NU480CL Unit 10 Capstone Synthesis Report Example

Did the Admission Screen Reach Its Two Targets? A Capstone Synthesis Report on Eight Weeks of Nurse Screening for Serious Illness on a Composite Rehab Unit, Answering in the First Paragraph and Then Testing the Sphere Placement, the Changes Made and What the Facility Might Keep

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 10 Capstone Synthesis Report

[Instructor Name]

[Date]

The facility and every result are composite and bracketed for the writer's own data; the report demonstrates the form of a capstone synthesis rather than reporting a real project.

Verdicts

Screening: met. Over eight weeks, [91] percent of short-stay admissions were screened within [48] hours, against a target of [90] percent. Conversations: not met as first defined, close under the revised definition. Under the original measure, [11] of [24] positive screens, [46] percent, were offered and held a goals discussion, written up before the care-planning conference. Under the definition approved in week eight, which counts qualifying social worker and progress notes, the figure was [17] of [24], [71] percent, against a target of [75] percent.

Introduction

The project asked whether a three-item screen completed by nurses at admission to a [36]-bed rehabilitation hall could make sure patients with serious illness were asked early what mattered most to them. At baseline, [4] of [15] seriously ill admissions had a goals conversation in the first week. The project was placed in the hospice, palliative and supportive care sphere because its aim was conversation, not function (American Association of Colleges of Nursing, 2021).

Methods in Brief

Nurses completed three items within [48] hours: the surprise question, serious illness with repeated hospitalizations and a function score at or below [50] percent. Positive screens notified the attending clinician and, from week four, the social worker. Measures were tracked weekly on run charts with changes dated (Langley et al., 2009).

Run Charts With Dated Notes

Screening rose from [74] percent in week one to a stable [85] to [93] percent after week four, when evening arrivals moved to next-morning screening. Conversations stayed between [one] and [two] a week until week five, when the social worker was copied in, then rose to [three] or [four] a week.

The two changes that mattered were both about who did the work, not about the screen itself.

What the Evening Change Contributed

Moving evening screens to the next morning removed most missed screens without lengthening the evening admission. Evening nurses reported less pressure; day nurses completed the screen in about [four] minutes.

What the Social Worker and the Nurse Practitioner Contributed

Copying the social worker in moved first conversations to the family meeting she already held within [72] hours. The palliative nurse practitioner saw [six] patients referred after those conversations, using her weekly visit list for patients who needed specialist input. Conversations led first by the social worker, with clinicians joining, were judged acceptable under the approved definition, which required the patient's understanding, what mattered most and a recorded plan (Bernacki & Block, 2014).

The Placement, Tested Again

Did the project stay in the supportive care sphere? The measures were screening and conversations, not function or discharge. Of [24] patients who screened positive, [19] continued full rehabilitation, [three] changed to a comfort-focused plan and [two] were readmitted to hospital. The screen did not steer patients away from rehabilitation; it made their choices explicit. That supports the placement.

Balancing Measures

Family concerns: [two] in eight weeks, both resolved after explanation. Evening admission time: unchanged. Therapy participation for patients who screened positive: similar to others, which answered the therapists' concern.

Limits That Belong to This Project

The definition of a conversation changed in week eight, so the two figures for the second aim are not strictly comparable; both are reported. Eight weeks on one hall is a short period. The screen's accuracy was not tested; the surprise question and function score identify patients who may benefit, not those certain to decline. Some conversations may have happened without any note. Results are composite and illustrate the form of the report.

Who Would Own It Next

If the facility keeps the screen, ownership should sit with the hall's nurse manager for screening and with the social worker for conversations, with monthly run charts reviewed at the quality committee. Hospital programs that sustained palliative screening built it into routine assessments and assigned clear responders (Weissman & Meier, 2011).

Patient and Family Voices

At the end of the pilot, [six] families who had a goals conversation were asked, with permission, whether it helped. [Five] said it did; one said it came too early, before her father had recovered from surgery enough to take part. That comment suggests offering, for some patients, a later conversation rather than skipping it. Several families said the most useful part was hearing, in plain words, that the screen did not mean therapy would stop.

What Staff Said at the End

Evening nurses said the change to next-morning screening made the project possible. Day nurses said the three items were quick and that the family reply on the handout was the most useful part. One attending clinician said the social worker's first conversations made his own shorter and better prepared. The admissions coordinator reported no change in referrals from either hospital over the eight weeks, which eased her early worry that the hall would be seen as a hospice unit.

What I Would Do Differently

I would define a goals conversation and its documentation before the first week, not in week eight. The late change made the second target harder to interpret and cost two weeks of checking notes by hand. I would also plan from the start how families first hear about the screen, since the portal problem surfaced only when a daughter raised it. Finally, I would ask the therapists to join the first planning meeting; their concern about participation was answered by the data, but it could have been answered sooner by including them.

Cost and Workload

The screen adds about [four] minutes per admission for the day nurse, or roughly [40] minutes a week on a hall with [ten] admissions. The social worker absorbed most conversations into existing family meetings, adding about [15] minutes for each positive screen. No new staff, software or paid tools were needed; the template change was made by the facility's records lead in an afternoon.

Recommendations

1. Keep the screen in the admission assessment with next-morning completion for evening arrivals.

2. Keep the social worker on every positive screen and offer the conversation at the existing family meeting.

3. Adopt the approved conversation definition and a single note template.

4. Review accuracy after six months by comparing positive screens with outcomes.

What the Project Says About the Hall

A rehabilitation hall can ask about goals early without losing its identity. Patients sent to post-acute care near the end of life are better served when their goals are known (Flint et al., 2019).

Conclusion

One target was met and one came close. The changes that worked were about people and timing, and the facility has a clear owner and a modest workload if it chooses to continue.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education.

Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271

Flint, L. A., David, D. J., & Smith, A. K. (2019). Rehabbed to death. New England Journal of Medicine, 380(5), 408-409. https://doi.org/10.1056/NEJMp1809354

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Weissman, D. E., & Meier, D. E. (2011). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the Center to Advance Palliative Care. Journal of Palliative Medicine, 14(1), 17-23. https://doi.org/10.1089/jpm.2010.0347