| Course | NU753 Transforming the Health Care Organization |
|---|---|
| Unit | Unit 1 |
| Paper type | Microsystem assessment |
| Length | About 1,100 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NU753 Unit 1
A Hallway a Reader Could Walk: A Microsystem Assessment of 5 West, a 28-Bed Colorectal Surgical Unit, Using the Dartmouth 5 Ps
[Student Name]
Purdue University Global
NU753: Transforming the Health Care Organization
Unit 1 Microsystem Assessment
[Instructor Name]
[Date]
The hospital system, unit and every figure are composite; numbers are bracketed placeholders.
Why the Microsystem
Clinical microsystems are the small, front-line units where patients, clinicians and support staff meet, and research on high-performing units found that their performance depends on how these elements work together day to day (Nelson et al., 2002). The Dartmouth 5 Ps, purpose, patients, professionals, processes and patterns, give a structured way to describe a microsystem before trying to change it. This assessment of 5 West is the first step in a term-long project on its colorectal surgery service.
Purpose
In six staff interviews, the unit's purpose was described most often as "getting surgical patients safely through recovery and home." Two nurses added "without falls," a phrase that also appears on a banner at the nurses' station counting [212] days since the last fall. The hospital's budget describes 5 West differently, as a surgical inpatient unit expected to maintain an occupancy of [88] percent. The two purposes are compatible but not the same: one emphasizes safe recovery, the other full beds. That difference will matter when a pathway designed to shorten stays is proposed.
Patients
5 West admitted [1,420] patients last year. The largest single group was [320] patients having elective colorectal resections, mostly for cancer or diverticular disease; the rest were general surgical, urologic and emergency admissions. The median age was [64], and [31] percent were over seventy-five. The median length of stay for elective colorectal resection was [5.9] days. About [22] percent of colorectal patients went to a skilled nursing facility after discharge instead of going home.
Professionals
Every role that touches a patient in a day was counted. The unit employs [58] registered nurses by headcount, with a ratio of one nurse to [four or five] patients on days and [five or six] at night. Two nursing assistants work each shift. A clinical nurse specialist is shared with two other surgical units. Four colorectal surgeons admit to the unit, with residents covering at night. Physical therapists come from a separate department, see patients on weekdays by referral, and cover weekends only on request. A case manager and a social worker are shared with another unit, and a dietitian visits on referral.
Processes
A day on 5 West begins before [0700], when the colorectal surgeons round, often before the night nurses have given report. Plans made on those rounds reach the day nurses secondhand or through orders. Nursing report runs from [0700] to [0730]. Physical therapy referrals are entered by the surgical team, usually on the first postoperative day, and seen when a therapist is free. Discharge orders are written after the surgeons' second visit, typically late morning, and discharge follows medication reconciliation, teaching and transport, which explains the median discharge time of [2:40] in the afternoon.
Several handoffs are fragile. The preoperative clinic, where patients receive instructions before surgery, has no regular contact with 5 West. Patients arrive having fasted since midnight, on instructions nobody on the unit wrote. And patients go home with instructions that the clinic does not see.
5 West does its own work carefully, but the steps before and after it belong to other people, and nobody on the unit knows what those people are telling its patients.
One Patient's Path Through the Unit
Following one composite patient shows how the processes feel from the bed. Mr. [S.], [68], had a laparoscopic right colectomy on a Tuesday. He had fasted from midnight Monday on the clinic's instructions and arrived on 5 West at [1500], drowsy from a patient-controlled opioid pump. On Wednesday the surgeons rounded at [0640] and wrote "ambulate" in the orders; his nurse, caring for five patients, walked him to the doorway at [1100]. Physical therapy saw him Thursday afternoon. He started clear liquids Wednesday evening and solid food Friday. He went home on the following Monday at [3:10] in the afternoon, after waiting four hours for his discharge teaching and a ride. Nothing in his care was unsafe, and every step followed an order or a habit. But the path was set by when people were available, not by what his recovery needed.
What Staff Said They Would Change
Asked what they would change if they could, the six staff interviewed gave consistent answers. Four wanted someone whose job was to get patients walking. Three wanted to hear the surgeons' plans directly rather than through orders. Two wanted patients to arrive less hungry and thirsty. None mentioned falls, which suggests that the fall-free banner reflects what the unit is rewarded for more than what staff think matters most.
Patterns
Four patterns stand out, and each is a habit of the unit rather than a failing of any person in it. First, work is organized around the surgeons' early rounds, and nursing plans adapt to them rather than being part of them. Second, walking after surgery depends on who is available: nurses encourage it, but the unit has no one whose job is mobility, and physical therapy sees patients late. Third, the unit measures what it is rewarded for, falls, and celebrates a long fall-free streak, while it does not measure how soon patients walk, eat or go home. Fourth, communication with the preoperative clinic and with home is almost absent.
What the Assessment Suggests
Taken together, the five Ps describe a unit that is safe by its own measure and slower than it could be by others. Enhanced recovery pathways for colorectal surgery, which combine elements before, during and after surgery, such as shorter fasting, early feeding and early mobility, have been linked to shorter hospital stays and lower complication rates (Ljungqvist et al., 2017). The ERAS Society's guideline for elective colorectal surgery sets out those elements in detail (Gustafsson et al., 2019). Several of them, including early walking and coordination with the preoperative clinic, run directly against the patterns found here. Later units will examine the structure, culture and costs involved in changing them.
Limits
The assessment rests on six interviews, a year of administrative data and two days of observation. Night shift processes were observed less than day shift, and the patient perspective comes only indirectly, from complaint records and discharge surveys. A follow-up assessment should add structured interviews with patients and families, since they experience the handoffs between clinic, unit and home that no single department sees whole.
References
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., . . . Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World Journal of Surgery, 43(3), 659-695. https://doi.org/10.1007/s00268-018-4844-y
Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced recovery after surgery: A review. JAMA Surgery, 152(3), 292-298. https://doi.org/10.1001/jamasurg.2016.4952
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002). Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. The Joint Commission Journal on Quality Improvement, 28(9), 472-493. https://doi.org/10.1016/S1070-3241(02)28051-7
NU753 Unit 1 instructions, in plain terms
The first NU753 assignment asks you to describe a clinical microsystem closely enough that change can be planned around it. Most sections name the Dartmouth 5 Ps, purpose, patients, professionals, processes and patterns, and expect a year of data on a few measures, staff interviews, observation and a synthesis of what the patterns suggest. Around 2,000 words with a few exhibits is common. Faculty reward assessments that make each P concrete with local figures, trace at least one process across a full day or patient path, describe patterns as habits of the unit rather than faults of individuals, and name the handoffs to other units that no single department owns. The limits of your data sources belong in the paper as well, since they shape how far the patterns can be trusted.
How the NU 753 Unit 1 example is put together
The assessment opens by explaining what a clinical microsystem is and why the 5 Ps are used. Purpose sets staff descriptions from six interviews beside the budget's occupancy target. Patients gives a year of admissions, the colorectal volume, age and length of stay. Professionals counts every role that touches a patient in a day. Processes follows a day from early surgical rounds to afternoon discharge and names three fragile handoffs, with the highlighted sentence on steps owned by others. A composite patient's path and staff suggestions follow. Four patterns are named. The final sections link the patterns to enhanced recovery elements from a review and the ERAS Society guideline, and state the assessment's limits.
NU753 Unit 1 rubric: what earns full points
Microsystem assessments are commonly marked on use of the framework, data, process description, synthesis and limits. Use of the framework earns credit when each P is addressed with evidence rather than general statements. Data are judged on specificity, source and period. Process description rewards tracing work through time, showing handoffs and delays. Synthesis is credited when patterns are identified and connected to a direction for change. Limits earn points when the sources and their gaps are named, such as thin night-shift observation or the absence of patient interviews. Exhibits, such as a profile table or a swim-lane diagram, usually support the processes section and are expected in many sections.
Common NU753 Unit 1 mistakes, and how to avoid them
A frequent weakness is describing the unit's purpose from its mission statement instead of asking staff what they believe it is. Another is listing staff roles without explaining how they interact. Some assessments describe processes as policies rather than as what actually happens. Others identify problems without patterns, so the reader cannot see what drives them. Many ignore the handoffs to other units, which is often where the most important problems sit. And the patient perspective is frequently absent. Interview staff, trace a real day, follow one patient's path, name the patterns as habits, and say plainly which sources you lacked.
Get an NU753 Unit 1 example written to your instructions
Your microsystem is the one you work in or can observe, so describe it briefly and send that with the prompt and rubric. For free, as the first custom sample, a composite assessment comes back in 24-48h showing each P at the depth your instructions ask, the workflow charted rather than summarized. 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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NU753 Unit 1 questions, answered
What counts as a clinical microsystem?
The smallest group that actually delivers care to a defined set of patients, with its own staff, processes and information: an inpatient unit, a clinic, a dialysis center, a home health team. A whole hospital is too large, and a single shift is too small. Most prompts want a unit you can observe directly, because the assessment depends on detail only presence supplies.
Is the 5 Ps framework required, or can another model be used?
Many sections name it because it was built for exactly this kind of frontline assessment. Where the prompt leaves the framework open, the 5 Ps still suits a unit-level description well, since it separates who the patients are from what the staff do and from what the data show. The sample follows whichever model your instructions specify.
How much data does the assessment need?
Enough to make each P concrete, which usually means twelve months of a few measures rather than a snapshot of many. Admissions, length of stay, discharge timing, staffing and one quality measure carry most assessments. Where your site will not share figures, say what you used instead; an honest substitute is better than an unexplained gap.
Where can I find a free NU753 Unit 1 sample paper?
The complete NU753 Unit 1 microsystem assessment appears on this page, with each of the 5 Ps, a composite patient's path, what staff would change, four patterns, the link to an enhanced recovery pathway and limits, plus three references. An assessment of your own unit can be drafted.
What does the fall-free banner show in NU753 Unit 1?
It shows what the unit is rewarded for. Celebrating days without a fall signals that keeping patients safely in bed is the valued achievement, which works against early walking after surgery, a key element of enhanced recovery.