NU800 Unit 10 Full Proposal Draft Example

Four Contradictions Found and Repaired: A Full DNP Proposal Draft on Steroid Hyperglycemia, Assembled From Nine Chapters and Checked Against Itself

[Student Name]

Purdue University Global

NU800: DNP Project Proposal

Unit 10 Full Proposal Draft

[Instructor Name]

[Date]

The units, figures, budget and timeline are composite; numbers are bracketed. The sample presents the proposal's structure, a one-page contradiction log and condensed chapters.

The Contradiction Log

Contradiction 1. The objectives chapter set a target of [75] percent of eligible patient-days with afternoon checks; the evaluation plan set [80] percent. Repair: [80] percent in both, since the evaluation plan was written later with baseline data in hand, and the objectives were revised to match.

Contradiction 2. An early draft of the problem chapter said escalation would occur at [200] mg/dL; the PICOT worksheet and methods used two readings above [216]. Repair: [216] on two readings throughout, following British guidance on steroid hyperglycemia (Roberts et al., 2018), with [180] kept as the threshold for continuing checks.

Contradiction 3. The PICOT worksheet defined a monitored patient-day as one with two or more readings, at least one of them taken after [1100]; the analysis section of the methods said "one afternoon reading." Repair: the worksheet's definition in every chapter, because a single reading cannot distinguish a morning low from a day that was never checked in the morning.

Contradiction 4. The methods capped the suggested NPH dose at [0.4] units per kilogram; the pharmacy protocol attached as an appendix capped it at [0.3]. Repair: the pharmacy protocol's [0.3], since it is the document prescribers will see, and the methods were changed to match after discussion with the pharmacist.

None of the four contradictions was an error in any single chapter; each appeared only when two chapters written months apart were read on the same page.

How the Contradictions Were Found

The chapters were written over nine units, each revised after faculty feedback, and each was internally consistent. The contradictions appeared only when every number in the proposal was copied into a single list with its chapter and page, and the list was sorted by topic. Thresholds, time windows, doses and targets were checked first, since those are the figures a reader will compare. The same list will be kept as the project runs, so that any change to a figure in one place is made everywhere.

Abstract

On two medical units, people newly prescribed high-dose glucocorticoids are rarely checked when steroid hyperglycemia peaks, and about [31] of every 100 monitored glucocorticoid patient-days include a reading above 250 mg/dL. This quality improvement project will introduce a nurse-driven bundle: automatic glucose checks before lunch and dinner when a qualifying steroid is ordered, escalation of two readings above 216 mg/dL with an NPH suggestion, a taper prompt and a discharge check. Using a pre-post design with weekly run charts over [16] baseline and [12] implementation weeks, the project will measure hyperglycemic patient-days, afternoon check completion and hypoglycemia as a balancing measure.

Chapter 1: Problem, Purpose and Objectives

The problem statement rests on one rate and one gap sentence. The purpose is to reduce hyperglycemic patient-days among patients on high-dose glucocorticoids without increasing hypoglycemia. Three objectives follow: afternoon checks on at least [80] percent of eligible patient-days by week [six]; escalation of at least [75] percent of qualifying episodes; and a sustained shift below the baseline median in hyperglycemic patient-days by week [12].

Chapter 2: Evidence

The search and synthesis show that steroid hyperglycemia is common, often unmonitored and highest in the afternoon, that scheduled insulin outperforms correction alone in hospitalized patients, and that direct evidence for NPH timed to steroids is limited but supportive. The ADA hospital standards support monitoring and insulin adjustment for patients on glucocorticoids (American Diabetes Association Professional Practice Committee, 2024).

Chapter 3: Framework

COM-B was chosen to explain why checks are missed, with each component mapped to a part of the bundle (Michie et al., 2011). The social opportunity row, lunch break coverage and the norm that glucose checks are for diabetic patients, remains thin and is flagged for the evaluation.

Chapter 4: Methods

The methods specify the setting, sample, four-part bundle, implementation procedures, measures, fidelity checks and analysis, and will be reported using SQUIRE 2.0 (Ogrinc et al., 2016).

Chapter 5: Evaluation

The evaluation plan lists structure, process, outcome and balancing measures with collectors, schedules and thresholds set in advance, and a decision table that says what the team will do with each pattern of results.

Timeline

Weeks one to [16] are the retrospective baseline, drawn from stored records. Education takes weeks [17] and [18]. Implementation runs from week [19] to week [30]. The final report is due at week [34].

Budget

The budget is short, because most of what the bundle needs, from glucometers to the order-set system, already exists on the units. Printing of huddle materials and break-coverage cards costs about $[150]. Paid education time for [96] staff at [15] minutes each comes to about $[1,200]. Informatics time to build the order-set trigger is absorbed within the department's existing work, and the project lead's time is part of the DNP practicum.

Appendices

Five appendices support the chapters: the order-set specification with the steroid equivalence table; the pharmacy-approved NPH protocol; the huddle education script with the glucose curve; the data collection tool with definitions for each measure; and the letter from the chief nursing officer supporting the project. The data collection tool repeats every measure's definition word for word from the evaluation chapter, which was one of the checks used to find contradiction 3.

What Could Go Wrong

The draft names three ways the project could be delayed or weakened. The order-set build could take longer than planned if informatics priorities change. Prescribers might decline the NPH suggestion often enough that escalation leads to little change in treatment. And staffing shortages during implementation could make pre-lunch checks hard to sustain, the social opportunity barrier the framework identified. Each risk has an early warning in the evaluation plan: the structure measure for the order set, the process measure for scheduled insulin, and the separate reporting of pre-lunch checks.

What Remains Before Submission

Two steps remain. The pharmacy and therapeutics committee must approve the order set, scheduled for its [April] meeting. And the institutional review board must confirm that the project is quality improvement. Neither changes the design, but both could change the start date. If either is delayed past [May], the baseline period will be extended rather than shortened, so the comparison keeps at least [16] weeks of data on each side of the change.

References

American Diabetes Association Professional Practice Committee. (2024). 16. Diabetes care in the hospital: Standards of care in diabetes 2024. Diabetes Care, 47(Suppl. 1), S295-S306. https://doi.org/10.2337/dc24-S016

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, Article 42. https://doi.org/10.1186/1748-5908-6-42

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Roberts, A., James, J., Dhatariya, K., & Joint British Diabetes Societies for Inpatient Care. (2018). Management of hyperglycaemia and steroid (glucocorticoid) therapy: A guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group. Diabetic Medicine, 35(8), 1011-1017. https://doi.org/10.1111/dme.13675