Alarm fatigue in nursing
In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures. Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, if tables, graphs, surveys, educational materials, etc. are created. Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. Benchmark Information This benchmark assignment assesses the following programmatic competencies: RN to BSN 1.1: Exemplify professionalism in diverse health care settings. 2.2: Comprehend nursing concepts and health theories. 3.2: Implement patient care decisions based on evidence-based practice.
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Capstone project change proposal
Background
Alarm fatigue is a primary concern in healthcare because of the adverse effects the problem poses on the patients and healthcare providers. The main concern of this capstone project is the prevention of alarm fatigue among nurses in the critical care units. Despite the widespread incidences of alarm fatigue among nurses in the critical care units, there exist challenges in the evaluation of incidences of alarm fatigue, causing significant concern for healthcare facilities. The most effective evidence-based practice that can be effective in the prevention of alarm fatigue among critical care nurses is implementing staff education, thereby improving healthcare outcomes. The performance of educational programs among healthcare providers will benefit the healthcare providers and improve patient outcomes by increasing alarm responsiveness (Bi et al., 2020).
Clinical Problem Statement
Alarm fatigue is a global challenge that has affected all healthcare facilities, including those in developed countries and the United States. Alarm fatigue among healthcare providers in the critical care units is a critical challenge in the healthcare workforce that the nurse shortage has already hit. Alarm fatigue is associated with alarm desensitization which leads to poor response to alarm hence, significant deviation in vital parameters causing a clinical problem that increases the mortality and morbidity among patients (Baker & Rodger, 2020). Other direct effects of alarm fatigue in the critical care units include increased healthcare costs, nurse burnout, reduced provider productivity, and nurse turnover, ultimately expanding the nurse shortage. Vital sign abnormality is the most significant adverse effect of alarm fatigue on patients and negatively impacts their healthcare outcomes.
Purpose of the Change Proposal
The change proposal aims to prevent alarm fatigue and associated effects. For instance, one of the consequences of alarm fatigue is alarm desensitization, affecting the responsiveness towards alarms and leading to vital sign abnormality. Educational programs are essential because they significantly increase nurse responsiveness towards alarms and limit instances of vital sign deviation (Bi et al., 2020).
Also, the educational programs will help promote resilience among healthcare providers to overcome some adverse effects such as burnout, occupational stress, and reduced productivity. With the appropriate implementation of the educational programs, there will be a reduction in the number of stressors due to a change in perception and development of resilience among healthcare providers to cope with the high number of alarms.
After analyzing the intervention, the information that will be obtained will be critical in helping implement the protocol. The protocol’s performance will see essential care nurses undergo educational training to avert alarm fatigue.
The healthcare staff will undergo an educational program that will help them understand the essence of responding to alarms appropriately and also help them gain skills on how best to avoid the challenges associated with excess alarms.
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PICOT question
For inpatient intermediate care nurses, will be a decrease of clinically inconsequential alerts compared to a non-reduction of insignificant alerts decrease telemetry alarm fatigue and increase alarm responsiveness within six months?
The literature search strategy employed
The search strategy utilized was the use of CINAHL and MedLine databases, rich in up-to-date, peer-reviewed nursing articles. The essence of relying on peer-reviewed article websites was to ensure that the results were peer-reviewed, meaning that the content of the pieces was reliable and free from errors or biases. The application of peer-reviewed practices also helps in the effective implementation of evidence-based interventions. Another effective strategy that was employed was the use of keywords when searching for preproperate articles. Some of the keywords used include “alarm fatigue,” “critical care nurses,” “strategies to prevent alarm fatigue,” “effects of alarm fatigue,” and “educational strategies to prevent alarm fatigue.” During the search, 35 publications related to the prevention of alarm fatigue were obtained. Still, some materials did not meet the appropriate criteria for inclusion in the study. After additional refining of the materials, only eight papers met the inclusion criteria. The eight articles used were published within the past five years and were composed of qualitative and quantitative study designs.
Evaluation of the literature
In terms of the strategy, the evaluation of literature is based on the compassion of approaches that are used to reduce alarm fatigue which includes educational programs among healthcare providers and the modification of alarm threshold aimed at reducing the number of clinically insignificant alerts or false alarms (Fernandes, Miles, & Lucena, 2020). Among the two approaches, the most recommended for reducing alarm fatigue is the use of educational programs. Adjusting alarm frequency is not used widely because some institutions have set policies and regulations preventing healthcare providers from changing tele-alarm settings. The adoption of educational programs aimed at reducing alarm fatigue are essential because they increase the level of resilience among healthcare providers besides acting as an important stimulant to responsiveness towards alarms (Fernandes et al., 2019). In addition, educational programs help improve the provider-patient relationship essential in enhancing effective healthcare.
Applicable change or nursing theory utilized
The nursing theory that was applied is the change theory, which consists of three main components: the driving forces, restraining forces, and equilibrium. The driving forces are the factors that ignite or cause a change. For instance, in this case, the driving force is alarm fatigue, which is the main driving force for initiating a change. Restraining forces are the ones that counter or antagonize the driving forces. The restraining forces oppose the driving forces and work in the opposite direction. The restraining forces lead to a shift in the equilibrium, thereby opposing the implementation of change. One restraining force in implementing staff education programs is resistance among healthcare providers who don’t want to be part of the change process either due to the fear that some of the changes may affect their routines (Endrejat, Baumgarten & Kauffeld, 2017). The equilibrium state is the point at which the restraining and opposing forces are equal.
Proposed implementation plan with outcome measures
The significant outcomes of preventing alarm fatigue are to increase responsiveness toward alarms by reducing alarm desensitization. Besides, reducing alarm fatigue helps improve patient outcomes by effectively responding to the monitoring devices and correcting identified parameters before they get out of range (Lewis & Oster, 2019). Also, implementing the educational plan will increase knowledge and skills among healthcare providers, thereby increasing their competence and the ability to serve vulnerable patient populations such as those in intensive care units. Educational programs can, among other benefits, increase self-awareness among the healthcare providers and, therefore, resilience, reduced stress, and low turnover rates. Educational programs can help nurse leaders identify the most vulnerable healthcare providers at a higher risk of alarm fatigue and provide effective interventions to overcome the challenge.
Use of evidence-based practice in creating the intervention plan
The use of evidence is essential in research because it is one of the means of achieving a successful project implementation. According to the study, one of the main questions that were meant to guide the project implementation is to question if educational programs can reduce alarm fatigue among nurses in the critical care units. With the preceptor’s guidance, the search for suitable research papers was performed as outlined in the search strategy. Further, a literature summary was developed relevant to the research study after literature exclusion was conducted. In addition, concrete results were described that formed part of the project’s performance assessment.
Plan for evaluating the proposed nursing intervention
One of the most effective strategies for evaluating the effectiveness of the project in nursing is conducting a summative evaluation. Summative evaluation is essential in project implementation because it helps design assessment or evaluation questions regarding how often healthcare providers respond to the alarms from monitoring devices in the critical care units. The frequency of response to the alarms will give an ideal picture of the effectiveness of the educational programs in reducing alarm fatigue which is demonstrated through alarm desensitization (Winters et al., 2018). The involvement of the stakeholders in the evaluation criteria will be significant in that stakeholders help assess whether the resources have been adequately used.
Potential barriers to plan implementation
One likely barrier to implementing the proposed plan is resistance from the nurses, who may feel like the project is undermining their culture or norm. Staff resistance is a common barrier in project implementation which can result from poor communication or disinformation (Mareš, 2018). One way to overcome staff resistance is through effective communication using appropriate communication channels. Another barrier to the proposed implementation is the lack of adequate financial resources, which is the leading resource required in the performance of any project.
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Conclusion
Educational programs among critical care nurses are a game-changer in preventing alarm fatigue because healthcare providers who are most affected by alarm fatigue mostly lack adequate knowledge to help develop resilience. Besides, educational programs enhance the ability of healthcare providers to appreciate the essence of responding to all alarms to prevent adverse events among patients, such as significant vital sign deviations.
References
Baker, K., & Rodger, J. (2020). Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions. Informatics in Medicine Unlocked, 18, 100300.
Bi, J., Yin, X., Li, H., Gao, R., Zhang, Q., Zhong, T., … & Li, Z. (2020). Effects of monitor alarm management training on nurses’ alarm fatigue: A randomized controlled trial. Journal of clinical nursing, 29(21-22), 4203-4216.
Endrejat, P. C., Baumgarten, F., & Kauffeld, S. (2017). When theory meets practice: Combining Lewin’s ideas about change with motivational interviewing to increase energy-saving behaviours within organizations. Journal of Change Management, 17(2), 101-120.
Fernandes, C. O., Miles, S., De Lucena, C. J. P., & Cowan, D. (2019). Artificial intelligence technologies for coping with alarm fatigue in hospital environments because of sensory overload: algorithm development and validation. Journal of medical Internet research, 21(11), e15406.
Fernandes, C., Miles, S., & Lucena, C. J. P. (2020). Detecting false alarms by analyzing alarm-context information: algorithm development and validation. JMIR Medical Informatics, 8(5), e15407.
Lewis, C. L., & Oster, C. A. (2019). Research outcomes of implementing cease: an innovative, nurse-driven, evidence-based, patient-customized monitoring bundle to decrease alarm fatigue in the intensive care unit/step-down unit. Dimensions of Critical Care Nursing, 38(3), 160-173.
Mareš, J. (2018). Resistance of health personnel to changes in healthcare. Kontakt, 20(3), e262-e272.. Resistance of health personnel to changes in healthcare. Kontakt, 20(3), e262-e272.
Winters, B. D., Cvach, M. M., Bonafide, C. P., Hu, X., Konkani, A., O’Connor, M. F., … & Kane-Gill, S. L. (2018). Technological distractions (part 2): a summary of approaches to manage clinical alarms with intent to reduce alarm fatigue. Critical care medicine, 46(1), 130-137.
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ubric Criteria
Revisions Incorporated as Directed by Instructor 10 points
Criteria Description
Revisions Incorporated as Directed by Instructor
5. 5: Excellent
10 points
All revisions are incorporated. The revision greatly improves the
accuracy and clarity of the project.
4. 4: Good
8.9 points
The key aspects were revised. The revision generally improves the
accuracy and clarity of the project.
3. 3: Satisfactory
7.9 points
Most key aspects were revised. Some aspects are still vague or contain
minor inaccuracies.
2. 2: Less Than Satisfactory
7.5 points
Revision is incomplete. Many aspects are still incomplete, inaccurate, or
unclear.
1. 1: Unsatisfactory
0 points
Revision is omitted.
Background 10 points
Criteria Description
Background
Collapse All
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5. 5: Excellent
10 points
Background of clinical problem are clearly and logically presented.
Relevant support and rationale are evident.
4. 4: Good
8.9 points
Background of clinical problem are presented. Minor aspects are unclear
or require support.
3. 3: Satisfactory
7.9 points
Background of clinical problem are summarized. There are minor
omissions or inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Background of clinical problem is incomplete.
1. 1: Unsatisfactory
0 points
Background of clinical problem omitted.
Clinical Problem Statement 10 points
Criteria Description
Clinical Problem Statement
5. 5: Excellent
10 points
Clinical problem statement is clearly and logically presented. Relevant
support and rationale are evident.
4. 4: Good
8.9 points
Clinical problem statement is presented. Minor aspects are unclear or
require support.
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3. 3: Satisfactory
7.9 points
Clinical problem statement is summarized. There are minor omissions or
inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Clinical problem statement is incomplete.
1. 1: Unsatisfactory
0 points
Clinical problem statement omitted.
Purpose of Change Proposal 10 points
Criteria Description
Purpose of Change Proposal
5. 5: Excellent
10 points
Purpose of the change proposal in relation to providing patient care in
the changing health care system is logically presented. Relevant support
and rationale are evident.
4. 4: Good
8.9 points
Purpose of the change proposal in relation to providing patient care in
the changing health care system is presented. Minor aspects are unclear
or require support.
3. 3: Satisfactory
7.9 points
Purpose of the change proposal in relation to providing patient care in
the changing health care system is summarized. There are minor
omissions or inaccuracies. Some support or information is needed.
7.5 points
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2. 2: Less Than Satisfactory
Purpose of the change proposal in relation to providing patient care in
the changing health care system is incomplete.
1. 1: Unsatisfactory
0 points
Purpose of the change proposal in relation to providing patient care in
the changing health care system is omitted.
PICOT Question 10 points
Criteria Description
PICOT Question
5. 5: Excellent
10 points
Topic and criteria are clearly and logically presented. Relevant support
and rationale are evident.
4. 4: Good
8.9 points
Topic and criteria are presented. Minor aspects are unclear or require
support.
3. 3: Satisfactory
7.9 points
Topic and most criteria are presented. There are minor omissions or
inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Topic is presented but criteria is incomplete.
1. 1: Unsatisfactory
0 points
PICOT questions is omitted.
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Literature Search 10 points
Criteria Description
Literature Search
5. 5: Excellent
10 points
Topic and criteria are clearly and logically presented. Relevant support
and rationale are evident.
4. 4: Good
8.9 points
Topic and criteria are presented. Minor aspects are unclear or require
support.
3. 3: Satisfactory
7.9 points
Topic and most criteria are presented. There are minor omissions or
inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Topic is presented but criteria is incomplete.
1. 1: Unsatisfactory
0 points
Literature search strategy employed omitted.
Evaluation of Literature 10 points
Criteria Description
Evaluation of Literature
5. 5: Excellent
10 points
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Evaluation of literature is clearly and logically presented. Relevant
support and rationale are evident.
4. 4: Good
8.9 points
Evaluation of literature is presented. Minor aspects are unclear or
require support.
3. 3: Satisfactory
7.9 points
Evaluation of literature is summarized. There are minor omissions or
inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Evaluation of literature is incomplete.
1. 1: Unsatisfactory
0 points
Evaluation of literature omitted.
Change or Nursing Theory 10 points
Criteria Description
Change or Nursing Theory
5. 5: Excellent
10 points
Change or nursing theory is logically presented. Relevant support and
rationale are evident.
4. 4: Good
8.9 points
Change or nursing theory is presented. Minor aspects are unclear or
require support.
7.9 points
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3. 3: Satisfactory
Change or nursing theory is summarized. There are minor omissions or
inaccuracies. Some support or information is needed.
2. 2: Less Than Satisfactory
7.5 points
Change or nursing theory is incomplete.
1. 1: Unsatisfactory
0 points
Change or nursing theory omitted.
Implementation Plan and Outcome Measures 20 points
Criteria Description
Implementation Plan and Outcome Measures
5. 5: Excellent
20 points
Implementation plan and outcome measures are clearly and logically
presented. Relevant support and rationale are evident.
4. 4: Good
17.8 points
Implementation plan and outcome measures are presented. Minor
aspects are unclear or require support.
3. 3: Satisfactory
15.8 points
Implementation plan and outcome measures are summarized. There are
minor omissions or inaccuracies. Some support or information is
needed.
2. 2: Less Than Satisfactory
15 points
Implementation plan and outcome measures are presented is incomplete.
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1. 1: Unsatisfactory
0 points
Implementation plan and outcome measures are omitted.
Use of Evidence-Based Practice in Intervention Plan 20 points
Criteria Description
Use of Evidence-Based Practice in Intervention Plan
5. 5: Excellent
20 points
Use of evidence-based practice in intervention plan is clearly and
logically presented. Relevant support and rationale are evident.
4. 4: Good
17.8 points
Use of evidence-based practice in intervention plan is presented. Minor
aspects are unclear or require support.
3. 3: Satisfactory
15.8 points
Use of evidence-based practice in intervention plan is summarized.
There are minor omissions or inaccuracies. Some support or information
is needed.
2. 2: Less Than Satisfactory
15 points
Use of evidence-based practice in intervention plan is incomplete.
1. 1: Unsatisfactory
0 points
Use of evidence-based practice in intervention plan omitted.
Plan for Evaluating Proposed Nursing Intervention 20 points
Criteria Description
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Plan for Evaluating Proposed Nursing Intervention
5. 5: Excellent
20 points
Plan for evaluating proposed nursing intervention is clearly and logically
presented. Relevant support and rationale are evident.
4. 4: Good
17.8 points
Plan for evaluating proposed nursing intervention is presented. Minor
aspects are unclear or require support.
3. 3: Satisfactory
15.8 points
Plan for evaluating proposed nursing intervention is summarized. There
are minor omissions or inaccuracies. Some support or information is
needed.
2. 2: Less Than Satisfactory
15 points
Plan for evaluating proposed nursing intervention is incomplete.
1. 1: Unsatisfactory
0 points
Plan for evaluating proposed nursing intervention omitted.
Potential Barriers and Plan to Overcome Barriers 20 points
Criteria Description
Potential Barriers and Plan to Overcome Barriers
5. 5: Excellent
20 points
Potential barriers and plan to overcome barriers are clearly and logically
presented. Relevant support and rationale are evident.
17.8 points
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4. 4: Good
Potential barriers and plan to overcome barriers are presented. Minor
aspects are unclear or require support.
3. 3: Satisfactory
15.8 points
Potential barriers and plan to overcome barriers are summarized. There
are minor omissions or inaccuracies. Some support or information is
needed.
2. 2: Less Than Satisfactory
15 points
Potential barriers and plan to overcome barriers are incomplete.
1. 1: Unsatisfactory
0 points
Potential barriers and plan to overcome barriers are omitted.
Thesis Development and Purpose 10 points
Criteria Description
Thesis Development and Purpose
5. 5: Excellent
10 points
Thesis is comprehensive and contains the essence of the paper. Thesis
statement makes the purpose of the paper clear.
4. 4: Good
8.9 points
Thesis is clear and forecasts the development of the paper. Thesis is
descriptive and reflective of the arguments and appropriate to the
purpose.
3. 3: Satisfactory
7.9 points
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Thesis is apparent and appropriate to purpose.
2. 2: Less Than Satisfactory
7.5 points
Thesis is insufficiently developed or vague. Purpose is not clear.
1. 1: Unsatisfactory
0 points
Paper lacks any discernible overall purpose or organizing claim.
Argument Logic and Construction 10 points
Criteria Description
Argument Logic and Construction
5. 5: Excellent
10 points
Clear and convincing argument that presents a persuasive claim in a
distinctive and compelling manner. All sources are authoritative.
4. 4: Good
8.9 points
Argument shows logical progressions. Techniques of argumentation are
evident. There is a smooth progression of claims from introduction to
conclusion. Most sources are authoritative.
3. 3: Satisfactory
7.9 points
Argument is orderly, but may have a few inconsistencies. The argument
presents minimal justification of claims. Argument logically, but not
thoroughly, supports the purpose. Sources used are credible.
Introduction and conclusion bracket the thesis.
2. 2: Less Than Satisfactory
7.5 points
Sufficient justification of claims is lacking. Argument lacks consistent
unity. There are obvious flaws in the logic. Some sources have
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questionable credibility.
1. 1: Unsatisfactory
0 points
Statement of purpose is not justified by the conclusion. The conclusion
does not support the claim made. Argument is incoherent and uses
noncredible sources.
Criteria 3Mechanics of Writing (includes spelling,
punctuation, grammar, language use)
10 points
Criteria Description
Criteria 3Mechanics of Writing (includes spelling, punctuation, grammar,
language use)
5. 5: Excellent
10 points
Writer is clearly in command of standard, written, academic English.
4. 4: Good
8.9 points
Prose is largely free of mechanical errors, although a few may be
present. A variety of sentence structures and effective figures of speech
are used.
3. 3: Satisfactory
7.9 points
Some mechanical errors or typos are present, but they are not overly
distracting to the reader. Correct sentence structure and audienceappropriate language are used.
2. 2: Less Than Satisfactory
7.5 points
Frequent and repetitive mechanical errors distract the reader.
Inconsistencies in language choice (register), sentence structure, or word
choice are present.
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1. 1: Unsatisfactory
0 points
Surface errors are pervasive enough that they impede communication of
meaning. Inappropriate word choice or sentence construction is used.
Paper Format (use of appropriate style for the major and
assignment)
4 points
Criteria Description
Paper Format (use of appropriate style for the major and assignment)
5. 5: Excellent
4 points
All format elements are correct.
4. 4: Good
3.56 points
Template is fully used; There are virtually no errors in formatting style.
3. 3: Satisfactory
3.16 points
Template is used, and formatting is correct, although some minor errors
may be present.
2. 2: Less Than Satisfactory
3 points
Template is used, but some elements are missing or mistaken; lack of
control with formatting is apparent.
1. 1: Unsatisfactory
0 points
Template is not used appropriately or documentation format is rarely
followed correctly.
Documentation of Sources 6 points
Criteria Description
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Documentation of Sources (citations, footnotes, references, bibliography,
etc., as appropriate to assignment and style)
5. 5: Excellent
6 points
Sources are completely and correctly documented, as appropriate to
assignment and style, and format is free of error.
4. 4: Good
5.34 points
Sources are documented, as appropriate to assignment and style, and
format is mostly correct.
3. 3: Satisfactory
4.74 points
Sources are documented, as appropriate to assignment and style,
although some formatting errors may be present.
2. 2: Less Than Satisfactory
4.5 points
Documentation of sources is inconsistent or incorrect, as appropriate to
assignment and style, with numerous formatting errors.
1. 1: Unsatisfactory
0 points
Sources are not documented.
Total 200 points