NURS 4220 Capstone Paper Guide.

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NURS 4220 Capstone Paper Guide.

 

The Capstone Paper is the culminating assignment of your undergraduate-nursing program at Walden University. In this assignment you will identify a quality improvement practice problem, review and synthesize evidence-based practice evidence, and propose an evidence-based quality improvement plan that you will use to address your practice problem.NURS 4220 Capstone Paper Guide.

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Capstone Paper Overview

 

The Capstone Paper is written in sections each week and submitted for grading in two parts.

 

Capstone Paper: Part I (3-4 pages) includes the Practice Problem; Analysis of Evidence; and Quality Improvement Process sections that are written during the first three weeks of the course. The Capstone Paper, Part I will be submitted for grading at the conclusion of Week 3.NURS 4220 Capstone Paper Guide.

 

Capstone Paper: Part II (3-4 pages) includes the Evidence-Based Practice Quality Improvement Plan Explanation and Project Resources sections written in weeks 4 and 5. Part II of the capstone paper is submitted for grading at the conclusion of Week 5.

 

The two parts of the Capstone paper are designed to be combined into one document and used in conjunction with your storyboard to present a quality improvement plan. You may use these documents demonstrate to your employer an understanding of quality improvement processes that improve patient care and/or patientsafety.NURS 4220 Capstone Paper Guide.

 

Assignment Template

 

You will use the Walden University APA Course Template to complete this Assignment.

 

  • Walden University. Walden templates: General templates: APA course paper template with advice (6th). Retrieved from http://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-2774360
    • Delete the abstract page in the template. This is not required for this course.
    • The template includes the correct font and formatting: 12 pt. Times New Roman font, double spacing, and 1-inch margins on all sides.

 

Writing Standards

 

  • Review the Academic Writing Expectations Checklist Capstone Level found in your Week 1 Learning Resources
    • Note the new expectations for Use of evidence and Credit to Source
    • Use a Scholarly Voice
      • http://academicguides.waldenu.edu/writingcenter/scholarlyvoice
      • http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859
    • Review the Walden University Writing Center webpage: Using Evidence: Synthesis – http://academicguides.waldenu.edu/writingcenter/evidence/synthesis

 

Rubrics (found on the Course Information page)

 

  • Week 3 Assignment Rubric
  • Week 5 Assignment Rubric

 

 

Capstone Paper, Part I

 

  • Introduction (Completed in Week 1)
    • State the practice problem in measurable terms and that reflect quality indicators.

This is the same problem described in the Week 1 Practice Experience discussion.

Provide the rationale for selecting the practice problem

  • Include a purpose statement.
  • Analysis of Evidence (Completed in Week 2)
    • Synthesize a minimum of 5 evidence-based practice resources that support your practice problem. Include a minimum of two to three research studies obtained from the Walden Library.
  • Quality Improvement Process (Completed in Week 3)
    • Describe the quality improvement process and a brief overview the quality model that will be used to improve your practice problem. Include a description of a quality tool that will be used in the quality improvement plan.
    • This process will be used to support the detailed proposed quality improvement plan in Week 4
    • Explain why the specific quality model was selected and document your explanation with references.
    • Summary

Summarize the key points discussed in the paper

Introduction

The practice problem in this assignment is diabetes and its increased prevalence in the United States. It is estimated that more than 30 million Americans live with this diabetes with about 129 million surgeries related to this condition having been done in 2018 (Weir&Deeb, 2016). The outpatient setting accounts for more than half of the surgeries. In addition, diabetes has increased the morbidity and mortality rates as well as the costs of healthcare.

The problem was selected because of its relevance in my practice organization.I work in a local hospital, in the Ambulatory Surgery Department (ASU) where half of our patients are diabetic or pre-diabetic and hence, there is a need to understand diabetes as a condition, its impact on my practice, its management as well as quality improvement plan to address the healthcare problem. As such, the purpose of this paper is to examine diabetes in my practice setting, analyze the available evidence supporting the practice problem and provide a quality improvement process presenting a quality model and a quality tool employed in the quality improvement plan.

Analysis of Evidence

The burden of diabetes increases by day with more than 10% of the adult population and over 25% of the elderly adult population of 65 years and above being affected. Type 2 diabetes is the most common condition even though about a million Americans live with Type 1 diabetes. It is projected that by 2050, a third oof the American population will be diagnosed with the disease with ethnic and racial minorities as well as elderly adults taking the lead(Thompson et al., 2016). Diabetes presents an enormous economic challenge ion the healthcare sector associated with lost productivity and increased direct medical costs. The approximate expenditure of diabetic patients is 2.3 times higher than that of healthy persons.

Surgery is undertaken on patients whose condition is not well controlled by medication. It is only considered to treat people with a BMI of 35 to 39.9 with type 2 diabetes mellitus. In the United States, some of the surgical procedures taken to treat diabetes include Roux-en-y Gastric Bypass which modifies the gastrointestinal tract in a way that food bypasses the stomach and the upper section of the small intestine(Schauer et al., 2017). Other bariatric surgeries includeAdjustable Gastric Band and Duodenal Switch and they are effective in attaining the desired weight loss, improving diabetes related health problems, reducing the type and medication dosage as well as reducing the blood sugar in 90% of patients. In addition, about 78% of diabetic patients undergoing surgery eliminate the need for medication use and also have their blood sugar levels reduced to normal(Jangid, Chaturvedi &Khinchi, 2017).

Quality Improvement Process

In my practice organization, surgery is the main treatment approach given to diabetic patients. These are conducted in the Ambulatory Surgery Department (ASU) and patients undergoing the procedure are advised not to eat after midnight to prevent the risk of aspiration during surgery.The problem we were experiencing was extreme hypoglycemia in some of our diabetic post-surgical patients. The cause of the problem was due to the fact that some of our diabetic patients were NPO for an extended period of time, sometimes 12-14 hours or longer.  We have also had patients come back from surgery with a blood glucose of 29mg/dl. This resulted in the patient being admitted and taken to ICU overnight.

In order to overcome these challenges, a quality improvement practice process is necessary. The plan will involve scheduling of all diabetic patients to the earlier surgery or times to limit time of NPO. As soon as a diabetic patient arrives in the morning, their blood glucose is measured to establish his baseline for the day and every 4-6 hours afterwards while NPO. For all patients who cannot be taken to surgery early, allowing them to have at least 4 oz of apple juice or other clear sugary fluid up to 2 hours before scheduled surgery to improve post-surgical glycemic level will be done.

The quality improvement tool to be used in the quality improvement plan is a Cause-and-effect diagram. This tool is selected due to its ability to identify, sort and display possible causesof the problems identified above and effect which can be more easily measured in this quantitative research. In general, it will be important in illustrating the link between the given outcome and the influencing factors graphically.

On the other hand, the quality improvement process uses a Model for Improvement (MFI)which entails the rapid process cycle referred to as Plan Do Study Act (PDSA)(Sangeetha et al., 2020). This model is essential in testing the effects of small changes, making them and spreading the effective changes throughout the ASU.

Summary

Diabetes is a major healthcare issue affecting millions of people in the US. However, it can be treated using psychotherapy, pharmacotherapy and surgery. A quality improvement process is essential in preventing complications after surgery associated with NPO. A Model for Improvement involving Plan Do Study Act is important in informing the practice improvement. An effective tool for this process is the Cause-and-effect diagram

RE: Group C Practice Experience Discussion – Week 1

COLLAPSE

Top of Form

Diabetes continues to be prevalent in the United States with over 30 million Americans living with this disease. With medical technological advances, new procedures are able to be performed  for various conditions.  In 2018 nearly 129 million surgeries were carried out with over half of them in the out patient setting (Weir, Deeb 2016).  I work in a local hospital, in the Ambulatory Surgery Department (ASU) where half of our patients are diabetic or pre-diabetic. All patients, as part of their pre-surgical checklist,  are instructed not to eat after midnight to prevent the risk of aspiration during surgery. Our ASU is operational from 6am-7pm and all surgical patients are told to come at 6am regardless to their actual time of surgery. The problem we were experiencing was extreme hypoglycemia in some of our diabetic post surgical patients. The cause of the problem was due to the fact that some of our diabetic patients were NPO for an extended period of time, sometimes 12-14 hours or longer.

In our department we, in the past we have had patients come back from surgery with a blood glucose of 29mg/dl. This resulted in the patient being admitted and taken to ICU over night. If we could find ways to improve of this practice we could improve patient outcomes. One step would be to schedule all diabetic patients to the earlier surgery OR times to limit time of NPO. As soon as a diabetic patient arrives in the morning , his Blood Glucose is measured to establish his baseline for the day and every 4-6 hrs afterwards while NPO (2016). For all patients who can not be taken to surgery early, allowing them to have at least 4 oz of apple juice or other clear sugary fluid up to 2 hours before scheduled surgery to improve post surgical glycemic level.

This type of research is Quantitative to show cause and effect and can be more easily measured than qualitative, and mixed method.

Required Content

Identified the quality improvement problem.—

Excellent 9 (6%) – 10 (6.67%)

Proficient 8 (5.33%) – 8 (5.33%)

Basic 7 (4.67%) – 7 (4.67%)

Needs Improvement 0 (0%) – 6 (4%)

Required Content

Stated in measureable terms that reflect quality indicators.—

Excellent 9 (6%) – 10 (6.67%)

Proficient 8 (5.33%) – 8 (5.33%)

Basic 7 (4.67%) – 7 (4.67%)

Needs Improvement 0 (0%) – 6 (4%)

Required Content

Provided the rationale for selecting the practice problem including the importance in improving patient outcomes.—

Excellent 18 (12%) – 20 (13.33%)

Proficient 16 (10.67%) – 17 (11.33%)

Basic 14 (9.33%) – 15 (10%)

Needs Improvement 0 (0%) – 13 (8.67%)

Required Content

Synthesize the findings from the analysis of evidence that support the practice problem.—

Excellent 36 (24%) – 40 (26.67%)

Proficient 32 (21.33%) – 35 (23.33%)

Basic 28 (18.67%) – 31 (20.67%)

Needs Improvement 0 (0%) – 27 (18%)

Required Content

Applied a quality improvement process to the practice problem.—

Excellent 23 (15.33%) – 25 (16.67%)

Proficient 20 (13.33%) – 22 (14.67%)

Basic 18 (12%) – 19 (12.67%)

Needs Improvement 0 (0%) – 17 (11.33%)

Required Content

Chose a specific quality improvement tool that will be used throughout the project.—

Excellent 14 (9.33%) – 15 (10%)

Proficient 12 (8%) – 13 (8.67%)

Basic 11 (7.33%) – 11 (7.33%)

Needs Improvement 0 (0%) – 10 (6.67%)

Academic Writing Expectations (AWE 4) Capstone Level

Displays sentence and paragraph level skills: Constructs simple, complex and compound sentences. Writes without spelling, grammatical or syntax errors. Writes without sentence fragments or run on sentences.Uses punctuation appropriately. Writes appropriate introductions and conclusions.

Demonstrates essay level skills: Cohesion and flow by using transition sentences. Precision, clarity and academic tone. Awareness of discipline specific audience.

Displays academic expression: Scholarly voice: evidence of the Provider’s own ideas with a well-organized presentation of evidence. Synthesizes resources by using own words. Limits use of quotes appropriately (no more than one short, unique quote). Uses evidence from course learning resources, scholarly resources and seeks additional resources to support content as required in the assignment. Minimum of five references are required.—

Excellent 14 (9.33%) – 15 (10%)

Proficient 12 (8%) – 13 (8.67%)

Basic 11 (7.33%) – 11 (7.33%)

Needs Improvement 0 (0%) – 10 (6.67%)

APA Formatting: cover page, title of paper on second page, level headings, Times New Roman 12 font, 1″ margins, and page numbers.

APA References: Uses in-text citations appropriately and format correctly. Paraphrases to avoid plagiarizing the source.

Reference list is in alphabetical order, hanging indent, double spaced in format. Each specific entry contains all information required by APA format including author, year of publication, title of publication, pages, DOI, website, as appropriate.—

Excellent 14 (9.33%) – 15 (10%)

Proficient 12 (8%) – 13 (8.67%)

Basic 11 (7.33%) – 11 (7.33%)

Needs Improvement 0 (0%) – 10 (6.67%)