| Course | NU712 Quality Improvement and Interprofessional Collaboration for the Doctoral Nurse |
|---|---|
| Unit | Unit 2 |
| Paper type | Implementation framework analysis |
| Length | About 1,160 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU712 Unit 2
Five Domains, Three Barriers That Matter: A Unit 2 CFIR and Systems Analysis of Taking an Insulin Discharge Bundle Hospital-Wide
[Student Name]
Purdue University Global
NU712: Quality Improvement and Interprofessional Collaboration for the Doctoral Nurse
Unit 2 Implementation Framework Analysis
[Instructor Name]
[Date]
The hospital, units and findings are composite and illustrative; the frameworks and studies cited are real.
The Improvement and the Question
The bundle has five parts: one supervised self-injection with the pen the patient will use at home, a short plain-language plan, that pen dispensed on the first insulin day, a check-in within three days of discharge and a reserved seat in the outpatient diabetes class. It has run on four units for six months, with a readiness flag in the electronic record. The DNP project will take it to the remaining six units and evaluate it there. The question for this analysis is what will help or hinder that phase, and what the project should do about it before NU802.
Why CFIR, and Why Add Systems Thinking
Damschroder et al. (2022) updated CFIR after feedback from experienced users. In the revision, determinants sit in five domains, which ask in turn about the change being introduced, forces outside the hospital's walls, conditions inside them, the people involved in their various roles and the way the work of implementing is carried out. It is a determinant framework, meant to identify contextual factors that can work against implementation, and its authors note that many implementations fail even with detailed plans because of those factors.
CFIR lists factors, but it says less about how they affect each other over time. Whelan et al. (2023) reviewed studies that combined systems thinking with implementation science constructs in community prevention and found only 14 studies that did so, despite the argument that combining them could strengthen implementation and sustain change. This analysis uses CFIR to identify the factors and a systems view to see how they interact.
The Domains Applied
Innovation. The bundle's evidence base is moderate: patients with high A1C who saw an educator in hospital came back within a month less often in a large retrospective cohort (Healy et al., 2013), and the pilot units' results are promising but small. Its complexity is moderate, five components across four departments. Its adaptability is a strength, since the core and adaptable parts are already defined.
Outer setting. Payers do not reward the bundle directly, and diabetes is not among the conditions in the federal readmission penalty program, although many patients starting insulin also have heart failure or pneumonia. Insulin prices and coverage shape what patients can buy, which the bundle cannot change.
Inner setting. The hospital's structure and culture were assessed in the systems leadership course: values and strategy support the bundle, while systems and structure work against it. The key inner-setting constructs are available resources, especially a single diabetes educator, and relative priority, since six units are also implementing a new sepsis bundle this year.
Individuals. Unit champions exist on four units; the remaining six have none yet. Hospitalists' views range from supportive to skeptical. Patients and families have been consulted through the advisory council.
Implementation process. Planning is strong, with a spread plan and a readiness flag. Reflecting and evaluating is the weakest construct, because returns are counted monthly but nobody has been assigned to discuss them with units.
Most of CFIR's constructs describe this hospital accurately; only three of them describe where the project could fail.
The Three Constructs That Matter
Available resources in the inner setting. With one educator, the three-day check-in cannot reach patients from six more units. If check-ins lapse, the component most tied to early safety disappears quietly.
Relative priority. The sepsis bundle has executive attention and an external reporting requirement. On units implementing both, managers will protect sepsis first.
Reflecting and evaluating. Without someone discussing each unit's numbers with its staff, units will not know whether the bundle is working for them, and the data the readiness flag produces will sit unused.
How the Barriers Interact
A systems view shows that these three are linked. If check-ins lapse for lack of educator time, fewer problems are found early, more patients return and the bundle looks less effective on the dashboard. A less effective-looking bundle loses priority to sepsis, which further reduces the time managers give it. Meanwhile, without reflection meetings, nobody connects the rising returns to the lapsed check-ins. This is a reinforcing loop of decline, and it explains how a sound improvement could fade without anyone deciding to stop it.
The same loop can run in the other direction. If check-ins are protected, problems are found, returns fall, the dashboard shows benefit and the bundle holds its priority.
Strategies
Each strategy targets one construct, and together they interrupt the loop.
1. Resources: replace part of the educator's calls with two-way text follow-up, as proposed in the informatics course, so that a nurse calls only patients with a worrying answer or no reply.
2. Relative priority: schedule each unit's go-live at least eight weeks away from its sepsis bundle go-live, agreed with the chief nursing officer.
3. Reflecting and evaluating: add a 15-minute bundle review to each unit's monthly council meeting, using the dashboard, led by the unit champion.
What Staff Said
The choice of three constructs was tested against interviews with eleven staff from four units: two managers, four champions, two pharmacists, two case managers and one hospitalist. Asked what would most likely stop the bundle on their unit, seven named time for follow-up or teaching, five named competing initiatives and four said nobody looked at the numbers with them. Only one named the evidence for the bundle, and none named the outer setting. The interviews do not prove the analysis right, but they match the constructs it chose, and they suggest that staff see the risks the framework identifies.
The pharmacists added a point the framework had not surfaced: when pens are dispensed on the first insulin day, unused pens return to pharmacy if the insulin is stopped, which adds work they had not been asked about. That belongs under the innovation's cost and will be raised with the pharmacy director before the next wave.
Limits
CFIR is a determinant framework; it identifies barriers but does not prove which ones caused a failure. The analysis's choice of three constructs is a judgment based on the pilot and on staff interviews, and the project will test it by tracking whether units with protected check-ins and regular reviews hold their results better than those without.
Conclusion
CFIR describes the bundle's next phase thoroughly, but three constructs will decide it: educator capacity, competition with the sepsis bundle and whether anyone reviews the data with staff. A systems view shows that these three can feed one another into a quiet decline. Protecting check-ins through text follow-up, separating go-lives and building monthly reviews into councils address all three at once.
References
Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17(1), 75. https://doi.org/10.1186/s13012-022-01245-0
Healy, S. J., Black, D., Harris, C., Lorenz, A., & Dungan, K. M. (2013). Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care, 36(10), 2960-2967. https://doi.org/10.2337/dc13-0108
Whelan, J., Fraser, P., Bolton, K. A., Love, P., Strugnell, C., Boelsen-Robinson, T., Blake, M. R., Martin, E., Allender, S., & Bell, C. (2023). Combining systems thinking approaches and implementation science constructs within community-based prevention: A systematic review. Health Research Policy and Systems, 21(1), 85. https://doi.org/10.1186/s12961-023-01023-4
What the NU712 Unit 2 assignment asks for
The Unit 2 assignment typically asks students to take one improvement and examine it through an implementation science framework, and many prompts pair that framework with systems thinking. Expect to describe the change and the setting, apply the framework's domains to real local conditions and identify which factors are most likely to decide the outcome. Instructors want selection, not a tour of every construct, so the analysis should argue why a few constructs matter more than the rest. Systems thinking is usually expected to show how barriers interact rather than listing them side by side. Strategies should answer the barriers you chose. Some versions also ask students to check their judgment against staff views or pilot data, and most expect the limits of a determinant framework to be stated plainly.
How this NU712 Unit 2 example is built
The paper opens with the bundle's five parts and the plan to carry it to six more units, then poses one question: what will help or hinder that phase. A short section explains why CFIR was chosen and why Whelan and colleagues' review argues for adding systems thinking. Each of the five domains is then filled with facts from the hospital, from the evidence for inpatient diabetes teaching to the single educator and a competing sepsis rollout. A highlighted line says that most constructs describe the hospital but only three describe how the project could fail. The systems section traces a reinforcing loop in which lapsed check-ins raise returns and cost the bundle its priority. Three strategies follow, one per construct, then interview findings from eleven staff, a pharmacy issue the framework missed and the analysis's limits.
Reading the NU712 Unit 2 grading rubric
The heaviest weight in this unit's rubric usually falls on application: whether the framework's domains are filled with the setting's own facts rather than definitions. The choice of a few decisive constructs earns credit when it is argued, so a reason for each pick matters. Systems thinking is graded on whether it explains interaction, such as a loop that could make a sound change fade, and a diagram described in words is enough. Strategies are judged on fit, each one matched to a named barrier, with an owner and a timeline where possible. Checking the analysis against staff input or data shows doctoral judgment and is often rewarded. A stated limit, such as a determinant framework's inability to prove cause, shows awareness of method. Accurate citation of Damschroder and colleagues' 2022 update matters, since many sources still describe the 2009 version.
Common NU712 Unit 2 mistakes, and how to avoid them
The usual weakness here is a paper that recites the framework, domain by domain, without ever making a judgment about which factors matter. A second is citing the original 2009 framework and missing the 2022 changes to domain names. Some analyses list barriers well but propose strategies that do not touch them, such as more education for a problem caused by staffing. Others add systems thinking as a label and never trace how one barrier affects another. Leaving out the people who will carry the change, such as pharmacists or unit champions, weakens the inner-setting and individuals sections. Before drafting, interview a handful of staff about what would stop the change, and compare their answers with your chosen constructs. A custom analysis can be shaped around the improvement you are preparing for NU802.
Get an NU712 Unit 2 example written to your instructions
Share the improvement, the setting and the analysis instructions with the rubric. A custom analysis applies the framework to predict barriers and choose strategies. Turnaround is 24-48h, free the first time. 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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NU712 Unit 2 questions, answered
What is CFIR?
The Consolidated Framework for Implementation Research, a determinant framework that organizes factors affecting implementation into domains such as the innovation, the outer and inner settings, the individuals involved and the implementation process.
Should every CFIR construct be discussed?
No. Choose the constructs that matter most in your setting and explain why.
How does systems thinking add to an implementation framework?
It shows how factors interact over time, such as feedback loops, which a list of determinants may miss.
Where can I find a free NU712 Unit 2 sample paper?
This page holds the complete NU712 Unit 2 implementation framework analysis, which applies CFIR and a systems view to spreading an insulin discharge bundle and settles on three constructs that will decide the result.
Which three CFIR constructs does the NU712 Unit 2 sample choose?
Available resources, because one diabetes educator cannot cover six more units, relative priority against a sepsis bundle, and reflecting and evaluating, since nobody yet reviews each unit's numbers with its staff.