| Course | NU804 DNP Project II |
|---|---|
| Unit | Unit 8 |
| Paper type | Unexpected finding discussion |
| Length | About 1,140 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 NU804 Unit 8
Nine Said "Not Sure How Much": A Unit 8 Discussion of an Unexpected Finding About Correction Scales After Discharge on New Insulin
[Student Name]
Purdue University Global
NU804: DNP Project II
Unit 8 Unexpected Finding Discussion
[Instructor Name]
[Date]
The hospital, patients, replies and figures are composite and illustrative; the studies and standards cited are real.
The Finding
The second day-one question asks whether the patient has taken today's dose and offers three numbered replies: yes, no, or "not sure how much." The improvement cycles before the project had used the third option rarely; it was added to catch patients unsure of a dose. In the first three months, 27 of the 33 patients replied on day one. Nine of the 27 chose "not sure how much," a third of those who replied.
The nurses' call notes for those nine were consistent. Most patients had given the basal dose correctly. Their uncertainty was about mealtime correction: how many units to add for a given glucose reading. Eight of the nine had been discharged on basal insulin plus a correction scale, a table of extra units by glucose range. Among the 14 patients who replied and were discharged on basal insulin alone, with or without tablets, only one chose "not sure how much."
The patients were not unsure about insulin; they were unsure about a table.
Why It Was Unexpected
The bundle's teaching focuses on the pen and the basal dose, because that is what patients must do every day. Correction scales were mentioned in teaching and printed on the plan, but nobody had treated them as a separate skill. The pilot year had not raised the question, partly because the pilot's follow-up calls did not ask about doses in a way that would reveal it.
Four Possible Explanations
1. The regimen is too complex for the first week at home. A patient new to insulin must learn a pen, a meter, timing and lows. Adding arithmetic at every meal may simply be too much. If this is the explanation, uncertainty should fall when regimens are simpler.
2. The plan presents the scale poorly. The one-page plan prints the scale as a table with five glucose ranges. Patients with limited numeracy may struggle to read it under stress. If this is the explanation, a clearer format should reduce uncertainty even when the regimen is unchanged.
3. Teaching does not include the scale. The supervised injection covers one dose, usually the basal dose, so patients may never practice using the scale before going home. If this is the explanation, adding a practice calculation to teach-back should help.
4. The question itself is confusing. "Not sure how much" may attract patients who are only mildly unsure, and the call notes may overstate the pattern. If so, rewording the question would move the count even though teaching stayed the same.
How Far Nine Patients Can Take Us
The finding rests on nine patients. Its pattern by regimen is striking, but the patients on correction scales also differed in other ways: they had higher admission A1C, more had type 2 diabetes with long-standing poor control and more were cardiac step-down patients discharged by one hospitalist group. Any of those differences could contribute.
To tell the explanations apart, the project can add three things without new burden. The plan template can record the regimen type for every patient, so the pattern can be checked as numbers grow. The teach-back checklist can record whether a correction calculation was practiced. And the day-seven call can ask patients on scales to talk through one example, which tests understanding directly rather than through a self-report.
What the Literature Says
For choosing a discharge regimen, the national hospital standards point the team toward the patient's earlier treatment, the glucose pattern during the stay and what the patient can realistically manage at home (American Diabetes Association Professional Practice Committee, 2025). Umpierrez et al. (2014) tested a discharge algorithm based on admission A1C across several hospitals: patients with higher A1C went home on oral agents plus basal insulin or on basal-bolus insulin, and those with lower A1C returned to their previous treatment, with or without basal insulin. A1C fell substantially in the highest group over 12 weeks, but lows were reported in 44 percent of patients discharged on basal-bolus regimens, more than in any other group. The study did not test correction scales as such, but it suggests that more complex regimens at discharge carry more risk, and it offers an approach to choosing simpler ones.
Talevski et al. (2020) found teach-back effective across many settings, which supports adding a correction calculation to the supervised dose regardless of which explanation proves right.
Who Else the Finding Concerns
The finding also matters beyond nursing. Pharmacists counsel patients on new prescriptions and could check the correction scale at the same time. The outpatient diabetes educators see patients two to three weeks later and could ask directly about correction doses rather than waiting for a problem. Primary care clinics receive the discharge summary and may not know a patient is unsure of the scale. Sharing the finding with each group costs little and may catch patients the bundle misses. The patient and family advisory council will also be asked to look at the reprinted scale, since its members can say more quickly than staff whether the wording makes sense to someone at a kitchen table with a meter in hand.
What to Change, and What Not To
The project should not change the bundle's core on the strength of nine patients. It should make two small, low-risk changes now and take one question to the hospitalists.
Now. Add one correction calculation, using the patient's own scale and a sample reading, to the teach-back for every patient discharged with a scale. Redesign the scale on the plan as a row of plain statements, "If your sugar is 201 to 250, add 2 units," tested with three patients before use.
To the hospitalists. Present the finding at their weekly meeting, with the call notes summarized, and ask whether a simpler discharge regimen would serve some of these patients, using the hospital's discharge algorithm work as a starting point. That decision belongs to prescribers, not to the bundle.
Measure. Report the share of "not sure how much" replies by regimen each month, with the correction-calculation step added to the audit.
Conclusion
An unexpected answer to a follow-up question showed that patients sent home with correction scales were far more often unsure of their dose. The finding is small and could have several causes, so the response is proportionate: practice the calculation in teaching, print the scale more clearly, track the pattern and ask prescribers whether simpler regimens would fit some patients better. If the pattern holds as numbers grow, it may be the most useful thing this project teaches the hospital.
References
American Diabetes Association Professional Practice Committee. (2025). 16. Diabetes care in the hospital: Standards of care in diabetes-2025. Diabetes Care, 48(Suppl. 1), S321-S334. https://doi.org/10.2337/dc25-S016
Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350
Umpierrez, G. E., Reyes, D., Smiley, D., Hermayer, K., Khan, A., Olson, D. E., Pasquel, F., Jacobs, S., Newton, C., Peng, L., & Fonseca, V. (2014). Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care, 37(11), 2934-2939. https://doi.org/10.2337/dc14-0479
Reading the NU 804 Unit 8 instructions
The Unit 8 prompt typically asks students to discuss something unexpected in their implementation and what it means for the project. Expect to describe the finding precisely, explain why it was unexpected, offer several possible explanations and say what data would distinguish them. Instructors look for proportion: a small finding should lead to measured changes and further tracking, not a redesign. Literature that helps interpret the finding strengthens the discussion. Many prompts ask which changes the student will make now, which questions belong to other professions and how the finding will be monitored. Small numbers should be acknowledged openly. Writing the explanations so that each predicts something different shows scientific thinking, and a clear plan for measuring them turns a surprise into part of the evaluation.
How the NU 804 Unit 8 example is put together
The paper opens with the text question, the replies and the striking split by regimen, under a highlighted line that patients were unsure about a table rather than about insulin. A section explains why nobody expected it, since teaching centered on the basal dose. Four explanations follow, each with what it would predict. The data section names other differences between the groups and three low-burden ways to tell the explanations apart. The literature section uses the national hospital standards and Umpierrez and colleagues' algorithm study, and Talevski and colleagues support adding a calculation to teach-back. A section on who else the finding concerns brings in pharmacists, outpatient educators, primary care and the advisory council. The changes are divided into what to do now, what to ask hospitalists and what to measure.
Reading the NU804 Unit 8 grading rubric
Discussion papers on an unexpected finding are usually graded on precision, reasoning and proportion. The finding should be stated with exact counts and the pattern that makes it interesting. Several explanations earn more than one, especially when each predicts something different. Graders value awareness of confounding, such as differences between patient groups beyond the one highlighted. Literature should help interpret the finding rather than decorate it. The response earns credit when it is proportionate to the evidence, with low-risk changes now and larger questions referred to those who own them. A monitoring plan shows the finding will be followed. Clear organization, cautious language and correct APA 7 entries for the hospital standards and the algorithm study finish the list.
Common NU804 Unit 8 mistakes, and how to avoid them
Papers on surprises often jump to a single explanation and a large change, which overreacts to a handful of patients. Others dismiss the finding as noise without checking it. Some students describe the finding vaguely, losing the pattern that gives it meaning. Ignoring other professions is common when the finding touches prescribing or pharmacy. Literature cited without connection to the finding adds length but not credit. Leaving out how the finding will be tracked means the next report cannot say whether the response worked. Start by writing the finding as a count, then list three explanations and what each would predict. Send the finding and your data, and the discussion can be drafted around your project.
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NU804 Unit 8 questions, answered
What counts as an unexpected finding?
Any result or event the plan did not predict, such as a process measure moving the wrong way.
Should I change the project because of it?
Only after checking the data and discussing with the mentor; sometimes the right answer is to measure more.
How do I explain possible causes?
List plausible explanations and say what data would tell them apart.
Where can I find a free NU804 Unit 8 sample paper?
Read the complete NU804 Unit 8 unexpected finding discussion here: insulin patients unsure of their dose after discharge, nearly all of them sent home with a correction scale.
What does the NU804 Unit 8 sample change right away?
A practice correction calculation is added to teach-back for patients going home with a scale, and the scale is reprinted as plain statements tested with three patients before use.