Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date The Impact of the Use of External Female Catheters in Preventing Catheter-Acquired Urinary Tract Infections Impact of the Problem on the Patient Catheter-associated urinary tract infections (CAUTIs) are among the most frequent hospital-acquired infections globally. These infections commonly arise from prolonged or improper use of indwelling catheters, contamination during insertion, or lapses in aseptic maintenance techniques. Over time, the continued presence of a Foley catheter allows bacterial colonization and biofilm formation within the urinary tract, ultimately leading to infection. For patients receiving care at home, diagnosing a urinary tract infection (UTI) often requires laboratory confirmation, which can delay timely treatment and elevate the risk of complications, including hospitalization. Hospitalized individuals are even more vulnerable, facing possible outcomes such as fever, discomfort, sepsis, and dependence on intravenous antibiotics. Recurrent CAUTIs can foster antimicrobial resistance, further complicating recovery. Moreover, repeated infections contribute to emotional distress, decreased autonomy, and diminished quality of life, thereby impeding rehabilitation and overall well-being. Impact of the Problem on the Organization From an institutional perspective, CAUTIs have significant implications for healthcare organizations. These infections increase overall hospital costs through extended patient stays, higher antibiotic use, and a greater demand on nursing and infection control teams. Hospitals exceeding infection benchmarks established by national agencies may also face financial penalties or reduced reimbursement. Additionally, recurring CAUTI cases erode patient trust, negatively affect satisfaction scores, and tarnish an organization’s reputation. Reducing CAUTI rates not only enhances patient safety outcomes but also promotes operational efficiency and resource optimization. Successful CAUTI prevention demonstrates the organization’s commitment to quality improvement and patient-centered care. Identification of PICO Components Component Description P (Population) Female patients using urinary catheters I (Intervention) Use of external female catheters C (Comparison) Indwelling Foley catheters O (Outcome) Reduction in catheter-associated urinary tract infections Evidence-Based Practice (EBP) Question In female patients with urinary catheters, does the use of external female catheters compared to indwelling Foley catheters reduce the risk of catheter-associated urinary tract infections (CAUTIs)? “A Single Institution Pre-/Post-Comparison After Introduction of an External Urinary Collection Device for Female Medical Patients” (Research Article) Background and Introduction This retrospective investigation assessed the effects of implementing an external urinary collection device (EUCD)—specifically the PureWick system—across the Internal Medicine, Family Medicine, and Neurology departments of one healthcare institution. The study excluded specific populations such as pregnant individuals, incarcerated persons, and those admitted to specialized services. The primary goal was to compare CAUTI rates before and after the adoption of EUCDs and determine whether the intervention effectively reduced infection rates compared to indwelling urinary catheters (IUCs). Methodology A retrospective observational study design was employed to analyze adult female inpatients who had either IUCs or EUCDs during hospitalization. Data collection spanned two distinct periods: three months before and twelve months following EUCD implementation. Infection incidence was measured as episodes per 1,000 catheter days and per 10,000 patient days. Variables such as patient age, body mass index (BMI), comorbidities, and postoperative complications were documented. Statistical analysis included Chi-square tests for categorical data and Mann–Whitney U tests for continuous data, using IBM SPSS Statistics (Version 24). Level of Evidence Based on the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model, this study qualifies as Level 3 evidence, representing non-experimental research that provides moderate-quality evidence derived from retrospective data. Ethical Considerations The project received approval from the Institutional Review Board (IRB). As the study used pre-existing medical records, informed consent was not required. Researchers followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines to maintain transparency, accuracy, and ethical integrity in reporting. Data Analysis and Findings A total of 848 female patients were included—292 received EUCDs, and 656 had IUCs. Before EUCD implementation, CAUTI rates for IUCs were 2.3 per 1,000 catheter days and 15.4 per 10,000 patient days. Post-implementation, rates for IUCs rose to 9.3 per 1,000 catheter days and 70.7 per 10,000 patient days, whereas EUCD-related CAUTI rates were 33.9 per 1,000 catheter days and 15.5 per 10,000 patient days. Although statistical significance was not achieved, findings suggested that EUCDs could offer infection reduction benefits for select patients. Variability in comorbid conditions and inconsistent device usage may have influenced results. Quality Rating Under the JHNEBP appraisal, the study received a Good Quality (Level B) rating, indicating reasonably reliable results that contribute to evidence-based nursing practice. Alignment with the EBP Question The study closely aligns with the EBP question, as it directly compares infection outcomes between traditional indwelling catheters and external female collection devices. While the reduction in CAUTI incidence was not definitive, results indicated that EUCDs might serve as a viable alternative when applied under standardized care protocols. “Reducing the Risk of Indwelling Catheter–Associated Urinary Tract Infection in Female Patients by Implementing an Alternative Female External Urinary Collection Device: A Quality Improvement Project” (Non-Research Article) Background and Introduction In a 386-bed community hospital in California, a quality improvement (QI) project aimed to reduce CAUTI rates among female patients. The initiative incorporated a female external urinary collection device (FEUC) featuring continuous suction. This intervention empowered nursing staff to utilize the device autonomously, without requiring physician authorization, thereby facilitating early adoption and continuous monitoring. Type and Level of Evidence According to the JHNEBP hierarchy, this QI project is classified as Level 5 evidence, which reflects experiential and organizational-level findings. The intervention was evaluated across several departments, including medical-surgical, telemetry, intensive care, and rehabilitation units, by comparing pre- and post-implementation CAUTI data. Findings and Quality Rating During the initial year following FEUC introduction, CAUTI rates dropped significantly. However, the second year showed a stabilization trend, likely due to inconsistent adherence to new procedures. The project was awarded a Quality B (Good) rating, reflecting reliable and well-documented outcomes that support ongoing practice improvement. Author’s Recommendations The authors advocated for integrating EUCDs within comprehensive CAUTI prevention bundles. This strategy should include ongoing staff education, multidisciplinary collaboration, and robust monitoring systems to ensure sustainable infection reduction among hospitalized female patients. Recommended Practice Change To effectively decrease CAUTI rates, hospitals should adopt evidence-based protocols to guide when EUCDs are appropriate alternatives to indwelling catheters. Staff training on device use, hygiene, perineal care, and

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date Clinical Practice Problem: Medication Errors in Hospitals Medication errors continue to be a major concern in hospital settings, threatening patient safety and undermining the efficiency of healthcare delivery. Such errors—ranging from incorrect drug prescriptions and improper dosages to timing inaccuracies—can lead to adverse drug reactions, extended hospital stays, or even fatal outcomes. These incidents often reduce patients’ confidence in healthcare institutions while exposing hospitals to financial strain through legal actions, reputational harm, and increased operational costs due to corrective treatments and prolonged patient care. From an organizational standpoint, recurring medication errors can also diminish staff morale and increase provider burnout. Healthcare professionals may experience frustration, guilt, or anxiety when errors occur, contributing to reduced job satisfaction and performance. Therefore, minimizing medication errors is crucial for both patient well-being and healthcare system sustainability. The introduction of Computerized Physician Order Entry (CPOE) systems has emerged as a reliable strategy to address this challenge. These systems enable clinicians to input medication orders electronically, reducing transcription errors and misinterpretations that often occur with handwritten prescriptions. Compared to conventional manual ordering, CPOE systems enhance communication among healthcare professionals, promote accuracy, and ultimately lead to safer patient outcomes and improved care efficiency (Collins et al., 2021; Elsaid et al., 2020). PICO Components of Medication Errors in Hospitals PICO Element Description Supporting Literature P (Patient/Population/Problem) Hospitalized patients exposed to or at risk of medication errors, including incorrect drug administration, inappropriate dosage, or mistimed delivery. Collins et al. (2021); Elsaid et al. (2020) I (Intervention) Implementation of a Computerized Physician Order Entry (CPOE) system integrated with clinical decision support (CDS) tools. Collins et al. (2021) C (Comparison) Traditional manual prescription systems relying on handwritten or basic electronic orders without embedded decision support features. Elsaid et al. (2020) O (Outcome) Significant reduction in medication errors and adverse drug events, contributing to improved patient safety and healthcare quality. Collins et al. (2021); Elsaid et al. (2020) Evidence-Based Practice (EBP) Question For hospitalized patients, does the use of a Computerized Physician Order Entry (CPOE) system with integrated clinical decision support, compared to traditional manual medication ordering, reduce medication errors and enhance patient safety? Background/Introduction Abraham et al. (2020) conducted a systematic overview titled “Effects of CPOE-based medication ordering on outcomes: An overview of systematic reviews,” which examined the influence of CPOE systems on medication safety within hospitals. The researchers synthesized data from several systematic reviews to determine the effectiveness of CPOE systems in mitigating medication-related errors and improving patient outcomes. Although the adoption of CPOE systems is widespread, the authors emphasized that success rates vary depending on factors such as user training, system customization, and implementation methodology. These factors highlight the importance of aligning technological interventions with clinical workflow to ensure optimal safety benefits. Research Methodology The research adopted a systematic review design, analyzing seven systematic reviews that collectively covered 118 primary studies. These studies evaluated critical outcomes, including medication error rates, adverse drug events, and mortality statistics. Rigorous inclusion and exclusion criteria, structured data extraction, and multi-reviewer assessments were applied to enhance reliability and eliminate bias. This comprehensive approach provided a credible synthesis of evidence supporting the use of CPOE systems in clinical practice (Abraham et al., 2020). Level of Evidence Using the JHNEBP Model According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, systematic reviews represent Level I evidence—the highest level in the evidence hierarchy. This level ensures that findings are drawn from multiple studies, providing robust, evidence-based conclusions on the clinical effectiveness of CPOE systems in minimizing medication errors (Abraham et al., 2020; Johns Hopkins Medicine, 2022). Summary of Data Analysis Abraham et al. (2020) employed meta-analytic techniques to aggregate data from the included systematic reviews. The analysis revealed a statistically significant reduction in medication errors and adverse drug reactions following CPOE implementation. However, effects on patient mortality and hospital stay duration were inconsistent, suggesting that while CPOE systems substantially improve medication safety, additional interventions—such as clinical decision support optimization and continuous training—may be required to achieve broader clinical outcomes. Ethical Considerations Since the study was a secondary analysis of existing research, no direct patient involvement occurred. Ethical considerations primarily revolved around data integrity, transparency, and unbiased reporting. Each included study had previously received institutional ethical approval. The authors ensured objective synthesis and avoided selective interpretation, maintaining academic and research integrity (Abraham et al., 2020). Quality Rating According to JHNEBP Using the JHNEBP appraisal tool, the study by Abraham et al. (2020) earned an “A” quality rating due to its rigorous methodology, comprehensive synthesis, and consistent outcomes. The systematic review design reduced researcher bias and strengthened the reliability of the findings, making it a dependable resource for evidence-based decision-making in hospital settings (Johns Hopkins Medicine, 2022). Results Analysis The results demonstrated a substantial reduction in medication error rates and adverse drug events across hospitals utilizing CPOE systems. The magnitude of improvement was influenced by system configuration, clinical workflow alignment, and user compliance. Although improvements in patient mortality were not uniform, the reduction in prescription errors supports the implementation of CPOE systems as a vital component of patient safety initiatives (Abraham et al., 2020). Non-Research-Based Evidence Background/Introduction The narrative review by Kinlay et al. (2021), titled “Medication Errors Related to Computerized Provider Order Entry Systems in Hospitals and How They Change Over Time,” explored the dynamic nature of CPOE systems and their evolving impact on medication safety. The authors noted that while CPOE systems reduce human-related prescription errors, they can inadvertently introduce new types of errors, especially during initial implementation phases. The review emphasized the necessity of ongoing system evaluation and staff training to mitigate these challenges and ensure long-term safety improvements. Types and Level of Evidence This narrative review, grounded in expert insights and literature synthesis rather than primary data collection, corresponds to Level V evidence according to the JHNEBP model. Although not empirical, such evidence provides valuable contextual understanding and practical recommendations for clinical application (Johns Hopkins Medicine, 2022). Quality Rating The review received a “B” quality rating under the JHNEBP model. While it offers rich insights and actionable

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date D219 Performance Assessment: Scholarship in Nursing Practice – Johns Hopkins Modules Evidence-Based Practice (EBP) and the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model serves as a systematic framework that supports nurses and healthcare professionals in integrating the best available research, clinical expertise, and patient values into clinical decision-making. This structured model simplifies the implementation of evidence-based practice (EBP) by providing well-defined tools, step-by-step guidelines, and templates that promote critical thinking and data-driven practice changes (Dang et al., 2022). By following the JHNEBP model, healthcare organizations can ensure that interventions are grounded in credible research, practical for the clinical setting, and tailored to patient-centered outcomes. The sections below address key concepts and questions derived from the Johns Hopkins instructional modules. Which Part of the JHNEBP Model Assists Staff in Completing an EBP Project? Question Which part of the JHNEBP model assists staff in completing an EBP project? Answer The synthesis and summary tools of the JHNEBP model are instrumental in assisting staff to complete an EBP project effectively. These tools help teams consolidate research findings from multiple sources and organize them into structured summaries. This process allows nurses and clinicians to interpret data efficiently, identify trends, and make well-supported decisions. By presenting information in a concise, evidence-based format, the synthesis and summary tools bridge the gap between research and real-world clinical practice, ensuring informed decision-making and better patient outcomes (Johns Hopkins Medicine, 2024). What Is the First Step in the EBP Process? Question According to the videos above, which of the following is the first item in the EBP process? Answer The first step in the EBP process is to assemble a multidisciplinary team that collaborates to define the specific EBP question. By including nurses, physicians, administrators, and other stakeholders, this collaborative team ensures that diverse perspectives contribute to identifying clinically relevant problems. This approach enhances the clarity and focus of the EBP question, laying the groundwork for evidence-based inquiry and application (Dang & Dearholt, 2018). What Is the Second Step in the EBP Process? Question According to the videos above, which of the following is the second item in the EBP process? Answer The second step involves searching, appraising, and synthesizing the evidence. In this phase, the team conducts comprehensive literature searches to locate the most credible and recent studies. After gathering evidence, the team evaluates the quality, reliability, and applicability of the research. Synthesizing this information ensures that any resulting recommendations are based on solid, scientifically validated findings. This step transforms research data into a meaningful foundation for clinical practice. What Is the Third Step in the EBP Process? Question According to the videos above, which of the following is the third item in the EBP process? Answer The third step in the EBP process is to develop recommendations for practice changes and determine their feasibility. During this stage, the team evaluates potential interventions by considering organizational resources, readiness for change, and potential obstacles. This ensures that proposed strategies are not only evidence-based but also practical within the given healthcare environment. The goal is to balance innovation with realistic application, paving the way for successful implementation (Johns Hopkins Medicine, 2024). What Is the Final Step in the EBP Process? Question According to the videos above, which of the following is the last item in the EBP process? Answer The final step of the EBP process is to create an action plan. This involves designing a structured implementation strategy that includes assigning roles, establishing timelines, and determining evaluation metrics. The action plan ensures accountability and provides a roadmap for assessing outcomes. Continuous feedback and outcome evaluation help refine the practice change, ensuring long-term sustainability and continuous improvement in care quality (Dang et al., 2022). Why Should Evidence-Based Practice Be Implemented? Question According to the videos above, what is a reason for implementing EBP? Answer EBP should be implemented because it integrates expert opinion with patient and staff preferences, creating a holistic approach to healthcare. This method ensures that decisions are guided by scientific evidence while respecting the values and expectations of patients and clinical staff. As a result, patient care becomes more personalized, ethical, and effective, aligning with the principles of patient-centered practice (Melnyk & Fineout-Overholt, 2019). What Is Another Reason for Implementing EBP? Question According to the videos above, which of the following is a second reason for implementing EBP? Answer Another reason for implementing EBP is that it empowers nurses to make meaningful, real-world changes to clinical practice. By engaging with current research, nurses can challenge outdated traditions and improve care delivery based on validated evidence. This proactive involvement fosters professional growth, innovation, and a culture of ongoing improvement within healthcare organizations (Titler, 2018). Summary of the Johns Hopkins EBP Process Step Description Purpose Step 1 Assemble a multidisciplinary team To collaboratively define the EBP question and establish shared goals. Step 2 Search, appraise, and synthesize evidence To gather and critically evaluate the best available research. Step 3 Develop recommendations and assess feasibility To propose evidence-based interventions and evaluate their practicality. Step 4 Create and implement an action plan To execute recommendations and monitor effectiveness through structured evaluation. This systematic and iterative process ensures that clinical practices are guided by robust scientific evidence while remaining adaptable to patient and organizational needs. Through ongoing evaluation and teamwork, the JHNEBP model supports sustainable quality improvements in healthcare delivery. References Dang, D., & Dearholt, S. L. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Sigma Theta Tau International. Dang, D., Bickford, M., & Dearholt, S. (2022). Johns Hopkins nursing evidence-based practice: Model and guidelines (4th ed.). Sigma Theta Tau International. Johns Hopkins Medicine. (2024). Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model and tools. https://www.hopkinsmedicine.org/nursing/ebp D219 Task 2 – EBP Process Overview and Assessment Insights Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer. Titler, M. G. (2018). Translation science and context. Research and Theory for Nursing Practice, 32(2), 99–122. https://doi.org/10.1891/1541-6577.32.2.99

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date Review of Evidence-Based Practice to Decrease CAUTIs Impact of the Problem on the Patient Catheter-associated urinary tract infections (CAUTIs) are a persistent source of preventable harm among hospitalized patients in the United States. Research indicates that between 15% and 25% of inpatients require an indwelling urinary catheter at some point during their hospitalization, and approximately 75% of hospital-acquired urinary tract infections (HAUTIs) are linked to catheter use (Shadle et al., 2021). The use of indwelling catheters significantly elevates the risk of bacterial colonization and infection, contributing to longer hospitalizations, increased morbidity and mortality rates, and a surge in treatment-related costs—estimated at approximately $14,000 per affected patient (Shadle et al., 2021). Patients with CAUTIs often experience pain, discomfort, fever, and potential complications such as sepsis, which can prolong recovery and diminish overall quality of life. Preventing these infections is, therefore, critical for improving clinical outcomes, enhancing patient satisfaction, and decreasing unnecessary healthcare expenditures. Effective infection control practices not only protect patients but also foster a culture of safety and quality within healthcare systems. Impact of the Problem on the Organization From an institutional standpoint, CAUTIs are categorized as hospital-acquired infections (HAIs) and must be reported to both the National Healthcare Safety Network (NHSN) and the Centers for Medicare & Medicaid Services (CMS). These infections directly affect hospital performance indicators, reimbursement models, and accreditation status (Rubi, Mudey, & Kunjalwar, 2022). Healthcare organizations dedicate substantial resources to infection control initiatives, continuous staff training, and surveillance programs aimed at reducing CAUTI incidence. Successfully decreasing CAUTI rates aligns with national patient safety goals and value-based purchasing programs that financially incentivize improved outcomes and decreased readmission rates. Ultimately, reducing CAUTIs contributes to enhanced institutional credibility, operational efficiency, and cost savings through reduced penalties and shorter lengths of stay. B.1 Identify the PICO Components PICO Element Description P (Population/Problem) Adult patients admitted to medical-surgical or intensive care units in acute care hospitals. I (Intervention) Discontinuation of indwelling urinary catheters when no longer medically indicated. C (Comparison) Utilization of evidence-based interventions such as daily chlorhexidine bathing, timely catheter removal, and use of alternative urinary devices. O (Outcome) Reduction in the occurrence of hospital-acquired CAUTIs among adult inpatients. B.2 Evidence-Based Practice Question What evidence-based interventions can be implemented to decrease the number of hospital-acquired catheter-associated urinary tract infections (CAUTIs)? A. Research Article Daily Bathing with 4% Chlorhexidine Gluconate in Intensive Care Settings: A Randomized Controlled Trial C.1 Background Introduction Palloto et al. (2019) conducted a randomized controlled trial (RCT) to investigate whether daily bathing with 4% chlorhexidine gluconate (CHG) effectively prevents hospital-acquired infections, particularly in intensive care unit (ICU) settings. The study was prompted by mounting evidence indicating that CHG reduces microbial colonization and prevents the transmission of multidrug-resistant organisms, thereby decreasing the incidence of infections such as CAUTIs and ventilator-associated pneumonia (VAP). C.2 Methodology This single-blind, parallel-group RCT was carried out from August 2015 to April 2016 in both an ICU and a post-cardiac surgery ICU (PC-ICU). Adult patients aged 18 years and older admitted for at least one night were considered eligible. Participants were randomly allocated to the CHG intervention group or to the control group receiving standard bathing care (Palloto et al., 2019). C.3 Level of Evidence According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, the study qualifies as Level I evidence, representing the highest standard of reliability in research design. C.4 Data Analysis Data were analyzed using R statistical software, with a significance threshold set at p < 0.05. The Kolmogorov–Smirnov test was used to verify the normal distribution of data, while the Mann–Whitney and chi-square tests (with Yate’s correction) were used for group comparisons (Palloto et al., 2019). C.5 Ethical Considerations Institutional ethical approval was obtained prior to data collection. Written informed consent was secured from capable patients, and consent waivers were utilized when necessary. Patients unable to provide immediate consent were re-consented once capable, consistent with the ethical guidelines of the Declaration of Helsinki (Palloto et al., 2019). C.6 Quality Rating Using the JHNEBP appraisal tool, this study received a Grade A (High Quality) rating, signifying a robust research design, ethical rigor, and reliable statistical analysis. C.7 Analysis of Results and Conclusions The RCT demonstrated that daily CHG bathing significantly reduced the incidence of hospital-acquired infections, including CAUTIs and VAP, without increasing adverse effects or mortality. Over the study period, 108 HAIs occurred among 91 patients, and CAUTI rates decreased to 4.9 per 1,000 patient-days (Palloto et al., 2019). These findings affirm the clinical effectiveness and safety of daily CHG bathing in reducing infection risks in high-acuity environments. C.7.a Alignment to the EBP Question This study directly addresses the EBP question by confirming that daily CHG bathing constitutes an effective evidence-based intervention for reducing CAUTI rates among hospitalized patients (Palloto et al., 2019). D. Non-Research Article Short-Term Urinary Catheters and Their Risks: An Integrated Systematic Review D.1 Background Introduction Gyesi-Appiah, Brown, and Clifton (2020) conducted an integrated systematic review to examine the risks associated with short-term urinary catheterization. Their findings revealed a direct relationship between the duration of catheterization and the risk of infection, estimating a 3–7% daily increase in the likelihood of developing a urinary tract infection when the catheter remains in situ. D.2 Type of Evidence The review synthesized evidence from 12 primary studies conducted between 2013 and 2018 that explored urinary catheter use, duration, and related complications (Gyesi-Appiah et al., 2020). D.3 Level of Evidence Following the JHNEBP model, this integrative review is classified as Level V evidence, reflecting a synthesis of non-experimental studies. D.4 Quality Rating The review received a Grade B (Good Quality) rating based on its comprehensive search strategy and methodological rigor. Databases utilized included CINAHL, Medline, and the British Nursing Index (Gyesi-Appiah et al., 2020). D.5 Authors’ Recommendations The authors emphasized the necessity of removing urinary catheters as soon as they are no longer medically justified. Early removal was identified as a crucial strategy for decreasing CAUTI rates, supporting the premise of the current EBP question. E. Recommended

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date Evidence-Based Practice and Applied Nursing Research: Hospital Fall Prevention Clinical Practice Problem: Hospital Falls Hospital falls remain a critical challenge in healthcare environments, posing threats to patient safety, increasing morbidity and mortality rates, and generating significant healthcare costs. These incidents can result in fractures, traumatic brain injuries, and prolonged hospital stays that diminish overall patient outcomes and trust in healthcare systems. According to LeLaurin and Shorr (2019), approximately one million falls occur in U.S. hospitals each year, causing an estimated 250,000 injuries and 11,000 deaths. Such data highlight the severity of this issue and the urgent need for effective fall prevention strategies. Moreover, the Centers for Disease Control and Prevention (CDC, 2021) estimated that in 2015 alone, medical expenses resulting from falls—both fatal and nonfatal—reached nearly $50 billion. These costs reflect not only direct medical expenses but also extended hospitalization and rehabilitation services. Given these statistics, implementing evidence-based approaches to prevent falls in hospitalized patients is essential to enhance patient safety and reduce economic strain on healthcare systems. Identify the PICO Components PICO Element Description P (Population/Problem) Hospitalized patients identified as being at risk for falls I (Intervention) Implementation of comprehensive and structured fall prevention education programs C (Comparison) Absence or limited exposure to fall prevention education O (Outcome) Reduction in the frequency or elimination of hospital falls Evidence-Based Practice (EBP) Question In hospitalized patients at risk for falls (P), how effective is implementing fall prevention education (I) compared to limited or no fall prevention education (C) in decreasing or eliminating the number of falls (O)? This EBP question seeks to determine whether educational interventions can effectively minimize fall rates among inpatients, promoting safety and improving health outcomes. Research Article Citationde Freitas Luzia, M., Vidor, I. D., da Silva, A. C. F. E., & de Fátima Lucena, A. (2020). Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Applied Nursing Research, 54. https://doi.org/10.1016/j.apnr.2020.151273 Background and Introduction The study by de Freitas Luzia et al. (2020) explored how structured nursing interventions influence fall prevention among hospitalized patients categorized as high-risk. Using the Nursing Outcomes Classification (NOC) as a framework, the research emphasized the role of nursing care plans and education in enhancing patient awareness, engagement, and adherence to safety protocols. This focus on nursing outcomes is crucial because nurses are often at the frontline of fall risk assessment and prevention. Methodology This quantitative, cross-sectional research involved adult participants aged 17 years and above who were classified as high risk for falls using the Morse Fall Scale (MFS). The study was conducted in both clinical and surgical hospital units, ensuring a diverse participant population. Methodological Aspect Description Design Cross-sectional quantitative design Sample Size 68 patients Inclusion Criteria Adults aged ≥17 years, identified as high risk for falls Assessment Tool Morse Fall Scale (MFS) According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, this study aligns with Level II evidence, indicating strong reliability with some quasi-experimental control in participant selection. Data Analysis The study utilized the Statistical Package for the Social Sciences (SPSS) for data analysis. Pearson and Spearman correlation tests assessed relationships between knowledge levels and fall prevention behaviors. Independent t-tests and Generalized Estimating Equations (GEE) with Post Hoc Least Significance Difference (LSD) tests determined significant mean differences across time and interventions. This robust statistical approach ensured accurate evaluation of educational intervention effectiveness. Ethical Considerations Ethical approval was obtained from the institutional review board, and all participants provided informed consent. Ethical compliance ensured participants’ autonomy, confidentiality, and voluntary participation throughout the study. Quality Rating The study was graded as Quality B, indicating strong methodological quality with minimal limitations. One notable limitation was the exclusion of patients with cognitive impairments, which could reduce the generalizability of findings to broader hospital populations. Analysis of Results and Conclusions Findings indicated that patients’ baseline knowledge regarding fall prevention was generally low. However, educational interventions led to significant improvements in awareness and preventive behaviors. The results underscored that continuous nursing education and patient engagement programs are effective in reducing hospital fall rates. The study concluded that integrating structured educational frameworks such as NOC into nursing care plans can lead to safer hospital environments. Alignment to the EBP Question This study aligns directly with the EBP question, providing compelling evidence that structured educational interventions meaningfully reduce fall occurrences among hospitalized patients. Non-Research Article CitationHeng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w Background and Introduction The scoping review by Heng et al. (2020) synthesized evidence from multiple studies focusing on patient education as a central intervention for fall prevention in hospitals. The review examined the effectiveness, structure, and theoretical underpinnings of educational programs aimed at improving patient engagement in safety behaviors. The authors highlighted that fall prevention education must be patient-centered, evidence-based, and adaptable to individual learning needs. Type and Level of Evidence Aspect Details Type of Study Scoping Review Level of Evidence Level V Quality Rating B – Good quality Author’s Recommendations Heng et al. (2020) concluded that well-designed patient education programs, grounded in behavioral and cognitive learning theories, significantly contribute to fall prevention. They emphasized the importance of incorporating visual aids, interactive learning sessions, and ongoing reinforcement to sustain knowledge retention and behavioral change. Alignment to the EBP Question This review strongly supports the EBP question by affirming that patient education is a pivotal component in reducing fall risks. When education is structured, consistent, and patient-focused, it significantly enhances adherence to fall prevention strategies. Recommended Practice Change The recommended practice change involves implementing a comprehensive fall prevention education program tailored for patients identified as being at high risk of falling. Educational modules should be delivered by bedside nurses and supported by evidence-based tools, including visual materials, demonstrations, and regular reinforcement. Studies by Luzia et al. (2020) and Heng et al. (2020) collectively demonstrate that empowering patients with knowledge not only reduces falls but also promotes shared responsibility in

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date Non-Pharmacological Pain Management Impact of the Problem on the Patient Pain is an inevitable human experience that affects individuals at various stages of life. When pain becomes persistent, it can profoundly interfere with one’s physical activities, mental health, and social relationships. Chronic pain often leads to frustration, anxiety, depression, and diminished quality of life. Traditionally, many patients rely on pharmacological treatments, particularly opioids, to manage their discomfort. Although these medications can be effective in the short term, long-term usage frequently results in tolerance, dependence, or addiction. In addition, opioid use is associated with side effects such as constipation, sedation, respiratory suppression, and cognitive impairment. For patients receiving palliative or end-of-life care, these side effects can significantly reduce comfort and dignity. Non-pharmacological interventions—such as cognitive-behavioral therapy (CBT), guided relaxation, mindfulness-based stress reduction, and physical therapy—provide valuable alternatives or complementary methods to manage pain effectively without the adverse effects of drug dependence. Impact of the Problem on the Organization The opioid crisis has imposed a tremendous strain on the U.S. healthcare system. Stoicea et al. (2019) reported that approximately 66% of drug overdoses in 2016 were related to opioids. This public health issue contributes to higher hospitalization rates, emergency visits, and healthcare costs due to addiction treatment and rehabilitation efforts. From an organizational standpoint, the overuse of opioids undermines safety, increases the risk of litigation, and reduces patient trust in care systems. Integrating non-pharmacological strategies into clinical protocols can mitigate these issues by reducing the frequency of opioid prescriptions and minimizing misuse among patients and families. Furthermore, organizations that adopt holistic pain management approaches often experience enhanced patient satisfaction, reduced readmission rates, and overall improvement in patient recovery outcomes—all of which promote cost-effective, quality-centered care. PICO Components PICO Element Description P (Population) Patients experiencing or at risk for pain I (Intervention) Implementation of non-pharmacological pain management techniques C (Comparison) Absence or lack of non-pharmacological interventions O (Outcome) Measurable reduction in pain intensity and improved quality of life Evidence-Based Practice (EBP) Question Will the use of non-pharmacological interventions reduce pain compared to the absence of such interventions in patients who are at risk for pain? Psychosocial Interventions for Pain Management in Advanced Cancer Patients Background and Introduction Warth et al. (2020) examined the impact of psychosocial interventions on managing pain among individuals with advanced cancer. Patients receiving palliative care often experience restricted physical mobility and emotional distress, which can intensify pain perception. Therefore, integrating non-pharmacological interventions—such as music therapy, art therapy, guided imagery, and mindfulness—becomes essential for improving emotional resilience and comfort. The study aimed to determine whether the combination of psychosocial and pharmacological therapies yields superior pain control and quality of life outcomes. Methodology The researchers conducted a systematic review and meta-analysis using multiple databases in oncology and palliative care. The screening process employed Rayyan, a digital tool that facilitates systematic review management and inclusion criteria assessment. Statistical analyses utilized Cohen’s d to measure effect size, along with Q-statistics and I² tests to evaluate heterogeneity across studies. Moderator analyses identified possible sources of variation in intervention outcomes (Warth et al., 2020). Level of Evidence and Ethical Considerations Category Details Level of Evidence Level I – Systematic Review and Meta-analysis Ethical Considerations The study adhered to ethical standards of research integrity, with no reported conflicts of interest. Quality Rating A – High Quality Data Analysis and Conclusions Although the included studies featured relatively small sample sizes, findings consistently demonstrated a statistically significant reduction in self-reported pain among participants who received psychosocial interventions. The results indicated that therapies such as music and mindfulness-based programs effectively alleviate pain and enhance emotional well-being. Consequently, psychosocial methods should be considered complementary tools within comprehensive cancer pain management plans. Alignment with the EBP Question The study’s outcomes directly support the EBP question, confirming that the integration of non-pharmacological interventions—specifically psychosocial therapies—plays a substantial role in reducing pain and improving quality of life when combined with standard medical treatments. Non-Pharmacological Management of Persistent Headaches Associated with Neck Pain Background and Type of Evidence Côté et al. (2019) developed clinical practice guidelines focusing on non-pharmacological management of persistent headaches related to neck pain. These guidelines, formulated under the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration, aim to translate scientific evidence into practical strategies applicable in clinical settings. D219 Non-Pharmacological Pain Management Strategies in Nursing Practice Type of Evidence Level of Evidence Quality Rating Clinical Practice Guideline Level IV A Authors’ Recommendations The authors recommend a patient-centered care pathway that tailors interventions to the type and severity of headache. Suggested treatments include low-load endurance exercises for craniocervical and cervicoscapular regions, general physical exercise, clinical massage, and structured patient education (Côté et al., 2019). These methods aim to restore muscle coordination, enhance posture, and relieve tension contributing to chronic headache symptoms. Recommended Practice Change Healthcare providers should prioritize the incorporation of non-pharmacological pain management into clinical routines. Interventions such as mindfulness-based relaxation, CBT, and art-based therapies have demonstrated significant benefits in reducing pain perception, particularly in individuals with chronic pain or terminal illnesses (Warth et al., 2020). By standardizing these approaches across healthcare systems, professionals can improve treatment consistency, promote holistic well-being, and reduce unnecessary dependence on medications (Côté et al., 2019). Implementation Strategy Key Stakeholders Stakeholder Role in Implementation Clinical Nurse Educator Provides staff training and patient education on evidence-based, non-pharmacological pain management techniques. Unit Manager Monitors team compliance with the new guidelines and assesses performance outcomes. Chief Nursing Officer (CNO) Updates organizational policies to align with non-pharmacological best practices. Barriers to Implementation A major challenge in adopting non-pharmacological interventions is patient adherence. Many patients expect immediate relief from medications and may resist non-drug-based treatments that require consistent effort. Other barriers include limited access to trained professionals, insufficient institutional resources, and lack of awareness about the efficacy of these interventions. Strategies to Overcome Barriers To enhance adoption, healthcare professionals should: Indicators to Measure Outcomes The success of implementation can be evaluated through quantitative and qualitative measures such as: Consistent decreases in reported pain and improved

Student Name Western Governors University D219 Scholarship in Nursing Practice Prof. Name Date Impact of the Problem on the Patient Hospital-acquired pneumonia (HAP) remains one of the most prevalent yet avoidable complications among patients receiving acute care. When patients are hospitalized, their normal routines—such as maintaining personal hygiene, engaging in physical movement, and sustaining nutritional balance—are often disrupted. These changes, coupled with weakened immunity due to illness or surgery, substantially increase vulnerability to infections such as pneumonia. Patients who develop HAP often require more intensive care interventions, such as intravenous antibiotics, oxygen therapy, and extended monitoring. This condition is frequently associated with severe complications, including sepsis and prolonged hospital stays. As a result, many patients experience delayed recovery and may require transfer to skilled nursing facilities rather than returning home. This shift not only diminishes the patient’s independence but also impacts their overall quality of life and emotional well-being. Beyond the physical toll, HAP contributes to significant psychological distress. Patients commonly experience anxiety, depression, and decreased motivation to participate in rehabilitation or self-care activities. These emotional burdens can slow recovery, particularly in postoperative or elderly populations. Preventive strategies such as maintaining consistent oral hygiene routines and encouraging early mobility are therefore essential in reducing infection risks and supporting holistic recovery. Impact of the Problem on the Organization Hospital-acquired pneumonia (HAP) presents considerable organizational and financial challenges. The Centers for Medicare & Medicaid Services (CMS) classify HAP as a preventable condition, meaning related treatment costs are not reimbursed. Consequently, hospitals face increased financial strain due to extended patient stays, additional treatments, and reduced bed turnover rates. In operational terms, HAP contributes to higher workloads for healthcare staff and the need for resource-intensive interventions such as respiratory therapy and antibiotic administration. These demands can divert nursing resources from other essential care activities, leading to staff fatigue and decreased efficiency. From a performance perspective, hospitals with higher HAP rates may experience reduced quality scores, affecting their accreditation status, public image, and patient trust. Healthcare organizations, therefore, have a strong incentive to implement evidence-based strategies such as standardized oral care protocols. These initiatives not only improve patient outcomes but also enhance operational efficiency, compliance with safety standards, and institutional reputation. 1. Identify the PICO Components PICO Element Description P (Population) Hospitalized patients I (Intervention) Implementation of a scheduled oral care protocol C (Comparison) Absence of a standardized oral care protocol O (Outcome) Reduction in hospital-acquired pneumonia (HAP) incidence 2. Evidence-Based Practice Question Question:For hospitalized patients, will implementing a protocol of scheduled oral care reduce hospital-acquired pneumonia compared to having no standardized oral care protocol? This evidence-based question explores whether structured oral hygiene practices can effectively decrease the occurrence of non-ventilator hospital-acquired pneumonia (NV-HAP) among inpatients. The underlying goal is to determine the role of consistent oral care in preventing infection and improving clinical outcomes in acute care settings. Research Article Title Impact of an Oral Care Intervention among Medical-Surgical Patients 1. Background Introduction The selected research investigates the effectiveness of a structured oral care protocol in reducing the prevalence of non-ventilator hospital-acquired pneumonia (NV-HAP) among patients in a community hospital. It underscores the importance of standardized oral care as a fundamental preventive measure for infections in non-intubated patients, especially those at risk due to immobility or compromised immunity. 2. Methodology The study utilized a quantitative, quasi-experimental design, collecting data both before and after implementing the oral care intervention. Data collection followed the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance guidelines for NV-HAP identification. An interdisciplinary oral care team conducted a comprehensive gap analysis to evaluate existing practices and introduced enhanced oral care tools, staff education, and consistent documentation procedures. 3. Level of Evidence Conducted over two years in a 208-bed community hospital, this study qualifies as Level III evidence according to the Johns Hopkins Evidence-Based Practice (JHEBP) Model. The quasi-experimental design ensured real-world applicability, and oversight by a nurse scientist enhanced methodological reliability. 4. Data Analysis Data collected over 28 months demonstrated a 58% reduction in NV-HAP cases post-intervention. Pneumonia diagnoses were validated through clinical assessment and chest radiographs. The NV-HAP rate was calculated using the following formula: [\text{NV-HAP Rate} = \left(\frac{\text{Number of NV-HAP Cases}}{\text{Patient Days}}\right) \times 1000] (Stepinski et al., 2022). 5. Ethical Considerations The hospital’s Institutional Review Board (IRB) approved and annually renewed the study. Informed consent was not necessary, as the intervention was part of standard nursing care. Ethical risks were minimal because no additional harm or deviation from routine care occurred. 6. Quality Rating Using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) appraisal tool, the study achieved a Level I (high-quality) rating. The findings were consistent, clearly presented, and directly applicable to nursing practice in similar clinical environments. 7. Analysis of the Results/Conclusions – Alignment to the EBP Question The study’s results directly support the EBP question, demonstrating that implementing a structured oral care routine (four times daily) substantially lowers NV-HAP incidence. This confirms that oral hygiene is not only a comfort measure but also a critical infection prevention strategy in acute care. Non-Research Article Title Oral Health Status and the Etiology and Prevention of Non-Ventilator Hospital-Associated Pneumonia 1. Background Introduction This article examines the relationship between oral health and the development of non-ventilator hospital-acquired pneumonia (NVHAP). It synthesizes existing evidence on the microbial causes and pathogenesis of NVHAP, emphasizing how bacterial colonization in the oral cavity contributes to infection. The review highlights oral hygiene as a key preventive intervention that disrupts bacterial growth and lowers pneumonia risk. 2. Type of Evidence The publication is a literature review that integrates findings from multiple peer-reviewed studies, clinical trials, and hospital reports. It consolidates data to develop best-practice recommendations for oral hygiene in hospitalized patients. 3. Level of Evidence Based on the Johns Hopkins EBP Model, this article represents Level V evidence—a summary of prior research used to generate clinical guidance. 4. Quality Rating The article received a high-quality rating under the JHEBP framework. Evidence presented shows that structured oral hygiene programs reduce NVHAP cases by 37%, resulting in an estimated savings of $1.72 million, 500 hospital days, and eight patient lives annually (Scannapieco et al., 2022).