NU480CL Unit 5 Capstone Stakeholder Analysis Example

Who Gains, Who Gives Minutes, Who Could Stop It: A Stakeholder Analysis for an Admission Goals Screen on a Composite Short-Stay Hall, Sorting Each Group by Benefit, Time Cost and Power to Halt the Project

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 5 Stakeholder Analysis

[Instructor Name]

[Date]

The facility and stakeholders are composite; minute estimates are bracketed from the writer's own timing, and concerns are paraphrased from conversations held with permission.

Method

Mapping who is touched by a change, what each party wants and how much power each holds lets a project plan for them instead of being surprised (Bryson, 2004). For each group I asked three questions and recorded answers in minutes and decisions rather than adjectives.

Evening Admitting Nurses

Gains: a defined route for a concern they already feel, according to two nurses who said they sometimes notice a patient who seems too ill for rehabilitation but do not know whom to tell. Time given up: about [six] minutes per admission, timed on [five] practice admissions, for three items and the notification. Could halt it: yes, in practice, by not completing the screen.

Day Nurses

Gains: earlier clarity about goals for the patients they care for during the stay. Time: little, unless they admit; occasional questions from families. Could halt it: no.

Attending Clinicians

Gains: earlier notice of patients who may need a goals conversation, before a crisis. Time: about [15] to [30] minutes per conversation, for [15] to [18] positive screens a month across [five] clinicians. Could halt it: yes, by not holding conversations, which would make the second target impossible.

Admissions Coordinator

Concern: that palliative language at admission could make hospitals think the facility is not committed to rehabilitation, and reduce referrals. Time: none. Could halt it: indirectly, through the administrator.

The most powerful objection came from someone whose work the screen never touches, because referrals keep the hall full.

Therapy Staff

Concern: that patients who discuss goals might lose motivation for therapy. Response: most patients who have goals conversations continue rehabilitation, and patients who choose otherwise are entitled to that choice. The project will track whether therapy participation changes for patients who screen positive. Could halt it: no, but their support matters for how patients hear the message.

Social Worker

Gains: a structured trigger for conversations she already wants to have. Time: [10] to [20] minutes per positive screen for family contact. Could halt it: no; she is a strong supporter.

Palliative Nurse Practitioner

Gains: patients identified earlier. Time: possibly more referrals on her one weekly visit. Could halt it: no, but she has asked that routine conversations go to attendings first.

Director of Nursing

Gains: a quality initiative aligned with person-centered care. Could halt it: yes, as the sponsor who controls the form.

Patients and Families as Stakeholders

Gains: the chance to say what matters early. Risk: alarm if the screen is explained poorly. Two family members I spoke with welcomed the idea. Conversations that begin by asking what patients understand and what they hope for are less likely to cause distress (Bernacki & Block, 2014).

Three Groups That Could Stop It

1. Evening nurses, by non-completion. Response: three items in the existing form, a one-page guide and weekly feedback.

2. Attending clinicians, by not holding conversations. Response: the medical director introduces the project; the social worker can begin the conversation and bring in the clinician.

3. The administrator, through referral concerns. Response: frame the screen as part of person-centered admission, used for every patient who meets criteria, and share early data on therapy participation.

How the Information Was Gathered

I spoke with [eight] nurses across shifts, three attending clinicians, the admissions coordinator, two therapists, the social worker, the palliative nurse practitioner and the director of nursing over two weeks, using the same three questions and noting answers in their words. Time estimates came from timing practice screens on [five] admissions with the evening charge nurse's help. Families were asked only with their permission and the social worker's introduction.

Competing Interests

Two tensions matter most. The admissions coordinator wants the hall to look like rehabilitation to referring hospitals; the palliative nurse practitioner wants seriously ill patients identified early. Both are legitimate. The screen's framing, a standard goals question put to every patient who qualifies, is the attempt to serve both. The second conflict is between attending clinicians' limited time and the target for conversations. Routing first conversations through the social worker, who can begin the discussion and bring the clinician in, reduces the clinicians' share of the work.

What the Analysis Changed in the Plan

The analysis changed three things in the charter: the notification now goes to the social worker as well as the attending, the screen's introduction to families uses the word goals rather than palliative, and the project will track therapy participation to answer the therapists' concern with data.

Minutes, Not Adjectives

Recording time in minutes made the costs concrete. [Six] minutes per admission across about [40] admissions a month is about four hours of evening nursing time. That is the figure to present to the director, alongside the number of conversations it produces (Weissman & Meier, 2011).

References

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

Bryson, J. M. (2004). What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Management Review, 6(1), 21-53. https://doi.org/10.1080/14719030410001675722

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