| Course | NU800 DNP Project Proposal |
|---|---|
| Unit | Unit 5 |
| Paper type | Evidence synthesis |
| Length | About 1,100 words, 6 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 NU800 Unit 5
Common, Unwatched and Highest in the Afternoon: An Evidence Synthesis for a Glucocorticoid Hyperglycemia Project, Built Claim by Claim From Eight Sources, With the Question on Which They Split and the One None Can Answer
[Student Name]
Purdue University Global
NU800: DNP Project Proposal
Unit 5 Evidence Synthesis
[Instructor Name]
[Date]
The sources are real and summarized from their publications; the project context is composite.
Claim 1: Steroid Hyperglycemia Is Common and Often Unmonitored
Two hospital studies, using different thresholds and different ways of counting, reach the same conclusion. In a one-month review at an academic hospital, a quarter of patients receiving high-dose corticosteroids had no glucose measured at all, and among those who were measured, a majority crossed 200 mg/dL at least once, several of them with no prior diabetes diagnosis (Donihi et al., 2006). A six-month audit of 80 steroid-treated inpatients with no diabetes history found that 70 percent reached 10 mmol/L, roughly 180 mg/dL, at least once, and almost all of that hyperglycemia appeared within the first two days (Fong & Cheung, 2013). Because one study counted patients with repeated readings above 200 and the other patients with any reading above 180, their percentages cannot be compared directly; what they share is the direction and the finding that monitoring was inconsistent. The composite units' own data, with nearly half of patients without diabetes unchecked in the first 48 hours, fit the same pattern.
Claim 2: The Peak Comes in the Afternoon
Every source that addresses timing agrees that glucose rises after a morning steroid dose and peaks in the afternoon and evening. The audit observed this directly, noting afternoon peaks after a single morning prednisone dose and a return close to baseline overnight (Fong & Cheung, 2013). A review of glucocorticoid-induced hyperglycemia explained the pattern through the drug's effects on insulin sensitivity and hepatic glucose production, which follow the steroid's action over the day (Clore & Thurby-Hay, 2009). British guidance therefore advises checking before lunch or before the evening meal rather than relying on a fasting reading (Roberts et al., 2018). Read together, these sources explain why the units' fasting checks miss the problem: they measure glucose at the time a morning steroid's effect is lowest.
Every source that speaks to timing points to the same hours, and those are the hours the units are not checking.
Claim 3: Scheduled Insulin Outperforms Correction Alone, Though Direct Evidence in Steroid Patients Is Thin
The best evidence that scheduled insulin controls inpatient hyperglycemia better than correctional insulin alone comes from a population other than this project's. Among general medicine inpatients with type 2 diabetes randomized to one of two regimens, basal-bolus insulin reached the glucose target in about twice as many patients as sliding-scale insulin alone, without more hypoglycemia (Umpierrez et al., 2007). The Endocrine Society's guideline draws on that evidence in recommending scheduled insulin rather than correction alone for persistent hyperglycemia (Umpierrez et al., 2012). For patients on steroids specifically, one small randomized trial found that adding NPH to a standard regimen did not change mean glucose overall, though glucose was lower by the third day, with no increase in severe hypoglycemia (Grommesh et al., 2016). The direct evidence supports NPH timed to the steroid as reasonable, not as proven superior.
Where the Sources Split: Threshold and First Response
The sources diverge on two practical questions. The first is the threshold for action. The ADA hospital standards place the goal range for the majority of non-critically ill patients at 140 to 180 mg/dL (American Diabetes Association Professional Practice Committee, 2024), while British guidance uses a threshold of about 12 mmol/L, roughly 216 mg/dL, on two occasions before adding treatment (Roberts et al., 2018). The second is the first response. British guidance offers a morning sulfonylurea as an option for some patients, while the American guidance emphasizes insulin. The project resolves the first question by using 180 mg/dL to continue monitoring and 216 mg/dL on two readings to escalate, combining the ADA target with the British trigger, and resolves the second by using insulin, consistent with the hospital's existing order sets and US guidance. Both choices will be stated in the methods as decisions, not as findings of the evidence.
What No Source Can Say
None of the eight sources tests the specific bundle this project proposes: afternoon checks triggered by a steroid order, an escalation rule and a taper prompt. The evidence supports each part separately, but it cannot say which part would do the most work. If hyperglycemic patient-days fall, the design will not reveal whether monitoring, escalation or the taper prompt was responsible. The evaluation plan will therefore track each part's process measure separately, so that at least the parts that were delivered can be distinguished from those that were not.
What the Evidence Means for Each Part of the Bundle
Each part of the planned bundle can now be traced to the claims above. The order-set trigger answers claim 1: if hyperglycemia is common and often unmonitored, monitoring should start automatically with the steroid rather than depend on someone remembering a history of diabetes. Checks before lunch and dinner answer claim 2, since they fall in the hours when the steroid's effect is greatest. The escalation rule and the NPH suggestion answer claim 3, moving patients with persistent hyperglycemia from correction alone to scheduled insulin timed to the steroid. The taper prompt has the thinnest direct support; it rests on the pharmacology described in the review and on the concern that insulin outlasting a falling steroid dose could cause hypoglycemia, which is why hypoglycemia is the project's balancing measure. The discharge check rests on the finding, in the units' own chart review, that most newly hyperglycemic patients went home without a plan.
Strength of the Body of Evidence
Using the Johns Hopkins approach to summarizing a body of evidence (Dang et al., 2021), the evidence on the problem is consistent but observational, the evidence on treatment is experimental but mostly indirect, and the guidance is consensus-based where direct evidence is lacking. Taken together, it is sufficient to justify a practice change evaluated as a quality improvement project, but not to predict the size of the effect.
Conclusion
The sources agree on what matters most for this project: steroid hyperglycemia is common, often missed and highest in the afternoon. They agree less on thresholds and first-line treatment, where the project must make explicit choices. And they are silent on which part of a combined bundle works, which the project can address only partly, by measuring each part.
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
Clore, J. N., & Thurby-Hay, L. (2009). Glucocorticoid-induced hyperglycemia. Endocrine Practice, 15(5), 469-474. https://doi.org/10.4158/EP08331.RAR
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Donihi, A. C., Raval, D., Saul, M., Korytkowski, M. T., & DeVita, M. A. (2006). Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients. Endocrine Practice, 12(4), 358-362. https://doi.org/10.4158/EP.12.4.358
Fong, A. C., & Cheung, N. W. (2013). The high incidence of steroid-induced hyperglycaemia in hospital. Diabetes Research and Clinical Practice, 99(3), 277-280. https://doi.org/10.1016/j.diabres.2012.12.023
Grommesh, B., Lausch, M. J., Vannelli, A. J., Mullen, D. M., Bergenstal, R. M., Richter, S. A., & Fish, L. H. (2016). Hospital insulin protocol aims for glucose control in glucocorticoid-induced hyperglycemia. Endocrine Practice, 22(2), 180-189. https://doi.org/10.4158/EP15818.OR
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
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 97(1), 16-38. https://doi.org/10.1210/jc.2011-2098
Umpierrez, G. E., Smiley, D., Zisman, A., Prieto, L. M., Palacio, A., Ceron, M., Puig, A., & Mejia, R. (2007). Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care, 30(9), 2181-2186. https://doi.org/10.2337/dc07-0295
The Purdue Global NU800 Unit 5 instructions
The Unit 5 assignment asks you to synthesize the evidence in your table into an argument for your project. Most versions want continuous prose organized by claims, with sources speaking to one another, a clear statement of where the evidence agrees and disagrees, what it cannot answer, and a judgment of the body of evidence as a whole. Around five pages is typical. Faculty reward syntheses that avoid summarizing one study per paragraph, report findings accurately, label indirect evidence, and show how each part of the planned intervention follows from the evidence. When the literature does not settle a question your project needs answered, say so and describe how the design will handle the uncertainty.
How the NU 800 Unit 5 example is put together
The synthesis builds four claim sections. The first sets two observational studies side by side, noting that their percentages differ because they count differently. The second gathers every source on timing and carries the highlighted sentence about the hours the units are not checking. The third presents scheduled insulin evidence, naming the basal-bolus trial as indirect and the NPH trial as small. A section on where sources split contrasts American and British thresholds and first responses and states the project's choices as decisions. A section traces each bundle part to the claims, another admits that no source tests the bundle, and a final section judges the body of evidence.
NU800 Unit 5 rubric: what earns full points
Evidence syntheses are commonly assessed on organization, integration, accuracy, critical judgment and application. Organization earns credit when the synthesis is built around claims rather than studies. Integration rewards paragraphs in which sources are compared and their differences explained. Accuracy is judged on correct reporting of findings and designs. Critical judgment is credited when the synthesis identifies disagreement, indirect evidence and gaps honestly. Application scores well when each part of the intervention is traced to the evidence and uncertainties are carried into the design. Most rubrics also score consistent APA citation, which takes care with guideline panels and trials listing many authors.
Common NU800 Unit 5 mistakes, and how to avoid them
A frequent weakness is an annotated bibliography under claim headings, with one study per paragraph. Another is presenting agreement where sources used different measures. Some syntheses treat guidelines as primary evidence rather than as summaries of it. Others hide disagreement, which a committee will notice when reading the sources. Many never connect the evidence to specific parts of the intervention. And gaps are often left unstated. Build claims, set sources against each other, explain why numbers differ, show where the literature splits and how you decided, trace each bundle part to its evidence, and say what no source can tell you. Finally, reread your synthesis without the headings; if it still reads as an argument, the claims are doing their work.
Get an NU800 Unit 5 example written to your instructions
Send the evidence table you finished in Unit 4, or the studies behind it, together with the synthesis prompt and rubric. What arrives within 24-48h, the first custom sample free of charge, groups those studies by claim, weighs them by design and marks exactly where the evidence splits, with each claim traced back to its rows. 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.
More NU800 papers and DNP samples
- NU800 Unit 1: Problem Statement, Steroid Glucose
- NU800 Unit 2: PICOT Worksheet, Steroid Hyperglycemia
- NU800 Unit 3: Search Strategy Report
- NU800 Unit 4: Evidence Table, Steroid Hyperglycemia
- NU800 Unit 6: Framework Selection Paper
- NU800 Unit 7: Methods Section Draft
- NU800 Unit 8: Evaluation Plan
- NU800 Unit 9: Discussion Board Post
- NU800 Unit 10: Full Proposal Draft
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- NU743 Unit 5: Decision Tree, Appendicitis
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NU800 Unit 5 questions, answered
How many claims should a synthesis be organized around?
As many as the evidence actually makes, which for a focused practice question is often three to five. Too few and the argument flattens into one heading; too many and each becomes a single study in disguise. The sample uses four, three where its sources broadly agree and one where they split, because that pattern matches what the eleven studies show.
Where can I find a free NU800 Unit 5 sample paper?
The complete NU800 Unit 5 evidence synthesis is on this page, with four claims, where the sources split, how each bundle part follows from the evidence, what no source can say and a judgment of the whole body, plus nine references. A synthesis for your own project can be drafted.
Where do the sources disagree in NU800 Unit 5?
On the threshold for action and the first response. The ADA sets a target of 140 to 180 mg/dL, while British guidance uses about 216 mg/dL on two readings, and British guidance offers a sulfonylurea option where US guidance emphasizes insulin.
What can no source answer in NU800 Unit 5?
Which part of a combined monitoring, escalation, taper and discharge bundle produces any improvement. The project will track each part's process measure so that delivered parts can at least be distinguished from those that were not.
How strong is the evidence in NU800 Unit 5?
Consistent but observational on the problem, experimental but mostly indirect on treatment, and consensus-based in the guidelines. It justifies a practice change evaluated as quality improvement, but cannot predict the size of the effect.