Running head: PROPOSAL 1

Benchmark - Evidence-Based Practice Proposal Final Paper

Student’s Name:

Institutional Affiliation:

PROPOSAL 2

Abstract

The time spent in Emergency Departments (EDs) is the most significant in a patient’s

hospital stay period. This is because this is where lifesaving emergency services are offered. This

section is the most challenging for care providers because a slight delay can result in undesirable

consequences on the patients’ health. However, in recent decades, Overcrowding in emergency

departments (EDs) resulting in delays has been a trend in many care organizations. It has now

become a global problem and has been identified as a national crisis in many states. Previous

studies have shown that the major cause of the overcrowding is the inefficiency of the nurses to

accurately carry out diagnosis on the patient within the shortest time possible after admission. With

reference to existing literature in this topic, the goal of this study is to qualify the hypothesis that

nurses who have taken a triage assessment class achieve more accurate and timely diagnosis for

patients with cardiac related chest pain within 10 minutes of patient arrival to Emergency

department compare to the nurses who have not acquired the training. The current study delivered

online triage training to nurses globally using facebook and twitter live videos, for 2 hours daily

for a period of 4 weeks. The study then applied both qualitative and quantitative methods of data

collection. The evaluation showed that nurse triage training resulted in reduced delay and

overcrowding in the emergency department.

PROPOSAL 3

Section A

Evidence Based Practice Proposal

It is important to understand an organization’s culture in order to start assessing its

readiness for EBP implementation. Organization Culture and Readiness for System-Wide

Integration of Evidence-Based Practice is a tool that can be used to assess the organizations level

of readiness. From the survey, one of the categories that scored high is the availability of the

necessary technological equipment. For the EBP to be implemented effectively various

technological equipment such as EHRs will be required which were readily available within the

organization. Another category that scored high is the availability of resources and facilities that

could enhance the efficient implementation of EBP. The organization has libraries which can be

of great significance because the team responsible can be in a better position of researching and

acquiring more knowledge about the EBP. The other resource is the easy accessibility of the

organization's research department. On the other hand, the category that scored low is

employee’s attitude and level of knowledge in regard to the EBP project and organizations

culture. The employees lacked enough knowledge on the importance of the EBP project and how

it would help increase efficiency and quality of services offered to be in line with the

organization's culture.

Project Barriers

One of the project barriers is insufficient funds cater for all the expenses incurred during

the project. Another project barrier is lack of sufficient time to carry out more research regarding

the EBP. The time constraint is facilitated by the heavy workload involved and staff shortage.

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Facilitators

One of the facilitators of the project is appropriate management support. With the help

and support the approval of the necessary project procedures and the financial budget necessary

for the implementation of the project will be easy to achieve. The management also helps the

team in the decision-making process which facilitates the effective implementation of the

project. Another project facilitator is information availability, enabled by easy access to the

internet and also the use of the organization's library materials (Kaplan, Zeller, Damitio, Culbert,

& Bayley, 2014).

Integrating Clinical Inquiry

Clinical inquiry can be integrated into the organization through assessment, skill

building, staff engagement, building infrastructure and generating questions. Some of the weaker

areas of the organization such as lack of enough knowledge by the employees regarding the

importance of using EBP can be strengthened through the introduction of training programs and

seminars .these strategies will increase the employee’s level of knowledge and skills regarding

the use of EBP. This, in turn, can also help change their attitude towards the EBP (Fain, 2017).

Section B

Problem Description

PICOT Research Question

(P) In an Emergency Department, in regards to triage process, are nurses (I) whom have

taken a triage assessment class (C) compared to nurses whom have not participated in a triage

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assessment class (O) more accurately diagnosing patients with cardiac related chest pain (T)

within 10 minutes of patient arrival to Emergency department?

Background

The emergency department of most healthcare organization experience overcrowding due

to the inefficiency of the nurses to accurately carry out diagnosis on the patient within the

shortest time possible. The overcrowding phenomenon in the emergency department has raised

concern in the public health field for the past ten years with several research works carried to

determine the best solution (DiSomma et al., 2015). Research studies have revealed that triage

assessment practice which calls for effective utilization of the available resources to make an

accurate decision is the most preferred solution to the overcrowding issue. However, the nursing

department in most health organizations still expresses variations in the use of the Emergency

Severity Index (ESI) triage algorithm causing the delays in the emergency departments. Majority

of the nurses tend to commit the mistriage on the patients. Nurses who have experience in

Emergency Severity Index (ESI) triage algorithm do not usually commit mistriage and finish the

patient assessment and diagnosis within average 10 minutes thus the need for ESI education in

the nursing profession.

Purpose

The pre-eminent goal of this project is to evaluate the impacts of implementing a triage

assessment process in nurses serving in the Emergency Department on time taken to handle the

patients, focusing on patients complaining of chest pain and receiving treatment within ten

minutes of arrival regardless of nature of chest pain, cardiac related or non- cardiac related.

PROPOSAL 6

Stakeholders

The stakeholders in this research include the nursing departments in all health

organizations handling emergency issues, nursing students through their organizations such as

National Student Nurses’ Association, the nursing organizations such as International Council of

Nurses, the nursing accreditation bodies and nursing training institutions.

Rationale

Most of the nurses in the emergency department misapply the existing Emergency

Service Index triage criteria causing mistriage in the patients, especially patients complaining of

chest pain. The challenge is prominent as most adults express under triage during the ESI

algorithm application. The emergency department being the leading victim of mistriage, it is

essential the nursing professionals refresh themselves on the concept of proper triage ESI

assignment to patients to eradicate the incidences of mistriage. Accurately apply the concept of

ESI triage will help to reduce overcrowding in the emergency department and providing timely

treatment for patients complaining of true (cardiac related) chest pain. There is the need to

improve the existing process of educating practicing nurses in the emergency department on the

ESI triage practice. The new training strategy should involve the establishment of simulation

environment which requires knowledge-sharing and practical high-risk skill utilization to help in

improving the competence on the nursing professionals serving in the emergency departments

(Evans & Kohl, 2014).

The DNP quality improvement educational program that involves the use of social media

platforms such as YouTube and Facebook to help the nursing professionals working in the

emergency departments across the world to share their knowledge and experiences in the

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application of ESI triage practice would be a great program to share and include in reinforcing

the importance of proper triage. The platforms provide room for interaction allowing the

members to have enriching conversations among themselves and understand their areas of

weaknesses and strengths in handling patients with emergency needs. All these efforts aim at

reducing the amount of time taken in the assessment and diagnosis of the patients at the

emergency department thus eliminating the phenomenon of overcrowding in such places

(Fitzgeral, Radmanesh, & Hawkins, 2015). ESI triage practice is an essential aspect of the

emergency management process in a health organization.

Section C

Literature Support

Critical Appraisal of Evidence

The results of the study comprising the article are valid because they address the problem

of overcrowding in the emergency department. The study participants in the intervention and the

comparison groups are similar despite the difference in hostels. The intervention is identified into

the suggestion of ensuring more efficiency in the ED. The participants in the comparison groups

received a reasonable treatment/care based on the treatment of the exposure of interest of the

intervention group. There was no follow-up between groups. There is an appreciable use of

statistical information to enrich the authors of the article present. The use of percentages and

numbers are appropriate. The outcomes were measured with the same instrument regardless of

the circumstances of the operations of the emergency department at each hospital.

The result of the study indicates that the solution to the challenge of ED overcrowding is

determining the full capacity protocol (FCP). For instance, the hospital should pronounce that if

all the beds in the emergency department are filled, then the ED is full, and they should not admit

PROPOSAL 8

others. The results of the study are transformative to the healthcare sector. However, their

precision cannot be determined because of the purpose manner in which they were presented.

The study population of the article is similar to one of the writers of the assignment. The study

results can be used to make a difference in the healthcare sector because they provide a

suggestion that is valid for dealing with the problem of overcrowding. The author utilized

information from the United States Department of Health. The study has internal validity

because it handles the issue of overcrowding in emergency departments. The researcher’s main

inclusion criterion was working as a nurse at the emergency department in the selected hospital.

The results of the study are valid because they address the subject problem of

overcrowding in emergency departments of hospitals. It proposes further education of the nurses

to help them determine the triage parameters appropriately to avoid subjective responses when

asked for the patients to attend to first. The study participants in intervention and comparison

groups are similar. The intervention is identified as the subjection of the emergency department

nurses to further education to train them to use the Emergency Severity Index (ESI) more

appropriately. The study also lacks follow-up and control groups that can be used for comparison

of the basis of the results if the research. There is minimal use of statistical information. The

statistics used are not determinate of the conclusion made because the numbers appear abstract

and whose inclusion of forced.

The measurement of the outcome of the study was obtained post intervention. The

outcomes are measured across the same groups, and hence, they are measured with the same

instrument. The results of the study state that the nurses in a majority of the ED in hospitals do

comprehend the use of ESI and hence, the basis of their allowance of the attendance of the

patient is subjective and not based on the severity of the case because they do not have sufficient

PROPOSAL 9

analytical skills. The results change the perspective of patients towards the nurse. The qualitative

results lack quantifiable precision. The results will help in caring for patients but they will not

make an instant impact in healthcare because they require nurse training. The study’s main

inclusion criterion was working as a nurse at a hospital. No databases were used for the study.

The study is invalid and irrelevant to the PICOT. It deals with the impact of social media

on the healthcare sector while the PICOT addresses issues of the emergency department, triage,

and diagnosis of cardiac issues. The intervention mentioned in the article is the use of social

media platforms to enhance connectivity between patients and their healthcare providers. The

control group of the study is the people without fast internet connection and smart technology.

There is a significant comparison between the preceding generations and the current dispensation

that entails connectivity through the internet. There is an appropriate use of statistic. It is

evidenced in the first statement of the study when the author avails statistics relevant to their

objective. The outcomes measured with valid and reliable instruments that bare the internet-

connected devices available in healthcare. The results of the study indicate that medical

education can be transferred through the technological capacities that the internet has availed.

The authors observe that there is a shift in preferences of the students to use online

content as compared to the former generations of healthcare students that had to attend classes.

The results lack quantifiable precision. The study is not similar to that of the author of the

evidence-based approach. The findings of the research can be used to make a difference in the

general healthcare, but its perspective is skewed towards a different topic in comparison to the

issue of the emergency department and triage. The author does not refer to specific databases for

information but uses other studies whose sources are not identified clearly. The study has

internal validity because its findings are independently relevant to the issue of the impact of

PROPOSAL 10

technology in healthcare. However, it lacks external validity because it addresses a topic that is

not part of the current discussion.

Section D

Solution Description

Proposed Solution

The proposed solution to the problem is increased triage training of nurses attending to

patients to ensure there is uniformity in the Emergency Severity Index (ESI) triage algorithm

amongst the nurses. The solution is based on the need for nurses to demonstrate efficiency in

conducting assessments of patients that report to emergency rooms complaining of chest pains.

Due to the possible severity of their conditions, the ability of nurses to undergo triage training to

improve their experience in the ESI triage algorithm and be able to provide assessments to

patients within ten minutes. The treatment is not unrealistic as most of the nursing personnel

have the necessary training and can improve their ESI triage algorithm competencies to ensure

they can conduct assessments on patients with chest pains within short time spans of less than ten

minutes.

Organization Culture

The proposed solution aligns with the culture of the organization where it aims at

demonstrating high levels of efficiency in the provision of healthcare services to patients. The

ability to improve the efficiency of patient assessments amongst nurses aligns with the cultural

beliefs and shared forms of thinking at the facility of providing patient-centered care. The

solution also aligns with the norms at the healthcare facility where the action is guided by

PROPOSAL 11

evidence to ensure the expectations on areas like patient safety, autonomy, and dignity are

upheld.

Expected Outcomes

One of the expected outcomes is that the nurses that have undergone triage assessment

training are able to effectively diagnose patients with chest pains in less than ten minutes after

the patients report to the emergency rooms. The triage assessment training facilitates the nurses

to identify the nature of the chest pain and the likely condition that the patient is suffering from.

The nurses will conduct such assessments in less than ten minutes for every patient thereby

eliminating the long queues that lead to overcrowding of patients in emergency rooms.

Method to Achieve Outcomes

The hospital will provide the health professionals that will offer training to the nurses that

are still unfamiliar with the triage assessments. The training will be offered in areas such as rapid

assessment, patient categorization and finally allocation of the patients based on the causes of the

chest pains and likely diagnosis (Milbrett & Halm, 2014). The proficiency of the trained nurses

will be evaluated through ESI triage algorithm tests to determine whether the trained nurses have

acquired the required competencies in conducting assessments on patients with chest pains.

To attain the outcomes, only nurses that have undergone triage assessment training will

be deployed in the emergency rooms. Also, such nursing professionals must operate in well-

equipped emergency rooms to ensure they can easily access the needed equipment to facilitate

faster diagnosis. Further, the patients designated to emergency rooms, especially those

complaining of chest pains, must be easily identified and directed to avoid delays.

One of the barriers is language differences between the nurses in the emergency rooms

and some of the patients. The language barrier will be eliminated by ensuring there are

PROPOSAL 12

interpreters that are well-acquainted with the local languages to facilitate ease of communication

between the nurses and the patients. An assumption is that the hospital will provide the necessary

support and continuity to ensure the gained skills by the nurses in triage assessments are

nurtured.

Outcome Impact

The outcomes will lead to quality care improvement that culminates to positive health

outcomes. The increases in the number of nurses with triage training in conducting assessments

on patients with chest pains will lead to timely diagnoses and eliminate the likelihood of

mortality due to delays in diagnosing chest complications. It will also reduce readmission rates

due to the correct diagnosis of chest problems thereby reducing the costs incurred by patients in

the treatment of chest pains (Chung, 2015).

Section E

Change Model

Rogers uses communication in his diffusion innovation theory to elaborate on the way

ideas pick momentum and cover a social system with individuals within the setup embracing the

new analogy and, in the process, enhancing the way they do things (Shiels, 2018). The theory

focuses on communication as the primary tool used in adopting a new idea and applies

throughout the process of implementing the concept right from inception to realization of the

desired results (Dibra, 2015). The document describes the implementation of a triage assessment

process to nurses working in the Emergency Department on the period taken to diagnose

individuals. It emphasizes on patients presenting with chest pains who are supposed to receive

treatment within 10 minutes of arrival irrespective of the nature of chest pain be it cardiac related

or non-cardiac related. The implementation process borrows a lot from the diffusion innovation

PROPOSAL 13

theory since its suggestion in informing and training nurses on the Emergency Severity Index

(ESI) triage algorithm and using it at the basis for continuous assessment of the process. The

phases involved in the implementation process include, persuasion, implementation, decision,

knowledge, and confirmation.

Knowledge Stage

It is essential to create awareness when a new project or idea is proposed. It ensures that

all the stakeholders are involved and acts as a motivating factor for the parties involved to

welcome the concept (Dibra, 2015). The efficient diagnosis of patients in the emergency

department is a collective responsibility. Therefore, it is necessary to enlighten the individuals in

the hospital environment of its essence and its contribution to improving care provision within

the organization. At this stage, the stakeholder, particularly the nurses, need to have the

theoretical knowledge of the proposed change, resins for its adoption, and the method of

implementation.

Persuasion Stage

A new idea is not always welcomed with everybody in the organization. Therefore, the

proposed solution of training nurses on ESI is not an exception. It is highly possible that there

will be few individuals or groups that will not embrace the project. The second stage is crucial in

clarifying the information given in the previous step. Individuals are provided with the

knowledge and are given time to submit their reactions regarding the suggested solution. The

people who are opposed to the idea are then presented with more information and taken through

step by step process of implementation and the benefits of the project to convince them to buy

the idea. It enables the smooth implementation of the concept.

PROPOSAL 14

Decision Stage

After the parties involved are well informed of the proposed solution, the organization

has to decide on whether to implement the project or not. The decision is based on the reaction

and responses collected during the first two stages. Since nurses are the primary players in the

proposed solution, they might level some concerns over the project that need to be addressed

before the organization decides to implement the idea. In most cases, if the project is well

designed and the stakeholders are sufficiently informed, then it is readily accepted. In such a

case, the organization proceeds to the implementation stage while incorporating the suggestions

of the players involved.

Implementation Stage

The implementation stage involves rolling out the suggested solution, as outlined in the

proposal. The implementation begins with the outsourcing of professionals in the triage

assessment field that will train nurses in the organization. The training will concentrate on

patient categorization, rapid assessment, and allocation of patients based on the cause of the

chest pain (Stephenson, Phelps & Colburn, 2018). After rolling out the program, the organization

will monitor the implementation process using the tools provided in the proposal.

Confirmation Stage

It is the last stage of the implementation process according to the diffusion of innovation

theory. Once the proposal is implemented, it is imperative to test it and confirm that it is moving

PROPOSAL 15

in the right direction. The first tool to employ in the evaluation is the ESI triage algorithm tests to

check the proficiency of the trained nurses. The confirmation stage also involves tracking of the

improvement in the time that nurses take to diagnose a patient in the emergency department if it

is falling within the limit.

Section F

Evaluation of the Process

Setting and Access to Potential Subjects

The education program on improving triage assessment process will take place

online. Facebook is where the nurses across the world will share knowledge and experience on

the application of emergency service index triage practice. This setting is better compared to the

traditional classroom setting. Online education has been preferred because of flexibility and

convenience. Many learners will be reached all over the world, unlike traditional means where

only a few nurses would be reached (McCutcheon, Lohan, Traynor & Martin, 2015). Besides,

learning by sharing experiences will be more educative.

With the increase in the use of technology, many nurses can access online services hence

PROPOSAL 16

will be easily reachable there. The stakeholders such as National Students Nurses Association,

International Council of Nurses and Nursing Accreditation Bodies will help in creating

awareness of the education program to the nurses (Goodman, Melkers & Pallais, 2019). Many

nurses follow twitter feeds and Facebook pages of these nursing organizations hence will reach

the nurses very fast. Social media is currently a fast and reliable means of sending information.

A Facebook page will be created and the nurses will be required to give consent to participate by

only following the Facebook page where education will take place.

Timeline

The preparation in regard to resource mobilization will take one month and the

education program will take another 4 weeks, Monday to Friday, for 2 hours every day between

6 pm and 8 pm. Creation of awareness of the program will take one month. The flexible

schedule will ensure make as many nurses as possible to participate in the program.

The first 1 month will be used to creation of awareness of gathering and mobilizing of the

required resources. The next three weeks will be used to deliver theoretical knowledge to

establish a background for practical training.th next three weeks will be used to assess the level

PROPOSAL 17

of knowledge acquisition through questions and answers. The last 4 weeks will be utilized to

gather study participants feedback in terms of comments, more questions, and suggestions

Resources

The most crucial resource is the financial resource. One of the learning resource need for

this program is nurse educators. These are human resources. They will be online full time to

answer any question or comment on the experiences of the nurses as they share. For the two

hours in a day, they will be available to offer education. Other resources needed include narrated

learning modules, medical videos, and nurse simulations, IT software, IT specialists,

organizational social media sites and managers and computers.

Methods and Instruments

Several methods and instruments will be utilized in the program. One of the

instruments to be used is a nursing self-assessment form and nursing games for assessment.

Competency inventory of nursing students (CINSs) will measure the competency of the nursing

students. This instrument covers ethics, general clinical skills, accountability, biomedical

PROPOSAL 18

science, critical thinking, caring, communication and teamwork (Reljić, Lorber, Vrbnjak,

Sharvin, & Strauss, 2017). All these qualities are needed in the emergency department.

Process for Delivering the Intervention

Training will be conducted for 2 hours daily and for the rest of the day, nurses

will be allowed to share their experiences. The nurses, who miss a certain session, will be in a

position to follow up on the lesson and what the nurses have shared. The educators will be

streaming live on Facebook and after the lesson; a video of the lesson will be uploaded on the

page for the sake of those who were not available at the particular time of the lesson.

Data Collection Plan

Since it will be difficult to meet the participants face to face, questionnaires will the

provided on the Facebook page and those interested will be able to fill privately and submit

privately to the educators.

Ways of Dealing with Barriers

PROPOSAL 19

One of the barriers to successfully deliver online education is the lack of a

student's motivation. It is the responsibility of the educator or instructor to create an online

environment where the students are eager to learn. Students can be encouraged to use

applications such as Skype and chat forums to know their classmates and that will increase

motivation. Continuous assessment tests will also motivate the nurse. The educators should also

chunk their content to make it easy for the brain to digest.

Budget Plan

Activity /resource Cost ($)

Educators 30,000

Data/ wifi 2,000

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Computers 10,000

Others 20,000

Evaluation after Implementation

The Facebook page will not be deleted after the implementation. However, after

the whole process is over, the nurses will be allowed to quit the page at their own pleasure.

However those interested can stay and keep sharing.

Section G

Evaluation of Process

Rationale for the Methods used in Collecting the Outcome Data

In order to evaluate if the Triage assessment process among nurses serving in the

emergency department is effective in reducing the amount of time taken to prescribe treatment for

patients with chest pain, a combination of both qualitative and quantitative methods was used.

Qualitative methods will employ statistical analysis by use of simple observable sampling and

comparison between cases techniques, while quantitative techniques will measure the actual

PROPOSAL 21

quantifiable entities and instances in which the Triage assessment tool shall have helped reduce

the time taken by nurses to offer treatment to patients with chest pain (Wisdom, Cavaleri,

Onwuegbuzie, & Green, 2012). The guidelines will take into consideration the instructions issued

by CDC on chest pain related complications as well as the guidelines implemented by nurses and

other healthcare givers of experience. The data collected will be subjected to ANOVA for analysis

to determine whether there is a correlation between Triage assessment and the time that nurses

take to treat patients with chest pain (Almeida & Queirós, 2017). External factors that might affect

the results such as the sterility of the room as well as the number of patients will be assessed by

qualitative analysis, although only to a limited extent.

How Measures Evaluate Objectives

This study will apply questionnaires, scaled checklists as well as observations in

establishing a relation to its objectives. Questionnaires have the potential to provide the capability

to obtain a massive size of information from large samples of participants through a short span of

time, and by use of limited resources. Besides, results acquired from questionnaires can be easily

quantified by use of analytical software tools and hence ease of data comparison. However, the

use if scaled checklists contribute largely towards decision making in the dimensions of the best

PROPOSAL 22

approaches to solving existing research problems. For this reason, it is easier to incorporate scaled

checklists into the daily routines of hospitals during research. The two methods collect data that is

focused towards eliminating the errors that are associated with research. Besides, the two methods

allow data to be effectively compared with the previously existing situations in these hospitals. In

the event that the time taken by nurses to offer treatment to patients with chest-related pains is

reduced, then the outcome measured shall have aligned with the objectives of the study. Adoption

of the two methods will ensure that feedback of the program is acquired at all times.

Measurement of Outcomes

This research study will combine both quantitative and qualitative research methods. The

measurement if to these parameters will be conducted using questionnaires for qualitative

measurements and scaled checklists to measure quantitative methods. Validity refers to the

measure of preciseness of the results obtained from a given scientific research study. Besides,

validity can be said to be the extent to which the results obtained from a measuring represent the

variables that they are meant to represent. In this study, validity will be measured depending on

whether it covers the constructs of interest in the outlined research objectives. Reliability is defined

as the consistency of the measures obtained in the results (ChristopheSapi, Marie-Claude Simeoni,

PROPOSAL 23

Khammar, Stephanie Antoniot, & Pascal Auquier, 2005). Reliability will be measured by

evaluating the pattern of the results across multiple sets that will obtained. This will occur after a

thorough analysis and verification of the results. If the results remain consistent, they shall be said

to be reliable while an inconsistent pattern of results shall be considered unreliable.

In Case of Negative Results

If the outcome of the study do not provide positive results, it is advisable not to conclude

that nothing new was derived from the entire study that could add onto the existing knowledge.

On the contrary, negative results confirm status quo. It therefore signifies that there is no much

difference in the comparison between the previous knowledge and the outcome of the study

conducted. Therefore, in case of negative results, it is important to analyze the aspects that led to

the failure. This may be in terms methodological issues, in which one would re-start the entire

research process.

Implications for Practice and Future Research

The Triage assessment technique ought to be effectively applied in hospitals among nurses

who serve in the Emergency Department of hospitals to increase their efficiency in handling

PROPOSAL 24

speedy prescriptions to patients who complain of chest pains. This will reduce the overcrowding

phenomenon common in the emergency departments of most hospitals. The triage assessment

practice has the potential to impose an effective utilization of resources so as to enhance an

effective decision making process. However, further research need to shift its focus towards

finding out the preferred measures and environmental conditions within which the triage and

emergency assessment would be carried out for both cardiac related and non-cardiac related chest

complications.

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References

Almeida, F.,Queiros, A,(2017).Strengths and Limitations of Qualitative and Quantitative

Research Methods. Jourl of Medical Research, 14(2), 21-36.

ChristopheSapi, Marie-ClaudeSimeoniM,Khammar,..,StephanieAntoniot,& PascalAuquier

(2005). Reliability and validity of the VSP-A, a health –related quality of life instrument

for ill and healthy adolescents. Journal of Adolescent Health, 36(40), 327-336.

Chung, J. (2015). An exploration of accident and emergency nurse experiences of triage decision

making in Hong Kong. Accident and Emergency Nursing, 13, 206-213.

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Dibra, M., (2015). Rogers’s theory on the diffusion of innovation-the most appropriate

theoretical model in the study of factors influencing the integration of sustainability in

tourism businesses. Procedia-Social and Behavioral Sciences, 195, 1453-1462.

Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015).

Overcrowding in emergency department: an international issue. Internal and emergency

medicine, 10(2), 171-175.

Evans, L., & Kohl, D. (2014). Mission impossible? Educating an emergency nurse. Journal of

Emergency Nursing, 40(3), 253-256.

Fain, J. A. (2017). Reading, understanding, and applying nursing research. FA Davis.

Fitzgerald, R. T., Radmanesh, A., & Hawkins, C. M. (2015). Social media in medical education.

American Journal of Neuroradiology, 36(10), 1814-1815.

Goodman, J., Melkers, J., & Pallais, A. (2019). Can online delivery increase access to

education?. Journal of Labor Economics, 37(1), 1-34.

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Kaplan, L., Zeller, E., Damitio, D., Culbert, S., & Bayley, K. B. (2014). Improving the culture of

evidence-based practice at a Magnet® hospital. Journal for nurses in professional

development, 30(6), 274-280

McCutcheon, K., Lohan, M., Traynor, M., & Martin, D. (2015). A systematic review evaluating

the impact of online or blended learning vs. face‐to‐face learning of clinical skills in

undergraduate nurse education. Journal of advanced nursing, 71(2), 255-270.

Milbrett, P., & Halm, M. (2014). Characteristics and predictors of frequent utilization of

emergency services. Journal of Emergency Nursing, 35, 191-198.

Reljić, N. M., Lorber, M., Vrbnjak, D., Sharvin, B., & Strauss, M. (2017). Assessment of clinical

nursing competencies: a Literature review. In Teaching and Learning in Nursing.

IntechOpen.

Shiels, E. M., (2018). Implementation of emergency preparedness in long term care and Rogers'

diffusion of innovation theory.

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Stephenson, R., Phelps, A., & Colburn, J. (2018). Diffusion of Innovations and Program

Implementation in Areas of Health Behavior/Education/Promotion, Physical Activity, and

Physical Education. ICHPER-SD Journal of Research, 10(1), 3-11.

Wisdom, J. P., Cavaleri, M. A., Onwuegbuzie, A. J., & Green, C. A. (2012). Methodological

Reporting in Qualitative, Quantitative, and Mixed Methods Health Services Research

Articles. Health Services Reserch, 47(2), 721–745.

Appendices

Conceptual Model

Dependent Variable

Triage Training

Rapid Assessment

Patient categorization

Allocation of patients based

on likely diagnosis

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Data Collection Tools

1. Observation

2. Questionnaires

3. Scaled checklist

Major independent

variable

Improved experience in

triage algorithm

Other Independent variables

Reduced morbidity and mortality in

emergency ward

Reduced time taken in assessment

and diagnosis in emergency ward

Reduced overcrowding in

emergency ward

Reduced cost of chest pain

treatment

Reduced rate of hospital re-

admission

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Study Questionnaire

1. How has triage training impacted your nursing experience?

2. Would you recommend triage training to your colleagues?

3. How has the rate of emergency room mortality and morbidity of your assigned

patients changed since you enrolled for the training?

4. How has the rate of hospital readmission of your assigned patients changed

since you enrolled for the training?

Scaled checklist

1. Nursing triage training achieves reduced morbidity and mortality in emergency

ward. Yes or No

PROPOSAL 31

2. Nursing triage training achieves reduced time taken in assessment and

diagnosis in emergency ward. Yes or No

3. Nursing triage training achieves reduced overcrowding in emergency ward. Yes

or No

4. Nursing triage training achieves reduced cost of chest pain treatment. Yes or

No

5. Nursing triage training achieves reduced rate of hospital re-admission. Yes or

No

Data Evaluation Tools

1. Qualitative analysis through statistical analysis of simple observable sampling data.

2. Qualitative analysis to actual quantifiable entities and instance that the proposed strategy

has achieved positive outcomes.

Timeframe

PROPOSAL 32

Timeline Activities Involved

First month Creation of awareness

and gathering of the

required resources

Week one of 2nd month The theory part of the

lesson

Week two 2nd month Theory

Week three 2nd month Question and answer

Week 4 2nd month Comments, more

questions, any

suggestions.

Total timeframe 2 months

List of resources

1. financial resource

PROPOSAL 33

2. nurse educators

3. narrated learning modules

4. medical videos

5. nurse simulations

6. IT software

7. IT specialist

8. organizational social media sites

9. Social media managers

10. Computers.

Budget Plan

Activity /resource Cost ($)

Educators 30,000

Data/ wifi 2,000

Computers 10,000

Others 20,000

PROPOSAL 34

Total cost 62,000

Informed consent form

Informed consent form

Informed Consent form for nursing practitioners invited to participate in study to determine

whether nursing triage training reduces overcrowding and delays in the emergency department.

Name of Principal Investigator……………

Name of Organization……………

Name of Sponsor………………..

Name of Proposal and version………..

PART I: Information Sheet

PROPOSAL 35

Introduction

I ……. A student at…….... I am doing research on the impact of nurse triage training on delay

and overcrowding in emergency departments, which is very common health problem in this

country. I am going to give you information and invite you to be part of this research. You do

not have to decide today whether or not you will participate in the research. Before you decide,

you can talk to anyone you feel comfortable with about the research. There may be some words

that you do not understand. Please ask me to stop as we go through the information and I will

take time to explain. If you have questions later, you can ask them of me.

Purpose of the research

Emergency department delays and overcrowding are the leading cause of emergency room

morbidity, mortality, and increased cost of healthcare, increased hospital readmission rate in US

healthcare today. The reason I am doing this research is to find out if the triage nurse training

can eradicate the problem.

Type of Research Intervention

This research will involve a 2 hour real-time online training on triage for 4 weeks

Participant selection

PROPOSAL 36

I am inviting all emergency department nurse practitioners to participate.

Voluntary Participation

Your participation in this research is entirely voluntary. If you choose to participate, You may

change your mind later and stop participating even if you agreed earlier.

Information on the triage training

1. Rapid Assessment

2. Patient categorization

3. Allocation of patients based on likely diagnosis

Duration and Description of the Process

1. First month - Creation of awareness and gathering of the required resources

1. Week one and 2nd.weeks of 2nd month- The theory part of the lesson

2. Week three 2nd month. Question and answer

3. Week 4 of the 2nd month-Comments, more questions, any suggestions.

Reimbursements

You will not be given any other money or gifts to take part in this research.

PROPOSAL 37

Confidentiality

The information that we collect from this research project will be kept confidential. Information

about you that will be collected during the research will be put away and no-one but the

researchers will be able to see it. Any information about you will have a number on it instead of

your name. Only the researchers will know what your number is and we will lock that

information up with a lock and key.

Right to Refuse or Withdraw

You do not have to take part in this research if you do not wish to do so. You may also stop

participating in the research at any time you choose. It is your choice and all of your rights will

still be respected.

Who to Contact

If you have any questions you may ask them now or later, even after the study has started. If

you wish to ask questions later, you may contact any of the following: [name, address/telephone

number/e-mail])

PART II: Certificate of Consent

PROPOSAL 38

I have read the foregoing information, or it has been read to me. I have had the opportunity

to ask questions about it and any questions that I have asked have been answered to my

satisfaction. I consent voluntarily to participate as a participant in this research.

Name of Participant__________________

Signature of Participant ___________________

Date ___________________________

Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and to

the best of my ability made sure that the participant understands that the following will

be done:

1.

2.

PROPOSAL 39

3.

I confirm that the participant was given an opportunity to ask questions about the

study, and all the questions asked by the participant have been answered correctly and to

the best of my ability. I confirm that the individual has not been coerced into giving

consent, and the consent has been given freely and voluntarily.

A copy of this ICF has been provided to the participant.

Print Name of Researcher/person taking the consent________________________

Signature of Researcher /person taking the consent__________________________

Date ___________________________

Day/month/year

PROPOSAL 40