Student Name Western Governors University D226 BSNU Capstone Prof. Name Date What are Surgical Site Infections (SSIs) and why are they significant in healthcare? Surgical Site Infections (SSIs) are infections that occur after surgery in the part of the body where the procedure took place. These infections may involve only the skin surface or extend deeper into tissues, organs, or implanted materials. SSIs are a major cause of morbidity, prolonged hospital stays, increased healthcare costs, and sometimes mortality. According to the Centers for Disease Control and Prevention (CDC), SSIs account for approximately 20% of all healthcare-associated infections in hospitalized patients (CDC, 2023). Their prevention and control are critical in ensuring patient safety, promoting faster recovery, and supporting value-based care models that focus on improving quality while reducing costs. BSNU Capstone Course Task One: Healthcare Change Proposal This paper represents Task One of the BSNU Capstone Course, focusing on the creation of a comprehensive healthcare change proposal. The purpose of this paper is to identify an organizational sponsor who will evaluate, support, and approve the proposed initiative. The document also includes sponsor feedback, supporting evidence, and a clear justification of how the change contributes to value-based care improvement. Additionally, this proposal identifies essential stakeholders, outlines a strategic implementation plan, and concludes with a reflective discussion of the author’s leadership role and influence as a change agent in clinical transformation. Organizational Context The proposed change will be implemented at the Mike O’Callaghan Military Medical Center (MOMMC), a military treatment facility (MTF) managed by the Defense Health Agency (DHA) and the Department of Defense (DoD). Located at Nellis Air Force Base in Las Vegas, Nevada, MOMMC provides emergency and specialty medical services to active-duty service members, dependents, and DoD beneficiaries. The author currently serves as a civilian contractor and registered nurse in MOMMC’s Emergency Department (ED). The ED consists of twenty beds and two trauma bays, with staffing composed of military personnel, civilian employees, and contractors. Due to its Trauma Level III designation, MOMMC receives both military and civilian trauma cases. While staffing stability is generally strong, challenges arise during military deployments. Approximately 40% of the ED workforce comprises civilian and contract employees, ensuring continuous coverage during deployment rotations. Change Proposal Description Current Process At present, patients entering the emergency department check in at a front desk staffed by two registration technicians. These staff members perform full patient registration before the patient undergoes triage or medical evaluation. This process, while administratively thorough, introduces delays for patients presenting with critical conditions such as chest pain or cardiac distress. Proposed Change The proposed modification involves relocating registration technicians to the back area of the department, where they will handle administrative and clerical responsibilities. In their place, a medical technician and a registered nurse (RN) will be stationed at the front desk to conduct rapid symptom assessment and quick registration. This restructuring prioritizes clinical triage at the initial point of contact, ensuring that patients exhibiting ST-Segment Elevation Myocardial Infarction (STEMI) symptoms are identified and treated without delay. Purpose of the Change The primary goal of this proposal is to reduce the “door-to-EKG” time for patients exhibiting cardiac symptoms. According to the American Heart Association (AHA) and the American College of Cardiology (ACC), a 12-lead EKG should be obtained within 10 minutes of a patient’s arrival to the ED (Dechamps et al., 2016). Currently, MOMMC achieves this benchmark for only 40–60% of patients. By placing medically trained professionals at the front desk, the emergency department can significantly improve early recognition and timely intervention, leading to improved patient survival rates and alignment with national cardiac care standards. Impact of Proposed Change Aspect Current State Proposed Change Expected Outcome Staffing at Front Desk Two registration technicians One medical technician and one registered nurse Quicker symptom recognition and faster EKG administration Door-to-EKG Time (STEMI Patients) 40–60% compliance with 10-minute standard 100% compliance with 10-minute benchmark Improved clinical outcomes and compliance with AHA standards Patient Flow Delays during registration Streamlined triage and registration Reduced wait times and enhanced satisfaction Role of Registration Technicians Full registration Administrative support at back desk Better utilization of staff skills This staffing redesign aligns clinical expertise with frontline patient needs, optimizing both efficiency and safety in emergency cardiac care. Feedback from Organizational Sponsor Brian Hubbard, RN, BSN, MPA, was selected as the organizational sponsor due to his background in intensive care, cardiac catheterization, and supervisory nursing roles at MOMMC. He offered practical recommendations emphasizing data-driven decision-making and adaptive leadership. Mr. Hubbard endorsed the proposed staffing model and advised a 60–90-day pilot implementation before formal adoption. During the trial, nurses and medics may need to work 1–2 additional shifts per month, potentially encountering minor resistance. He stressed the need for transparent communication and staff engagement, highlighting the link between the proposed change and improved patient outcomes. Potential Barriers and Strategies Barrier Description Mitigation Strategy Staff Resistance Temporary workload increase and schedule adjustments Foster open dialogue, involve staff in planning, and emphasize patient safety benefits Administrative Resistance Possible hesitancy from DoD or DHA to alter staffing models Present outcome-based evidence and compliance with national cardiac guidelines Skill Gaps Staff may lack familiarity with rapid registration Provide structured training and mentorship programs Overcoming these barriers requires strong leadership and staff empowerment, ensuring all team members understand the long-term benefits of the new process. Value-Based Care Enhancement The proposal aligns directly with value-based care principles by enhancing clinical efficiency, patient safety, and satisfaction without increasing financial burden. Key improvements include: By optimizing staff placement and workflow, MOMMC can deliver higher-quality care while maintaining fiscal responsibility. Key Stakeholders and Collaboration Stakeholder Role in Implementation Staff Nurses and Medics Conduct rapid triage and EKGs Registration Technicians Manage back-end administrative functions Emergency Room Nurse Manager Supervise workflow and staffing Emergency Department Medical Director Provide clinical governance Registration Director Oversee registration processes Chief Nurse Support policy alignment and resource allocation Hospital Commander Endorse organizational support Staffing Chief Approve and formalize staffing adjustments Regular monthly progress meetings will be scheduled to review Genesis charting

Student Name Western Governors University D226 BSNU Capstone Prof. Name Date  Introduction BSNU Capstone Course Task One: Healthcare Change Proposal This paper fulfills Task One of the BSNU Capstone Course by outlining a comprehensive healthcare change proposal aimed at enhancing emergency department operations at Mike O’Callaghan Military Medical Center (MOMMC). The proposal identifies an organizational sponsor responsible for reviewing and approving the change. It incorporates sponsor feedback, supporting evidence, and a rationale for how the change will advance value-based care. Additionally, it highlights essential stakeholders, provides a detailed implementation plan, and concludes with a reflective statement on the author’s role as a change agent during this process. Organizational Context The proposed change will take place at the Mike O’Callaghan Military Medical Center (MOMMC), a military hospital operating under the Defense Health Agency (DHA) and the Department of Defense (DoD). MOMMC is situated at Nellis Air Force Base in Las Vegas, Nevada. The author works at MOMMC as a civilian contractor and registered nurse within the emergency department. MOMMC’s emergency department contains twenty beds and two trauma bays and is staffed by a diverse team including military personnel, civilians, and contractors. This team encompasses doctors, nurses, medics, and administrative staff. Though the hospital primarily serves military members and DoD beneficiaries, its Trauma Level III status has increased the number of civilian emergency transports from the surrounding community. Staffing at MOMMC is generally consistent due to the mixed personnel, but temporary shortages can arise when military staff are deployed. About 40% of the emergency room staff are civilians and contractors, which helps maintain stable coverage during such deployments. Change Proposal Description What is the current process for patient registration in the emergency department? Currently, patients check in at the emergency room’s front desk, which is staffed by two registration technicians. These technicians complete full patient registrations before the patients are triaged. What change is being proposed? The proposal suggests relocating the registration technicians to the back of the emergency department, where they would handle unit clerk and registration duties. Instead, a medical technician and a registered nurse would be stationed at the front desk. Their role would be to conduct quick patient registrations and perform rapid symptom assessments. What is the purpose of this change? The primary aim is to reduce the door-to-EKG time, particularly for patients exhibiting symptoms of ST-Segment Elevation Myocardial Infarction (STEMI). Currently, non-medically trained registration staff delay the identification of STEMI symptoms and the administration of EKGs within the national guideline of 10 minutes after patient arrival. Positioning medically trained personnel at the front desk will improve rapid symptom recognition and prompt treatment initiation for high-risk cardiac patients. Registration technicians would then focus on administrative tasks aligned with their expertise. Impact of Proposed Change Aspect Current State Proposed Change Expected Outcome Staffing at Front Desk Two registration technicians One medical technician and one registered nurse Faster symptom recognition and quicker EKGs Door-to-EKG Time for STEMI Patients 40%-60% within 10-minute standard Target 100% compliance Improved patient outcomes and accreditation compliance Patient Flow Delays due to non-medical front desk staff Streamlined registration and triage process Improved throughput and patient satisfaction Role of Registration Technicians Full patient registration Back-end registration and administrative support Better alignment with staff expertise According to guidelines from the American Heart Association and American College of Cardiology, a 12-lead EKG must be completed within 10 minutes of arrival for patients with chest pain or cardiac symptoms (Dechamps et al., 2016). Coronary artery disease is responsible for about 500,000 deaths annually in the U.S. (Butt et al., 2020). This staffing adjustment aligns personnel capabilities with clinical priorities, supporting timely care and potentially reducing cardiac morbidity and mortality. Feedback from Organizational Sponsor Brian Hubbard, RN, BSN, MPA, was selected as the organizational sponsor because of his expertise as an ICU nurse, cardiac catheterization nurse, and nursing supervisor at MOMMC. He emphasized the importance of data-driven decision-making and acknowledged staffing challenges. Mr. Hubbard recommended initiating a 60 to 90-day pilot period for the new staffing model before formalizing the changes. This trial would temporarily require nurses and medics to take on 1-2 additional shifts per month, which could meet some resistance. He stressed the importance of early staff engagement to communicate the benefits of the change, focusing on improved patient care and longer-term staffing stability. Potential Barriers and Mitigation Strategies Barrier Description Mitigation Strategy Staff Resistance Increased work hours and training demands Transparent communication, education on patient benefits, and involving staff in planning Administrative Resistance Potential reluctance from DoD and DHA to increase staffing Use of statistical data and accreditation requirements to justify changes Skill Gaps Lack of familiarity with quick registration Provide targeted training and ongoing support Staff buy-in is crucial for overcoming resistance. Education sessions that emphasize improved patient outcomes and regulatory compliance will be key. Value-Based Care Enhancement The proposed change advances value-based care by promoting interdisciplinary collaboration to optimize outcomes. Medically trained staff at the initial patient contact point can: This strategy benefits all emergency department patients by decreasing wait times and ensuring timely treatment initiation. Key Stakeholders and Collaboration Stakeholder Role Staff Nurses and Medics Implement changes and deliver patient care Registration Technicians Manage registration and administrative tasks Emergency Room Nurse Manager Oversee nursing operations and staffing Emergency Department Medical Director Provide clinical oversight and guidance Registration Director Manage registration processes Chief Nurse Provide nursing leadership and resource support Hospital Commander Authorize organizational resources Staffing Chief Approve staffing document changes Monthly meetings will track progress, review Genesis charting data, and address staff feedback. Metrics such as door-to-EKG time, length of stay, and patient satisfaction will guide ongoing decisions. Resources and Cost Considerations The plan leverages existing internal resources including management, charge nurses, and staff cooperation. Military personnel are not compensated hourly, so the staffing adjustment will not increase payroll expenses. No additional external funding or resources are needed. Implementation Plan Phase Description Planning Engage stakeholders continuously and finalize proposal Milestones Collect weekly/monthly data on door-to-EKG times and patient flow Implementation Roll out after staff

Student Name Western Governors University D226 BSNU Capstone Prof. Name Date Introduction A1a. Professional Mission Statement As a dedicated wound care nurse, my core mission is to provide exemplary, evidence-driven care that not only facilitates healing but also enhances the overall well-being and quality of life for patients. I am committed to merging clinical expertise with a patient-focused approach to develop standardized care protocols. This approach aims to reduce inconsistencies in treatment and ensure every patient benefits from reliable, effective interventions. Looking forward, I aspire to evolve into a leadership role where I can foster a collaborative environment that promotes continuous learning and professional development, ultimately driving better patient outcomes and satisfaction. A1b. Mission Statement Reflection How will reflecting on the professional mission statement guide your nursing career? Reflecting on my professional mission serves as a compass for my nursing journey by highlighting the importance of evidence-based practice, patient-centered care, and leadership development. Staying current with research allows me to apply the most effective treatments, particularly in complex wound care, which can significantly improve healing timelines and reduce complications. For instance, employing wound dressings supported by robust clinical studies can prevent infections and speed recovery. Moreover, respecting patient values and cultural backgrounds strengthens trust and satisfaction, which are critical components of holistic care. As I transition toward leadership, fostering teamwork and advocating for innovation will empower me to implement advanced wound care protocols, enhancing the quality and consistency of care delivered by the healthcare team. This mission statement aligns closely with my professional values and directs my clinical and managerial decisions. Learner & Healthcare Professional A2a. Which two papers represent you as a learner and healthcare professional? Two academic works that best exemplify my development as a learner and healthcare professional are the D226 Task 1 paper and the D221 Performance Assessment. These assignments were instrumental in advancing my research competencies and deepening my grasp of evidence-based practice (EBP), which is essential for driving clinical improvements. Through these papers, I mastered focused literature searching and efficient use of scholarly databases to find credible EBP sources, skills critical to advocating and implementing practice changes. They also demonstrate my analytical strengths in problem-solving by providing thorough assessments and designing well-supported, practical solutions that weigh both obstacles and benefits. A2b. Discuss how specific artifacts in your portfolio represent your professional strengths. My professional strengths include leadership, effective communication, critical thinking, and teamwork. The following table summarizes how selected portfolio artifacts highlight these competencies: Paper Name Course/Task Demonstrated Strengths Description D226 Task 1 Paper D226 Research skills, Problem-solving Conducted a detailed analysis of unit challenges and proposed evidence-based interventions. D221 Performance Assessment D221 Detail orientation, Leadership, Communication Evaluated barriers and benefits to change; developed strategies for implementation and stakeholder engagement. These works illustrate my ability to systematically identify clinical issues, synthesize data, and develop comprehensive, stakeholder-inclusive solutions. A2c. What challenges did you encounter during the BSN program? Balancing my chronic health issues and learning disabilities alongside the rigorous demands of the BSN curriculum posed significant challenges. Symptoms such as fatigue, malaise, and migraines frequently hindered my ability to meet deadlines. Additionally, medications prescribed to manage these conditions sometimes intensified my cognitive difficulties. Due to the absence of formal documentation for my learning disabilities, securing academic accommodations was complicated, necessitating self-devised strategies to support my learning and successfully complete assignments. A2ci. How did you overcome these challenges? I managed these obstacles through a robust support network and proactive self-advocacy. Securing a low-stress outpatient position aligned with my studies reduced overall stress and allowed better health management. Emotional support from my spouse was crucial in mitigating mental strain. I collaborated with my physician to optimize medication regimens, minimizing cognitive side effects. My coworkers helped identify distraction-free testing environments, and guidance from my program coordinator eased the process of navigating institutional accommodations, collectively enabling my academic progression. A2d. How did the BSN program contribute to your professional growth? The BSN program was transformative in enhancing my role as an outpatient wound care case manager and sparked my interest in preceptorship. It deepened my commitment to educating patients and staff and strengthened my critical evaluation of workplace practices. Collaborations with nurse managers and program directors resulted in tailored care improvement initiatives addressing our patient population’s specific needs. This experience nurtured a holistic, comprehensive approach to patient care—emphasizing coordinated referrals and innovative solutions targeting community health determinants. Ethically Competent Practice Professional Definition / Competency 8: Ethically Competent Practice This competency embodies cultivating a professional identity rooted in accountability, collaboration, and ethical conduct, aligned with nursing standards and core values. B1 & B2: How did the Culturally Competent course enhance your practice? The Culturally Competent course solidified my dedication to delivering respectful, culturally sensitive care. It heightened my awareness of personal biases and instilled a proactive approach to prevent them from affecting patient interactions. This sensitivity enables me to advocate effectively for diverse patient populations and support colleagues in improving their cultural competence. Integrating patients’ cultural beliefs into individualized care plans fosters a more holistic, respectful healthcare environment. Scholarship Professional Definition / Competency 3: Scholarship Scholarship involves synthesizing best available evidence, clinical expertise, and patient preferences to advance healthcare quality both locally and globally. B1. How did the Evidence-Based Practice and Applied Nursing Research Performance Assessment help your understanding of EBP? This assessment refined my ability to critically evaluate and apply research to justify clinical practice changes. I learned to differentiate between various types of evidence, assess their relevance, and use data to advocate effectively within healthcare settings. Understanding the synergy between professional values, clinical expertise, and research is essential for ethically sound and contextually appropriate EBP implementation. B2. Why is EBP crucial in nursing? EBP is fundamental to nursing as it combines up-to-date research, clinical judgment, and patient values to enhance care quality. It supports informed decision-making, improves patient safety, and minimizes practice variation. Through standardized protocols and continuous quality improvement, EBP ultimately leads to greater patient satisfaction and better health outcomes. Task 1: Evidence-Based Practice and Applied