NURS 839 Week 4 Assignment 5 Scholarly Project Proposal Methodology Paper Example

Scholarly Project Proposal, Methodology: A Twelve-Week Pre-Post Quality Improvement Design for a Silicone Foam Dressing Protocol in Fourteen Operating Rooms

Design

The project will answer the PICOT question with a pre-post quality improvement design using a historical comparison group. Outcomes for eligible patients in the twelve weeks after implementation will be compared with outcomes for eligible patients in the same twelve calendar weeks of the previous year, before any protocol existed. Moran et al. (2017) describe quality improvement designs of this kind as appropriate for DNP projects that implement evidence-based practices rather than test new interventions, and the Iowa Model's piloting phase calls for exactly this kind of local evaluation before wider adoption (Iowa Model Collaborative, 2017).

The design has known threats to internal validity. History is the main one: other changes in the operating rooms during the project period could affect injury rates. The team will record any concurrent changes, such as new support surfaces, and the comparison will use the same calendar weeks to reduce seasonal effects. A second threat is detection bias, since nurses aware of the project may look harder for injuries afterward. The structured skin assessment described below will be used in the implementation period, and baseline injuries will be drawn from wound care consultations, which may undercount; this limitation will be reported rather than hidden.

Setting

The project will take place in the main operating suite of a 350-bed nonprofit community hospital, with fourteen operating rooms performing orthopedic, spine, general, colorectal, gynecologic and urologic surgery, and in the four surgical inpatient units where patients recover. About 2,600 operations a year are booked at three hours or more, roughly 600 in any twelve-week period.

Population and Sample

The population is adults whose operations are booked for three or more hours under anesthesia. Patients qualify if they are adults with a booked anesthesia time of at least three hours, or any duration for patients with diabetes or a body mass index of 40 or more, reflecting evidence that these factors raise risk (Johansson et al., 2026), and a postoperative stay of at least 24 hours. Exclusion criteria are an existing pressure injury at the sacrum or heels, a documented allergy to adhesives and planned postoperative intensive care admission, since intensive care units follow their own dressing protocol. All eligible patients in each period form a convenience sample; no individual consent is required for a practice standard approved for all eligible patients.

Intervention

The protocol, approved as a nursing standing order, has six steps. First, the day before surgery, the scheduling system flags eligible cases on the surgical list. Second, in the preoperative area, the nurse inspects the sacrum and heels and documents baseline skin status. Third, after induction and before final positioning, the circulating nurse places a multilayer silicone foam sacral dressing and two heel dressings, confirming sacral placement with the surgeon when it lies near the preparation field. Fourth, the dressings are recorded on the intraoperative record. Fifth, the dressings stay on for as long as three days, lifted each shift on the inpatient unit for skin assessment and replaced if soiled or displaced. Sixth, at 72 hours or discharge, the dressings are removed and a final assessment is documented.

Measures

Primary Outcome

The primary outcome is the proportion of eligible patients who develop a new injury of stage 1 or above at the sacrum or a heel within three days of the operation, staged according to the revised national system (Edsberg et al., 2016). In the implementation period, nurses will check skin every shift by looking at its tone and feeling its warmth and firmness while asking about pain, instead of relying on redness, which supports detection across skin tones (Neu et al., 2026).

Secondary Outcomes

Secondary outcomes are the stage of any injury, device-related injuries and length of stay. Patient characteristics recorded for every case are age, sex, body mass index, diabetes, preoperative albumin when available, surgical position, actual anesthesia time and skin tone category.

Implementation Outcomes

Four implementation outcomes will be measured (Proctor et al., 2011). Adoption is the proportion of surgical services using the protocol by week 4. Penetration is the proportion of eligible cases in which all three dressings were documented. Fidelity is assessed by direct observation of ten cases a week against a five-item checklist. Acceptability is measured at week 6 with a four-item survey of circulating nurses and surgeons using a five-point scale.

Data Collection and Management

Comparison-period data will come from the health record and the wound care consultation log, pulled by the informatics nurse. During the implementation period, the project lead will extract the same variables weekly and add the structured skin assessments and audit results. Data will be entered into a password-protected spreadsheet on the hospital's secure network, with each patient assigned a study number and the link between numbers and medical record numbers kept separately by the informatics nurse. Two wound care nurses will review every reported injury to confirm staging, resolving disagreements by discussion. Their agreement on the first twenty cases will be recorded to show how consistently stage 1 injuries are identified.

Data Analysis

Analysis will use SPSS. Descriptive statistics will summarize patient characteristics in each period, reporting averages with their spread for measured variables and counts with percentages for categories, and the two periods will be compared with independent t tests and chi-square tests to detect differences in patient mix. The primary outcome will be compared between periods with a chi-square test, switching to Fisher's exact test when expected counts are too small for chi-square, at a significance level of .05. Logistic regression will estimate the odds of injury in the implementation period while adjusting for diabetes, body mass index and anesthesia time. Implementation outcomes will be reported descriptively, and weekly penetration and injury counts will be displayed on run charts and interpreted with standard run chart rules. Results will also be reported by skin tone category, so that any group in which injuries remain common is visible to the team. The baseline rate from consultation records is about 2%, roughly a dozen injuries in twelve weeks, and is probably an undercount. With about 600 patients per period, the project will have limited statistical power to detect even a halving of that rate, so the difference between periods will be presented with a 95% interval around it and rely on run charts to show change over time rather than on a single significance test. A pre-post project cannot prove the dressings caused the change; it can show whether the change happened and how faithfully the practice was delivered.

Protection of Human Subjects

The project lead has completed CITI training in human subjects protection. Before data collection, the project lead will ask both the hospital's review board and the university's review process to confirm its quality improvement status. No identifiable information will appear in any report. The dressings are an approved, low-risk standard of care, and any skin reaction will be documented and the dressing discontinued.

Timeline and Resources

Weeks 1 and 2 of the project cover staff education, the scheduling flag and the checklist change; weeks 3 to 14 cover implementation and data collection; and weeks 15 and 16 cover analysis and reporting. Resources include about 1,800 dressing sets for the period, at roughly $14 a set, education time for 60 perioperative staff, informatics time to build the flag and report and the project lead's time for audits, as described by Roush (2019) in planning the practical demands of a capstone.

References

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing, 43(6), 585-597. https://doi.org/10.1097/WON.0000000000000281

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Johansson, V. R., Dahl, O., Falk, A. C., Nilsson, U., Dehara, M., & von Vogelsang, A. C. (2026). Risk factors for position-related injuries in adult surgical patients: A systematic review and meta-analysis. International Journal of Nursing Studies Advances, 11, Article 100676. https://doi.org/10.1016/j.ijnsa.2026.100676

Moran, K., Burson, R., & Conrad, D. (Eds.). (2017). The doctor of nursing practice scholarly project: A framework for success (2nd ed.). Jones & Bartlett Learning.

Neu, C., Furtado, S., Dyck, R., Sheikh, F., Tremain, L., & Johnson, D. (2026). Early identification of pressure injury: An equity-informed initiative. Advances in Skin & Wound Care, 39(6), 288-293. https://doi.org/10.1097/ASW.0000000000000475

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Roush, K. (2019). A nurse's step-by-step guide to writing your dissertation or capstone (2nd ed.). Sigma Theta Tau International.