The Importance of Capstone Projects
This report will attempt to represent a capstone experience that I have had in the past year and will explore the learning experience with respect to my self assessment and my professional portfolio. First and foremost, a capstone project can be described as the culminating project, a multifaceted assignment that attempts to culminate the entire academic experience. According to the Mazi et al. (2013), a capstone project or a capstone experience incorporates identification of any existing problem prevailing in the real world setting followed by application of learned skills and methods in order to arrive at a strategic solution that can address the problem directly. Elaborating more, it has to be mentioned that a capstone experience helps in defining an existing issue, discover and implement the techniques required to master the issue and implement the solution to the real world problem setting in order to make a positive difference in the society (Rowan et al., 2015). Hence, undoubtedly it can be stated that the capstone experience projects have fundamental importance in the health care setting and the value based nature of these projects hold significant value in the health care setting. As per the article by the Page et al. (2014), the capstone experience provides the nurses with the opportunity to implement their knowledge and expertise on a real world based problem scenario with respect to the clinical practice setting. As a result this experience provides them with the opportunity to expand or enhance their critical thinking and learning skills. It has to be mentioned in this context that the capstone project represents a research based problem solving session. According to the Barajas?Nava et al. (2013), in the profession of nursing, the importance of leadership, self assessment, reflection, and critical analytical abilities are a prerequisite in order to be able to avail steady profession growth, all the while providing care that is safe and effective. Hence, it can be easily deduced that the capstone project provides the nurses with the opportunity to improve or build all the above mentioned abilities before embarking on the professional journey. Along with that, it has to be acknowledged in this context that for the nurse it is crucial to master the art of evidence based practice (Lee et al., 2013). Now evidence base practice can be defined as the practice of integrating the best available evidence in the internet focused on clinical expertise and care applied by the health care professionals in order to improve the patient outcomes and enhance the safety and effectiveness of the care that has been provided to the patient (Burns, 2014). The capstone experience provides the students with the opportunity to implement extensive research, synthesize relevant and authentic information and apply that information in order arrive at a solution regarding the problem under focus for the study. Hence, it has to be mentioned in this context that the capstone experience has a very significant role in the nursing degree.
Prevalence of Healthcare Associated Infections in Burn Patients
For this capstone project, the research aim focuses on the infection prevalence for the burn wounds in patients. It has to be mentioned in this context that a vast majority of people all over the world have been reported to acquire health care associated infection or HCAI (Azzopardi et al., 2014). According to the authors, close to 165000 Australians were found you be acquiring health care associated infections on a yearly basis. And among the vast majority if the different people acquiring the HCAI, a large portion of the large figure is contributed by the burn patients. There are various contributing factors to the burn patients being more vulnerable to the healthcare associated infections. According to the Srigley et al. (2014), the burn patients have already lost the skin barrier of protection that can ward off the risk of infection to some extent. Along with that the burn patients are often immune deficiency and they often go through invasive treatment procedures. Moreover the long term hospice stay also adds to the infection risk and the culmination of the above mentioned factors contribute to enhancing the vulnerability of the burn patients towards acquiring a variety of different HCAIs. I would like to mention the fact that during my placement experience, I had the opportunity to practice in a burn unit, where I encountered the fact that the frequency of acquiring different health care associated infections in the burn patients were far more accelerated when compared to the rest of the units of the health care facility I worked in. Hence I had chosen the research topic for my capstone project to be “Infection prevention in burn unit”. The primary goals or objectives of this project had been to reduce the incidence rate of health care associated infections in the burn unit patients. We had emphasized in one of the most important and prominent infection control techniques used in the health care, hand hygiene. The staffs of the unit were encouraged to commence on a diligent hand hygiene technique to reduce the occurrence of the burn associated infections. The other objectives for the project had been to create a safe practice culture in the unit and providing an opportunity for the staff to improve and enhance the knowledge regarding the importance of hand hygiene for preventing infections (Jeschke et al., 2015).
According to the Bulman and Schutz, (2013), competence can be defined as the combination of knowledge, skills, attitudes and judgment required to provide professional nursing services with respect to the nursing professionals. Now it has to be mentioned that nursing is a professional field where there is a significant pressure of adhering to the ever-changing guidelines, practice standards and legislations; and hence in order to develop and enhance the competence levels a thorough and consistent self assessment performed regularly and periodically. According to the Kashiwagi et al. (2016), it has to be mentioned that for the students or new professionals the self assessment can serve as a potent tool for self learning. It has to been proceed to be empowering the students with knowledge and skills. The purpose of a self assessment program is to ensure that the students or the participants undertaking can have the opportunity to recognize their strengths and weaknesses so that they can take actions in accordance; that will help them build upon their strengths. The self assessment is basically the process that helps the health care professionals to be lifelong learners and equip them with the sills for autonomy in both the learning experience and the professional practice. As per the article by the authors, the process of self assessment is comprised of three components, self observation, self judgment and the self evaluation. I had taken the assistance of a questionnaire tool for the self assessment and I would like to mention in this context that it had been an exceptional opportunity for me to discover my strengths and weaknesses at the same time. It has to be mentioned in this context that in order to be a professional with the competence and skills to be continuing to provide a care that is not just safe and effective to my patient but to be undergoing professional practice all the while being updated to the different practice legislations and protocol standards. By this self assessment I had discovered the fact that I have very limited knowledge regarding the burn wounds of the patients and how it gets infected and what can be done to prevent it. Along with that I had also discovered the fact that I have very limited knowledge regarding the hand hygiene practice standards and protocol guidelines issues by the World Health Organization. However the strengths that I have discovered about myself had been that I have good time management skills, good team leading skills, effective communication skills, effective problem solving skills, analytical thinking skills, commitment to the professional development; clear understanding of the professional boundaries and change acceptance. I would like to mention in this context that this self assessment activity has helped me understand the professional and personal issues I have which can serve as challenges in not just the path of successful completion of the project but also in the picture for my professional growth in the future in the field of nursing. Along with that, I would like to mention the fact that this self assessment tool had been an excellent tool for me to gain the confidence to be able to complete this capstone project.
Self-Assessment and Professional Development
The learning and developmental goals I have set for this project include that by the end of this project I will have extensive knowledge and skills regarding the management of burn injuries, their infection risk and how to take infection control risks to be able to prevent the infection of the burn injuries. The second goal I have set for my professional development is to be able to have an extensive evidence based knowledge and understanding on the hand hygiene protocol, how it can be implemented in the health care scenario and how to maintain compliance to the hand hygiene protocol in the real world health care scenario.
Reflection has immense value in professional development; it provides the professionals with optimal frameworks so that they can revisit their previous practice and maintain practices concurrent with the latest guidelines. According to the Shircore et al. (2013), reflective practice can be defined as the practice of studying, exploring, and along with that analyzing the different contextual factors associated with the experience event and be able to understand whether or not they had been able to achieve the objectives and goals set for the experience or event. It has to be mentioned in this context that reflection is professional tool that has many a components and there are a variety of different models and frameworks. Although all the reflective processes have very similar components, critical thinking, evaluating, and learning from practice that gives the insights into self-assessment and practice. Hence, it has to be mentioned that this particular practice has immense value in the context of evidence based practice as well. Researchers are of the opinion that reflective practice and documentation has been proved to be a valued tool for professional practice and educational development that helps them generate and retain valuable knowledge and expertise that is valuable in their field of profession but also generate self awareness of their strengths and flaws. It has to be mentioned that for a profession that involves providing care interventions and support to the patients, it is very important for the profession to refrain from making errors. According to the Kashiwagi et al. (2016), the reflective process helps the nurses or other health care professionals keep from making similar errors in the future enhancing the safety and effectiveness of the care provided. Hence, it has to be mentioned that reflection holds a significant importance in revisiting any experience and be able to judge how successfully the project has been implemented and along with that whether there have been any flaws left behind in the process of project. Along with that the reflection will also be able to judge to what extent the project goals have been achieved, the skills or knowledge obtained, how effective have been solution decided for the problem selected for the capstone project. From the different variety of reflection frameworks that are available, the reflective framework that has been chosen for my project is the Burtons reflective framework.
Learning and Development Goals
On a more elaborative note, it has to be mentioned that the Burtons reflective framework is a fairly straightforward systematic and very easy to implement framework. This developmental reflection framework had been introduced in the 1970s and ever since had been utilized by different health care professionals for the purpose of a simple yet effective reflection framework. This model comprises of only three segments, the first element is “What”, that describes the nature and details of the event or experience. The second element of the reflective model is the “so what”, which is the segment where the implications of the project and discussed and lastly, the third and final element of the reflection framework is the “now what” where the future implication of the event or experience is discussed (Jayatilleke & Mackie, 2013).
This is the most important and most 9impactful section of the reflection model, where the entire experience or in this case the capstone project will be explained in detail. It has to be mentioned in this context, that this particular segment of the model represents five key questions for the professionals along with the event, What were the roles of the people involved?, What was my role?, What were the problems?, What happened? And finally what did I do? Hence this particular segment scrutinizes not just the experience of the capstone project but also emphasizes on the roles of all the stakeholders associated with the project. First and foremost, the capstone project for this study had been infection prevention in the burn units through the emphasis on the hand hygiene. The population that has been selected for this study had been all the staffs of hospitals; however the special emphasis is going to be on the staffs of burn unit. The time frame for this particular project had been close to a year. The evaluation method that has been chosen by me for the project had been obtaining, processing, analyzing and evaluating the HCAIs rate before and after the project.
It has to be mentioned in this context that the Burn care units have been reported to be the only unit that is far more prone to the variety of health care associated infections than the rest of the units. And hence, the importance of infection control measures need to be robust, effective and time saving for this particular staff. There is various types standard protocol that can be used for the infection control or prevention of the health care associated infections. However, as for the project we had limited resources, we had to decide on the most relevant and cost effective type of infection control measure, the hand hygiene. Now it has to be mentioned here that the most of the occurrences of the infection is facilitated by the contaminated hands if the health care providers. According to the guidelines mentioned by the World Health Organization, routine hand washing is by far the most effective and low expense measures to prevent and reduce the frequency of health care associated infection (Who.int, 2018). Hence, for this project, we had selected the hand hygiene technique to be the solution for infection management of burn injuries. The primary objective for this project had been decreasing the Decreasing the incidence of infection among patient in the burn unit through emphasizing on hand hygiene. And along with that provide Proving opportunity for health care worker upgrading the knowledge regarding the importance of hand hygiene for preventing infections (Tekin et al., 2014).
Reflection
The strategies that had been selected for this project focused on changing the education levels of the nursing staff regarding hand hygiene and infection control and along with that implementing better hand hygiene practices in the facility, especially in the burn unit. The first strategy that we had selected and implemented had been providing ongoing education, in-service trainings to staffs by using various instructive postures, brochures and pocket card regarding the importance of hand hygiene. As mentioned by the authors the most of the infection risk in the health care facility is the lack of knowledge and education among the staff regarding how to implement best hand hygiene practice and the need for its implementation. In support the authors have stated that, a vast majority of medical staff had only brief and superficial knowledge regarding the WHO recommended hand hygiene protocol and the detrimental impact of the lack of compliance to the hand hygiene practices on their health and the health of the patients (Who.int, 2018). I would also like to mention that by the virtue of the extensive research that we had performed for the study had helped us avail the information that there is a massive lack of compliance to the hand hygiene practices in both the developed and developing counties and along with that, the average time spend for the hand washing practices range from 6.6 to 30 seconds. Hence, the lack of education and training in the staff and awareness about the hand hygiene had been identified as the crucial need for our project to implement. However, soon we had discovered the fact that only training and educational posters or brochures were not enough for enhancing the safe hand hygiene compliance or reduce the incidence of the burn injury infections. Hence the second strategy we developed focused on monitoring the progress of hand hygiene program, by creating multidisciplinary team that emphasize the importance of hand hygiene on regular basis. The effective actions taken by the team had been effective in changing the education levels of the staff regarding the hand hygiene practices and acquainting them with the five moments of hand hygiene recommended by WHO. The third strategy for the project had been Establishment of a process of periodical monitoring and feedback on the rates on HCAIs. This had been successfully performed by the multidisciplinary team with collaboration of the burn unit nurses and had been a very important step for us to understand the impact of our solutions and the progress of the project (Öncül et al., 2014). The fourth and last strategy that we had implemented in the project had been creating adequate supply of taps and other essential things that are needed to perform hand hygiene. Now, as per a report shared by the local authorities, it had been discovered that the lack of supplies and adequate resources also act as barriers for successful and adequate hand hygiene practices and add to the burden of hospital acquired infection rates, especially in the burn injury, surgical units and critical care units. Hence, the adequate supply of taps, making sinks available in necessary and strategic places and mild antibacterial soap along with alcohol rub helped in facilitating the progress of the project and had helped in making the successful (Uhlemann et al., 2014).
Now in order to discuss the role I have played in the project it has to be mentioned that I had been serving as the supervisor of the project and a part of the multidisciplinary evaluation team. I had played a central role in planning the strategies, taking part in the educational program, and in monitoring the progress of the project. It had been an exhilarating opportunity for me to implement the entire project in a real world setting and overcome the barriers that had been present. First and foremost barrier that I had encountered had been the resistance from the older staff of the burn unit that refused to participate in the training sessions and workshops due to heavy workload, lack of awareness and cooperation and burnout due to the staff shortage. However, we had been able to overcome the resistance by motivational counseling attempted by my multidisciplinary team and the cooperation from the health care facility administrative authority for which I am very grateful. The second barrier that we had encountered had been time constraint and financial limitations for the supply of the resources and the trainers of the educational workshops. However, I had written to the trainers selected personally explaining our plight in the issue and requested them to provide the training without any expenses and to which they had agreed graciously. We had also prepared the pamphlets and posters on our own to ensure that minimal resources were invested which helped us buy necessary hand hygiene supplies for the staff.
The second part of the reflective framework had been the analysis part involving three different questions, What was the outcome?, What did you learn?, and What was important? Considering the outcome of the project, it has to be mentioned that our project had been successful in educing he percentage of HCAI in the burn unit by a 7.5% in the initial 6 months. And after the follow up of feedback sessions and training, the rates increased to 8.5% in the next six months. I would like to mention that it had been excellent success given the time constraints financial limits that we had restricting the progress of the project. According to the Monistrol et al. (2012), burn injury provides an increased risk to the patients for infection and hence there is need for enhanced infection risk assessment and following the prevention protocol. In case the health care facilities are not following the standard infection control let along an extensive infection control regimen for the selected patient population, the risk for infection is far more accelerated and can even pose a significant fatality risk to the patients. It has to be mentioned that MRSA or methicillin resistant Staphylococcus aureus is a deadly HCAI that spreads through wound based contact transmission and as the pathogen is resistant to the most of the common broad spectrum antibiotics controlling the infection becomes extremely difficult. As per the Mitchell et al. (2017), it has to be mentioned that for the burn injuries, the patients are already under extreme threat for delayed wound healing and several other health risks, the added burden of HCAI, especially MRSA can be a fatal threat to the patients to second or third degree burns. Hence, the importance of hand hygiene is undoubtedly is a very important aspect and hence our strategy had been successful. However, while conducting the training sessions we discovered that a few of our staffs had limited English proficiency and their cultural diversity restricted them from optimal inclusion in the programs. Hence, the next time onwards it will be important to incorporate higher cultural safety and competence in the training program including the language interpreters cultural liaison staff.
This is the third and final element of the reflective model, where the consequences of the actions are evaluated and future plans are made. For this project, the training and education program had been extremely successful for the staff except for the culturally diverse staffs with limited English proficiency that were still unsure of the five moments of hand hygiene. Hence the improvements required for this step include improving the cultural appropriateness of the training programs and the resources used. Secondly, the financial planning if the project had been flawed which became a challenge for us to buy the supplies necessary for the burn unit staff to maintain a diligent five moments of hand hygiene. Other than that, the project had been successful in identifying a solution to the problem of burn wound infection with HCAI. An 8.5% reduction rate that we had achieved in the project serves to be a promising initiative based on which better and more specialized strategies can be designed and implemented in other vulnerable patient populations such as surgical ward, chronic care unit, respiratory and cardiac rehabilitation units and palliative wards.
Working towards Masters of Nursing in Clinical Leadership, University of Western Sydney
Working towards Certificate IV in Workplace Assessment and Training
Positive Approach to the Care of the Older Person with Dementia in October 2016
Facilitator course for Dementia Care and Competency Network in August 2016
Falls Prevention and Falls Risk Management Strategies for Clinical Staff in June 2016.
Infection Risk: Screening, Assessment and Management Plans for Adults in June 2016.
Bachelor of Nursing, University of Western Sydney, graduated in 2013.
ProfessionalMembership:
Registered as a Registered Nurse with Nursing and Midwifery Board of Australia.
12
Union Member of the New South Wales Nurses and Midwives Association.
Personal Goal:
My personal goal is to minimize or prevent the health care associated infection risk in the patients with burn injury on the ward by using training and educational awareness enhancing strategies and timeframe to achieve this goal is 12 months. Along with that, my personal goal also had been to improve the resource supply status of the burn unit for five moments of hand hygiene maintenance.
Work experience:
1) Registered Nurse (RN4) Westmead Hospital Aug. 2013 till current
2) Assistant in Nursing Heartbeat Agency Parramatta Aug. 2011 – Jan. 2013
3) Personal care assistant Paraquad NSW (Ferguson Lodge), Lidcombe March 2009 – Jan 2013
Key strength:
Accomplishing task on time
Good team leader
Effective communication skill
Good problem solving skill
Commitment to professional development
Clear understanding of professional boundaries
Keen to take on changes and challenges
Current Position Description:
Summary of Capstone Experience outcomes:
Aim:
The aim of this capstone experience project is to reduce the health care associated infection risk by training the staff and enhancing the hand hygiene resource availability
Identify the Issue:
The risk for health care associated infection is 165000 for the Australian demographics and the burn unit is the most at risk population for acquiring the infection. The issue is to reduce the incidence rate of HCAI in the burn unit by training the staff and enhancing the resource availability.
Action Plan and Description:
Immediately after the identification of the issue, we had performed a thorough assessment of the level of awareness among the burn unit staff regarding health care associated infection and how it can be overcome. The assessment involved both awareness of the staff regarding the infection risk and their level of knowledge regarding the WHO approved hand hygiene practices. Soon it had been discovered that the that the staff had a very minimal understanding of infection risk due to hand based contamination and how it can impact the patient with the burn injuries or other wounds. Level of awareness in the staff regarding the hand hygiene practices and how to adhere to the five moments of hand hygiene was also found to be minimal in the staff of the burn unit. Hence we had started on the training campaigns and educational workshops to enhance the knowledge of infection prevention and hand hygiene. Although it had been discovered that few of the staff had been culturally diverse and had limited english proficiency we did not have enough resources or availability of language interpreters to aid to the staff hence we have resorted to verbally explaining to them the five moments of hand hygiene. But it had been a challenge for the success of the capstone project. Hand hygiene program has run for at least 3 months after which the hand hygiene practices of the nurses were monitored and its effect on the incidence rate of healthcare associated infection in the burn unit was analysed by the multidisciplinary team selected. In that it is what it was discovered that many of the staff where not abiding by the hand hygiene program and many had accepted that the lack of resources for hand hygiene practices was the main contributing factor behind the lack of compliance. Hence we had to hence we had to resort to purchasing the necessary supplies and resources for better handwriting maintenance and adhering to the five moments of hand hygiene for the staff within the limited budget that we had. Soon it had been discovered to be successful and there was decrease of 8.5% was discovered in the burn wound infection rates in the health care unit.
Considering the outcome of the capstone project it can be mentioned that it has been a positive and successful project which enhanced the understanding and knowledge of the existing staff regarding the hand hygiene practices and infection control and also have been successful in reducing the infection rates in the selected unit within the 12 months time frame that the project was run for. For my personal and professional development I would like to mention that this capstone experience project enhanced my understanding of infection prevention in the burn injury units. This experience improved my patience and it also improved my presentation and communication skills. During the course of the project I had to take charge and lead the team which enhances my confidence and leadership qualities as well. And along with that this project at given me the opportunity to improve my evidence-based practice skills which will benefit me exponentially in the future. Hence, I would like to state that capstone experience has been an excellent opportunity for me to enhance my clinical practice skills in the real world practical scenario and bridge the gap between the theoretical learning and practical application based skills and knowledge. Discussion experience also helped me perform a self assessment which helped in discovering the strengths and weaknesses I have in terms of professional and personal traits. For reflective practice, I had taken the help of Burton’s reflection framework that also helped me revisit the entire experience and discover the few errors that I have committed and the weaknesses in my professional practice which I will attempt to improve in the future.
References:
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Azzopardi, E. A., Azzopardi, E., Camilleri, L., Villapalos, J., Boyce, D. E., Dziewulski, P., … & Whitaker, I. S. (2014). Gram negative wound infection in hospitalised adult burn patients-systematic review and metanalysis. PloS one, 9(4), e95042.
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Öncül, O., Öksüz, S., Acar, A., Ülkür, E., Turhan, V., Uygur, F., . . . Görenek, L. (2014). Nosocomial infection characteristics in a burn intensive care unit: Analysis of an eleven-year active surveillance. Burns : Journal of the International Society for Burn Injuries, 40(5), 835-41.
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Tekin, R., Dal, T., Bozkurt, F., Deveci, Ö., Palanc?, Y., Arslan, E., … & Ho?o?lu, S. (2014). Risk factors for nosocomial burn wound infection caused by multidrug resistant Acinetobacter baumannii. Journal of Burn Care & Research, 35(1), e73-e80.
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