NU590 Unit 10 practicum summary paper example

What Held and What Did Not: A Practicum Summary of Three Principles Applied to Preoperative Fasting Instructions

[Student Name]

Purdue University Global

NU590: Applying Principles of Advanced Nursing Practice - Clinical

Unit 10 Practicum Summary Paper

[Instructor Name]

[Date]

The department is composite; results are bracketed for the writer's own data, and hours, evaluations and preceptor records are kept outside this paper.

Introduction

Over ten units, this practicum aimed to close a gap that the literature has described for decades: adults are told to take nothing after midnight before surgery, although the anesthesia policy lets them drink clear fluids up to two hours before anesthesia (American Society of Anesthesiologists Committee on Standards and Practice Parameters, 2017). The gap here was not knowledge. The anesthesia chair supported the policy, and the pre-admission nurses knew it. The gap was in the instruction patients heard. The project revised that instruction and the tools around it. This paper summarizes the result by principle, then states what did not hold and why, and ends with the question the next course must answer.

Summary Table

1. Revised call script: held, documented on [84] percent of audited calls over [five] weeks.

2. Stop-time calculator card: held, in use at all call stations; [six] of [seven] nurses rated it useful.

3. Check-in question on last clear liquid: held, on the form and asked at every check-in audited.

4. Exception line, including GLP-1 receptor agonists: held, [nine] patients routed to anesthesia.

5. Surgical order set default: did not hold, unchanged, in the informatics queue until [month].

6. Surgeon office sheets: partly held, [two] of [four] offices using the new line.

Principle One: Translating Evidence Into Standard Work

Applying this principle meant turning a policy sentence into something a nurse does the same way on every call. Evidence that sits in a policy binder changes nothing until it becomes a sentence someone says aloud to a patient. The script, the card and the check-in question are the standard work. Each was designed around a specific constraint the organizational assessment found: nurses' time on calls, the intake field that mixed food with liquid, and the lack of any tool for computing a stop time.

These components held. The script's documented use rose from [68] percent in the first audited week to [90] percent by the last, and the card became the nurses' own tool; two nurses suggested adding a column for patients arriving before 06:00, which was done. The exception line, rewritten by the chair to include patients on GLP-1 receptor agonists in line with multisociety guidance (Kindel et al., 2024), cost six days at the start and has since routed [nine] patients to individual review. Every one of those routes was appropriate on audit.

What did not hold under this principle was small: [one] nurse continued to add "nothing after midnight" out of habit on early calls in the first week, which a one-to-one conversation corrected.

Principle Two: Engagement Along the Route

The stakeholder analysis ordered groups by when they speak to the patient, and the principle was to engage each voice so that none contradicted the next. This held inside the hospital. The pre-admission nurses delivered the script; the pre-op nurses asked the new question; the chair signed the wording and agreed a review threshold in advance; the perioperative director received updates at go-live and at week 8.

It held only partly outside. Two of the four surgeon offices adopted the replacement line after the chair's note and a follow-up call. The other two had not replied by the end of the term. The Unit 9 journal traces this to the plan's own sequence: the offices were scheduled after launch, although the analysis had placed them first on the route. During the final three audit weeks, [seven] patients mentioned an instruction from their surgeon's office that differed from the call, and [four] of them had followed the stricter one. Stakeholder maps are useful only if they are revisited and allowed to shape decisions as positions shift (Brugha & Varvasovszky, 2000); here the map was right and the plan did not follow it.

Principle Three: Systems Thinking About Ownership

The third principle was to ask, for each part of the problem, who owned it and whether the project could change it. The implementation framework used in the organizational assessment distinguishes the inner setting of an organization from its outer setting, and warns that barriers in each call for different strategies (Damschroder et al., 2009). The script sat inside nursing practice, which the project could change. The order set sat with the informatics committee, and the surgeon office sheets with the surgeons; neither belonged to nursing.

This principle held as a way of scoping. By keeping the order set out of the objectives, the project avoided depending on a committee calendar. The chair submitted the request in week 5, and pre-op nurses now document the difference between the default and the policy by note. What did not hold is the result: the midnight default still prints on every order, and a new staff member reading the chart could take it as the instruction. The workaround is safe because the check-in question catches any conflict, but it is untidy, and it depends on people remembering.

Early Intake Figures

Over the last [three] weeks, the median time since last intake at check-in was about [6.1] hours across all arrival bands, against a baseline median in the range of [7.9] to [13.9] hours by band. This figure is preliminary and not yet comparable. The intake field mixes food and liquid and depends on recall; three weeks is a short period; the new check-in question, which separates the two, has run only since go-live and has no baseline of its own. The figure is encouraging and it is all this paper will say about it.

What Did Not Hold, and Why

The order set did not change because it was never the project's to change; its owner's queue ends after the term. Two offices did not adopt the new line because the writer reached them late and had no relationship with their surgeons. The early-week habit on one call was a training gap corrected within days. Each failure has an owner and a cause, and none of them is a failure of the evidence. The pattern matches the wider literature, which has found that the gap in preoperative fasting lies in implementation rather than research (Hewson & Moppett, 2020).

Handoff to the Evaluation Course

The unanswered question is whether the revised script shortened clear-liquid fasting times without increasing fasting-related delays. The next course should compare median clear-liquid fasting time from the new check-in question over [twelve] weeks with a baseline built from a [two]-week sample of the same question asked before go-live, which the site has agreed to collect retrospectively from nurse notes where recorded. Delays should continue to be split between patients who drank on schedule, patients who drank late and patients who ate. The strategies used, educational meetings, a reminder tool, audit and feedback and a champion, are named in the shared vocabulary of implementation research (Powell et al., 2015), so the evaluation can report them in the same terms.

Conclusion

The components inside nursing held: script, card, check-in question and exception line. The components outside it did not yet: the order set and half the offices. The principles explain both results, and the most important lesson for the writer is the one from the route: the first voice a patient hears must be reached first.

Appendix A holds the final script and Appendix B the calculator card.

References

American Society of Anesthesiologists Committee on Standards and Practice Parameters. (2017). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures. Anesthesiology, 126(3), 376-393. https://doi.org/10.1097/ALN.0000000000001452

Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50

Hewson, D. W., & Moppett, I. (2020). Preoperative fasting and prevention of pulmonary aspiration in adults: Research feast, quality improvement famine. British Journal of Anaesthesia, 124(4), 361-363. https://doi.org/10.1016/j.bja.2019.12.018

Kindel, T. L., Wang, A. Y., Wadhwa, A., Schulman, A. R., Sharaiha, R. Z., Kroh, M., Ghanem, O. M., Levy, S., Joshi, G. P., & LaMasters, T. L. (2024). Multisociety clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surgery for Obesity and Related Diseases, 20(12), 1183-1186. https://doi.org/10.1016/j.soard.2024.08.033

Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10, 21. https://doi.org/10.1186/s13012-015-0209-1