NU480CL Unit 3 Practicum Site Assessment Example

Forty-One Admissions, Most After 1500, and a Palliative Visit One Day a Week: A Site Assessment for a Capstone Project in a Composite Rehabilitation Facility, Built From Figures the Writer Collected

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 3 Site Assessment

[Instructor Name]

[Date]

All site figures are composite and bracketed as the writer's own collection from records and observation; tools named are real, and any data collection follows the facility's approval and privacy rules.

Flow Before Description

Over [four] weeks, the [36]-bed hall admitted [41] patients, nearly all from two local hospitals. Median length of stay was [19] days. [26] admissions, [63] percent, arrived after [1500], when the day admitting nurse has left and evening nurses carry the admission with a full assignment. Weekend admissions were [9].

Baseline From the Charts

With the facility's approval, I reviewed the records of all [41] admissions. Documented conversation about goals of care within the first [seven] days: [9] of [41], [22] percent. Advance directive or health care proxy on file at admission: [14] of [41]. Admissions with features suggesting serious illness, such as metastatic cancer, heart failure with recent hospitalizations, advanced dementia or dialysis: [15] of [41]. Of those [15], documented goals conversation within seven days: [4]. Palliative consultation requested during the stay: [3].

Who Might Screen Positive

Using criteria adapted from hospital palliative screening, which flag patients with serious illness and markers such as repeated hospitalizations or declining function (Weissman & Meier, 2011), roughly [15] to [18] patients a month would likely screen positive. The surprise question, which asks the clinician whether a death within the coming year would come as a surprise, has modest accuracy for predicting death but is simple to ask (Downar et al., 2017). The Palliative Performance Scale gives a quick rating of function and decline (Anderson et al., 1996).

Four of fifteen seriously ill patients had their goals discussed in the first week; the screen is meant to change that number, not the illness.

Afternoon Arrivals

The timing matters. Evening nurses admit most patients while caring for others, and admission assessments already take about [45] minutes. A screen that adds more than a few minutes, or that sits outside the admission form, is likely to be skipped. This shaped the decision to use three items embedded in the existing form.

Palliative Access in Hours

The contracted palliative nurse practitioner visits on [Wednesdays] for about [four] hours. A patient admitted on a Thursday with a positive screen could wait six days for a palliative visit. Goals conversations therefore need to be possible without her, led by the attending clinician or the social worker, with the nurse practitioner seeing patients who need specialist input.

What the Record Can Report

The electronic record can report the admission date and time, the completion of each section of the admission assessment and the presence of an advance directive. It cannot currently report whether a goals conversation took place unless a specific note type is used. The project will need a note template or a checkbox to measure its main outcome.

What Staff Said

I asked [eight] nurses and both day-shift nurse supervisors how goals of care come up on the hall now. Most said it happens "when something goes wrong," usually a return to the hospital or a sudden decline. Two evening nurses said they sometimes notice that a patient seems very ill for rehabilitation but are unsure whom to tell or whether it is their place. The social worker said families often ask her questions about prognosis that she cannot answer and that the attending clinician is hard to reach in the first days. These comments point to a gap the screen can fill: a defined moment and a defined route for a nurse's concern.

What Families Said

Two families I spoke with, with permission, said nobody had asked what their parent wanted beyond therapy goals. One daughter said she would have welcomed the question in the first week, "before everyone was exhausted."

Strengths of the Site

Experienced nurses, a social worker who already meets every family within [72] hours, an engaged director of nursing and a palliative nurse practitioner willing to train staff.

Constraints

Afternoon arrivals, limited palliative hours, a record that does not capture conversations and a facility identity built around rehabilitation, which may make palliative language feel out of place to some staff and families.

Data Still Needed

Two figures are missing. I do not yet know how many patients would want a goals conversation if offered, and I do not know how long such a conversation takes on this hall. The first can be estimated during the project from accepted and declined offers; the second from the time recorded in the new note template. Both will be reported with the final results, so the facility can judge the workload before deciding whether to keep the screen after the term ends.

What This Means for the Project

The screen must fit the evening admission, take under five minutes, trigger notification without waiting for the nurse practitioner and be measurable through a new note type.

References

Anderson, F., Downing, G. M., Hill, J., Casorso, L., & Lerch, N. (1996). Palliative Performance Scale (PPS): A new tool. Journal of Palliative Care, 12(1), 5-11. https://doi.org/10.1177/082585979601200102

Downar, J., Goldman, R., Pinto, R., Englesakis, M., & Adhikari, N. K. J. (2017). The "surprise question" for predicting death in seriously ill patients: A systematic review and meta-analysis. Canadian Medical Association Journal, 189(13), E484-E493. https://doi.org/10.1503/cmaj.160775

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