NURS 8720 Week 8 Project Feasibility Analysis Example

Designing to the Building: A Feasibility Analysis That Turns Four Constraints of a Community ICU Into Decisions About a Mobilization Project

Student Name

College of Nursing, Walden University

NURS 8720: Doctoral Seminar II

Instructor Name

Month Day, Year

Designing to the Building: A Feasibility Analysis That Turns Four Constraints of a Community ICU Into Decisions About a Mobilization Project

Four Constraints

No data analyst. The hospital has no analyst available to the ICU; quality reports are produced centrally on a fixed schedule.

An educator at half time. The ICU's nurse educator is employed half time and splits even that between the ICU and the step-down unit.

A twenty-one-week window. After the four-week prospective baseline, the project has from February to June 30 for improvement cycles.

Monthly reports. The electronic record's standard reports for the ICU arrive monthly, about ten days after the month ends.

Each constraint is treated below as information about what the project can be, not as an excuse for what it cannot do. Feasibility, in improvement work, means designing an intervention and its measurement so that the people in the setting can sustain them with the resources they actually have (Langley et al., 2009).

No Analyst: Choose a Measure the Record Already Produces

Without an analyst, a measure requiring custom queries, linking tables or cleaning free text is not feasible. The main measure was therefore designed so that the record can produce it with a standard report. The educator will add a single required field to the ventilator flowsheet: the highest ICU Mobility Scale level reached today, entered by the patient's nurse at 1800. The scale was chosen partly because it is a single number with clear definitions that bedside staff can apply consistently (Hodgson et al., 2014). The standard flowsheet report can then list, for every ventilated patient-day, the date and the level entered. Counting the days at level 3 or higher, and dividing by eligible days, is a spreadsheet calculation the project lead can do in under an hour a month.

The constraint also ruled out two measures considered earlier: minutes of mobilization per day, which would need a time-stamped entry for each session, and time from intubation to first mobilization, which would need linking ventilator start times to activity entries. Both are better measures in principle. Neither can be produced reliably here, and a measure that depends on someone's spare evening will not survive the project.

The single field also limits what can go wrong. A measure assembled from several fields can fail in several places, and each failure would need someone to investigate it. With one required field, a missing entry is visible on the report the next morning, and the champion can ask the nurse concerned while the day is still fresh.

A Half-Time Educator: Teach Inside Existing Huddles

Separate training sessions for 28 nurses across two shifts would take more of the educator's time than she has. The teaching is therefore folded into the unit's existing shift huddles, which happen at 0700 and 1900 every day and last about ten minutes. Over two weeks, each huddle covers one part of the protocol in five minutes: the safety screen, the whiteboard, calling the respiratory therapist, recording the scale level. Nearly every nurse attends several huddles in two weeks, so coverage comes from repetition rather than scheduled sessions. The champion on each shift handles questions during the shift, and the educator spends her project time, about two hours a week, reviewing the first entries and correcting misunderstandings.

The cost of this choice is depth. Huddle teaching cannot include hands-on practice of mobilizing a ventilated patient. That is addressed by pairing each nurse with the champion or the physical therapist for their first mobilization under the protocol.

Huddle teaching also has an advantage beyond saving time. Because it happens in the unit, at shift change, it reaches night nurses as easily as day nurses, and night nurses are the ones who complete the safety screen. Scheduled classes in the education room tend to be attended mostly by day staff, which would have left the first step of the protocol in the hands of the nurses least prepared for it.

A Twenty-One-Week Window: Plan Few Cycles and Accept Weekly Points Early

Twenty-one weeks allows five to seven cycles of two to three weeks. The project will therefore plan only the first two cycles in detail, the safety screen and the respiratory therapist call, and leave later cycles to be chosen from what those reveal. To see change within the window, the first eight weeks will be charted weekly, roughly 12 eligible days a week. Weekly points are noisier than monthly ones, but they give enough points for run chart rules to detect a shift within two months rather than six (Perla et al., 2011). After eight weeks, the chart moves to monthly points.

Monthly Reports: Accept a Ten-Day Lag, and Watch the Process in Real Time

Monthly reports arriving ten days late mean the main measure will always describe the recent past, not the present. The project accepts this lag for the main measure but adds a process measure that can be seen in real time: the night champion tallies, each morning, how many ventilated patients have a screen result on the whiteboard. That count takes two minutes and shows within days whether the first step of the protocol is happening. If screen completion falls, the team can respond before the monthly report confirms a drop in mobilization.

The Project That Fits the Building

Taken together, the four decisions produce a smaller project than the one first imagined: one main measure from a single flowsheet field, teaching in five-minute huddle segments, two planned cycles with later ones chosen as the project learns and a daily paper tally alongside a monthly report. It is a project the unit can run without help it does not have. Doctoral project guidance stresses that feasibility includes the resources, time and support available in the practice setting, and that a project designed beyond them is unlikely to be completed or sustained (Moran et al., 2020). The design that results is one the unit could keep running after the doctoral project ends, which is the strongest test of feasibility there is.

References

Hodgson, C., Needham, D., Haines, K., Bailey, M., Ward, A., Harrold, M., Young, P., Zanni, J., Buhr, H., Higgins, A., Presneill, J., & Berney, S. (2014). Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart & Lung, 43(1), 19-24. https://doi.org/10.1016/j.hrtlng.2013.11.003

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Moran, K. J., Burson, R., & Conrad, D. (2020). The doctor of nursing practice project: A framework for success (3rd ed.). Jones & Bartlett Learning.

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895