomes were measured with the same instrument regardless of
the circumstances of the operations of the emergency department at each hospital.
The result of the study indicates that the solution to the challenge of ED overcrowding is
determining the full capacity protocol (FCP). For instance, the hospital should pronounce that if
all the beds in the emergency department are filled, then the ED is full, and they should not admit
PROPOSAL 8
others. The results of the study are transformative to the healthcare sector. However, their
precision cannot be determined because of the purpose manner in which they were presented.
The study population of the article is similar to one of the writers of the assignment. The study
results can be used to make a difference in the healthcare sector because they provide a
suggestion that is valid for dealing with the problem of overcrowding. The author utilized
information from the United States Department of Health. The study has internal validity
because it handles the issue of overcrowding in emergency departments. The researcher’s main
inclusion criterion was working as a nurse at the emergency department in the selected hospital.
The results of the study are valid because they address the subject problem of
overcrowding in emergency departments of hospitals. It proposes further education of the nurses
to help them determine the triage parameters appropriately to avoid subjective responses when
asked for the patients to attend to first. The study participants in intervention and comparison
groups are similar. The intervention is identified as the subjection of the emergency department
nurses to further education to train them to use the Emergency Severity Index (ESI) more
appropriately. The study also lacks follow-up and control groups that can be used for comparison
of the basis of the results if the research. There is minimal use of statistical information. The
statistics used are not determinate of the conclusion made because the numbers appear abstract
and whose inclusion of forced.
The measurement of the outcome of the study was obtained post intervention. The
outcomes are measured across the same groups, and hence, they are measured with the same
instrument. The results of the study state that the nurses in a majority of the ED in hospitals do
comprehend the use of ESI and hence, the basis of their allowance of the attendance of the
patient is subjective and not based on the severity of the case because they do not have sufficient
PROPOSAL 9
analytical skills. The results change the perspective of patients towards the nurse. The qualitative
results lack quantifiable precision. The results will help in caring for patients but they will not
make an instant impact in healthcare because they require nurse training. The study’s main
inclusion criterion was working as a nurse at a hospital. No databases were used for the study.
The study is invalid and irrelevant to the PICOT. It deals with the impact of social media
on the healthcare sector while the PICOT addresses issues of the emergency department, triage,
and diagnosis of cardiac issues. The intervention mentioned in the article is the use of social
media platforms to enhance connectivity between patients and their healthcare providers. The
control group of the study is the people without fast internet connection and smart technology.
There is a significant comparison between the preceding generations and the current dispensation
that entails connectivity through the internet. There is an appropriate use of statistic. It is
evidenced in the first statement of the study when the author avails statistics relevant to their
objective. The outcomes measured with valid and reliable instruments that bare the internet-
connected devices available in healthcare. The results of the study indicate that medical
education can be transferred through the technological capacities that the internet has availed.
The authors observe that there is a shift in preferences of the students to use online
content as compared to the former generations of healthcare students that had to attend classes.
The results lack quantifiable precision. The study is not similar to that of the author of the
evidence-based approach. The findings of the research can be used to make a difference in the
general healthcare, but its perspective is skewed towards a different topic in comparison to the
issue of the emergency department and triage. The author does not refer to specific databases for
information but uses other studies whose sources are not identified clearly. The study has
internal validity because its findings are independently relevant to the issue of the impact of
PROPOSAL 10
technology in healthcare. However, it lacks external validity because it addresses a topic that is
not part of the current discussion.
Section D
Solution Description
Proposed Solution
The proposed solution to the problem is increased triage training of nurses attending to
patients to ensure there is uniformity in the Emergency Severity Index (ESI) triage algorithm
amongst the nurses. The solution is based on the need for nurses to demonstrate efficiency in
conducting assessments of patients that report to emergency rooms complaining of chest pains.
Due to the possible severity of their conditions, the ability of nurses to undergo triage training to
improve their experience in the ESI triage algorithm and be able to provide assessments to
patients within ten minutes. The treatment is not unrealistic as most of the nursing personnel
have the necessary training and can improve their ESI triage algorithm competencies to ensure
they can conduct assessments on patients with chest pains within short time spans of less than ten
minutes.
Organization Culture
The proposed solution aligns with the culture of the organization where it aims at
demonstrating high levels of efficiency in the provision of healthcare services to patients. The
ability to improve the efficiency of patient assessments amongst nurses aligns with the cultural
beliefs and shared forms of thinking at the facility of providing patient-centered care. The
solution also aligns with the norms at the healthcare facility where the action is guided by
PROPOSAL 11
evidence to ensure the expectations on areas like patient safety, autonomy, and dignity are
upheld.
Expected Outcomes
One of the expected outcomes is that the nurses that have undergone triage assessment
training are able to effectively diagnose patients with chest pains in less than ten minutes after
the patients report to the emergency rooms. The triage assessment training facilitates the nurses
to identify the nature of the chest pain and the likely condition that the patient is suffering from.
The nurses will conduct such assessments in less than ten minutes for every patient thereby
eliminating the long queues that lead to overcrowding of patients in emergency rooms.
Method to Achieve Outcomes
The hospital will provide the health professionals that will offer training to the nurses that
are still unfamiliar with the triage assessments. The training will be offered in areas such as rapid
assessment, patient categorization and finally allocation of the patients based on the causes of the
chest pains and likely diagnosis (Milbrett & Halm, 2014). The proficiency of the trained nurses
will be evaluated through ESI triage algorithm tests to determine whether the trained nurses have
acquired the required competencies in conducting assessments on patients with chest pains.
To attain the outcomes, only nurses that have undergone triage assessment training will
be deployed in the emergency rooms. Also, such nursing professionals must operate in well-
equipped emergency rooms to ensure they can easily access the needed equipment to facilitate
faster diagnosis. Further, the patients designated to emergency rooms, especially those
complaining of chest pains, must be easily identified and directed to avoid delays.
One of the barriers is language differences between the nurses in the emergency rooms
and some of the patients. The language barrier will be eliminated by ensuring there are
PROPOSAL 12
interpreters that are well-acquainted with the local languages to facilitate ease of communication
between the nurses and the patients. An assumption is that the hospital will provide the necessary
support and continuity to ensure the gained skills by the nurses in triage assessments are
nurtured.
Outcome Impact
The outcomes will lead to quality care improvement that culminates to positive health
outcomes. The increases in the number of nurses with triage training in conducting assessments
on patients with chest pains will lead to timely diagnoses and eliminate the likelihood of
mortality due to delays in diagnosing chest complications. It will also reduce readmission rates
due to the correct diagnosis of chest problems thereby reducing the costs incurred by patients in
the treatment of chest pains (Chung, 2015).
Section E
Change Model
Rogers uses communication in his diffusion innovation theory to elaborate on the way
ideas pick momentum and cover a social system with individuals within the setup embracing the
new analogy and, in the process, enhancing the way they do things (Shiels, 2018). The theory
focuses on communication as the primary tool used in adopting a new idea and applies
throughout the process of implementing the concept right from inception to realization of the
desired results (Dibra, 2015). The document describes the implementation of a triage assessment
process to nurses working in the Emergency Department on the period taken to diagnose
individuals. It emphasizes on patients presenting with chest pains who are supposed to receive
treatment within 10 minutes of arrival irrespective of the nature of chest pain be it cardiac related
or non-cardiac related. The implementation process borrows a lot from the diffusion innovation
PROPOSAL 13
theory since its suggestion in informing and training nurses on the Emergency Severity Index
(ESI) triage algorithm and using it at the basis for continuous assessment of the process. The
phases involved in the implementation process include, persuasion, implementation, decision,
knowledge, and confirmation.
Knowledge Stage
It is essential to create awareness when a new project or idea is proposed. It ensures that
all the stakeholders are involved and acts as a motivating factor for the parties involved to
welcome the concept (Dibra, 2015). The efficient diagnosis of patients in the emergency
department is a collective responsibility. Therefore, it is necessary to enlighten the individuals in
the hospital environment of its essence and its contribution to improving care provision within
the organization. At this stage, the stakeholder, particularly the nurses, need to have the
theoretical knowledge of the proposed change, resins for its adoption, and the method of
implementation.
Persuasion Stage
A new idea is not always welcomed with everybody in the organization. Therefore, the
proposed solution of training nurses on ESI is not an exception. It is highly possible that there
will be few individuals or groups that will not embrace the project. The second stage is crucial in
clarifying the information given in the previous step. Individuals are provided with the
knowledge and are given time to submit their reactions regarding the suggested solution. The
people who are opposed to the idea are then presented with more information and taken through
step by step process of implementation and the benefits of the project to convince them to buy
the idea. It enables the smooth implementation of the concept.
PROPOSAL 14
Decision Stage
After the parties involved are well informed of the proposed solution, the organization
has to decide on whether to implement the project or not. The decision is based on the reaction
and responses collected during the first two stages. Since nurses are the primary players in the
proposed solution, they might level some concerns over the project that need to be addressed
before the organization decides to implement the idea. In most cases, if the project is well
designed and the stakeholders are sufficiently informed, then it is readily accepted. In such a
case, the organization proceeds to the implementation stage while incorporating the suggestions
of the players involved.
Implementation Stage
The implementation stage involves rolling out the suggested solution, as outlined in the
proposal. The implementation begins with the outsourcing of professionals in the triage
assessment field that will train nurses in the organization. The training will concentrate on
patient categorization, rapid assessment, and allocation of patients based on the cause of the
chest pain (Stephenson, Phelps & Colburn, 2018). After rolling out the program, the organization
will monitor the implementation process using the tools provided in the proposal.
Confirmation Stage
It is the last stage of the implementation process according to the diffusion of innovation
theory. Once the proposal is implemented, it is imperative to test it and confirm that it is moving
PROPOSAL 15
in the right direction. The first tool to employ in the evaluation is the ESI triage algorithm tests to
check the proficiency of the trained nurses. The confirmation stage also involves tracking of the
improvement in the time that nurses take to diagnose a patient in the emergency department if it
is falling within the limit.
Section F
Evaluation of the Process
Setting and Access to Potential Subjects
The education program on improving triage assessment process will take place
online. Facebook is where the nurses across the world will share knowledge and experience on
the application of emergency service index triage practice. This setting is better compared to the
traditional classroom setting. Online education has been preferred because of flexibility and
convenience. Many learners will be reached all over the world, unlike traditional means where
only a few nurses would be reached (McCutcheon, Lohan, Traynor & Martin, 2015). Besides,
learning by sharing experiences will be more educative.
With the increase in the use of technology, many nurses can access online services hence
PROPOSAL 16
will be easily reachable there. The stakeholders such as National Students Nurses Association,
International Council of Nurses and Nursing Accreditation Bodies will help in creating
awareness of the education program to the nurses (Goodman, Melkers & Pallais, 2019). Many
nurses follow twitter feeds and Facebook pages of these nursing organizations hence will reach
the nurses very fast. Social media is currently a fast and reliable means of sending information.
A Facebook page will be created and the nurses will be required to give consent to participate by
only following the Facebook page where education will take place.
Timeline
The preparation in regard to resource mobilization will take one month and the
education program will take another 4 weeks, Monday to Friday, for 2 hours every day between
6 pm and 8 pm. Creation of awareness of the program will take one month. The flexible
schedule will ensure make as many nurses as possible to participate in the program.
The first 1 month will be used to creation of awareness of gathering and mobilizing of the
required resources. The next three weeks will be used to deliver theoretical knowledge to
establish a background for practical training.th next three weeks will be used to assess the level
PROPOSAL 17
of knowledge acquisition through questions and answers. The last 4 weeks will be utilized to
gather study participants feedback in terms of comments, more questions, and suggestions
Resources
The most crucial resource is the financial resource. One of the learning resource need for
this program is nurse educators. These are human resources. They will be online full time to
answer any question or comment on the experiences of the nurses as they share. For the two
hours in a day, they will be available to offer education. Other resources needed include narrated
learning modules, medical videos, and nurse simulations, IT software, IT specialists,
organizational social media sites and managers and computers.
Methods and Instruments
Several methods and instruments will be utilized in the program. One of the
instruments to be used is a nursing self-assessment form and nursing games for assessment.
Competency inventory of nursing students (CINSs) will measure the competency of the nursing
students. This instrument covers ethics, general clinical skills, accountability, biomedical
PROPOSAL 18
science, critical thinking, caring, communication and teamwork (Reljić, Lorber, Vrbnjak,
Sharvin, & Strauss, 2017). All these qualities are needed in the emergency department.
Process for Delivering the Intervention
Training will be conducted for 2 hours daily and for the rest of the day, nurses
will be allowed to share their experiences. The nurses, who miss a certain session, will be in a
position to follow up on the lesson and what the nurses have shared. The educators will be
streaming live on Facebook and after the lesson; a video of the lesson will be uploaded on the
page for the sake of those who were not available at the particular time of the lesson.
Data Collection Plan
Since it will be difficult to meet the participants face to face, questionnaires will the
provided on the Facebook page and those interested will be able to fill privately and submit
privately to the educators.
Ways of Dealing with Barriers
PROPOSAL 19
One of the barriers to successfully deliver online education is the lack of a
student's motivation. It is the responsibility of the educator or instructor to create an online
environment where the students are eager to learn. Students can be encouraged to use
applications such as Skype and chat forums to know their classmates and that will increase
motivation. Continuous assessment tests will also motivate the nurse. The educators should also
chunk their content to make it easy for the brain to digest.
Budget Plan
Activity /resource Cost ($)
Educators 30,000
Data/ wifi 2,000
PROPOSAL 20
Computers 10,000
Others 20,000
Evaluation after Implementation
The Facebook page will not be deleted after the implementation. However, after
the whole process is over, the nurses will be allowed to quit the page at their own pleasure.
However those interested can stay and keep sharing.
Section G
Evaluation of Process
Rationale for the Methods used in Collecting the Outcome Data
In order to evaluate if the Triage assessment process among nurses serving in the
emergency department is effective in reducing the amount of time taken to prescribe treatment for
patients with chest pain, a combination of both qualitative and quantitative methods was used.
Qualitative methods will employ statistical analysis by use of simple observable sampling and
comparison between cases techniques, while quantitative techniques will measure the actual
PROPOSAL 21
quantifiable entities and instances in which the Triage assessment tool shall have helped reduce
the time taken by nurses to offer treatment to patients with chest pain (Wisdom, Cavaleri,
Onwuegbuzie, & Green, 2012). The guidelines will take into consideration the instructions issued
by CDC on chest pain related complications as well as the guidelines implemented by nurses and
other healthcare givers of experience. The data collected will be subjected to ANOVA for analysis
to determine whether there is a correlation between Triage assessment and the time that nurses
take to treat patients with chest pain (Almeida & Queirós, 2017). External factors that might affect
the results such as the sterility of the room as well as the number of patients will be assessed by
qualitative analysis, although only to a limited extent.
How Measures Evaluate Objectives
This study will apply questionnaires, scaled checklists as well as observations in
establishing a relation to its objectives. Questionnaires have the potential to provide the capability
to obtain a massive size of information from large samples of participants through a short span of
time, and by use of limited resources. Besides, results acquired from questionnaires can be easily
quantified by use of analytical software tools and hence ease of data comparison. However, the
use if scaled checklists contribute largely towards decision making in the dimensions of the best
PROPOSAL 22
approaches to solving existing research problems. For this reason, it is easier to incorporate scaled
checklists into the daily routines of hospitals during research. The two methods collect data that is
focused towards eliminating the errors that are associated with research. Besides, the two methods
allow data to be effectively compared with the previously existing situations in these hospitals. In
the event that the time taken by nurses to offer treatment to patients with chest-related pains is
reduced, then the outcome measured shall have aligned with the objectives of the study. Adoption
of the two methods will ensure that feedback of the program is acquired at all times.
Measurement of Outcomes
This research study will combine both quantitative and qualitative research methods. The
measurement if to these parameters will be conducted using questionnaires for qualitative
measurements and scaled checklists to measure quantitative methods. Validity refers to the
measure of preciseness of the results obtained from a given scientific research study. Besides,
validity can be said to be the extent to which the results obtained from a measuring represent the
variables that they are meant to represent. In this study, validity will be measured depending on
whether it covers the constructs of interest in the outlined research objectives. Reliability is defined
as the consistency of the measures obtained in the results (ChristopheSapi, Marie-Claude Simeoni,
PROPOSAL 23
Khammar, Stephanie Antoniot, & Pascal Auquier, 2005). Reliability will be measured by
evaluating the pattern of the results across multiple sets that will obtained. This will occur after a
thorough analysis and verification of the results. If the results remain consistent, they shall be said
to be reliable while an inconsistent pattern of results shall be considered unreliable.
In Case of Negative Results
If the outcome of the study do not provide positive results, it is advisable not to conclude
that nothing new was derived from the entire study that could add onto the existing knowledge.
On the contrary, negative results confirm status quo. It therefore signifies that there is no much
difference in the comparison between the previous knowledge and the outcome of the study
conducted. Therefore, in case of negative results, it is important to analyze the aspects that led to
the failure. This may be in terms methodological issues, in which one would re-start the entire
research process.
Implications for Practice and Future Research
The Triage assessment technique ought to be effectively applied in hospitals among nurses
who serve in the Emergency Department of hospitals to increase their efficiency in handling
PROPOSAL 24
speedy prescriptions to patients who complain of chest pains. This will reduce the overcrowding
phenomenon common in the emergency departments of most hospitals. The triage assessment
practice has the potential to impose an effective utilization of resources so as to enhance an
effective decision making process. However, further research need to shift its focus towards
finding out the preferred measures and environmental conditions within which the triage and
emergency assessment would be carried out for both cardiac related and non-cardiac related chest
complications.
PROPOSAL 25
References
Almeida, F.,Queiros, A,(2017).Strengths and Limitations of Qualitative and Quantitative
Research Methods. Jourl of Medical Research, 14(2), 21-36.
ChristopheSapi, Marie-ClaudeSimeoniM,Khammar,..,StephanieAntoniot,& PascalAuquier
(2005). Reliability and validity of the VSP-A, a health –related quality of life instrument
for ill and healthy adolescents. Journal of Adolescent Health, 36(40), 327-336.
Chung, J. (2015). An exploration of accident and emergency nurse experiences of triage decision
making in Hong Kong. Accident and Emergency Nursing, 13, 206-213.
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Dibra, M., (2015). Rogers’s theory on the diffusion of innovation-the most appropriate
theoretical model in the study of factors influencing the integration of sustainability in
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medicine, 10(2), 171-175.
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education?. Journal of Labor Economics, 37(1), 1-34.
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Kaplan, L., Zeller, E., Damitio, D., Culbert, S., & Bayley, K. B. (2014). Improving the culture of
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Shiels, E. M., (2018). Implementation of emergency preparedness in long term care and Rogers'
diffusion of innovation theory.
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Stephenson, R., Phelps, A., & Colburn, J. (2018). Diffusion of Innovations and Program
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Appendices
Conceptual Model
Dependent Variable
Triage Training
Rapid Assessment
Patient categorization
Allocation of patients based
on likely diagnosis
PROPOSAL 29
Data Collection Tools
1. Observation
2. Questionnaires
3. Scaled checklist
Major independent
variable
Improved experience in
triage algorithm
Other Independent variables
Reduced morbidity and mortality in
emergency ward
Reduced time taken in assessment
and diagnosis in emergency ward
Reduced overcrowding in
emergency ward
Reduced cost of chest pain
treatment
Reduced rate of hospital re-
admission
PROPOSAL 30
Study Questionnaire
1. How has triage training impacted your nursing experience?
2. Would you recommend triage training to your colleagues?
3. How has the rate of emergency room mortality and morbidity of your assigned
patients changed since you enrolled for the training?
4. How has the rate of hospital readmission of your assigned patients changed
since you enrolled for the training?
Scaled checklist
1. Nursing triage training achieves reduced morbidity and mortality in emergency
ward. Yes or No
PROPOSAL 31
2. Nursing triage training achieves reduced time taken in assessment and
diagnosis in emergency ward. Yes or No
3. Nursing triage training achieves reduced overcrowding in emergency ward. Yes
or No
4. Nursing triage training achieves reduced cost of chest pain treatment. Yes or
No
5. Nursing triage training achieves reduced rate of hospital re-admission. Yes or
No
Data Evaluation Tools
1. Qualitative analysis through statistical analysis of simple observable sampling data.
2. Qualitative analysis to actual quantifiable entities and instance that the proposed strategy
has achieved positive outcomes.
Timeframe
PROPOSAL 32
Timeline Activities Involved
First month Creation of awareness
and gathering of the
required resources
Week one of 2nd month The theory part of the
lesson
Week two 2nd month Theory
Week three 2nd month Question and answer
Week 4 2nd month Comments, more
questions, any
suggestions.
Total timeframe 2 months
List of resources
1. financial resource
PROPOSAL 33
2. nurse educators
3. narrated learning modules
4. medical videos
5. nurse simulations
6. IT software
7. IT specialist
8. organizational social media sites
9. Social media managers
10. Computers.
Budget Plan
Activity /resource Cost ($)
Educators 30,000
Data/ wifi 2,000
Computers 10,000
Others 20,000
PROPOSAL 34
Total cost 62,000
Informed consent form
Informed consent form
Informed Consent form for nursing practitioners invited to participate in study to determine
whether nursing triage training reduces overcrowding and delays in the emergency department.
Name of Principal Investigator……………
Name of Organization……………
Name of Sponsor………………..
Name of Proposal and version………..
PART I: Information Sheet
PROPOSAL 35
Introduction
I ……. A student at…….... I am doing research on the impact of nurse triage training on delay
and overcrowding in emergency departments, which is very common health problem in this
country. I am going to give you information and invite you to be part of this research. You do
not have to decide today whether or not you will participate in the research. Before you decide,
you can talk to anyone you feel comfortable with about the research. There may be some words
that you do not understand. Please ask me to stop as we go through the information and I will
take time to explain. If you have questions later, you can ask them of me.
Purpose of the research
Emergency department delays and overcrowding are the leading cause of emergency room
morbidity, mortality, and increased cost of healthcare, increased hospital readmission rate in US
healthcare today. The reason I am doing this research is to find out if the triage nurse training
can eradicate the problem.
Type of Research Intervention
This research will involve a 2 hour real-time online training on triage for 4 weeks
Participant selection
PROPOSAL 36
I am inviting all emergency department nurse practitioners to participate.
Voluntary Participation
Your participation in this research is entirely voluntary. If you choose to participate, You may
change your mind later and stop participating even if you agreed earlier.
Information on the triage training
1. Rapid Assessment
2. Patient categorization
3. Allocation of patients based on likely diagnosis
Duration and Description of the Process
1. First month - Creation of awareness and gathering of the required resources
1. Week one and 2nd.weeks of 2nd month- The theory part of the lesson
2. Week three 2nd month. Question and answer
3. Week 4 of the 2nd month-Comments, more questions, any suggestions.
Reimbursements
You will not be given any other money or gifts to take part in this research.
PROPOSAL 37
Confidentiality
The information that we collect from this research project will be kept confidential. Information
about you that will be collected during the research will be put away and no-one but the
researchers will be able to see it. Any information about you will have a number on it instead of
your name. Only the researchers will know what your number is and we will lock that
information up with a lock and key.
Right to Refuse or Withdraw
You do not have to take part in this research if you do not wish to do so. You may also stop
participating in the research at any time you choose. It is your choice and all of your rights will
still be respected.
Who to Contact
If you have any questions you may ask them now or later, even after the study has started. If
you wish to ask questions later, you may contact any of the following: [name, address/telephone
number/e-mail])
PART II: Certificate of Consent
PROPOSAL 38
I have read the foregoing information, or it has been read to me. I have had the opportunity
to ask questions about it and any questions that I have asked have been answered to my
satisfaction. I consent voluntarily to participate as a participant in this research.
Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to
the best of my ability made sure that the participant understands that the following will
be done:
1.
2.
PROPOSAL 39
3.
I confirm that the participant was given an opportunity to ask questions about the
study, and all the questions asked by the participant have been answered correctly and to
the best of my ability. I confirm that the individual has not been coerced into giving
consent, and the consent has been given freely and voluntarily.
A copy of this ICF has been provided to the participant.
Print Name of Researcher/person taking the consent________________________
Signature of Researcher /person taking the consent__________________________
Date ___________________________
Day/month/year
PROPOSAL 40