Level 9/10 Academic Writing. UK ENGLISH. Preferably UK based authors in APA 7 referencing please. Quality Improvement Proposal: Education on Managing Patients’ Pain in Hospital Surgical Department. Portfolio of Evidence Effective Leadership in Healthcare Theory 6 Stem. PLAN: What is the topic or the problem? Topic: Education on Managing Patients’ Pain in Hospital Surgical Department DO: What is you are planning to do or change (who, what, where and when)? STUDY: What is your plan for measuring the effect of the change? Contents Indicative Word Count (7,000 +/-10%) PART 1: Self-assessment checklist N/A PART 2: Introduction 500 words PART 3: Search strategy (for part 4) 100 words Level 9 GUIDE Marking Criteria NUR09120 - Effective Leadership in Healthcare Criteria 75% + 65-74% Structure and presentation (Overall including Part 1 and 2 = 10%) Completion of all sections of the portfolio including  Self-Assessment Checklist  Introduction with brief overview of project and key areas for quality improvement (QI)  Completion of all sections of portfolio  Introduces topic and area of practice referring to policy with extensive integrated knowledge and understanding of QI topic.  Excellent use of appropriately selected evidence, policy and literature which is clearly linked to practice.  Well-structured sentences and paragraphs.  Follows guidelines for presentation of work.  Excellent use of headings where appropriate and correct formatting  All sections of self-assessment checklist scored  Completion of all sections of portfolio  Introduces topic and area of practice referring to policy with very good level of integrated knowledge and understanding of QI topic.  Appropriately selected evidence, policy and literature which is clearly linked to practice  Logical presentation.  Well-structured sentences and paragraphs.  Follows guidelines for presentation of work.  Good use of headings were appropriate and correct formatting  All sections of the self-assessment checklist scored     Referencing and Search Strategy (Overall referencing and Part 3 and 9 = 10%) Uses appropriate academic references and policy documents to support portfolio .Adheres to the APA7th referencing guidelines  Clear and effective search strategy  Extensive use of Appropriately selected evidence and literature.  No inaccuracies in citation method  Clear and effective search strategy  Comprehensive use of appropriately selected evidence and literature.  Occasional inaccuracies in citation method     Critical analysis of background and drivers for the QI proposal and leadership and change management approaches (Part 4 and 6 = 60%) • Provides sound rationale for the QI proposal by critically analyzing the topic, QI proposal, background drivers, incorporating appropriate research, national/international policy documents & guidelines • Critique, compare and contrast leadership and change management theories. • Justify your choice of approaches applied to the implementation plan for your QI proposal • Consider the potential barriers and enablers of implementation  Excellent rationale for QI proposal.  Evidence of an outstanding level of critical analysis integrated knowledge and understanding of topic, leadership and change management theory applied to the QI proposal  Extensive use of appropriately selected evidence and literature clearly linked to practice and QI, leadership and change management approaches  Exceptionally comprehensive discussion of potential barriers and enablers  Comprehensive rationale for QI proposal.  Very good level of critical analysis and integrated knowledge and understanding of topic, leadership and change management applied to the QI proposal  Comprehensive use of appropriately selected evidence clearly linked to practice and QI, leadership, and change management approaches  Comprehensive discussion of potential barriers and enablers The QI proposal (Part 5 = 10%) • Explain your QI proposal • Outline the topic/problem • Overall desired outcome • Plan to carry out the project (who what where, when) • Plan for measuring the effect of the change • Summarises key evidence to support QI  Excellent QI proposal  Excellent outline of the topic/ problem  Very clearly identifies the desired outcome using SMART principles  Exceptionally comprehensive plan to carry out the project  Exceptionally comprehensive plan for measuring the effect of the change  Excellent outline of key evidence to support QI  Comprehensive QI proposal  Very good outline of the topic/ problem  Clearly identifies the desired outcome, some SMART principles  Comprehensive plan to carry out the project  Comprehensive plan for measuring the effect of the change  Very good outline of key evidence to support QI Feedback, action plan and supervision record and reflective account (Part 7 and 8 = 10%)  Uses a reflective model NMC template to guide reflection Reflects on individual key learning from feedback and experience of developing portfolio  All sections of supervision record completed with detailed action plan  Excellent ability to reflect in and on practice in order to determine own learning needs  Excellent application of reflective model/NMC template  All sections of supervision record completed with detailed action plan  Very good ability to reflect in and on practice in order to determine own learning needs  Very good application of reflective model/NMC template marking guidance will assist you with flow and structure and will help keep you on track as to the expected module content and learning. Please note that students can structure the essay in whichever way that suits their style of writing but all criteria should be considered. All points made must be supported by referring to relevant literature (the reading list provides you with a broad range of literature although it is expected that students will also undertake their own literature search). Reference literature using APA 7th citation style. PART 4: Critical analysis of the background and drivers for the quality improvement proposal 2,000 words PART 5: The Proposal and summary of key evidence 1,000 words PART 6: A critical analysis of leadership and change management approaches applied to the planned implementation of the quality improvement proposal, considering barriers and enablers 2,000 words PART 7: Feedback, SNOB and action plan 400 words PART 8: Reflection on individual learning 1,000 words PART 9: References N/A Appendix for supporting evidence (if required) N/A Use Portfolio Template provided (check downloaded files please) Portfolio Template Formatting your work Have you formatted correctly? • Line spacing: 1.5 • Font type: Arial • Font size: 12 BN Assessment and Feedback Information 1. BN Assessment Overview The summative (or final) assessment for the module is a structured portfolio that will assess the learning outcomes of the module. The teaching and learning activities will support you to develop this as you progress through the module. You will develop and create a quality improvement (QI) proposal that is relevant to one area of practice that reflects the available evidence. You will critically analyse the evidence for the QI and apply leadership and change management approaches when you plan the implementation of your QI. A Portfolio Template is provided to structure your work later on in this workbook. The portfolio of evidence reflects work that is equivalent to 7,000 words. The actual word guidance for each section is included in the portfolio and this reflects a range of learning activities including: • Searching for appropriate evidence to justify your QI proposal. • Developing a proposal that could be taken forward in healthcare practice. • Feedback and Action Plan. • Reflection on formative feedback as you develop your quality improvement proposal. • Development of your work based on formative feedback opportunities. The portfolio of evidence template includes: • A proposal for a quality improvement in one area of practice. • A critical analysis of the evidence to provide a rationale for this QI proposal. • A critical analysis of leadership and change management approaches applied to the quality improvement proposal. • A record of feedback and personal action plan. • A reflective evaluation of your experience of developing the quality improvement proposal. 2. Formative Assessment During the module you will have many opportunities to gain formative feedback to support your learning and improve your work. You will be able to gain informal formative feedback opportunities which include feedback on your: • Quality improvement (QI) idea • Search strategy • Evidence based justification for your QI • Critical writing You will also have tutorials with a member of the academic team who will provide formative feedback to support you to develop your QI proposal and portfolio. There are also formal Formative Assessment points: Formative 1A - Formative Assessment of your Quality Improvement (QI) proposal with tutor feedback. Formative 1B - Formative Assessment of a 700 word draft of a section of your portfolio. 2. Formative Assessment 2.1. Search Strategy You will plan a search strategy that will help you to be effective in your literature searching. You can discuss your search strategy plan, search terms and limits etc., on the discussion board, and there is always help from our Subject Librarian (see drop in support). This will give you some formative feedback on your search strategy. The search strategy (& searching process using the databases), is worth spending time on now now to get it "right". We know that students who do this, and seek help early if they are struggling, are more likely to achieve well. A good search strategy will help you to find information using the library databases. For this assignment it is a requirement to use primary research and policy documents that will illustrate the problem you have identified and support the justification of your QI. · You can fill in your search strategy as soon as you start searching for evidence - it should guide your search. · Use the library databases to search for appropriate literature · When searching for evidence, make sure you use simple, appropriate search terms · See the example on the next page · This is part of your formative assessment in the third week of the module · If you are really struggling, ask the subject librarian for help. How to find and search a database This link will take you to a useful video that will help you to search the literature, you may have seen this before in second year modules, and you may like to remind yourself. 2. Formative Assessment 2.2. Example Search Strategy You will prepare your QI proposal using the template provided, this will be part of your portfolio for final submission. In week 1 and 2 of the module you will start searching literature about your topic/problem area and to support your QI proposal idea. In the tutorial in week 3 of the module you will present this to a small group and get formative feedback to help you develop your search strategy. You can click here to download a Search Strategy Template 2. Formative Assessment 2.3. Quality Improvement (QI) Proposal You will prepare your QI proposal using the template provided, this will be part of your portfolio for final submission. In week 1 and 2 of the module you will start searching literature about your topic/problem area and to support your QI proposal idea. In the tutorial in week 3 of the module you will present this to a small group and get formative feedback to help you develop your proposal. Here is an example of a QI Proposal 2.4. Example QI Proposal You can click and download a QI Proposal Template here The example below is based on the same topic as the example search strategy. PART 1: Self-assessment checklist NOTES (delete on your final document for submission) You should complete the following self-assessment checklist to ensure that you have meet the criteria of the portfolio and assessment. If there is any area that you have not included in your portfolio use this as an opportunity to revise and include this. This will also help identify areas that you may require further support or were you need to further develop your work. Self-Assessment Checklist Criteria Have I included this in my portfolio? Score on the following scale: 3: Included 2: Included but could be enhanced 1: Not included Introduction Introduces topic / problem and area of practice? Overview of quality improvement idea? Linked and supported by evidence and policy? Introduces portfolio and guides reader to what is to follow? Search strategy Have you completed each part to demonstrate how you searched for evidence? Could someone else replicate the search based on this information? Critical analysis of the background and drivers for the quality improvement proposal Critically analysed the topic and QI proposal incorporating primary research, national and international policy documents, guidelines and literature? Provided sound rationale for the QI proposal? Supported with use range of evidence? The Proposal and summary of key evidence Identified the topic / problem being proposed for quality improvement and the desired outcome? Explain the quality improvement proposal using the structured framework based on PDSA? Clear plan to carry out the project (who what where, when)? Clear plan for measuring the effects of the change (before and after implementation)? Summary of key evidence to support your QI (based on part 4 literature)? A critical analysis of leadership and change management Critically analysed leadership and change management theories? Discussed potential barriers and enablers? Applied this to how you would plan implementation of the quality improvement proposal? Supported with use range of evidence? Feedback, SNOB and action plan Completed feedback summaries and SNOB? Reflection on individual learning Reflected on key learning from completing portfolio and developing quality improvement proposal? Considered feedback from tutor, peer and practice? References Included a range of academic sources of evidence and policy documents? Have you used APA7th accurately in your text citations and reference list? Structure and presentation Well-structured sentences and paragraphs with a logical flow? Have you followed portfolio guidance/structure? Carefully proof read portfolio AND/OR someone else proof read portfolio? Have you remained within the word count (7,000 +/- 10%)? Have you formatted correctly? • Line spacing: 1.5 • Font type: Arial • Font size: 12   PART 2: Introduction NOTES (delete on your final document for submission) • Introduce the topic or the problem. • Introduce the area of practice where you plan to implement the proposal (eg: a ward, community, clinic, care home.) Please don’t specifically name the hospital, ward or community setting, but give us enough detail that we understand the context of your proposal e.g. a busy surgical ward in a large a teaching hospital. • Give an overview of quality improvement idea, tell us why it is important (e.g. it’s an issue that affects many patients/it’s an issue that can have serious implications for patients/it increases healthcare costs, etc.) • Introduces portfolio and guides reader to what is to follow. Tell us briefly what’s in your portfolio e.g. “In the following sections, I will….” • Link and support this with evidence and policy, using references appropriately where required. • You could write in the 1st or the 3rd person for this short section, pick one approach. PART 3: Search strategy (for part 4) NOTES (delete on your final document for submission) • You can fill this is as you go as soon as you start searching for evidence. • Use the library databases to search for appropriate literature • When searching for evidence, make sure you use simple, appropriate search terms • See the example in the Assessment section of Moodle • If you are really struggling, ask the subject librarian for help. Aspect Search terms Setting: the place where care is being delivered. It could be a hospital, part of a hospital, general practice or somewhere else in the community. Outcome: the thing that you are investigating or measuring in some way. Factor: something that might influence the thing you are measuring. People: the group of healthcare professionals, patients, family members or otherwise that you are interested in. Study Design: the type of research you want to find. Search terms to exclude from search Age / gender Publication Date Language Geography Databases used Number of articles returned: PART 4: Critical analysis of the background and drivers for the quality improvement proposal NOTES (delete on your final document for submission) • Critically analyse the topic and QI proposal incorporating primary research, national and international policy documents, guidelines and literature. Most importantly, include primary research evidence which provides evidence that there is a problem which might benefit from a quality improvement proposal. • Provide a sound rationale for the QI proposal based on the evidence. Justify your QI plan here. Start with the clinical context and the bare bones of what you want to do and why. • Relate this briefly to your experience or observations in practice. • Support your discussion with a range of evidence. Tell us about any policy documents that are relevant to your proposal: e.g. local NHS policies, best practice guidelines, NICE, etc, etc. Be sure to reference them appropriately. We don’t expect you to know these documents in minute detail, but we’d like to know that you’ve read them in enough detail that you can tell us why they’re relevant. Have the most recent “best practice” guidelines been supported or contradicted by research, for example? • Acknowledge and discuss any different points of view in the evidence you have gathered, debate pros and cons and argue your point of view based on the evidence. • Don’t worry too much if you’ve briefly said some of this already in your introduction. • We’d expect this section to be written in the 3rd person, and referenced throughout. PART 5: The proposal and summary of key evidence NOTES (delete on your final document for submission) When you seek feedback in practice, this section could be used to share/present your plan as it also includes the key evidence to convince people in practice that this is a useful QI. Quality Improvement Proposal Plan PLAN What is the topic or the problem? What is your overall desired outcome: improved patient experience, continuity of care, etc? DO What is you are planning to do or change (who, what, where and when)? Be specific and keep it simple STUDY What is your plan for measuring the effect of the change? How will you know a change has happened? Remember that you’ll need a baseline measurement as well as measuring after the proposal is implemented. This might be an audit, a before-and-after quiz or feedback form, etc. Try to keep it simple. Briefly summarise the key evidence to support your QI proposal. Use your research from part 4, choose evidence that is compelling and convincing and reference it. Think about what is really important. Consider what will convince people in practice that this QI proposal is worthwhile. You can use bullet points.   PART 6: A critical analysis of leadership and change management approaches applied to the planned implementation of the quality improvement proposal, considering barriers and enablers NOTES (delete on your final document for submission) In this section you should critically analyse the role of leadership and change management in the development of this proposal. • You should consider the leadership and change management approaches that are applicable to this small QI project. • Tell us about 2-3 leadership styles and 2-3 change management approaches, look at the Moodle materials on Leadership and Change management for guidance. Explain using evidence: • What are they? • What are the pros and cons for each? • Why they might or might not be appropriate or effective in your proposal? • Tell us why you’ve chosen the approaches you have, in preference to these others. • Explain how you might apply these (theoretically) in your project. • Consider the enablers and barriers you might encounter when implementing this QI proposal in practice. • How would you leadership and change management approach help you manage enablers and barriers? • We’d expect this to be written in the third person, and referenced throughout, though when you are discussing the application to practice you might prefer to use the first person for a short section. PART 7: Feedback, SNOB and action plan Notes – delete for submission: You should record the feedback you have received at formative opportunities you have had the opportunity to engage in. Thereafter complete the SNOB Analysis (Strengths, Needs, Opportunities and Barriers) as introduced in the tutorials. Use the information in your SNOB analysis to consider a personal action plan to support you moving forward to the summative assessment. If you did not do the formative work for any reason, just write “not applicable”, you do not have to explain personal details in here. Formative Feedback 1A Draft QI proposal. Summarise the feedback provided. Ensure you consider the feedforward comments provided. Formative Feedback 1B Draft 700 words. Summarise the feedback provided. Ensure you consider the feedforward comments provided. Feedback from Practice Ask staff in placement for feedback or comments on your theoretical QI proposal, do they think this will be a useful QI? Can they think of any enablers or barriers to implementing it? Summarise the feedback and consider the comments provided.   SNOB Analysis Strengths Things that you did well and can continue to do well. Opportunities Things that you got wrong or missed. Or could include to make your work better. Needs Extra things you need to do before the next assessment. Barriers Things that could make it difficult to do things you think are necessary. Personal Action Plan Based on your SNOB analysis what do you need to do to improve your work before the summative submission?   Record of other discussions & feedback Please summarise any relevant additional discussions with peers or tutors, SNOB analysis and action plan, you can use bullet points.   PART 8: Reflection on individual learning NOTES (delete on your final document for submission) Use the NMC template, or another reflection model if you prefer. Reference if using a different model and use appropriate headings to structure. Tell us about your key learning from developing the proposal and portfolio using the reflective tool structure. Consider your feedback and action plan. Have you identified any strengths or areas for development? Examples might be: time management, academic skills, finding or using evidence, communication, leadership and change management skills. You can write this in the 1st person, and we’d expect this to be appropriately referenced where needed, for example when using the NMC code. Reflective Account Adapted from: http://revalidation.nmc.org.uk/download-resources/forms-and-templates.html What was the nature of the activity and/or practice-related feedback and/or event or experience in your practice? What did you learn from the activity and/or feedback and/or event or experience in your practice? How did you and/or will you change or improve your practice as a result? How is this relevant to the Code? Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust PART 9: References Use APA7th – see library website for referencing guidance   Appendix for supporting evidence (if required) Portfolio Template – Assessment and Feedback Informations 3.2. Assessment Practicalities Here we include some useful guidance to support you during the module and the final submission. Please see Key Dates and Assessment information • Netiquette Guidelines • Word Count Guideline Portfolio Template Formatting your work Have you formatted correctly? • Line spacing: 1.5 • Font type: Arial • Font size: 12 Portfolio Template 3.3. Word Count Word limits The word count for your learning portfolio is 7,000 words, plus or minus 10%. With the blue notes deleted, part 2-8 of the portfolio template is just under 570 words, so we will bear this in mind when marking. Your title page, self assessment, reference list and any appendices are not counted in the word count. You are allowed 10% under or over the word count as per guidance in previous modules, so between 6,300 and 7,700 words is acceptable. If your portfolio is more than 700 words (10%) under the word count, consider whether you have really completed each section to the best of your ability. A portfolio that is substantially below the word count could potentially receive a very low grade, as the discussion and critical analysis is unlikely to be detailed enough. On the other hand, if you are way over the word count, consider if all the information is directly relevant and look for areas of superfluous description that does not enhance your discussion and analysis. 4. Academic Study Skills Help with Referencing Often one of the most frustrating part of academic writing is referencing. The following podcasts may help you understand the reason why we reference and how best to reference as part of your academic writing. You will also find a link to the School Referencing Guideline on the following page. Please use the School guideline when writing your assignment. The podcasts in the next section are just for information, they are not based on the official School guidance. Academic Study Skills 4.2. Avoiding Plagiarism The portfolio submission must be your own work. Plagiarism is defined as "unacknowledged incorporation in a student's work either in an examination or assessment of material derived from the work (published or unpublished) of another." This means that you may not use work from others and call it your own, whether in written work or in other formats such as music, audio and video. Plagiarism is considered a breach of academic conduct regulations, which is considered a serious offence. You can read the University’s Academic Conduct Regulations for more information. The following web link offers information regarding plagiarism and how to avoid it: Be Wise don't Plagiarise. Academic Study Skills 4.3. Improving your Critical Writing You may feel that you need to improve your critical writing skills for level 9 writing, or you may have had feedback saying that you need to develop this skill. There are a number of resources available to you to help you develop your critical writing skills. You have explored skills in critical writing and understanding research in previous modules and the there are a number of support mechanisms you can access. Please refer back on using research in your academic writing, for example: Research and Evidence Based Practice; Critiquing the Literature You can also access Academic Writing Support. Academic Regulations Here you will find the university regulations that may interest you. Spend some time to familiarise yourself. Fit to sit and extenuating circumstances Student conduct regulations Academic appeals regulations Fitness to practise regulations Tell us a bit about how you will apply theories to your QI plan “According to Kotter’s model it is crucial to communicate the importance of the QI early on in the change process to build a sense of urgency, understanding and support for the change (Kotter 1995; McGrath and Bates 2013). By briefing the team in a staff meeting before embarking on the project, several of Kotters steps can be achieved. The vision and rationale for the QI can be clearly communicated (step 4), staff can ask questions and this may identify potential barriers and enablers such as attitudes and knowledge about falls risk to patients (Smith et al, 2014), and this in turn will help with planning to remove any of the obstacles (step 5). It is vital to spend time on conveying the vision of this QI, and urgency around the outcomes reduce falls, otherwise change is likely to fail as people do not see the relevance of the change (Kotter 1995). In order to persuade the team, it is important for the leader to believe in the benefits of the QI change. This approach reflects the authentic leadership approach where sincerity and active listening are important requirements in making a genuine connection with the team and realising planned change (Murphy 2012; Sullivan and Garland, 2012).” • Pick a change model AND/OR • Pick a leadership approach • Discuss one aspect of these two theories that will fit with your implementation plan (the DO part of the you QI plan) • How will it help you to implement your QI, or overcome potential barriers. • https://www.thegeniusworks.com/2020/03/whats-your-leadership-style-its-ultimately-about-being-yourself-finding-what-works-authentically-for-you-whilst-embracing-different-characteristics-in-different-situations/ Portfolio requirements & assessment criteria Structure and presentation Referencing and Search Strategy Critical analysis of background and drivers for the QI proposal and leadership and change management approaches The QI proposal Feedback, action plan and supervision record and reflective account Part 7 and 8 10% Part 5 10% Feedback, action plan and supervision record and reflective account Use: - the checklist provided - the template provided and follow guidance in Blue Notes - the draft checker (closes 48 hrs before the submission deadline) - Make time for the tidying up required for a big piece of work - Check your work flows Change management model = example There are many change management models for instance: the Lewin’s change management model, The McKinsey 7-S model, Kotter’s theory, ADKAR, Bridges’ Transition Model, Kübler-Ross’ Change Curve, The Satir Change Management Model and many more (Patronis Jones, 2007). The Lewis model seems to be the most popular approach and most applicable to this project because the change process is split into three stages (Cummings et al, 2016). The stages are: (1) Unfreeze (2) Make a change (3) Refreeze (a) Unfreeze the current process to have a look at how things are done. Doing this helps give perspective to what needs to change and at the same time help people understand what is wrong with the current process and why it needs to change. (b) Make a change - prepare all involved, introduce the change, keep the communication line open, support the team and listen to feedback. (c) Refreeze - once the change has been tested, measured and then modified according to feedback (Cummings et al, 2016) Change management model - example There are many change management models for instance: the Lewin’s change management model, The McKinsey 7-S model, Kotter’s theory, ADKAR, Bridges’ Transition Model, Kübler-Ross’ Change Curve, The Satir Change Management Model and many more (Patronis Jones, 2007). The Lewis model seems to be the most popular approach and most applicable to this project because the change process is split into three stages (Cummings, Bridgman and Brown, 2016). The stages are: (1) Unfreeze ***LISTS and numbers/letters make work descriptive, not analytical*** (2) Make a change (3) Refreeze (a) Unfreeze the current process to have a look at how things are done. Doing this helps give perspective to what needs to change and at the same time help people understand what is wrong with the current process and why it needs to change. (REFERENCE?) (b) Make a change - prepare all involved, introduce the change, keep the communication line open, support the team and listen to feedback. (REFERENCE?) (c) Refreeze - once the change has been tested, measured and then modified according to feedback (Cummings, Bridgman and Brown, 2016) (NO CRITIQUE) engaging staff, and has a straight forward structure, both vital in order for the proposal to succeed. The next example is from a student who’s work was at distinction level  Extensive critical analysis, integrated knowledge and understanding of topic and QI methodology.  Extensive use of appropriately selected evidence clearly linked to practice and QI.  Resources  Improving quality whilst constraining costs is a longstanding concern for healthcare systems (Luce et al, 1994). Financial pressures on the NHS are well recognised (Robertson et al, 2017; Ross and Naylor, 2017; Scottish Government, 2009; Scottish Government, 2011). Health boards are continuously required to make savings whilst demand for healthcare increases (Audit Scotland, 2017; Robertson et al, 2017). Future cost projections show an unsustainable situation (Appleby, 2013). QI potentially boosts efficiency, however, the resources required and dependency on local context, means savings are not inevitable (Øvretveit, 2009; Powell et al, 2009; Robertson et al, 2017). Pressure on human resources – the workforce – receives less prominence but is equally important when understood as a great asset (Prabhu, 2017; Scottish Government, 2010). Currently, staff shortages, stretched capacity and low morale mean many leave the NHS (CQC, 2017; Health Foundation, 2011; Robertson et al, 2017).  Public inquiries  In recent years, high profile cases of healthcare failures have become visible in public media (McClimans et al, 2012; Powell et al DATE?). Resultantly, safety has become a public concern (Leatherman and Sutherland, 2003). In 1997, New Labour’s quality agenda responded to the Bristol Royal Infirmary and Shipman public inquires (Leatherman and Sutherland, 2003). More recently, the Francis Report into Mid Staffordshire NHS Foundation Trust made 290 recommendations following failures to listen, investigate and respond to patient and carer concerns (Department of Health, 2015; Francis, 2013). Visibility of failures has led to a rise in litigation (McSherry and Warr, 2008; NHS Litigation Authority, 2016). Rebuilding public trust – those who ultimately experience and judge care – is part of improving quality (Francis, 2013).  Evidence based practice  National clinical guidelines attempt to bring day-to-day procedure in line with best practice (Grimshaw et al, 2016; Powell et al, 2009). They also function to increase equity, ensuring all individuals receive quality care regardless of locality (Health Foundation, 2011). A scoping review by the Health Foundation found failure to implement best available evidence creates waste and inefficiencies (Perry et al, 2015). Despite this, uptake of guidelines is patchy (Healthcare Foundation, 2011). Local QI initiatives can address this, finding context specific solutions to delivering evidence based practice (Fulop and Robert, 2015).  Drivers and Carer Involvement  The above drivers indirectly provide impetus for involving carers more actively in care. Key policy sees working in partnership with patients, families and carers, mutuality, as central to successful outcomes (Scottish Government, 2010; Scottish Government, 2007). Interestingly, the associated outcome indicators makes no inclusion of carer involvement (Scottish Government, 2015a). Nor does the Mental Health Strategy 2017-2027 (Scottish Government, 2017). This contrasts with HIS’s (2017) recommendation that involving carers, harnessing their expertise, is a constituent of quality person-centred care (Carers UK, 2014; McSherry and Warr, 2008). Some Suggested UK References mostly based in Scotland Hall-Lord, M., Johansson, I., Schmidt, I., Larsson, B.W. (2002). Family members’ perceptions of pain and distress related to analgesics and psychotropic drugs, and quality of care of elderly nursing home residents. Health Soc Care Community. 11(3):1365-2524. Healthcare Improvement Scotland. (2015). 2015-2018 Strategy Delivery Plan for Medicines. National Health Services (NHS) Scotland. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/programme_resources/medicines_delivery_plan.aspx Healthcare Improvement Scotland. Growing pains: update report published on pain management services in Scotland. NHS Scotland. [News article]. Retrieved 2020, 04 July. http://www.healthcareimprovementscotland.org/our_work/long_term_conditions/programme_resources/chronic_pain_update_report/chronic_pain_news_article.aspx Healthcare Improvement Scotland. Long-term conditions: Chronic pain. NHS Scotland. [Press release]. Retrieved 2020, 04 July. http://www.healthcareimprovementscotland.org/our_work/long_term_conditions/chronic_pain_services.aspx Healthcare Improvement Scotland. (2012, 26 October). Update report on Scottish pain management. NHS Scotland. [Update report]. http://www.healthcareimprovementscotland.org/our_work/long_term_conditions/programme_resources/chronic_pain_update_report.aspx Horgas, A.L. & Dunn, K. (2001). Pain in nursing home residents: Comparison of residents’ self-report and nursing assistants’ perceptions. Journal of Gerontological Nursing. 27(3):44-53. Horgas, A.L & Elliott, A.F. (2004). Pain assessment and management in persons with dementia. Nurs Clin North Am. 39(3):593–606. International Association for the Study of Pain (IASP). (Last updated 2017, December 24). IASP Terminology. Retrieved 2020, June 6. https://www.iasp-pain.org/Education/Content.aspx? ItemNumber=1698#:~:text=The%20old%20definition%20read%3A%20%E2%80%9CAn,articulate%20their%20pain%2C%20said%20Dr. Kodama, Y. & Fukahori, H. (2017). Nurse managers’ attributes to promote change in their wards: a qualitative study. Nursing Open. (4):209-217. DOI: 10.1002/nop2.87. Lautenbacher, S., Kunz, M., Strate, P., Nielsen, J., & Arendt-Nielsen, L. (2005). Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain. 115(3):410–418. McCorkell, G. et al. (2017). Care of patients with dementia in an acute trauma and orthopaedics unit. Nursing Standard. 31: 36, 44-53. McDonald, D., Shea, M., Rose, L., Fedo, J. (2009). The effect of pain question phrasing on older adult pain information. J Pain Symptom Manage. 37 (6):1050–60. Metzinger, T. (2000). 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Edinburgh Napier University. School of Health and Social Care. Retrieved from: http://moodle.napier.ac.uk The British Pain Society. (2007). The Assessment of Pain in Older People: National Guidelines. [Module]. https://www.britishpainsociety.org/static/uploads/resources/files/book_pain_older_people.pdf The Health Foundation. (2013). Quality improvement made simple: What everyone should know about health care quality improvement. [Policy Brief]. https://www.health.org.uk/sites/default/files/QualityImprovementMadeSimple.pdf The Joint Commission. (2020). Pain Management: Leadership Responsibilities for Monitoring and Performance Improvement Activities – LD.04.03.13 EP 1. [Webpage]. https://www.jointcommission.org/en/standards/standard-faqs/ambulatory/leadership-ld/000002211/ The Scottish Government. (2010). Long Term Conditions Collaborative: Improving Care Pathways. [Policy Brief]. ISBN: 978-0-7559-8251-6. The Scottish Government. (2019). Scotland’s finances 2019-2020: key facts and figures. [Online report]. https://www.gov.scot/publications/scotlands-finances-2019-2020-key-facts-figures/ Treede, R-D. (2018). The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Reports. NCBI. DOI: 10.1097/PR9.0000000000000643. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902252/ Warden, V., Hurley, A. C., & Volicer, V. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) Scale. Journal of the American Medical Directors Association, 4(1), 9-15. Retrieved from http://www.geriatricpain.org/Content/Assessment/Impaired/Pages/PAIDADTool.aspx Wardner, L.D., Scipio, C.D., Hirsh, A.T., Torres, C.A., & Robinson, M.E. (2012). The Perception of Pain in Others: How Gender, Race, and Age Influence Pain Expectations. NCBI. DOI: 10.1016/j.jpain.2011.10.014 Willian Bridge Associates. (2019). Leading Organizational Transition. Retrieved from: https://wmbridges.com/ Zwakhalen, S.M.G., Hamers, J.P.H., Peijnenburg, R.H.A., & Berger, M.P.F. (2007). Nursing staff knowledge and beliefs about pain in elderly nursing home residents with dementia. Pain Research Management. 12, 177-184. Please NOTE: Number of required References: 50 References in APA7. Accurate use of APA 7th in accordance with School of Health & Social Care referencing guidance. Referencing Using APA 7th citation Sample PART 5: The proposal and summary of key evidence. Quality Improvement Proposal Plan PLAN A “confusion” or “disconnect” between patient and healthcare professional definitions of pain can lead to misconceptions, such as that pain tolerance comes better with age, thus leading to inadequate assessment, ill management, and inappropriate treatment. Although the ward admits short-term respite patients, its elderly patients require regular complex hospital care and nursing interventions, as long-term conditions include heart failure, stroke, diabetes, cancer, multiple sclerosis, Huntington’s disease, Parkinson’s disease, and motor-neuron disease. There are cases in the acute ward in which the patient still cannot identify the severity of pain due to cognitive impairment. Nursing staff would base pain scores on the patient’s non-verbal cues like facial expressions, agitated body language, or aggressive behavior, but definitions of “mild,” “moderate,” and “severe” as used in the Abbey may vary among nurses. This “variation” in definition not only affects reporting, but also how pain is assessed and managed. This directly concerns patient safety: the frustration among healthcare providers to accurately measure and assess pain can also lead to errors in treating pain. The desired outcome of this QI is a validation of understanding of pain/pain scores among healthcare providers in the ward, thereby increasing the possibility of more accurate, standardized pain assessment, particularly in nonverbal demented patients and patients unwilling to report pain. It is then proposed that the acute ward explore the use of BPAT, not only does it integrate the subjectivity of the Abbey and the high-sensitivity but low specificity of the PAINAD, but the improved combination could also allow further validation or opportunities for validation given the comments section for the patient’s usual healthcare providers and family. This QI may aid in providing a more patient-centred, value-based health care. More accurate pain assessments may also help reduce NHS costs allowing reallocation of resources to other critical aspects in the ward that need more support. DO WHO: Elderly with cognitive impairment, nurses, doctors, and patient families and relatives WHAT: (1) To identify the attitudes and beliefs of patients, healthcare providers, and family about how the concerned patient reports pain; (2) To map out communication patterns in and barriers to pain assessment in the community; (3) To evaluate the effectiveness of BPAT as a pain assessment tool for cognitively impaired patients in an acute ward setting; (4) To determine issues regarding the use of BPAT, if any; and (5) To recommend any intervention or mitigating strategy for the issues identified, if any. WHERE: Acute ward in the hospital WHEN: Trial for 3 months (coinciding HBCCC reviews), can be run in 2 more cycles for further validation STUDY Before administering BPAT, a team assessing patient communication patterns and challenges will be formed, enabling patient-centered care in the initiative. The team should gather as much information as possible from the patients, staff, and families regarding how the concerned patient reports pain. Serving as initial audit of pain assessment related issues, it aids in mapping out the patterns and difficulties in communication more effectively. Patient consent (and the staff, if needed) must be sought, thus a letter to the family must be drafted before gathering data on communication patterns and barriers. To avoid health-related data loss and interruption of operations, BPAT will be administered alongside APS currently used by the staff. Completion of the comments section by all parties concerned must be ensured. Issues encountered during the administration of both pain scales must be carefully logged for comparison. Briefly summarize the key evidence to support your QI proposal. • The Scottish Government (2019) have continuously worked with NHS to provide its increasing ageing population with chronic pain with accessible, beneficial, safe, effective, and patient-centered healthcare services through establishment and publication of necessary guidelines and policies, and conduct of workshops and research on chronic pain assessment and management. • Although there are validated pain assessment tools, there is still a “disconnect” regarding how pain is experienced by patients and defined by patients and healthcare providers alike (Treede, 2018). • Barriers still go back to communication, coming from attitudes and belief, interpersonal interaction, pain assessment tools, and self-reporting measures (Schofield & Abdulla, 2018). • The10-minute consultation in UK is a limiting factor among the elderly in reporting pain meaningfully, which can be addressed by allotting more time for consultation (Schofield & Abdulla, 2018). • Attitude, being an influential factor in pain assessment, can be affected by various aspects, including different cultural and social factors (Schofield & Abdulla, 2018). • Pain perception varies across age groups, and young and older adults would have different sensitivities to experimental pain, for example (Lautenbacher et al., 2005; Rittger et al., 2011, as cited in Wardner et al., 2012, para. 3), contributing to inconsistencies in definition, assessment, and treatment. • Continuous suffering from unrelieved pain occurs because of the patient’s attitude towards “unreal pain” thus “engagement with self-management and coping with pain should be an essential aspect of any pain management service” (Schofield & Abdulla, 2018, para. 6). • Patients and healthcare providers generally consider narcotics as addictive, resulting in under-usage (Hall-Lord et al., 2002). • A single pain scale used in a specific setting can lead to uniformity and consistency (Layman Young et al., 2006, as cited in Gregory, 2017). • Even standardized assessment tools are not utilized in practice (Gregory, 2017), due to trust issues that nurses have regarding the pain scores generated using the assessment tool, resulting in the staff relying more on their experience (Dowding et al. (2016, as cited in Gregory, 2017). • An evaluation of the Abbey Pain Scale, PAINAD, and CNPI as used in acute care wards and trauma wards (Gregory, 2012) revealed that: o APS is subjective, requiring prior knowledge of the patient; o PAINAD has issues regarding “consolalibility” and Cheyne Stokes respiration; and o the CNPI has no clear pain score interpretation guidelines (Gregory, 2017). • Initially, BPAT is practical, feasible, and easy to use in acute and trauma settings, with 98% of the participants claiming it was easy to use and that it helped identify pain (Gregory, 2017), usually taking only two minutes to administer (Gregory, 2017). • Using BPAT in an acute setting resulted in pain interventions, including administering analgesics and adjusting medication and/or comfort measures (Gregory, 2017, para. 27). • The comments section of the BPAT allows involvement of concerned parties in assessing and managing pain of the patient (Gregory, 2017). Get Custom Writing Services

ANSWER. PAPER DETAILS
Academic Level	Undergraduate
Subject Area	Nursing
Paper Type	Dissertation
Number of Pages	26 Page(s)/7150 words
Sources	50
Format
Spacing	Double Spacing

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