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NU 631 Week 14 Assignment 1: EBP Grant Proposal Week 14 Assignment 1 EBP Grant Proposal NU 631 Week 14 Assignment 1: EBP Grant Proposal Value: 100 points Due: Day 7 Grading category: Assignments Instructions For this assignment, incorporate all of the work you have done for your EBP project in the course and write a grant proposal for The Daisy Foundation. (Note: you do not actually submit the application; rather, just complete the assignment for this course.) This grant proposal is similar to other grants that you might submit in the future. Grant proposals are typically submitted as one comprehensive document. Review the grant information: J. Patrick Barnes Grants: Grant Types. Review the grant application form: Evidence-Based Practice Grant Application Form. Include the following in your assignment: Purpose of the Project Background EBP Model (remember, you are using the IOWA model for this project) Proposed Change Outcomes Evaluation Plan Dissemination Plan (journal articles you would want to write in—refer to Week 15 for journal information) and rationale Appendices Informed Consent Template (from Week 7; you should have made revisions based on faculty feedback and submit the revised form for this assignment) Human Subjects Research Training Certificate (from Week 7 after you have made edits based on faculty feedback) Literature Matrix (from Week 9; you should have made revisions based on faculty feedback and submit the revised form for this assignment) Description of Tools and Instruments you plan to use for your EBP proposal (from Week 11; you should have made revisions based on faculty feedback and submit the revised form for this assignment) including aspects such as: name, author, number of questions, validity and reliability, and how it is administered (self, clinician, or researcher administered) References List APA format is required in your Word document. Page length, excluding the title and references list, is between 10 and 12 pages. Please refer to the Grading Rubric for details on how this activity will be graded. To Submit Your Assignment: Select the Add Submissions button. Drag or upload your file to the File Picker. Select Save Changes. Abstract This study is being proposed to find out whether increased nursing education and training impacts prevention of pressure ulcer development in immobile nursing home patients. Pressure ulcers are localized areas of tissue destruction that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period. Purposive sample will be used to select the participants (n=59) from six (6) selected Long Term care facilities out of the twelve (12) in Massachusetts under one management. The participants will range from certified nursing assistants to licensed nurses involved in direct patients care at least three times weekly with n=31 in the standard group and n=28 in the intervention group. The study will be closely aligned with quantitative research and will use the case-control design group to evaluate the impact advanced nursing education and training has on pressure ulcer prevention in nursing home immobile patients. The Chi-Square Test will be used to test the hypothesis by comparing the observed frequencies, to enable the investigator to decide whether advanced nursing staff education and training impact the development of pressure ulcers in nursing home immobile patients. The expected outcome is that there will be less or no pressure ulcer development on the unit with intervention compared to the standard group. Key Words: Nursing Education and Training, Pressure Ulcer Prevention, Pressure ulcer development, Nursing home patients   Introduction Research problem The problem identified was the increase of pressure ulcers in health care facilities. Pressure ulcers continue to be a challenge on a daily basis (Fletcher et al., 2017), and a huge industry is focused finding preventative measures both national and international (Fletcher et al., 2017). Finding measures to prevent pressure ulcer occurrences helps the patients live better healthy lives. Pressure ulcers can change a person’s physical, social and they increase the mortality rate. A lot of sources provide information on nursing practice and such sources include traditional, authority, trial and error, personal experience, intuition, borrowed evidence and scientific research (Schmidt & Brown, 2009). Although Evidence Based Practices (EBP) are important to nursing practice; nursing professionalstinue to be challenged in keepingwith new research information and technology that can assist them in providing the better-quality patient care. Research purpose The purpose of this study is to assess how effective increased nursing education and training impact the prevention of pressure ulcer development in immobile nursing home patients. Research Aims/Objectives The research question for this study is: what causes pressure ulcers, who is at risk for getting these ulcers and how do we prevent them from occurring? The following is the hypothesis: There will be a significant reduction in pressure ulcer incidence in the group with higher education and that receives training when compared with standard group. Purpose The primary aim of this study is to evaluate the effectiveness of advanced nursing education and training on the incidence of pressure ulcer development in nursing home patients. Procedure The study is scheduled to take place from June 14, 2021, through August 2021. Fifty participants are required to participate in the study, and they will be required to fill out a questionnaire with 25 multiple questions about basic wound/skin care. They will also provide demographic information such as date of birth, education level including type of license if applicable, gender, nursing experience, special wound care experience and long-term care experience. Costs, Benefits and Risks There are no major risks involved in participating in the study but there will be an inconvenience of travel to other locations to participate in the scheduled trainings at no cost. There is no payment for this participation The participant will need to take time to fill out the questionnaire before the deadline. A certificate of attendance will be awarded to all the participants at the completion of the study and five nursing CEU will be awarded to the intervention group. Confidentiality During the study, your confidentiality and identity will be protected. No real names or specific birth dates will be used in the interpretation of the results. A special code or number will be assigned to each participant and the facility they come from to use when filling out any documents so that the researcher does not know who filled out the questionnaire. No unauthorized personnel will have access to the data collected during the research process. This data will be kept for five years after the research and will then be destroyed according to the federal laws. Participation, Dismissal and Withdrawal from the Study Participation in this research is voluntary; participants can choose to withdraw from the study without affecting their relationship with the facility they work for. The participant is free to withdraw their consent at any time without prejudice. On the other hand, the investigator can also withdraw your consent from participating in the study if circumstances arise that warrant so. The investigators are registered nurses in the state of Massachusetts and abide with the laws of the state to report any information regarding elderly abuse, neglect, threatened homicide or suicide. Privacy The records of this study will be kept private. Because of the need to keep participants’ privacy, the study records will be stored away in password coded cabinets. Any electronic information will be coded and secured in password -protected files. Anyone who accesses these cabinets and files will have a special code that identifies who they are. All responses to the study will be anonymous that way, not even the researcher will know whose responses they are.  Responses are anonymous when the researcher does not know the identity or any identifying information about who wrote them. In case of any kept data, it will be securely protected in password-coded cabinets. No personal identifying information will be kept. Any personal information will be carefully destroyed after the end of the study. No published reports will include any personal information that will make it possible to identify you. Review of Literature Introduction This literature review will cover a topic that has continued to command the attention of the nursing profession for the longest time in years and remains a clinical challenge today, impacting negatively on health and financial gain; and that is pressure ulcers (Rodrigues, 2016). The research question is does increased nursing staff education and training impacts the prevention of pressure ulcer development in immobile nursing home patients?” The literature review is aimed at obtaining the most current knowledge regarding the education and training of nurses and how they impact the prevention of pressure ulcer in immobile patients. This review includes both empirical and theoretical literature and the following databases were used: EBSCO host, EBSCO Cochrane collection, CINAHL Plus, MEDLINE, Health Source:  Nursing/Academic Edition and Psych. All articles obtained with full text through Regis College Library. The other online search engines used were Google scholar, PubMed.gov and Google search to find articles and other reading materials that provided information regarding evidence-based research on pressure ulcer prevention. The keywords used were pressure ulcers, nursing education and pressure ulcer prevention. The search generated hundreds of written articles that contained the words pressure ulcer. Nursing education and research books were also used to gain supporting information on pressure ulcers prevention as well as official government sources. The final search includes eight research articles; both qualitative and quantitative designs were used in the selected studies. Sample size in reviewed studies varied from n=14 to n=99,396. Participants of these studies were recruited from different health care settings such as hospital and long-term care facilities, and they included both men and women, Different types of research designs were used both in quantitative and qualitative study, and all the studies were approved by the respective ethics and review boards of the respective countries in which the studies took place. Empirical Literature A lot of advanced studies have been conducted regarding pressure ulcer prevention and wound healing techniques. These studies range from skin products for instance topical growth therapy, modified therapy for scar tissue production, use of skin cleaners and protectors to help manage and maintain skin integrity and hence preventing incontinence-associated dermatitis (Avsar and Karadag,2018). Samuriwo, (2010), conducted a qualitative research study where (n=16) on the effects of education and experience on nurses’ value of pressure ulcer prevention. Results showed a significant relationship between education, experience and values as evidenced by nurses’ prior exposure to high grade pressure ulcers and post education, increased the value they placed on pressure ulcer prevention. In his research article, Samuriwo greatly appreciated nursing education on pressure ulcer prevention. He emphasized that little or no knowledge on pressure ulcer presented low value of pressure ulcer prevention thus nurses were less likely to undertake preventative interventions in clinical practice. In another cohort study different stages of bundle implementation, Lavalle et al., (2019) concluded that the use of pressure ulcer prevention bundles increased staff motivation to provide comprehensive care to the clients hence reducing the pressure ulcer incidents. The implication to current practice is that the pressure ulcer bundles placed a high value on pressure ulcer leading to proactive preventative measures of pressure ulcers. Nurses place a lower value on pressure ulcer prevention than with any other aspects of nursing (Samuriwo, 2010). Due to the above findings, the investigator therefore argues the need to revise the nursing curriculum today. In nursing education and schools, several clinical rotations are completed in places such as hospitals, rehabilitation centers, long term care facilities, community nursing, home health care with school nursing. However, no rotations have been scheduled in wound care centers to expose and teach new nurses what wound care is all about and how to maintain proper skin care. In a retrospective mixed research study with time series diagram, the focus was on quality improvement on an orthopedic unit and looking more closely into pressure ulcers. Unbeck et al., assessed the effects of implementing the two-month theme improvements, focusing on one cycle at a time. There was believed to be a gap between the theory and practical knowledge that was affecting the professional and outcome improvement (Batalden and Stoltz; Brandrud et al., Unbeck, 2013). Noting that there was no best way of implementation (Bate et al., Unbeck, 2013), a design and application was set up, making it easy to understand and apply. And any changes in the nursing practices had been approved and in accordance with safe practices. Through Prevention of pressure ulcers is a two-step process the first being to identify patients at risk of developing pressure ulcers and the second step to reliably implement effective prevention strategies. Pressure ulcers are an important and potentially preventable problem in long term care (Poss, Murphy, Woodbury, Osted, Stevenson, Williams et al 2010; Moore 2010). Occurrences of pressure ulcers vary among facilities despite the availability of validated tools for evaluating at risk individuals. The key risk factors reported in the literature are both intrinsic and extrinsic including impaired mobility, poor nutrition, poor physical health, advanced age, moisture, medical device such as adhesive tape, impaired cognition, and sensory perception (Poss, et al 2012). During a non-experimental correlation descriptive study (n=866), three dependent variables likely to be sensitive to nursing practice were identified to examine the proportion of certified nurses and patient outcome. Even though there was no significant relationship found, all certified and non-certified personnel contributed to patient outcome (Krapohl, et al 2010). Week 14 Assignment 1 EBP Grant Proposal Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NU 631 Week 14 Assignment 1: EBP Grant Proposal Evidence-based practice points out that lack of identification of patients at risk for pressure ulcers, demonstrates the need for health care facilities to increase prediction, early assessment, and preventative strategies. A quantitative quasi experimental nonequivalent study carried out by Poss et al 2010 (n= 99,398) examined the potential of the Minimum data Set (MDS) assessment, mandated for use in Long-term care (LTC) homes to inform the risk of pressure ulcer using the Braden scale. The study was meant to stimulate Braden scale domains with MDS items using clinical expert input and use it as a starting point to develop a bed side MDS-based scale identifying residents at different levels of risk for developing pressure ulcers. In a comparative descriptive study (n=31) comparing in person and digital photograph assessment of stage III and IV pressure ulcers among veterans with spinal injuries; concluded that wound assessment can be improved towards the movement of automated system but noted that variations may be expected when assessors of different levels and training were involved as well as using digital media than with live viewing (Terris et al 2011). Appendix A Literature Matrix Qualitative Research Question Type of Study Research Design Sample, Sample Size, and How Selected Instruments Used, Reliability and Validity, Data Collection Methods Results (including statistical analysis Consistent with other Literature) Limitations.                  Samuriwo, Ray (PhD. Student) October 2010,   Effects of education and experience on nurses’ value of ulcer prevention,   British Journal of Nursing (Tissue Viability Supplement) volume 19 Number 20 (2010) What value do nurses place on pressure ulcer prevention? To determine the value that nurses place on pressure ulcer prevention.   Qualitative   Welsh Straussian grounded theory study Female Nurses ranging from second year nursing student to senior nurse managers recruited from a non-acute medical ward of 14 hospitals in one NHS trust and a university n=16 -Convenience sampling. No specific information given. -Indirect measures with, semi-structured focus group interviews. -Instrument reliable because values are ambiguous and mean different things to different people. -Nurses talked about their experiences about looking after patients with pressure ulcers, and the researcher elicited their values from what they said. -Data was collected in a two-stage process and interpreted through the Straussian grounded theory. Results were positive, as all the participants revealed how the value, they placed on pressure ulcer prevention had gone from low to high. -All identified the same key landmarks even though they had different levels of education and experience, become more proactive in preventing pressure ulcers. -The key point in transition being an encounter with a patient with a high-grade pressure ulcer caused the nurses to reappraise their values. -Education that nurses receive on pressure ulcer, prevention only appears to alter their value when they have some experience of looking after patients with pressure ulcer. Sample size small, non randomized not statistically significant, high concern for bias, minimum requirement is 20-30 individuals -Lack of hands on of the participants, most interventions delegated to health care assistants and students. -Values are primarily established by personal experience, an old weaker derived source of evidence. -Researcher is a student not an expert on the subject. -Gender exclusive participants all women in. -No statistical information given provided for comparison of high or low values. Jeff Poss et al, September 2010 Development of the inter RAI (Resident Assistance Instrument) pressure ulcer risk scale (PURS) for the use in long-term and home setting Biomed center (BMC) Doi: 10.1186/1471-2318-10-67 The purpose of this study was to examine the potential of Minimum Data Set (MDS) assessment, mandated for use in Ontario LTC homes, to inform the risk of Pressure Ulcers (PU).   Quasi-experimental non-equivalent group design study.   Comparative correlations design, using independent and dependent variables -Included an admission or baseline MDS assessment of residents having a stay of 14 days or longer (median time 91 days) -Three LTC homes with n=257 with MDS and Braden Scale assessments; n=12,896 from eight LTC homes with baseline/ reassessment of MDS data, n=13,062 from Complex Continuing Care Hospital (CCC) and n=73,183 from long stay home care clients. All assessed during the same time, restricted to those with no recorded pressure ulcer. -All assessments were done by trained clinical staff.             -Assessment using the RAI, data collection and analysis -spearman Rank Correlation (all significant at p<0.0001 Logistic regression of new Pressure ulcers was used to determine those MDS items was statistically significant (at p=0.05 or below) in a multivariable, parsimonious model. MDS items higher numbers more impairment   Instrument was valid but unreliable according to previously collected data -LTC homes the Braden scale was tested for its predictive ability with PU down to 1%from 9% with a c-statistic of 0.676. In CCC patients, distribution skewed towards the high-risk end of 9.7% with a c-statistic 0.607. In long stay home care, inter RAI PURS leaned more towards low risk much lower that, in LTC and CCC at 2.6% with c-statistic of 0.629 data analyzed using the   SAS and SAS enterprise Miner Tree Desktop version 9.1.3 were used for all data analyses -consistent with other literatures such as quality improvement in nursing homes (Abel RL 2005) and A longitudinal study of risk factors associated with the formation of PU (Brandeis GH et al 1994 -Risk assessment tools, including the Braden Scale, have been criticized for their generally weak properties D. Anthony et al (JCN 2008) -No information available for palliative and hospital Study not randomized controlled -Demographic information was unavailable for Braden scale sample. -Sample presented predominantly elder female residents. Possibility of under reporting pressure ulcers such as stage Lavallee.J.F., Grary,T.A.,  Dumville,J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle. A feasibity  study.  Health & social care in the community ,27 (4). https://doi.org/10.1111/hsc.12742 To examine implementation delivery and fidelity, staff views on using the intervention; and to investigate general study issues such as nursing home retirement and retention. Quantitative And Qualitative Mixed method feasibility study involving quantitative uncontrolled before and after study of the bundle. Qualitative semi structured face to face in 462 bed days were collected prior to implementing the bundle. Data of 1181 bed days was collected in the intervention phase. Quantitative data was collected for 5 weeks during monitoring of pressure ulcer prevention behavior by staff. Data collection went on for 9 weeks during implementation phase. Used three evidence-based elements: support surface, skin inspection and repositioning. Intervention such as intervention champions were incorporated. Each intervention had a behavioral change attached In recruitment and retention phase, nursing staff was unable to continue with the study due to staff shortage. Of the 21 participants (n=21) for nurses and healthcare assistants and (n=29) for residents in one nursing home, 12 attended the in-person training session (nurses (n=3), healthcare assistants (n=8), manager (n=1) and 4 participated in face-to-face interviews (n=4), it’s only the 4 that also attended the training. *Pre-intervention phase, 75% adherence to repositioning was noted. 5 more pressure ulcer cases were documented. *Intervention phase, 1181 data collected, no more cases were documented.   The study was a small scale, relying on self-reported behavior and participants knew their ulcers were being monitored. Inability to collect demographic information due to lack of ethical approval. Poor adherence rated due to several implementation issues, understaffing, disagreement with the content of the bundle Unbeck, M., Sterner, E., Elg, M., Fossum, B., Thor, J., & Pukk Härenstam, K. (2013). Design, application and impact of quality improvement ‘theme months’ in orthopaedic nursing: A mixed method case study on pressure ulcer International Journal of Nursing Studies, 50(4), 527–535. https://doi.org/10.1016/j.ijnurstu.2013.02.002 The purpose of this study is to report on the design and application of quality improvement theme months in orthopaedic nursing and evaluate the impact on PU as an example.   Mixed method study Retrospective mixed method with time series diagram The sample was taken from a 52-orthopedic department in a Swedish hospital where at least 3700 patients are admitted yearly. Some of the ways that this data was collected is through participant observation of improvement theme months, retrospective record review, review of hospital performance indicator measurements using statistical process control. Hospital process performance was assessed using a modified Norton scale. Impact on patient outcome was detected through retrospective record review. Patterns of theme months’ impact over time; was recorded through descriptive statistics and time series diagrams.   This was a 46 monthly point prevalence with samples ranging from 28-66 admissions. Substantial improvements were found in risk assessments rates for pressures in both longitudinal follow-up (P<0.001) and in the annual county council-wide measurements. Reduction in pressure ulcer rate was seen in county council-wide measurements. In the longitudinal, wider variations were noted (P<0.067). There was a decrease in pressure ulcer rates in the final ten-month period of the study. Retrospective record review was limited by the availability of data; missing data due to poor documentation will lead us to underestimate the true PU rates. Attribution may have contributed to the changes in performances.   A. (2017). Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis. Worldviews on Evidence-Based Nursing, 15(1), 54–61. https://doi.org/10.1111/wvn.12264 The purpose of the study was to determine the cost-effectiveness and efficacy of evidence-based   nursing intervention has on increasing tissue tolerance by maintain skin integrity Repeated measure design type of study was used. It was the frst time such kind of a study had been used. Questionnaires were used for this study. 154 adults enrolled into the program, 77 participants were the intervention group and another 77 were in the control group. The participants were all patients in in the cardiovascular department. The participants filled out questions about their health. Instruments included the Braden pressure ulcer risk assessment scale (BPURAS), Incontinence associated Dermatitis (IAD), Pressure ulcer identification form, Patient characteristics form and a cost table for all interventions. There was a deterioration of tissue integrity that was witnessed in 18.2% of patients in the intervention group compared to 54.5% in the control group (p<.05). The cost of increased tissue tolerance prevention in both the intervention and control groups was X= $204.34+41.07 and $138.90+1.70 respectively. Only two groups in the cardiovascular department were studied hence limiting the results.   Theoretical Literature Education of nurses influences the way of nursing practice as nurse educators are required to provide up-to-date educational material and textbooks are the most frequently used sources of knowledge. In a content analysis study (n=92) of nursing schools in German investigate the extent to which textbooks were evidence based, regarding preventing pressure ulcers and what recommendations to make to nursing students; to address the question if evidence-based education and nursing pressure ulcer prevention textbooks do match. The study then concluded that only one of the four analyzed textbooks used in the nursing schools complied with the recommendations of the German Expert Standards, the other books were incomplete (Wilborn, Halfens, Dassen, 2009). Education of health care professionals is a very important factor in the prevention of pressure ulcers (Wilborn et al, 2008). However, due to staff shortages that are evident today, releasing staff to attend training sessions is a big challenge; therefore, to address the education needs of nurses with respect to pressure ulcers, e-based education is seen as the best alternative method of delivering education (Jones, 2007). It was then concluded that to be able to minimize the risks of pressure ulcer effects, nursing needed to be educated on how to recognize the early signs of pressure damage and plan appropriate care (Jones,2007). While in another research (n=4), improving wound and pressure area care in nursing homes Sprakes (2010) described a collaborative project between a community skin care service and nursing home. The major purpose of the study was to establish whether implementation of wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. In conclusion there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits and nursing staff reported an increase in their knowledge and skills. For effective practice pressure ulcer prevention, it’s important for nurses to receive adequate education and training to practice competently as education is often cited as one of one of the reasons for the continuing high prevalence and incidence of pressure ulcer (Moore, 2010). Questions The research question for this study is: what causes pressure ulcers, who is at risk for getting these ulcers and how do we prevent them from occurring? The following is the hypothesis: There will be a significant reduction in pressure ulcer incidence in the group with higher education and that receives training when compared with standard group. Sample The demographic questions will include age, sex, type of license, level of education, years of experience and other questions that will be deemed important. A sample of fifty-nine participants. The investigator will be selecting two long term Care (LTC) facilities from a pool of six locations managed by one company in Massachusetts. Inclusion criteria certified and licensed nursing staff involved in direct patient care at least three times a week for a total of twenty-four hours.  Facility A will be the control group and facility B will be the experimental group. This will be a convenient sample and the participants will be requested to participate in the educational research study to determine whether advanced education impacts pressure ulcer development (N=59) will be used with non-equivalent groups; standard group will be N=31, the number of staff members on a one single unit, and the intervention group will be N=28 the number of all staff members on that unit. A letter will be sent out describing the study and inviting nurses and nursing assistants to participate in a confidential online survey will be drafted by the principal investigator and a link will be sent to the nursing home unit managers of the participating facilities. The participants will be able to choose between filling out the demographic survey online or a printed-out copy will also be available in the nursing office. A secure lockbox will be set up in the nursing staff lounge to insert in all the completed forms for pick-up. The survey will close in two weeks after the four-week reminder. All subjects will be adult certified and licensed nurses with an active certified nursing assistant certificate, a nursing license from the state of Massachusetts. Setting The proposed setting for the study will be the participating health facilities for the filling out of the questionnaire however two eight-hour training sessions including a focus group for the intervention group will be held at the same facility. Informed Consent The researcher will request approval from the Institutional Review Boards (IRB) at the participating Long Term Care facilities and will also submit a request to the ethical advising board for approval to conduct the study. No risk to the participants is anticipated as no direct patient care will be jeopardized. The participants will be sent a letter of implied consent stating that when they complete and return the demographic survey it implies consent to be included in the study. The letter will state the purpose of research project, why these subjects were selected, the length of time it will take to complete the survey and any risk or benefits to participating in the study. It will also state that upon completion of the survey all information will be confidential and their consent will be implied. Instruments/ Tools Implement strategies for pressure ulcer prevention, tools, or instruments of how to put these strategies into actions must be established first. Questionnaire and the Pressure Ulcer Knowledge Assessment Tool (PUKAT) were used to collect and assess data in this study. To appropriately collect the participant data, a questionnaire will be used. These questionnaires were very descriptive and included all the demographic information such as age, level of education, nursing experience if applicable, all of which was needed to determine whether the participants qualified for the study. The questionnaire will be accessed via internet or hard copy for those that cannot access the internet. This tool was adapted by (Dlungwane and Malinga,2020) who were studying the knowledge, attitude, and practices of the nurses in pressure ulcer prevention. For the questionnaire’s reliability, a Cronbach’s coefficient alpha was used to measure consistency, complementarity, and correlation coefficient. The questionnaire data was entered in an Excel spreadsheet, validated by an independent person, and imported to the Social Sciences (SPSS) IBM Version 23. Through a pilot study the validity of the Cronbach’s alpha results were confirmed. The PUKAT is an assessment tool with 26- items which help identify and prevent injuries/ulcers. This tool consists of areas such as risk assessment, nutrition, classification, development, and preventative measures (Khong et al, 2020). Before Khong (2020) used this tool, it was used in other studies by Demarre (2012), Beeckman (2011) and Simonetti (2015) as cited by Khong (2020). This instrument achieved an overall Cronbach’s α of 0.77, and the items’ Cronbach’s α ranged between 0.40 and 0.87. The lowest internal consistency was found for the concept of “risk assessment” (Cronbach’s α = 0.40). The instrument is stable with an overall intraclass correlation coefficient (ICC) of 0.88 (95% CI 0.79, 0.93, P < .001), (Khong, 2020). The PUKAT tool has very limited information of being used, apart from the Khong (2020) study, therefore there was nothing to compare it too. For this study, a questionnaire will be used to collect demographic data from participants. This will be done via internet or hard copy for those that can not access the internet. See Appendix C for a copy of the questionnaire Appendix B Nursing Staff Demographics Name (optional) ________________________  Participant number_________ Date of Birth___________________ Age_______ Gender:  Female____ Male___ Please circle off the most appropriate answer. 1.What is your primary language? English Spanish Other: Specify What is your ethnicity? Caucasian Black/African American c. American Indian/Alaska Native Asian Hawaiian Native/Pacific Islander   Some other race   (specify): ___________________   What is your Employment Status (check one)? F/T P/T Per Diem How many hours do you work a Week? <16                                                                         b.  16-28 29-35                                                                                                      d. 36-40 >40 What shift do you often Work? 8-hour Days (7am-3pm) b. 12-hour Days (7am-7pm) 8-hour Eve (3p-11p) d. 8-hour nights (11pm-7am) 12-hour Night (7pm-7am) f. Weekends only g. Other(specify) _________ What is the highest level of education Attained? Grade level (Specify) b. High School c. Some College (years) ____ College (graduate)____years e. master’s degree              f.  post-master’s certificate Doctorate What type of active Nursing License/certificate do you currently hold? Certified Nurse’s Assistant (CNA) b. License Practical Nurse (LPN) Registered Nurse (Associates) d. Registered Nurse (Bachelors) Registered Nurse (Masters) f. Registered Nurse (Doctorate) How many Years of nursing experience? <1 year b. 1-2years c. 3-5 years   d. 6-10years  e. 11-15 years 6-20 years g. >20years Are you wound care certified? Yes No How long have you been employed with the current facility? <1 year b. 1-2years c. 3-5 years 6-10years e. 11-15 years                        f. 16-20 years                         g. >20years     Appendix C Limitations The sample in the study does not show a great deal of variability, which compromises external validity and makes it difficult to apply the findings to other facilities. The patient variables and characteristics such as co-morbidities, age and nutrition status also influences pressure ulcer development. References Caro, I. D., & Heras, S. G. G. (2020, January 8). Incidence of hospital-acquired pressure ulcers in patients with “minimal risk” according to the “Norton-MI” scale. PloS one. https://pubmed.ncbi.nlm.nih.gov/31914154/. FLETCHER, J. A. C. Q. U. I., VOWDEN , P. E. T. E. R., SAMURIWO, R. A. Y., PANKHURST, S. A. R. A. H., & VERDON, A. M. Y. (2017). With a national focus on prevention, how well do we treat pressure ulcers?, 13(2). Jones, M. L. (2007). E-learning in wound care: developing pressure ulcer prevention education. British Journal of Nursing, 16(Sup3). https://doi.org/10.12968/bjon.2007.16.sup3.24529 Khong, B. P., Goh, B. C., Phang, L. Y., & David, T. (2020). Operating room nurses’ self‐reported knowledge and attitude on perioperative pressure injury. International Wound Journal, 17(2), 455–465. https://doi.org/10.1111/iwj.13295 Kraphol,G., Manojlovich,M.,Redman, R., Zhang,L.(2010). Nursing specialty certification and nurse –sensitive patient outcomes in the intensive care unit. American Journal of Critical Care. 19(6), 490-499. Malinga, S., & Dlungwane, T. (2020). Nurses’ Knowledge, Attitudes and Practices regarding Pressure Ulcer Prevention in the Umgungundlovu District, South Africa. Africa Journal of Nursing and Midwifery, 22(2). https://doi.org/10.25159/2520-5293/7691 Moore, Z. (2010). Bridging the theory–practice gap in pressure ulcer prevention. British Journal of Nursing, 19(Sup5). https://doi.org/10.12968/bjon.2010.19.sup5.77703 Poss, J., Murphy, K.M., Woodbury,G.M., Orsted,H., Stevenson,K. Williams,G. et al(2010). Development of inter RAI pressure ulcer risk scale(PURS) for use in long-term care and home care settings. BioMedCentral  10(67), 1471-2318 Samuriwo, R. (2010). Effects of education and experience on nurses’ value of ulcer prevention. British Journal of Nursing, 19(Sup10), 11–24. https://doi.org/10.12968/bjon.2010.19.sup10.79689 Schumidt, N.A, Brown, J.M.(2009). Evidence-based practice for nurses. Sudbury, MA:Bartletta Sprakes, K., & Tyrer, J. (2010). Improving wound and pressure area care in a nursing home. Nursing Standard, 25(10), 43–49. https://doi.org/10.7748/ns.25.10.43.s48 Terris, D. D., Woo, C., Jarczok, M. N., & Ho, C. H. (2011). Comparison of in-person and digital photograph assessment of stage III and IV pressure ulcers among veterans with spinal cord injuries. The Journal of Rehabilitation Research and Development, 48(3), 215. https://doi.org/10.1682/jrrd.2010.03.0036 Unbeck, M., Sterner, E., Elg, M., Fossum, B., Thor, J., & Pukk Härenstam, K. (2013). Design, application and impact of quality improvement ‘theme months’ in orthopaedic nursing: A mixed method case study on pressure ulcer prevention. International Journal of Nursing Studies, 50(4), 527–535. https://doi.org/10.1016/j.ijnurstu.2013.02.002 Wilborn, D., Halfens, R., & Dassen, T. (2009). Evidence-Based Education and Nursing Pressure Ulcer Prevention Textbooks: Does It Match?, 6(3), 167–172. https://doi.org/10.1111/j.1741-6787.2008.00129.x Submission status Writing Assignment Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Writing Assignment Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Content of Paper The writer demonstrates a well-articulated understanding of the subject matter in a clear, complex, and informative manner. The paper content and theories are well developed and linked to the paper requirements and practical experience. The paper includes relevant material that fulfills all objectives of the paper. Follows the assignment instructions around expectations for scholarly references. Uses scholarly resources that were not provided in the course materials. All instruction requirements noted. 30 points The writer demonstrates an understanding of the subject matter, and components of the paper are accurately represented with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Course materials and scholarly resources support required concepts. The paper includes relevant material that fulfills all objectives of the paper. Follows the assignment instructions around expectations for scholarly references. All instruction requirements noted. 26 points The writer demonstrates a moderate understanding of the subject matter as evidenced by components of the paper being summarized with minimal application to evidence-based practice, theory, or role-development. Course content is present but missing depth and or development. Does not follow the assignment instructions around expectations for scholarly references. Only uses scholarly resources that were provided in the course materials. Most instruction requirements are noted. 23 points Absent application to evidence-based practice, theory, or role development. Use of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. Content of paper is inaccurately portrayed or missing. Does not follow the assignment instructions around expectations for scholarly references. Does not use scholarly resources. Missing some instruction requirements. 20 points 30 Analysis and Synthesis of Paper Content and Meaning Through critical analysis, the submitted paper provides an accurate, clear, concise, and complete presentation of the required content. Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints. All instruction requirements noted. 30 points Paper is complete, providing evidence of further synthesis of course content via scholarly resources. Information is synthesized to help fulfill paper requirements. The content supports at least one viewpoint. All instruction requirements noted. 26 points Paper lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. The paper’s content may be confusing or unclear, and the summary may be incomplete. Most instruction requirements are noted. 23 points Submission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario. Demonstrates incomplete understanding of content and/or inadequate preparation. Missing some instruction requirements. Submits assignment late. 20 points 30 Application of Knowledge The summary of the paper provides information validated via scholarly resources that offer a multidisciplinary approach. The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application is provided. All questions posed within the assignment are answered in a well-developed manner with citations for validation. All instruction requirements noted. 30 points A summary of the paper’s content, findings, and knowledge gained from the assignment is presented. Student indicates how the information will be used within their professional practice. All instruction requirements noted. 26 points Objective criteria are not clearly used, allowing for a more superficial application of content between the assignment and the broader course content. Student’s indication of how they will apply this new knowledge to their clinical practice is vague. Most instruction requirements are noted. 23 points The application of knowledge is significantly lacking. Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible. Demonstrates incomplete understanding of content and/or inadequate preparation. Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice. Missing several instruction requirements. Submits assignment late. 20 points 30 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement and supportive content and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization, and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Missing significant content. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100 Order Now