HS499 Unit 1 Capstone Scoping Paper Example

From Caregiver Strain to One Kind of Transfer on Two Shifts: A Unit 1 Capstone Scoping Paper Narrowing a Nursing Home Problem

[Student Name]

Purdue University Global

HS499: Bachelor's Capstone in Health Science

Unit 1 Capstone Scoping Paper

[Instructor Name]

[Date]

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

The Starting Interest

I began the capstone wanting to study burnout among nursing assistants in long-term care. I have worked as a nursing assistant for six years and watched coworkers leave, injured or exhausted. The interest is real, but as a capstone question it fails a basic test: could a later unit gather evidence on it, and could anyone at a facility act on the answer? Burnout has many causes, no single owner and no measure a small facility collects routinely. A capstone built on it would end in a literature review and a hope.

Level Two: Musculoskeletal Injury Among Nursing Assistants

The first narrowing moves from strain in general to physical injury, which is recorded and costly. Among all occupations, few injure their workers' backs and shoulders as often as nursing assistant work in nursing homes, much of it from lifting and moving residents (Occupational Safety and Health Administration [OSHA], 2009). Programs that tackle resident handling as a system have reduced these injuries in pooled studies (Teeple et al., 2017). Injury is closer to something a facility can act on, because it appears on the injury log and in workers' compensation claims. But injury still spans bathing, repositioning in bed, transfers and falls, each with different causes and different fixes. A capstone on all of them would spread too thin.

Level Three: Resident Handling at Brookmere

The second narrowing moves to one facility and one kind of task. Brookmere Care Center, a composite 120-bed nursing home where I work, recorded 23 resident-handling injuries among nursing assistants in the past year, according to its injury and illness log. Resident handling covers the tasks with the clearest evidence base: research has shown that lifting a dependent adult by hand exceeds safe load limits in almost any technique, which is why a widely cited analysis recommended a 35-pound limit for manual patient lifting (Waters, 2007). Focusing on Brookmere gives the capstone data I can reach and people who can make decisions.

Level Four: Full-Body Transfers on Evening and Night Shifts

The final narrowing comes from the injury log itself. Of the 23 injuries, 17 happened on evening or night shifts, and 14 involved transferring a resident between bed, chair and toilet. Forty-one residents at Brookmere have care plans that call for a full-body mechanical lift. Day shift staff report using the lift for these residents most of the time; evening and night staff report frequently moving them by hand, especially after 9:00 p.m., when the equipment room is locked.

The capstone question therefore becomes: why are residents care-planned for a full-body lift moved manually on evening and night shifts at Brookmere, and what change in equipment access or practice would raise lift use on those shifts?

The final question names one task, one group of residents, two shifts and one facility, and every term in it can be counted from records that already exist.

What Night Staff Describe

Informal conversations with six evening and night nursing assistants, held before the capstone began, describe the problem in practical terms. The equipment room is locked at 9:00 p.m. because a lift was once damaged when it was left in a hallway. The key is held by the charge nurse, who is often on another hall passing medications. Slings are stored in the laundry room, and the right size for a particular resident is often missing. Two assistants work each hall at night, and fetching the key, the lift and a sling can take longer than the transfer itself, so staff move residents by hand to avoid leaving a call light unanswered. None of the assistants described this as a choice they wanted to make; several said they knew it was unsafe. These accounts are not evidence yet, but they suggest that access, not willingness or training, may be the main barrier, and they shape the data the capstone will collect.

Who Owns the Problem

A capstone question needs an owner who can act. At Brookmere, equipment storage is decided by the director of nursing, sling purchasing by the administrator, and laundry schedules by the environmental services manager. The quality assurance and performance improvement committee brings these roles together each month. Any recommendation will therefore be addressed to that committee, which can charter a change across departments. Knowing the owner from the start keeps the capstone from producing a recommendation that no one has the authority to adopt.

Why This Scope Can Be Answered in Ten Units

The data needed already exist or can be gathered without special approval: the injury log, care plan transfer fields, an equipment inventory, timed walks from halls to the equipment room and a short staff survey. The people who could act on the answer, the director of nursing, the administrator and the quality committee, are reachable. And the likely interventions, such as where lifts are kept at night, are within the facility's control rather than requiring new staff positions.

What Was Set Aside

Resident falls were considered and set aside. Falls matter greatly, but fall prevention involves medication review, environment and supervision, and Brookmere already has an active falls committee. Burnout, the original interest, is not abandoned; if transfers become safer, some strain may ease, and the capstone's final reflection can return to it.

Limits of the Scope

The capstone will study one facility, so its findings may not apply to others. It focuses on full-body transfers and leaves out sit-to-stand transfers, which involve different equipment. And it depends on staff reporting honestly how transfers happen at night, which the methods in later units will need to check against observation.

Why the Scope Matters Beyond Brookmere

Although the capstone studies one facility, the question it asks is common. Many nursing homes own lifts that sit unused at night because of storage, staffing or sling supply. A clear answer at Brookmere, including what did not work, could help other small facilities that face the same evening and night pattern, and the methods could be repeated by a nursing assistant at any of them.

Next Steps

Unit 2 will build an annotated bibliography grouped by what each source lets the project claim, and Unit 3 will turn the scope into a formal problem statement with its numbers.

References

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.

Teeple, E., Collins, J. E., Shrestha, S., Dennerlein, J. T., Losina, E., & Katz, J. N. (2017). Outcomes of safe patient handling and mobilization programs: A meta-analysis. Work, 58(2), 173-184. https://doi.org/10.3233/WOR-172608

Waters, T. R. (2007). When is it safe to manually lift a patient? American Journal of Nursing, 107(8), 53-58. https://doi.org/10.1097/01.NAJ.0000282296.18688.b1