In This Assignment, Students Will Pull Together The Capstone ✓ Solved

In this assignment, students will pull together the capstone

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice. Develop a 1,250 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures. Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, if tables, graphs, surveys, educational materials, etc. are created. Refer to the PICOT Question Paper, and Literature Review: Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Paper For Above Instructions

Title and Executive Summary

Proposal Title: Implementing a Nurse-Led Sepsis Screening and Early Intervention Bundle in an Adult Medical-Surgical Unit.

Executive Summary: Sepsis remains a leading cause of morbidity and mortality in hospitalized adults (Institute of Medicine, 2001). This capstone change proposal outlines a nurse-led screening and early intervention bundle grounded in evidence-based practice and change theory. The proposal includes a clinical problem statement, PICOT question, literature search and evaluation, selected change theory, implementation plan with measurable outcomes, evaluation strategy, and anticipated barriers with mitigation strategies.

Background and Clinical Problem Statement

Background: Hospital-acquired and community-onset sepsis are time-sensitive conditions where early detection and timely interventions drastically reduce mortality and length of stay (Melnyk & Fineout-Overholt, 2019). Many institutions lack standardized bedside screening performed consistently by nursing staff, resulting in delayed recognition and treatment.

Clinical Problem Statement: In a 30-bed adult medical-surgical unit, inconsistent sepsis screening by nursing staff contributes to delayed antibiotic administration and increased sepsis-related complications compared with unit benchmarks and evidence-based timelines (Pronovost et al., 2006).

Purpose of the Change Proposal

The purpose is to implement a nurse-led sepsis screening and early intervention bundle to improve timely recognition and management of sepsis, thereby reducing time-to-antibiotic administration, ICU transfers, and sepsis-related mortality. This aligns with evolving health systems emphasizing quality, safety, and value-based care (Institute of Medicine, 2001).

PICOT Question

In hospitalized adult medical-surgical patients (P), does implementation of a nurse-led sepsis screening and early intervention bundle (I), compared to current nonstandardized screening (C), reduce time-to-antibiotic administration and 30-day sepsis-related mortality (O) within 6 months of implementation (T)?

Literature Search Strategy Employed

A structured search was conducted in PubMed, CINAHL, Cochrane Library, and AHRQ resources using keyword combinations: “sepsis screening,” “nurse-led intervention,” “sepsis bundle,” “time to antibiotics,” and “early recognition.” Filters: English language, adult population, clinical trials and systematic reviews, last 10 years, and seminal older sources for theoretical frameworks. Reference lists of key articles were hand-searched for additional studies (Grol & Grimshaw, 2003).

Evaluation of the Literature

High-quality evidence supports early sepsis recognition and bundled care to decrease mortality and length of stay (Melnyk & Fineout-Overholt, 2019; Pronovost et al., 2006). Systematic reviews demonstrate that nurse-driven screening tools and protocols increase detection rates and reduce treatment delays (Cochrane and CINAHL reviews). Evidence quality ranged from randomized and quasi-experimental studies to implementation research; translation studies emphasize context, staff engagement, and iterative Plan-Do-Study-Act cycles for sustainable change (Rycroft-Malone, 2004).

Applicable Change / Nursing Theory Utilized

Kurt Lewin’s Change Theory (unfreeze-change-refreeze) will structure the transition, with Kotter’s Eight-Step model used to operationalize leadership, coalition-building, and anchoring changes in culture (Lewin, 1951; Kotter, 1996). Rycroft-Malone’s implementation framework informs context assessment and facilitation strategies to move evidence into practice (Rycroft-Malone, 2004).

Proposed Implementation Plan with Outcome Measures

Implementation Phases:

  • Preparation (Weeks 1–4): Stakeholder meetings, baseline data collection (time-to-antibiotic, screening compliance, ICU transfers, 30-day mortality), and staff education development.
  • Pilot (Weeks 5–12): Implement nurse-led screening tool (qSOFA + clinical trigger checklist) and a standing order set enabling nurses to initiate sepsis huddles and rapid labs/fluids per protocol during daytime hours.
  • Scale & Sustain (Months 4–6): Expand to full unit coverage, refine workflows, implement EHR prompts, and create audit-feedback loops.

Outcome Measures:

  • Primary: Median time-to-antibiotic administration for suspected sepsis (minutes).
  • Secondary: Screening compliance rate (%), ICU transfer rate for sepsis, length of stay, 30-day sepsis-related mortality, and nurse-reported confidence in sepsis recognition (surveys).

How Evidence-Based Practice Informed the Intervention

Intervention components derive from high-grade recommendations: standardized screening tools validated in clinical studies, nurse-led protocols shown to reduce delays, and bundle elements from sepsis guidelines (Melnyk & Fineout-Overholt, 2019). EBP steps—ask, acquire, appraise, apply, and assess—guided selection and tailoring of the bundle to the unit context (Polit & Beck, 2021).

Plan for Evaluating the Proposed Nursing Intervention

Evaluation will use a pre-post quasi-experimental design comparing baseline 3-month metrics to 6 months postimplementation. Continuous process monitoring via weekly audits and run charts will allow PDSA cycles for iterative improvement. Statistical analysis will assess median time changes (Wilcoxon or t-test as appropriate) and changes in secondary outcomes with chi-square testing for proportions (Grol & Grimshaw, 2003).

Identification of Potential Barriers and Mitigation Strategies

Anticipated barriers include staff resistance, workflow disruption, EHR integration delays, and resource limitations. Mitigation:

  • Engage nurse champions and leadership early to build buy-in (Kotter, 1996).
  • Provide brief, scenario-based training and competency checks to reduce perceived burden (Melnyk & Fineout-Overholt, 2019).
  • Use phased pilot and iterative PDSA cycles to minimize disruption and tailor workflow (Rycroft-Malone, 2004).
  • Secure IT prioritization for EHR prompts and standing orders; employ manual fallback procedures until digital tools are live.

Appendix

An appendix will include the sepsis screening checklist, nurse education slides, unit flowchart for the bundle, data collection templates, and the pre/post survey instrument. These materials will be used for training and fidelity monitoring.

Conclusion

This proposal integrates best available evidence, theory-driven change models, and pragmatic implementation strategies to improve sepsis recognition and outcomes through a nurse-led bundle. The structured evaluation plan allows measurement of clinical impact and sustainability, consistent with evidence translation principles (Melnyk & Fineout-Overholt, 2019; Rycroft-Malone, 2004).

References

  • Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients' care. The Lancet, 362(9391), 1225–1230.
  • Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.
  • Kotter, J. P. (1996). Leading Change. Harvard Business Review Press.
  • Lewin, K. (1951). Field Theory in Social Science: Selected Theoretical Papers. Harper & Row.
  • Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (4th ed.). Wolters Kluwer.
  • Polit, D. F., & Beck, C. T. (2021). Nursing Research: Generating and Assessing Evidence for Nursing Practice (11th ed.). Wolters Kluwer.
  • Pronovost, P., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725–2732.
  • Rycroft-Malone, J. (2004). The PARIHS framework—a framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.
  • Agency for Healthcare Research and Quality (AHRQ). (2014). Implementing an Evidence-Based Practice Initiative: Practical Guidance for Health Care Organizations. AHRQ Publication.
  • Doran, G. T. (1981). There's a S.M.A.R.T. way to write management's goals and objectives. Management Review, 70(11), 35–36.

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