HS499 Unit 6 Needs Assessment Example

Six Minutes to Fetch a Lift After 9 p.m.: A Unit 6 Capstone Needs Assessment Measuring the Gap Between Evidence and Practice

[Student Name]

Purdue University Global

HS499: Bachelor's Capstone in Health Science

Unit 6 Needs Assessment

[Instructor Name]

[Date]

Brookmere Care Center, its residents, staff and every measurement are composite; the sources cited are real.

Methods

Five sources were used:

1. The injury and illness log for the past two years.

2. An equipment and sling inventory taken on three nights in one month.

3. Timed walks, with a stopwatch, from the farthest room on each of four halls to the equipment room, collecting the key from the charge nurse first.

4. Care plan transfer fields for all 118 residents, reviewed on one date.

5. An anonymous staff survey returned by 58 of 94 nursing assistants, a 62 percent response rate.

Each finding is compared with a standard drawn from the literature synthesis, so that no expectation is invented locally.

Findings and Gaps

Gap 1: Lift access at night. Standard: lifts within reach of the residents who need them at all hours (Occupational Safety and Health Administration [OSHA], 2009). Practice: after the evening medication pass the equipment room is locked, and its only key travels with the charge nurse. Timed walks averaged six minutes to retrieve a lift, ranging from four to nine minutes, compared with under one minute during the day, when lifts are parked on halls. Gap: large.

Gap 2: Sling availability. Standard: each lift resident has a correctly sized sling available when needed. Practice: the inventory found 22 full-body slings for 41 lift residents; on the three nights counted, an average of 9 slings were in the laundry. The survey said slings were "usually available," while the inventory showed otherwise; both figures are reported, and the inventory is given more weight because it was counted. Gap: large.

Gap 3: Written policy. Standard: a written rule making mechanical transfer the expected method for residents care-planned for a lift (Collins et al., 2004). Practice: Brookmere's resident handling policy recommends lifts "when appropriate" and does not prohibit manual transfers. Gap: moderate.

Gap 4: Trained peer support on each shift. Standard: a trained resource person available on each shift. Practice: two day-shift staff are trained as lift resources; no one on evenings or nights. Gap: moderate.

Gap 5: Staffing on nights. Standard: none set by the evidence for nursing homes. Practice: two nursing assistants per hall on nights. Gap: not rated, because the evidence offers no standard and the capstone cannot change staffing; recorded so the recommendation works within it.

Gap 6: Care plan accuracy. Standard: transfer method in the care plan matches the resident's current status. Practice: 4 of 41 lift residents' care plans had not been updated in over six months. Gap: small.

The largest gaps are access gaps, a locked room and missing slings, not gaps in staff knowledge or willingness.

Ranking Rule

Gaps were ranked by two criteria stated in advance: how directly the gap explains manual transfers on evening and night shifts, judged from the injury log and survey comments, and whether the facility can close it within a pilot. Access and slings rank first and second because both directly prevent lift use at night and both can be fixed without new staff. Policy ranks third, peer support fourth and care plan accuracy fifth. Staffing is not ranked.

What Staff Said

Survey comments were consistent. Forty-four of the 58 respondents described fetching the lift at night as the main reason for manual transfers. Several wrote that they would use the lift every time if it were on the hall with the right sling. A smaller group, mostly newer staff, said they were never shown how to use the lift alone with two people.

Injury Pattern

Over two years, 31 of 44 resident-handling injuries occurred on evening or night shifts. Injuries clustered between 9:00 p.m. and 1:00 a.m., the hours after the equipment room locks and before residents settle.

What the Assessment Means

The evidence supports keeping lifts within reach and making their use expected (Lee et al., 2013). Brookmere's largest gaps are exactly there. The recommendation in later units should begin with access and slings, then add a written rule and a trained peer on evenings and nights.

How the Gaps Interact

The gaps reinforce one another. Even if lifts were parked on every hall, missing slings would still send staff to the laundry, and without a written rule, a nursing assistant facing a resident's call light and a missing sling has no backing for making the resident wait. Closing one gap alone may produce little change, which matches the literature's finding that combined programs work better than single measures. The recommendation therefore needs to address access and slings together, with the policy and peer support following closely.

Limits

The survey response rate was 62 percent, and staff who did not respond may differ. The inventory covered three nights. Timed walks were done by the author, who knows the building well, so real retrieval times may be longer.

References

Collins, J. W., Wolf, L., Bell, J., & Evanoff, B. (2004). An evaluation of a "best practices" musculoskeletal injury prevention program in nursing homes. Injury Prevention, 10(4), 206-211. https://doi.org/10.1136/ip.2004.005595

Lee, S.-J., Faucett, J., Gillen, M., & Krause, N. (2013). Musculoskeletal pain among critical-care nurses by availability and use of patient lifting equipment: An analysis of cross-sectional survey data. International Journal of Nursing Studies, 50(12), 1648-1657. https://doi.org/10.1016/j.ijnurstu.2013.03.010

Occupational Safety and Health Administration. (2009). Guidelines for nursing homes: Ergonomics for the prevention of musculoskeletal disorders (OSHA 3182-3R). U.S. Department of Labor.