NU298 Unit 5 Capstone Evidence Synthesis Example

Course	NU298 Capstone
Unit	Unit 5
Paper type	Evidence synthesis paper
Length	About 1,110 words, 7 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	BSN (prelicensure)
Updated	October 2026

Free sample paper for NU298 Unit 5

Common, Longer Than Needed, Safe to Shorten and Untested on Medical Units: A Capstone Evidence Synthesis on Fasting Orders for Hospitalized Adults, Organized as Four Claims With Their Sources and the Strength of Agreement Behind Each

[Student Name]

Purdue University Global

NU298: Capstone

Unit 5 Evidence Synthesis

[Instructor Name]

[Date]

The capstone and unit are composite; the sources are real and summarized from their published reports, and strength ratings are the writer's judgments using the Johns Hopkins approach.

What this part is doingThe synthesis is organized by claims rather than by source, which is what distinguishes synthesis from a string of summaries.

Introduction

The question behind this capstone is whether a composite medical unit can safely shorten fasting before procedures by allowing clear liquids until two hours beforehand and confirming procedure times. The literature search identified eleven sources and the annotated bibliography kept ten. This synthesis groups them under four claims, judges the strength of each using the Johns Hopkins approach to evidence (Dang et al., 2022) and states what the claims together support. The claims are ordered from strongest to weakest, so a reader can see where the project stands on firm ground and where it is extrapolating.

Claim 1: Fasting Orders on Medical Units Are Common and Often Longer Than Needed

Two studies from one academic center examined fasting orders for adult medical inpatients. In the earlier study, close to half of all admissions involved at least one period of ordered fasting, a typical order ran for roughly thirteen hours, reviewers judged a quarter of the orders unnecessary, and close to half of the meals patients missed could have been served (Sorita et al., 2015). In the later study, roughly a fifth of fasts ended with the procedure not performed at all, most often because the plan or the schedule changed (Sorita et al., 2017). Where they agree: both show fasting is frequent, long and often wasted. Where they differ: the first judged avoidability by expert review, the second described outcomes by indication; both come from one institution. Strength: moderate. The designs are observational and from one center, but the findings are consistent, large in scale and match the composite unit's own baseline of a median of about thirteen and a half hours.

Claim 2: Shorter Clear-Liquid Fasts Do Not Appear to Increase Aspiration

Pooling randomized trials in adults having elective surgery, a systematic review could find no sign that letting patients drink closer to their operation raised the rate of aspiration, regurgitation or related complications compared with a midnight fast (Brady et al., 2003). The national anesthesia guideline, updated in 2023, recommends allowing clear liquids until two hours before procedures requiring anesthesia or sedation for healthy patients having elective procedures (Joshi et al., 2023).

The strongest evidence in the set says shorter fluid fasts are safe; the weakest says whether a medical unit can actually deliver them.

Where they agree: both support a two-hour clear-liquid window. Where they differ: the trials are older and surgical, while the guideline is current but applies to healthy elective patients, not all medical inpatients. Strength: strong for healthy elective surgical patients, moderate when extended to medical inpatients. The capstone therefore keeps exclusions for patients with swallowing problems, bowel obstruction, delayed gastric emptying or a provider's specific instruction.

What this part is doingThe synthesis distinguishes where evidence applies directly and where it is extended, which is why the plan keeps exclusions.

Claim 3: Long Fasts Cause Distress and Physiological Strain

A scoping review of adults who were nil by mouth found psychological distress, thirst and social effects for patients and their families (Hepper et al., 2024). A narrative review described what long fasts before surgery do to the body, from blunted insulin action to muscle breakdown (Pimenta & de Aguilar-Nascimento, 2014). Where they agree: fasting is not neutral. Where they differ: one addresses experience, the other physiology; neither measures harm from a single procedural fast on a medical unit. Strength: moderate for distress, limited for clinical outcomes in this setting. The capstone uses a comfort rating rather than claiming clinical benefit.

Claim 4: Whether Nurse-Driven Changes Shorten Fasting on Medical Units Is Where the Evidence Thins

A commentary on reduced fasting for hospitalized surgical patients emphasized that changes are hard to sustain without audit and leadership support (Sparling & Yeh, 2023). An editorial described a hospital initiative allowing surgical patients to sip clear fluids until called (McNally, 2025). No study in the search tested a nurse-driven protocol on a medical unit. Where they agree: change is possible and sustainment needs attention. Where they differ: both concern surgical settings and neither is research. Strength: weak. This is the capstone's weakest claim, and it is why the project is framed as a pilot with measurement rather than as an established practice.

What this part is doingThe weakest claim is admitted plainly, which keeps the project from overstating what it can show.

Applying the Claims to This Unit's Patients

The composite unit's patients are older than most trial participants, many have diabetes, some take medicines that slow stomach emptying, and their procedures range from ultrasound to endoscopy with sedation. The evidence fits some of them well and others poorly. A seventy-year-old awaiting an abdominal ultrasound is close to the guideline's population; a patient with gastroparesis awaiting endoscopy is not. The plan therefore sorts patients rather than applying one rule: those who meet the guideline's description get the two-hour clear-liquid window, those with risk factors stay on the provider's individual order, and nurses ask the question for every fasting order at the start of each shift. This keeps the change within what the evidence supports.

Gaps the Synthesis Leaves Open

Three questions remain. No study in the set measured fasting duration before and after a nurse-driven change on a medical unit. None reported how patients with diabetes fared when clear liquids were allowed but meals were still held. And none examined whether confirmation calls to procedure areas are feasible on busy units. The pilot can collect data on all three, even if it cannot answer them definitively.

What this part is doingNaming the gaps turns the weak claim into a set of questions the pilot can measure.

Table of Strength

1. Common and longer than needed: moderate; two observational studies, consistent with local data.

2. Safe to shorten clear liquids: strong in surgical trials, moderate when extended.

3. Long fasts cause distress: moderate for experience, limited for outcomes.

4. Nurse-driven change works on medical units: weak; no direct study.

From Claims to Plan

Claim 1 justifies the problem and the baseline measure. Claim 2 justifies the two-hour clear-liquid window with exclusions. Claim 3 justifies a comfort measure. Claim 4 justifies piloting rather than adopting outright, using the Iowa Model's pilot step and an audit at eight weeks (Iowa Model Collaborative, 2017).

Conclusion

The evidence supports trying a shorter clear-liquid fast with procedure-time confirmation on the unit, with exclusions and a balancing measure. It does not yet show that such a change works on medical units, which is exactly what a well-measured pilot can begin to answer. The next unit turns these claims into an implementation plan with roles, timing and measures.

References

Brady, M. C., Kinn, S., Stuart, P., & Ness, V. (2003). Preoperative fasting for adults to prevent perioperative complications. Cochrane Database of Systematic Reviews, 2003(4), Article CD004423. https://doi.org/10.1002/14651858.CD004423

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Hepper, E. C., Wilson, J., Drinnan, M., & Patterson, J. M. (2024). Psychosocial impacts of being nil-by-mouth as an adult: A scoping review. Journal of Advanced Nursing, 80(9), 3499-3515. https://doi.org/10.1111/jan.16100

Iowa Model Collaborative. (2017). Iowa Model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration: A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 138(2), 132-151. https://doi.org/10.1097/ALN.0000000000004381

McNally, S. (2025). Scarlett McNally: Nil-by-mouth rules need updating to implement SipTilSend. BMJ, 388, Article r306. https://doi.org/10.1136/bmj.r306

Pimenta, G. P., & de Aguilar-Nascimento, J. E. (2014). Prolonged preoperative fasting in elective surgical patients: Why should we reduce it? Nutrition in Clinical Practice, 29(1), 22-28. https://doi.org/10.1177/0884533613514277

Sorita, A., Thongprayoon, C., Ahmed, A., Bates, R. E., Ratelle, J. T., Rieck, K. M., Devalapalli, A. P., Issa, M., Shah, R. M., Lalama, M. A., Wang, Z., Murad, M. H., & Kashiwagi, D. T. (2015). Frequency and appropriateness of fasting orders in the hospital. Mayo Clinic Proceedings, 90(9), 1225-1232. https://doi.org/10.1016/j.mayocp.2015.07.013

Sorita, A., Thongprayoon, C., Ratelle, J. T., Bates, R. E., Rieck, K. M., Devalapalli, A. P., Ahmed, A., & Kashiwagi, D. T. (2017). Characteristics and outcomes of fasting orders among medical inpatients. Journal of Hospital Medicine, 12(1), 36-39. https://doi.org/10.1002/jhm.2674

Sparling, J. L., & Yeh, D. D. (2023). Hungry for change: How best to implement and sustain reduced fasting times in hospitalized surgical patients? The Joint Commission Journal on Quality and Patient Safety, 49(11), 579-580. https://doi.org/10.1016/j.jcjq.2023.07.001

Reading the NU 298 Unit 5 instructions

Unit 5 commonly asks students to synthesize the evidence gathered for the capstone rather than summarize it source by source. Prompts usually want the evidence organized by themes or claims, agreement and disagreement among sources explained, the strength of each conclusion judged and a link from the synthesis to the proposed practice change. Instructors look for synthesis that crosses sources, honest grading that admits weak areas, attention to whether studies apply to the student's setting and a clear path from evidence to plan. A table of strength is often welcome. Expect four or five pages in APA style, and every source from the bibliography should appear somewhere in the argument.

Inside the NU298 Unit 5 example

The paper opens with the question and states that claims are ordered from strongest to weakest. Each of four claim sections presents its sources, where they agree, where they differ and a strength rating, using the Johns Hopkins approach. The second claim carries the highlighted sentence and a margin note on where the evidence applies directly and where it is extended. The fourth claim is graded weak, with a margin note. A section applies the claims to the unit's patients and explains the exclusions. Another names three gaps the pilot can measure. A numbered table of strength, a mapping from claims to plan and a conclusion follow.

NU298 Unit 5 rubric: what earns full points

Synthesis rubrics in NU 298 tend to give points for organization by claim, integration across sources, appraisal of strength, applicability to the setting, link to the plan and writing. Organization points depend on headings that are claims rather than author names. Integration points go to explaining agreement and difference among sources. Strength points are earned by grading each claim honestly, including a weak one. Applicability points reward discussing whether studies fit the unit's patients. Link points require each plan element to trace to a claim. Writing points cover APA format and clarity. A synthesis that tells the reader where the project is extrapolating usually earns the highest marks.

Common NU298 Unit 5 mistakes, and how to avoid them

Synthesis papers often lose points by summarizing each study in turn, which is a literature review rather than a synthesis. Another common error is grading every claim as strong because the sources are peer reviewed. Some students apply surgical evidence to medical patients without comment. Others propose a plan that does not follow from the evidence. Organize by claims, bring sources together under each, explain where they agree and differ, grade strength honestly, ask whether each study fits your setting and show which claim supports each part of the plan. Name what the evidence cannot yet answer and let the plan measure it. Read your claims aloud without the sources and ask whether each one sounds supported.

Get an NU298 Unit 5 example written to your instructions

By theme, by claim or through a matrix the course supplies, a Unit 5 synthesis argues across its sources rather than through them. Share the prompt and rubric, every source found to date and whichever evidence scheme the course grades against, and the sample says plainly where the evidence thins. The first custom sample is free and arrives in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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NU298 Unit 5 questions, answered

Where can I find a free NU298 Unit 5 sample paper?

The complete NU298 Unit 5 evidence synthesis is on this page, organizing capstone sources on hospital fasting into four graded claims with applicability, gaps and ten references. If your capstone question is different, we can help you organize your sources into claims.

How does synthesis go beyond summary in NU298 Unit 5?

A summary describes each source separately; a synthesis brings sources together under claims and explains what they show together.

How is the strength of a claim judged?

By the level and quality of the sources behind it, how consistently they agree and how well they apply to the setting.

Why admit a weak claim?

It tells the reader where the project is extrapolating and justifies testing the change in a pilot rather than adopting it outright.

Can surgical evidence be used for medical patients?

Sometimes, with care. The synthesis explains where it applies directly and keeps exclusions where patients differ from those studied.