NURS FPX9100 Assessment 6 Project Charter

Project Charter

NURS FPX9100 Assessment 6 Project Charter: COPD, which stands for Chronic Obstructive Pulmonary Disease, requires effective therapy to control the exacerbations and other symptoms. The current practices at the practicum site do not provide sufficient knowledge pertaining to COPD management, such as inadequate nutritional knowledge, delay in timely follow-ups, and failure to identify care needs. Patients receiving care from the hospital are not educated about smoking cessation and other lifestyle modifications to manage diseases. Patients do not have access to appropriate emergency services, and they have to experience longer wait times. The proposed practice problem of COPD is significant for the organization as it has implications for the quality of patient care, financial stability, and overall organizational performance. Currently, in the hospital, there is not any disease management program or specialized care services available for COPD patients. 

The gap or opportunity for change was identified by the increasing number of COPD cases and readmissions attributed to inadequate home management of the condition. Patients lack awareness of COPD management techniques, including dietary considerations and other therapies, leading to readmissions. This gap has contributed to the development of a comprehensive COPD management plan that will assist patients seeking specialized care.

NURS FPX9100 Assessment 6 Project Charter

A study by Amritphale et al. (2021) evaluated the US Nationwide Readmission Database (NRD) to sample COPD readmissions in the 30-days. It was concluded that an estimated 10.5% of the patients encountered an unplanned 30-day readmission, the most significant in the elderly population. The major aetiologies were co-morbidities, including diabetes mellitus and inadequate management at home. According to American Lung Association (2020), healthcare providers and COPD clinics must educate patients on nutritional guidelines to improve breathing and reduce complications that can result in hospitalization. A systematic review by Tarazona-Santabalbina et al. (2023) found that malnutrition is common in COPD patients and is associated with poor outcomes, including increased hospitalizations and mortality. For COPD, the major healthcare costs were attributed to inpatient services, accounting for 28.8% of the expenses, followed closely by prescription medications, which accounted for 28.5% of the costs (Nurmagambetov, 2022).

The desired condition requires implementing cost-effective care services to reduce COPD expenditures and improve patient outcomes. The effective strategies of nutritional interventions and telehealth to reduce unplanned readmissions will improve the outcomes and provide higher-value care. Therefore, care providers and staff must educate patients admitted to the hospital on nutritional modification and arrange timely follow-ups through telehealth.  Like NURS FPX9100 Assessment 6 Project Charter

Gap-Analysis tool: RCA (Root Cause Analysis)

The proposed intervention for COPD management includes the use of telehealth and nutritional modifications. Several studies support the implementation of non-pharmacological interventions, including telemonitoring to guide patients on breathing exercises, medication adherence, and dietary counseling. Telemonitoring was associated with fewer acute exacerbations in patients with COPD (Andersen et al., 2023).

In a systematic review and meta-analysis conducted by Hanlon et al. (2023), the efficacy of nutritional interventions for COPD patients was assessed. The study concluded that these interventions, encompassing dietary counseling and supplementation, have the potential to enhance lung function, decrease exacerbations, and improve the overall quality of life. A study by Scoditti et al. (2019) found that COPD patients often have inadequate dietary intake, including low intake of fruits and vegetables, which can contribute to malnutrition and poor outcomes. It was evaluated that patients need to increase their protein intake and limit starchy and simple carbohydrates to improve their nutritional status.

A systematic review revealed that under HRRP policies, the national 30-day all-cause readmission rate for acute exacerbations of COPD (AECOPD) is approximately 20%. These findings underscore the importance of implementing interventions to reduce COPD readmissions in hospital settings. The proposed intervention of a comprehensive care plan, which includes telehealth and nutritional interventions, aligns with these findings (Njoku et al., 2020).

The project aims to improve staff education on nutritional modifications and telehealth interventions for ameliorating COPD outcomes pertaining to improved lung functioning and quality of life.
 

The goals of the project are mentioned below.

• Reduction in readmission rate due to COPD will be achieved over the time period of 10 weeks through the intervention of telehealth and dietary modification.
• In the time period of 10 weeks, staff compliance will increase with nutritional interventions by implementing a comprehensive care plan consisting of evidence-based nutritional guidelines provided by a registered dietitian. This will be achieved through interdisciplinary collaboration and regular staff training sessions to ensure effective implementation and adherence to the care plan. 
• Staff knowledge regarding COPD management will increase, resulting in decreased hospital stays and the provision of cost-effective care services.

Part II

NURS FPX9100 Assessment 6 Project Charter

Healthcare providers and staff

(Dr Johnson, Nurse Anne, and Respiratory Therapist Lee)

Team Leader

(Ms. Erica, COPD care specialist)

Ms Erica is selected for the team leader role in this project because she has specialized knowledge and experience in COPD management. She can provide expert guidance and leadership in developing and implementing the interventions proposed in the project charter, such as nutritional counselling and telehealth services.

She has essential skills and knowledge in project management and leadership. As a COPD care specialist, she can better lead the project due to her emotional intelligence and can make fair decisions in task distribution and team management. She has performed in healthcare for the last five years and belongs to the Hispanic community, and she is aware of the diversity principles. Therefore, she can address ethical practices, diversity, equity, and inclusion in team leadership. She can provide education and training to staff on COPD management, which can improve staff knowledge and compliance with nutritional interventions, as she has experience in interdisciplinary collaboration. 

Ms Erica will utilize a collaborative and transformational leadership approach for this project, which will be beneficial in achieving the project’s goals and improving COPD management at the practicum site.

Collaborative leadership will be essential in communicating with other professionals, such as nutritionists, respiratory care specialists, nurses, and other members involved in the project. Nieuwboer et al. (2018) also supported the implementation of collaborative leadership in clinical decision-making to provide integrated care.  

Transformational leadership is also suitable for this project, as it aims to enhance COPD outcomes through interventions like nutritional counselling and telehealth services. By creating and effectively communicating a vision for the future, they can inspire and motivate team members to work towards achieving the project’s goals. A study by Nnate et al. (2021) implemented a transformational leadership approach for shared decision-making in a respiratory unit. The authors concluded that to enhance positive patient outcomes for COPD, it is preliminary to implement a multidisciplinary approach with effective change management principles.

NURS FPX9100 Assessment 6 Project Charter

These two approaches are selected due to their significant relation with intervention. By combining transformational leadership, which inspires and motivates team members towards project goals, with collaborative leadership, which fosters teamwork and collaboration, the project leader can cultivate a culture of innovation, collaboration, and teamwork. 

As a staff nurse, I have encountered several challenges regarding collaboration due to cultural barriers. Sometimes, insufficient knowledge about cultural practices can hinder the process of communication. Therefore, professionals and leaders must be aware of cultural competency. If the project requires innovation and creativity, the leader may need to take a more transformational approach to inspire and motivate team members to develop or come up with new ideas. However, when the project is confronted with a tight deadline, the leader may opt to employ a more directive leadership approach. This approach allows the leader to provide clear instructions, closely monitor progress, and ensure that the team remains focused and meets the deadline effectively.

Identify 4-6 team members (initials or fictitious name), department or affiliation and credentials or qualifications. Think about how a diverse set of individuals (demographics, disciplines, experiences, knowledge) will add to the team!

Describe each team member’s title, department or affiliation, qualifications/credentials and the rationale for inclusion and how the person contributes to the project’s success.

MS in nutritional sciences and dietetics.

Experience in respiratory diseases management through diet

She can provide effective leadership and guidance to the team, ensuring that the project aligns with the organization’s goals and objectives. Additionally, she can actively monitor the progress toward achieving the project’s goals.

She can contribute to remote patient monitoring through telehealth, emphasizing the importance of collaborative teamwork to ensure the successful implementation of telehealth. 

She can provide support to the team by assisting with patient care and monitoring patient progress.

 She can also provide feedback to the team on the effectiveness of the interventions and help identify areas for improvement.

Communication Plan: NURS FPX9100 Assessment 6 Project Charter

The team leader’s communication purpose would be to ensure that all team members are on the same page by engaging every team member. 

The team leader would need to share updates on the project’s progress, provide guidance and support to team members, and solicit feedback and input from the team.

The team leader holds the responsibility of communicating with all team members. 

The team leader plays a vital role in delivering messages and ensuring understanding among team members.

The Registered Dietitian’s goal in communicating with the team is to educate and include them in nutritional recommendations for COPD. 

The registered dietitian would have to communicate authentic and evidence-based nutritional advice, conduct training sessions for personnel, and get input from the group.

Regular communication between the Registered Dietitian and team members is essential to inform everyone about the project’s progress. 

The RD will communicate with the team on a daily basis to make necessary modifications to the plan and to communicate on the implementation stage on the project. 

To educate the staff on nutritional modification and telehealth, the dietitian will regularly communicate with staff through one-hour teaching sessions (PowerPoint presentation) at the practice site.

The dietitians will also resolve the queries of the staff regarding nutritional modification or knowledge gaps associated with them. 

Language differences between team members may hinder effective communication and understanding of nutritional concepts.
It is necessary for nurses to avoid jargon and other complicated terminologies in the teaching session.

Bullock et al. (2019) also explained that the use of medical jargon can hinder the process of communication. 

The purpose of communication for the Respiratory Therapist would be to inform members of respiratory care techniques for COPD through telehealth. 

The respiratory therapist will share evidence-based respiratory care guidelines, provide staff training sessions, and solicit team feedback and input. 

The therapist will educate the staff daily on respiratory care and management through breathing exercises and maintaining a current balance of medications. 

They will also evaluate the patients weekly to get their feedback on lifestyle changes.

They will have weekly updates and specific communication at key stages, including the project’s initiation, implementation phase, and completion.

The respiratory therapists will tailor the communication to meet each audience member’s needs and knowledge levels, ensuring that information is effectively conveyed.

The preferred method of communication will be video conferencing with team members and other stakeholders. The respiratory therapist can incorporate PowerPoint presentations or simulation methods in their communication approach (Marker et al., 2019).

The team leader is responsible for communication with the therapist.

It is important to deliver messages on respiratory care techniques.

Intervention and Measurement: NURS FPX9100 Assessment 6 Project Charter

The project incorporates two main interventions for staff education, telehealth, and nutritional modifications, which align with the existing literature on non-pharmacological interventions for COPD management. Research by Janjua et al. (2021) used standard Cochrane methodological procedures to evaluate the effect of telehealth interventions on COPD outcomes. The research found that multi‐component interventions related to remote patient monitoring are likely to result in fewer re-admission to hospitals with COPD exacerbations. According to Fomengia (2019), staff education on telehealth and other advanced technologies for COPD care can improve the self-management of COPD in patients. The study focused on evidence-based educational packets for staff and patients, which include the use of smart apps and other exercise therapies at home for enhanced lung functioning. Literature has also supported the use of nutritional interventions by staff to improve the quality of life for COPD patients. A nutritionally augmented multi-dimensional intervention which includes a nutrition plan with daily protein requirements and food supplements can improve the individual functional capacity and COPD symptoms (Hegelund et al., 2023)

According to American Lung Association (2019), it is recommended to use telehealth to provide remote monitoring and guidance on breathing exercises, medication adherence, and dietary counseling.

The telehealth intervention involves guiding patients through breathing exercises, medication adherence, and remote monitoring using video conferencing or phone calls, with implementation led by the Respiratory Therapist and Nurse Technician. The nutritional modification intervention entails providing evidence-based dietary guidelines to COPD patients, with the Registered Dietitian responsible for conducting training sessions for staff and ensuring effective implementation. 

The project’s logical progression stems from the literature synthesis supporting non-pharmacological interventions, leading to the practice recommendation for a comprehensive care plan and culminating in the proposed project intervention of staff education and implementation to enhance COPD outcomes in a hospital setting.

• Scope of work detailing week by week what will be done and estimated hours (include as appendix).
• Appropriate appendices are included.
• NURS FPX9100 Assessment 6 Project Charter

For this see the appendix

Improvement Model / Framework

The Chronic Care Model (CCM), which consists of six critical elements, can be a valuable tool for the COPD improvement project. The elements of self-management support, delivery system design, decision support, clinical information systems, community resources, and healthcare organization are all aligned with the project’s goals and objectives (Rose & O’Connor, 2021).

To improve care delivery and support patient care, the project proposes a telehealth intervention that aligns with the CCM’s delivery system design and clinical information system elements. Similarly, a nutritional modification intervention aligns with the CCM’s self-management support and community resources elements, seeking to empower patients in managing their condition and providing access to community resources for their care.

By employing the CCM, the project can adopt a comprehensive approach to chronic disease management. It addresses key aspects of care, encourages patient self-management, and promotes the use of available community resources. This framework offers a structured and cohesive approach that aligns with the proposed interventions and supports the goal of improving COPD management and outcomes.

The rationale for choosing the Chronic Care Model for the COPD project is that it aligns well with the goals and objectives oimproving COPD management and outcomes. COPD ichronic condition that requires long-term, integrated care involving various healthcare providers. The CCM emphasizes on patient and staff engagement, self-management support, and collaborative care. Additionally, the CCM recognizes the importance of community resources and healthcare system support in delivering effective care. This aligns with the project’s aim of implementing telehealth and nutritional modification interventions, which involve collaboration among care providers and hospital staff to provide high-quality care.

By adopting the Chronic Care Model, the project can leverage its evidence-based strategies and interventions to enhance care delivery improve patient outcomes, and promote sustainability in COPD management. The framework provides a structured and holistic approach that addresses the multifaceted nature of COPD and ensures a paent-centered and coordinated care experience.

Proposed Outcomes

As the project aims to reduce hospital readmissions due to COPD then, the balancing measure would be an increase in the ED room visits for COPD exacerbations

Increase in staff workload due to daily training sessions.

Part III

The data will be collected at regular intervals of one week following the staff training and education.

Over the period of ten weeks, in the first week, the data will be identified which needs to be collected, particularly for COPD outcomes. The data will be managed in the second and third weeks, and staff training sessions will be upheld. After training for 4 weeks, the staff will implement the intervention.

The results will be compared with the previous data and outcome measures in the last week.

And the final report will be prepared.

Specific measures for protecting the data from unauthorized access or disclosure will be the implementation of encrypted or password-protected (Fillmore et al., 2023)

Only authorized staff and team members will have access to the data.

• The project design consists of a Quality Improvement (QI) initiative for the staff and care providers. The aim is to enhance staff knowledge and education about COPD management through telehealth and dietary modification. It will assist patients in better managing their COPD at home and seeking care through telehealth.

• For measuring the reduction in readmission rate due to COPD, the method of analysis will be to calculate the mean and standard deviation of the readmission rates before and after the intervention. For the outcome measure of the improved staff compliance with the nutritional intervention, the method of analysis will be to calculate the percentage of staff who were compliant with the nutritional interventions before and after the intervention. The means of the knowledge scores will be calculated to know the percentage of the staff knowledge of COPD management. 
• A rating scale will be used to analyze data regarding patient satisfaction scores.

• The instrument used for assessing staff knowledge will be the COPD Knowledge Questionnaire (CKQ) by Bristol. It is a validated tool that can be used to evaluate staff understanding of managing COPD, but it will be modified with nutritional and telehealth knowledge to get accurate results. CKQ is a 20-item survey called the CKQ measures respondents’ knowledge of things, including COPD symptoms, risk factors, treatments, and self-management. The CKQ has demonstrated strong construct validity, test-retest reliability, and internal consistency (Ma et al., 2019).
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Describe the psychometric properties (reliability and validity) of any instruments, tools, surveys, or questionnaires used; status of permission to use instruments. If the instrument is not public, permission to use the instrument is attached as an appendix.