NR 451 Week 2 Discussion
Student Name
Chamberlain University
NR-451: RN Capstone Course
Prof. Name
Date
Week 2: The Clinical Question
The initiation of the capstone change project begins with identifying a relevant and impactful practice issue that warrants improvement. This practice issue must be directly linked to a systematic review chosen from the List of Approved Systematic Reviews for the capstone project. The link to this list is provided in the Week 3 Capstone Project: Milestone 1 guidelines.
Selecting the most suitable systematic review requires alignment with professional interests, current practice environment, and the potential for meaningful clinical application. Once the review is selected, the next step is to formulate a significant clinical question that will serve as the foundation for the capstone change project. This question should be precise, researchable, and directly relevant to nursing practice.
Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
The first step in this process involves carefully reviewing the list of approved systematic reviews and selecting one that aligns with my current clinical role and interests. My selection criteria included the prevalence of the issue in my patient population, the potential for measurable improvement, and its applicability to nursing-led interventions.
Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
A significant clinical question should be framed using the PICO(T) model (Patient/Population, Intervention, Comparison, Outcome, and Time). This ensures that the question is specific, measurable, and evidence-based. Below are two possible clinical questions considered for this project.
Relate how you developed the question.
The clinical questions were developed after observing recurring gaps in postoperative care and reviewing systematic reviews addressing infection control and postoperative recovery optimization. Input from multidisciplinary teams, including nursing staff and surgeons, further refined the focus areas.
Describe the importance of this question to your clinical practice previously, currently, or in the future.
This question is critically important because surgical site infections (SSIs) and delayed postoperative recovery remain significant challenges in surgical care. Addressing these issues has implications for patient safety, hospital costs, and quality metrics. In my previous practice, I observed that inconsistent adherence to postoperative protocols directly affected patient outcomes. Currently, I aim to implement evidence-based strategies that reduce infection rates and enhance recovery. In the future, integrating such protocols can standardize care and improve long-term outcomes for surgical patients.
Describe what a research-practice gap is.
A research-practice gap refers to the difference between what is supported by current evidence and what is implemented in clinical practice (Titler, 2018). In other words, it is the delay or failure to integrate best evidence into patient care. This gap may result from barriers such as lack of awareness, insufficient resources, or resistance to change. Closing the gap ensures that patients receive care based on the most recent and effective interventions.
Clinical Question Option 1
Question: Use of antimicrobial dressings and topical antibiotics vs. the traditional sterile gauze dressings on surgical sites cause decrease SSI’s.
| PICO(T) Component | Details |
|---|---|
| P (Patient/Population) | Adult patients undergoing surgery |
| I (Intervention) | Use of topical antibiotics, including antimicrobial dressings |
| C (Comparison) | Traditional sterile gauze dressings |
| O (Outcome) | Reduction in surgical site infections (SSIs) |
| T (Time Frame) | 30 days postoperatively |
This question addresses the ongoing challenge of SSIs, which contribute to extended hospital stays, increased healthcare costs, and patient morbidity. Literature suggests that antimicrobial dressings may offer superior protection compared to standard gauze, but adoption in practice varies (Leaper et al., 2020).
Clinical Question Option 2
Question: In patients with bowel surgery, how does early frequent ambulation and nourishment compare to conventional recovery methods of rest and bowel rest, affect the return of bowel function and length of hospitalization in the first 72 hours postoperatively?
NR 451 Week 2 Discussion
| PICO(T) Component | Details |
|---|---|
| P (Patient/Population) | Adult patients undergoing colorectal surgery |
| I (Intervention) | Early and frequent ambulation combined with early nutrition |
| C (Comparison) | Reduced ambulation and bowel rest |
| O (Outcome) | Return of bowel function and reduced length of hospital stay |
| T (Time Frame) | 72 hours postoperatively |
This question focuses on enhanced recovery protocols (ERAS), which emphasize early mobilization and nutrition to improve surgical outcomes. Research indicates these interventions can significantly reduce complications and hospitalization time (Ljungqvist et al., 2017). However, cultural beliefs and patient reluctance can limit implementation, making nursing advocacy crucial.
May I deviate from the chosen systematic review from the list and choose a different topic?
While adherence to the approved list of systematic reviews is generally expected for the capstone project, there may be situations where an alternate, equally evidence-based topic is warranted. Any deviation should be discussed with the course instructor to ensure alignment with project requirements.
References
Leaper, D., Assadian, O., & Edmiston, C. E. (2020). Approach to chronic wound infections. British Journal of Dermatology, 182(5), 959–969. https://doi.org/10.1111/bjd.18621
NR 451 Week 2 Discussion
Ljungqvist, O., Scott, M., & Fearon, K. C. H. (2017). Enhanced Recovery After Surgery: A review. JAMA Surgery, 152(3), 292–298. https://doi.org/10.1001/jamasurg.2016.4952
Titler, M. G. (2018). Translation science and context. In Patient safety and healthcare improvement at a glance (pp. 60–65). Wiley-Blackwell. https://doi.org/10.1002/9781119368704.ch13