Richard is a 62-year-old single man who says that his substance dependence and his bipolar disorder both emerged in his late teens.  He says that he started to drink to “feel better” when his episodes of depression made it hard for him to interact with his peers.  He also states that alcohol and cocaine are a natural part of his manic episodes.  He also notes that coming off the cocaine and binge drinking contribute to low mood, but he has not responded well to referrals to AA and past inpatient stays have led to only temporary abstinence.  Yet, Richard is now trying to forge a closer relationship with his adult children, and he says he is especially motivated to get a better handle on both his bipolar disorder and his substance use.  He has been more compliant with his mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual diagnoses addressed with psychotherapy. What diagnostic information would be most critical to collect in the first visit? Which diagnostic measures are recommended by the US clinical guidelines for the treatment of this patient’s family problem? Which evidence based harm reduction strategies would you recommend to treat this patient? Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient.  (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

After reading the provided articles and listening to our guest speakers discuss careers in nursing, you may be surprised to learn how many options nurses have in terms of careers beyond the typical hospital bedside. You find nurses in advanced practice as nurse practitioners and nurse anesthetists, as well as in academics, public health, administration, informatics, politics/government, consulting and a variety of practice settings beyond the hospital.

In this discussion board, share your reaction. You must specifically address the following two questions (and follow-up) in your response: 

1. What was something specific that you learned that you didn’t know before? Which source did you learn it from (e.g., which reading or which guest speaker)?
2. Did the wide variety of nursing options surprise you?

After stating whether you were surprised about the variety, address at least one of the following:

• Why do you think nurses have so many options when it comes to careers beyond direct patient care?
• What aspects of their training do you think prepares them for these many options? 
• Do you think any other graduate careers have as many options and why/why not?  

Feel free to post any other thoughts related to this topic. Responses may be only one paragraph, but no more than two.

After posting your response, read your peers’ thoughts and reply to at least one classmate.

Submit your 20-25 page final capstone project that synthesizes the work you completed in the previous four assessments

You will also be required to submit your completed practicum hours using CORE ELMS. You must submit a minimum of 20 hours with each assessment deliverable to receive a grade for the entire assessment.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Your final submission for your capstone project will bring together all of the sections you have worked on throughout this course, as well as the relevant revisions you have made to those sections based on feedback from your instructor, as well as feedback you have received or observations you may have made during your practicum experience. True professionals can learn to strive for continuous improvement in their work and incorporate feedback from colleagues and leaders to help scaffold improvement efforts. As a master’s-level nurse you will be expected to create and implement plans and evaluate their outcomes. Being able to envision a pathway for a project to move from the idea phase all the way through the evaluation phase is a critical skill. By successfully synthesizing the various sections of this project together into one final artifact, you will have demonstrated your competence in this essential skill.

Preparations

• Read Guiding Questions: Final Project Submission [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete this assessment.
• As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
  • What is the most useful skill or concept you learned while pursuing your MSN degree?
  • How will you leverage your degree to help you reach your ideal practice career path?
  • How will you be able to apply the work you have done on your capstone project to improve your personal practice?

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

For your final capstone project submission you will synthesize the work you completed in the previous four assessments. Please make sure that you have made relevant revisions as suggested by your instructor, as well as relevant additions that you uncovered during your practicum experience. The only brand-new content that you will need to create for this assessment is an Abstract and an Introduction.

This final submission will be graded using the seven program outcomes (POs) for the Master’s of Science in Nursing program. As a reminder they are:

1. Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.
2. Evaluate the best available evidence for use in clinical and organizational decision making.
3. Apply quality improvement methods to impact patient, population, and systems outcomes.
4. Design patient- and population-centered care to improve health outcomes.
5. Integrate interprofessional care to improve safety and quality and to decrease cost of care.
6. Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost of care.
7. Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.

In addition, you will be assessed on how well you incorporated the feedback you received from your instructor on your previous work in this course via the following criterion:

• Integrate writing feedback to improve the clarity and quality of final product.

You will also be assessed on the completion of hours toward your practicum experience.

• Demonstrate completion of hours toward the practicum experience.

See the scoring guide for specific grading criteria related to these requirements.

Abstract

• Summarize the purpose, approach, and any relevant findings of the final capstone project submission (PO #1).

Introduction

• Summarize your need, target population, and setting (PO #1).
• Provide a high-level overview of your intervention plan (PO #4).
• Justify the importance of your need and intervention plan (PO #1).
• Provide a high-level overview of your implementation plan (PO #4).
• Provide a high-level over view of your evaluation plan (PO #4).

Reminder: these instructions are an outline. Your heading for this this section should be Problem Statement and not Part 1: Problem Statement.

Part 1: Problem Statement

Need Statement

• Analyze a health promotion, quality improvement, prevention, education or management need (PO #1).

Population and Setting

• Describe a target population and setting in which an identified need will be addressed (PO #4).

Intervention Overview

• Explain an overview of one or more interventions that would help address an identified need within a target population and setting (PO #3).

Comparison of Approaches

• Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting. (PO #5).

Initial Outcome Draft

• Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education or management need (PO #4).

Time Estimate

• Propose a rough time frame for the development and implementation of an intervention to address and identified need (PO #1).

Part 2: Literature Review

• Analyze current evidence to validate an identified need and its appropriateness within the target population and setting (PO #2).
• Evaluate and synthesize resources from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need (PO #7).

PART 3: INTERVENTION PLAN

Intervention Plan Components

• Define the major components of an intervention plan for a health promotion, quality improvement, prevention, education, or management need (PO #4).
• Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components (PO #4).

Theoretical Foundations

• Evaluate theoretical nursing models, strategies from other disciplines, and health care technologies relevant to an intervention plan (PO #6).
• Justify the major components of an intervention by referencing relevant and contemporary evidence from the literature and best practices (PO #2).

Stakeholders, Policy, and Regulations

• Analyze the impact of stakeholder needs, health care policy, regulations, and governing bodies relevant to health care practice and specific components of an intervention plan (PO #7).

Ethical and Legal Implications

• Analyze relevant ethical and legal issues related to health care practice, organizational change, and specific components of an intervention plan (PO #1).

Part 4: Implementation Plan

Management and Leadership

• Propose strategies for leading, managing, and implementing professional nursing practices to ensure interprofessional collaboration during the implementation of an intervention plan (PO #5).
• Analyze the implications of change associated with proposed strategies for improving the quality and experience of care while controlling costs (PO #1).

Delivery and Technology

• Propose appropriate delivery methods to implement an intervention which will improve the quality of the project (PO #3).
• Evaluate the current and emerging technological options related to the proposed delivery methods (PO #6).

Stakeholders, Policy, and Regulations

• Analyze stakeholders, regulatory implications, and potential support that could impact the implementation of an intervention plan (PO #5).
• Propose existing or new policy considerations that would support the implementation of an intervention plan (PO #7).

Timeline

• Propose a timeline to implement an intervention plan with reference to specific factors that influence the timing of implementation (PO #1).

Part 5: Evaluation of Plan

• Define the outcomes that are the goal of an intervention plan (PO #4).
• Create an evaluation plan to determine the impact of an intervention for a health promotion, quality improvement, prevention, education, or management need (PO #3).

Part 6: Discussion

Advocacy

• Analyze the nurse’s role in leading change and driving improvements in the quality and experience of care (PO #1).
• Explain how the intervention plan affects nursing and interprofessional collaboration, and how the health care field gains from the plan (PO #5).

Future Steps

• Explain how the current project could be improved upon to create a bigger impact in the target population as well as to take advantage of emerging technology and care models to improve outcomes and safety (PO #6).

Reflection on Leading Change and Improvement

• Reflect on how the project has impacted your ability to lead change in personal practice and future leadership positions (PO #1).
• Reflect on the ways in which the completed intervention, implementation, and evaluation plans can be transferred into your personal practice to drive quality improvement in other contexts (PO #3).

Address Generally Throughout

• Integrate resources from diverse sources that illustrate support for all aspects of the project as appropriate throughout the final submission (PO #2).
• Clearly, concisely, and cohesively articulate a health care need, population, setting, stakeholders, supporting evidence, intervention, and evaluation (PO #6).
• Integrate writing feedback to improve the clarity and quality of final product.

Practicum Hours Submission

You have been tracking your completed practicum hours each week using the CORE ELMS. By placing the hours into CORE ELMS, you will ensure you are accumulating all hours that are needed to meet the requirements for your specialization and degree.

For this assessment, submit your final CORE ELMS practicum hours tracking log showing all confirmed hours earned at your site during the course. All 100 hours must be documented and confirmed in the CORE ELMS practicum hours tracking log.

You will not receive a grade for this assessment without a practicum hours log showing a minimum of 100 confirmed hours for the time period of this course. Your faculty instructor will review your hours to date and will contact you if he or she has any questions or concerns.

Note for Nursing Informatics learners: Although you will complete your capstone project in this course, your specialization requires 200 hours of practicum, so that work will continue beyond this course. You cannot carry over any hours from NURS-FPX6030. Your final 100 hours of practicum will be completed in NURS-FPX6025.

Additional Requirements

• Length of submission: 20–25 pages (including references).
• Written communication: Written communication is free of errors that detract from the overall message.
• Number of resources: 12–18 resources.
• APA formatting: Resources and citations are formatted according to current APA style.
• Font and font size: Times New Roman, 12 point.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.
• Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.
• Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.
• Competency 4: Design patient- and population-centered care to improve health outcomes.
• Competency 5: Integrate interprofessional care to improve safety and quality and to decrease cost of care.
• Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost of care.
• Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.

Note: You will also be assessed on two additional criteria unaligned to a course competency:

• Integrate writing feedback to improve the clarity and quality of the final product.
• Demonstrate completion of hours toward the practicum experience.

See the scoring guide for specific grading criteria related to these additional requirements.

Part 1:

• Research and  review at least four peer-reviewed articles on evidence-based practice applied in clinical decision support (CDS). Must be within 5 years.

Matrix attached

Part 2: Clinical Decision Support (CDS) Recommendation

Develop a 10- to 12-slide PowerPoint presentation in which you present your research and data to support your clinical decision support (CDS) recommendation for quality improvement.

Based on your research, address the following in your presentation:

• Synthesize your findings from your four articles, focusing on applicable models and/or theories relevant to CDS, quality improvement in your workplace, and on applicable evidence-based practice in nursing.
• Recommend CDS or information to consider in clinical decision making and explain your rationale for the recommendation. Be specific.
• Justify your recommendation. Be specific and provide examples.
• Recommend how you would address possible limitations or challenges, including:
  • Explain how you would avoid alert fatigue.
  • Explain under what conditions you would allow an override to an alert.
  • Explain how you would monitor compliance.
  • Identify factors that might contribute to continuous overrides.
  • Justify conditions under which an override may be necessary.
• Provide references in APA style at the end of your presentation—the reference slide or slides do not count toward your assignment total.