[Solved] Assigment .Apa seven . All instructions attached.

Assignment Prompt & Instructions

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– ## Attemptfeedbac1.docx

– ## CapstonePartIIintrucctions.docx

– ## CapstonePart1.docx

**## Attemptfeedbac1.docx**

Attempt feedback

You are on the right track. As per APA, you need to cite references throughout the paragraphs. In your Review of Literature, expand further on the research found.

**## CapstonePartIIintrucctions.docx**

Capstone Part II: Review of Literature

**CAPSTONE: PART II due 10/4/2025 by 11:59pm**

1. Review of Literature:

– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.

3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.

4. Discuss objectives for your practice change, Why is change necessary?

5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.

6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem

NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied

-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.

-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.

-This section should be minimum 4-6 pages long (not including the title and reference page).

-Use proper in-text citations with a properly formatted reference list.

-All papers must be written APA in the 3rd person.

**Rubric Capstone II.docx**

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CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Integration of
Knowledge
25 points
Thoroughly selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
25
Briefly selected and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
20
Vaguely selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
15
Did not select and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
0
Topic Focus
25 points
The health problem
is focused narrowly
enough for the
scope of this
assignment. A topic
statement provides
direction for the
paper. The topic is
consistently well
thought out,
thorough offers
insight into the topic,
and includes cited
evidence to support
the topic.
25
The health problem
is focused but
lacks direction. The
paper is about a
specific topic, but
the writer has not
established a
position. The topic
is somewhat well
thought out, offers
limited insight into
the topic, but does
not include cited
evidence to support
the topic.
20
The health problem
is too broad for the
scope of this
assignment.
15
The health problem
is unclear or
unrelated to the
discussion topic
with little or no
supporting
evidence.
0
Depth of
Discussion and
Cohesiveness
25 points
In-depth discussion
and elaboration in all
sections of the
paper.
Ties together
information from all
sources. Paper flows
from one issue to
the next with no
headings. The
author’s writing
demonstrates an
understanding of the
relationship among
material obtained
from all sources
Mostly, it ties
together information
from all sources.
In-depth discussion
and elaboration in
most sections of
the paper.
Mostly, it ties
together
information from all
sources. Paper
flows with only
some
disjointedness. The
author’s writing
demonstrates an
understanding of
the relationship
among material
obtained from all
sources.
The writer has
omitted content.
Quotations from
others outweigh the
writer’s own ideas
excessively.
Sometimes ties
together
information from all
sources. The paper
does not flow.
Disjointedness is
apparent. The
author’s writing
does not
demonstrate an
understanding of
the relationship
between material
obtained from all
sources.
Cursory discussion
in all the sections
of the paper or brief
discussion in only a
few sections.
It does not tie
together
information. Paper
does not flow and
appears to be
created from
disparate issues.
Headings are
necessary to link
concepts. Writing
does not
demonstrate an
understanding of
any relationship.

25 20
15
0
Spelling and
Grammar
10 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
Required word count
has been met.
8
More than 5 but
fewer than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
6
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 50 words
below the minimum
required count.
5
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
10 points
Over 5 current
sources, of which at
least 3 are peer-
review journal
articles or scholarly
books. Sources
include both general
background sources
and specialized
sources. Special-
interest sources and
popular literature
and acknowledged
as such if they are
cited. All websites
utilized are
authoritative.
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
Citations
5 points
Fewer than 5
incomplete citations
and/or quotations,
and APA format
errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources.

**## CapstonePart1.docx**

2

**Capstone Part I: PICOT Assignment**

Natalia Gomez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo, DNP, MSN, APRN-BC, APN

May 21, 2026

**Capstone Part I: PICOT Assignment**

Sleep has become an important public health problem. The quality of sleep is directly correlated to cognitive function, mood, immune function, and quality of life. However, a significant proportion of adults suffer from sleep failure or insufficient rest, and it is now one of the healthcare problems. According to Lim et al. (2023), sleep falls short of its many responsibilities to health, and untreated sleep disorders have been linked with cardiovascular disease, obesity, depression, anxiety, metabolic disorders, and reduced life expectancy worldwide. Around the world, at least one-third of people don't sleep enough, and approximately 10 percent have chronic insomnia. For the aged, then the sleeping problem is more prevalent. Prevalence of sleep disturbances among adults includes problems getting to sleep, poor-quality sleep, and sleepiness (difficulty falling asleep or staying asleep) occurring in 50 percent, 40 percent, and 30 percent, respectively (Pfeiffer et al., 2026). Poor sleep also leads to poor concentration, limited performance at work, high risk of accidents, and less-than-ideal health.

In addition to the physical and psychological burden, insomnia contributes substantially to healthcare costs and economic losses. In the United States, sleep disorders are estimated to cost billions of dollars annually because of increased healthcare utilization, absenteeism, reduced productivity, workplace accidents, and chronic disease management (Lim et al., 2023). Untreated insomnia frequently increases the risk of emergency department visits, mental health disorders, cardiovascular complications, and medication dependency. At the local level, residents of Miami-Dade County may experience additional barriers to healthy sleep due to socioeconomic disparities, demanding work schedules, shift employment, financial stress, and limited access to preventive healthcare education. Miami-Dade County includes a culturally diverse population with significant healthcare disparities, particularly among underserved and low-income communities, increasing vulnerability to untreated sleep disturbances. Because sleep problems often remain unmanaged in outpatient settings, many individuals attempt self-treatment or fail to recognize the long-term consequences of poor sleep quality.

The aim of the proposed study is to fill this gap with a simple solution, keeping the patients with sleep hygiene educational handouts. The costs will not be substantial as it is basically an educational exercise, which involves preparing teaching materials, expenses for printing the materials, training the hospital personnel, and evaluation after intervention. Educational handouts are more cost-effective than using a medication for the long-term, while experiencing any complications associated with insufficient sleep over time. This project is designed to evaluate the effect of sleep hygiene education on sleep quality among adult insomnia patients in adulthood after 8 weeks of sleep education. The proposed outcome is likely to be realistic because it is possible to assess sleep quality through standardized assessment instruments and patient reports.

The purpose of this capstone project is to evaluate if providing an organized sleep hygiene education handout to people diagnosed with mild insomnia in an outpatient clinic in Miami-Dade County will improve sleep quality over an 8-week period versus usual care. The proposed intervention aims to promote evidence-based behavior changes to improve sleep patterns, decrease symptoms of insomnia and promote long-term health outcomes via patient education. This objective is achievable and measurable using standard measures of sleep quality and patient self-report over the course of the intervention.

**PICOT Question**

PICO proposed is: In adults with mild insomnia, does providing a short educational handout on sleep hygiene, compared to usual care, improve sleep quality within eight weeks?

The target population for this project is adults diagnosed with mild insomnia in their outpatient or primary care settings. Mild insomnia refers to sleep problems that impair waking, but do not need intensive interventions or sleep medicine treatment. The target population is adults who have symptoms that make it hard to fall asleep, or sleep disturbances, or poor sleep quality.

The intervention involves giving patients a structured, educational handout about sleep hygiene, based on the evidence. Sleep hygiene education involves sleep-behavioral strategies that foster good sleep hygiene. They involve having regular sleep habits, avoiding caffeine late in the day, limiting the amount of halogenated light devices used in the evening, establishing sleep-friendly surroundings, and practicing relaxation exercises before sleep.

The comparison intervention is usual care. Typical treatment involves short-term counselling or pharmaceutical treatment alone, not structured/educational treatment. General guideline recommendations may be provided at appointments, but often are either vague and not strengthened by reinforcement, or they are not followed.

The expected outcome involves measurable improvement in sleep quality following implementation of the educational intervention. Sleep quality improvements may include shorter sleep onset periods, fewer nighttime awakenings, improved sleep duration, and increased patient satisfaction with sleep experiences. The timeframe selected for this intervention is eight weeks. This duration allows patients sufficient opportunity to implement behavioral changes and develop consistent sleep practices while permitting healthcare providers to monitor outcomes and assess effectiveness.

**Vulnerable Population and Setting**

The target population for the study is adult patients with mild insomnia treated in the outpatient clinic in Miami-Dade County. This population is at risk as sleep disturbances are often accompanied by a myriad of social and environmental risk factors that adversely affect health. Social determinants of health are important factors in the risk for insomnia among this population. Several factors can disrupt healthy sleep patterns, such as financial instability, work stress, irregular shifts, poor health-care access, and low levels of health literacy. Dual employment or shift work may cause circadian rhythm disturbances that make them more vulnerable to sleep disorders. Circadian rhythm disturbances are common among those who are working two jobs or working at night, making them more susceptible to sleep disorders.

Further, socioeconomic issues may affect access to preventative health education and behavioral interventions. Lower education may cause patients to not understand the importance of sleep hygiene and healthy sleep habits. Other cultural beliefs and family obligations can also affect sleep habits. Chronic stress, anxiety, depression, overconsumption of caffeine, sedentary lifestyle, obesity, and overuse of electronics before bedtime are some of the risk factors linked to mild insomnia. Moreover, sleep disorders were found to be significantly linked to physical and mental health problems, adding to the vulnerability of sleep disorder patients, as noted by Lim et al. (2023). The demand for change in this population is great, as untreated insomnia often worsens to more serious sleep disorders, which negatively impact health and life. Medical complications from poor sleep can add up to the healthcare expenses, affect productivity, and exacerbate chronic health conditions. In Miami-Dade County, there are disparities in health care across diverse populations that can lead to poor preventive care services.

**Evidence-Based Intervention Proposal**

The proposed evidence-based intervention consists of implementing a structured sleep hygiene educational program for adults diagnosed with mild insomnia in outpatient settings. The intervention will include a brief educational handout containing evidence-based behavioral strategies to improve sleep quality. Behavioral interventions are considered first-line approaches for insomnia management because they target modifiable lifestyle factors contributing to sleep disturbances and may reduce unnecessary pharmacologic treatment (Morin et al., 2023).

The educational handout will feature tips on maintaining regular sleep patterns, avoiding caffeine and alcohol, using less screen time, exercising, and creating sleep-friendly bedrooms. Several resources will be required for implementation. These include evaluation tools, printables, educational resources, staff training, and post-evaluation processes. Advanced practice registered nurses, clinic nurses, physicians, and support staff will be included in the healthcare team that will be involved in the project.

The intervention is highly feasible for advanced nursing practice as APRNs regularly deliver nursing coordination and patient education. Learner handouts can be incorporated into current working practices with little disruption and cost. The proposed timeframe starts with staff preparation and educational material development (first 2 weeks). Re-enlistment and baseline sleep evaluations will be performed in weeks 3 and 4. Educational interventions will take place in weeks 5 and 6. Follow-up assessments and outcome evaluation will take place in Weeks. 7 and 8.

**Theoretical Framework and Nursing Theory**

The theory that will be used for this capstone project is the Self-Care Deficit Nursing Theory by Dorothea Orem. According to Orem's theory, people can increase their health and health maintenance through self-care activities when they are given the appropriate education and support (Khademian et al., 2020). This framework is relevant to the proposed project, since the project involves the teaching of behaviours that can contribute to a better sleep quality. Adults who have mild insomnia may require guidance on healthy sleep habits and lifestyle modification that will enhance sleep outcomes.

The capstone project will assess the effectiveness of a brief educational handout about sleep hygiene for sleep quality improvement over a period of eight weeks. This theory will be used in an advanced practice nurse's role to help identify areas of knowledge gaps associated with sleep behaviors and to deliver evidence-based education. Patients will learn to establish regular sleep patterns, cut back on caffeine, avoid using electronic devices before bedtime, and set up a healthy sleep environment. Nurses will foster and instruct patients to encourage independent use of these behaviors. This theory aligns with patient-centered care by encouraging patients to take an active role in their own health care and adopt more sustainable behaviors that can help to enhance sleep quality and health outcomes.

**Conclusion**

Insomnia is a serious medical issue, with implications on the well-being, functioning, and economy of an individual and society. Sleep disturbances cause both physical and psychological problems, along with high utilization of healthcare resources and costs. Educational interventions addressing sleep hygiene issues constitute cost-effective and evidence-based ways to enhance the quality of sleep. The capstone project will assess the effectiveness of providing educational brochures in enhancing sleep outcomes of adult individuals with insomnia within eight weeks. Nursing theories such as Self Care Deficit Nursing Theory, as formulated by Orem, offer a solid basis for implementing interventions like patient education. Advanced practice nurses can improve patient outcomes, promote self-management, and support sustainable from using evidence-based interventions in their practice.

**References**

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare.
_Journal of Healthcare Leadership, 13_, 85–108.
[https://doi.org/10.2147/JHL.S289176](https://doi.org/10.2147/JHL.S289176)

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study.
_International Journal of Community Based Nursing & Midwifery_,
_8_(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

Lim, D. C., Najafi, A., Afifi, L., Bassetti, C. L., Buysse, D. J., Han, F., et al. (2023). The need to promote sleep health in public health agendas across the globe.
_The Lancet Public Health, 8_(10), e820–e826.
[https://doi.org/10.1016/S2468-2667(23)00154-0](https://doi.org/10.1016/S2468-2667(23)00154-0)

Melnyk, B. M., & Fineout Overholt, E. (2023).
_Evidence-based practice in nursing and healthcare: A guide to best practice_ (5th ed.). Wolters Kluwer.

Morin, C. M., Bei, B., Bjorvatn, B., Poyares, D., Spiegelhalder, K., & Wing, Y. K. (2023). World Sleep Society international sleep medicine guidelines position statement endorsement of behavioral and psychological treatments for chronic insomnia disorder in adults.
_Sleep Medicine, 109_, 164–169.
[https://doi.org/10.1016/j.sleep.2023.07.004](https://doi.org/10.1016/j.sleep.2023.07.004)

Pfeiffer, A. M., Triplett, C., & Schaefers, O. (2026). Improving sleep health through sleep hygiene education in adults aged 50–80 years.
_Frontiers in Sleep_,
_4_. https://doi.org/10.3389/frsle.2025.1722557

Zappalà, P., Lentini, M., Ronsivalle, S., Lavalle, S., La Via, L., & Maniaci, A. (2025). The Global Socioeconomic Burden of Obstructive Sleep Apnea: A Comprehensive Review.
_Healthcare_,
_13_(17), 2115. https://doi.org/10.3390/healthcare13172115

**## CapstonePart1.docx**

2

**Capstone Part I: PICOT Assignment**

Natalia Gomez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo, DNP, MSN, APRN-BC, APN

May 21, 2026

**Capstone Part I: PICOT Assignment**

Sleep has become an important public health problem. The quality of sleep is directly correlated to cognitive function, mood, immune function, and quality of life. However, a significant proportion of adults suffer from sleep failure or insufficient rest, and it is now one of the healthcare problems. According to Lim et al. (2023), sleep falls short of its many responsibilities to health, and untreated sleep disorders have been linked with cardiovascular disease, obesity, depression, anxiety, metabolic disorders, and reduced life expectancy worldwide. Around the world, at least one-third of people don't sleep enough, and approximately 10 percent have chronic insomnia. For the aged, then the sleeping problem is more prevalent. Prevalence of sleep disturbances among adults includes problems getting to sleep, poor-quality sleep, and sleepiness (difficulty falling asleep or staying asleep) occurring in 50 percent, 40 percent, and 30 percent, respectively (Pfeiffer et al., 2026). Poor sleep also leads to poor concentration, limited performance at work, high risk of accidents, and less-than-ideal health.

In addition to the physical and psychological burden, insomnia contributes substantially to healthcare costs and economic losses. In the United States, sleep disorders are estimated to cost billions of dollars annually because of increased healthcare utilization, absenteeism, reduced productivity, workplace accidents, and chronic disease management (Lim et al., 2023). Untreated insomnia frequently increases the risk of emergency department visits, mental health disorders, cardiovascular complications, and medication dependency. At the local level, residents of Miami-Dade County may experience additional barriers to healthy sleep due to socioeconomic disparities, demanding work schedules, shift employment, financial stress, and limited access to preventive healthcare education. Miami-Dade County includes a culturally diverse population with significant healthcare disparities, particularly among underserved and low-income communities, increasing vulnerability to untreated sleep disturbances. Because sleep problems often remain unmanaged in outpatient settings, many individuals attempt self-treatment or fail to recognize the long-term consequences of poor sleep quality.

The aim of the proposed study is to fill this gap with a simple solution, keeping the patients with sleep hygiene educational handouts. The costs will not be substantial as it is basically an educational exercise, which involves preparing teaching materials, expenses for printing the materials, training the hospital personnel, and evaluation after intervention. Educational handouts are more cost-effective than using a medication for the long-term, while experiencing any complications associated with insufficient sleep over time. This project is designed to evaluate the effect of sleep hygiene education on sleep quality among adult insomnia patients in adulthood after 8 weeks of sleep education. The proposed outcome is likely to be realistic because it is possible to assess sleep quality through standardized assessment instruments and patient reports.

The purpose of this capstone project is to evaluate if providing an organized sleep hygiene education handout to people diagnosed with mild insomnia in an outpatient clinic in Miami-Dade County will improve sleep quality over an 8-week period versus usual care. The proposed intervention aims to promote evidence-based behavior changes to improve sleep patterns, decrease symptoms of insomnia and promote long-term health outcomes via patient education. This objective is achievable and measurable using standard measures of sleep quality and patient self-report over the course of the intervention.

**PICOT Question**

PICO proposed is: In adults with mild insomnia, does providing a short educational handout on sleep hygiene, compared to usual care, improve sleep quality within eight weeks?

The target population for this project is adults diagnosed with mild insomnia in their outpatient or primary care settings. Mild insomnia refers to sleep problems that impair waking, but do not need intensive interventions or sleep medicine treatment. The target population is adults who have symptoms that make it hard to fall asleep, or sleep disturbances, or poor sleep quality.

The intervention involves giving patients a structured, educational handout about sleep hygiene, based on the evidence. Sleep hygiene education involves sleep-behavioral strategies that foster good sleep hygiene. They involve having regular sleep habits, avoiding caffeine late in the day, limiting the amount of halogenated light devices used in the evening, establishing sleep-friendly surroundings, and practicing relaxation exercises before sleep.

The comparison intervention is usual care. Typical treatment involves short-term counselling or pharmaceutical treatment alone, not structured/educational treatment. General guideline recommendations may be provided at appointments, but often are either vague and not strengthened by reinforcement, or they are not followed.

The expected outcome involves measurable improvement in sleep quality following implementation of the educational intervention. Sleep quality improvements may include shorter sleep onset periods, fewer nighttime awakenings, improved sleep duration, and increased patient satisfaction with sleep experiences. The timeframe selected for this intervention is eight weeks. This duration allows patients sufficient opportunity to implement behavioral changes and develop consistent sleep practices while permitting healthcare providers to monitor outcomes and assess effectiveness.

**Vulnerable Population and Setting**

The target population for the study is adult patients with mild insomnia treated in the outpatient clinic in Miami-Dade County. This population is at risk as sleep disturbances are often accompanied by a myriad of social and environmental risk factors that adversely affect health. Social determinants of health are important factors in the risk for insomnia among this population. Several factors can disrupt healthy sleep patterns, such as financial instability, work stress, irregular shifts, poor health-care access, and low levels of health literacy. Dual employment or shift work may cause circadian rhythm disturbances that make them more vulnerable to sleep disorders. Circadian rhythm disturbances are common among those who are working two jobs or working at night, making them more susceptible to sleep disorders.

Further, socioeconomic issues may affect access to preventative health education and behavioral interventions. Lower education may cause patients to not understand the importance of sleep hygiene and healthy sleep habits. Other cultural beliefs and family obligations can also affect sleep habits. Chronic stress, anxiety, depression, overconsumption of caffeine, sedentary lifestyle, obesity, and overuse of electronics before bedtime are some of the risk factors linked to mild insomnia. Moreover, sleep disorders were found to be significantly linked to physical and mental health problems, adding to the vulnerability of sleep disorder patients, as noted by Lim et al. (2023). The demand for change in this population is great, as untreated insomnia often worsens to more serious sleep disorders, which negatively impact health and life. Medical complications from poor sleep can add up to the healthcare expenses, affect productivity, and exacerbate chronic health conditions. In Miami-Dade County, there are disparities in health care across diverse populations that can lead to poor preventive care services.

**Evidence-Based Intervention Proposal**

The proposed evidence-based intervention consists of implementing a structured sleep hygiene educational program for adults diagnosed with mild insomnia in outpatient settings. The intervention will include a brief educational handout containing evidence-based behavioral strategies to improve sleep quality. Behavioral interventions are considered first-line approaches for insomnia management because they target modifiable lifestyle factors contributing to sleep disturbances and may reduce unnecessary pharmacologic treatment (Morin et al., 2023).

The educational handout will feature tips on maintaining regular sleep patterns, avoiding caffeine and alcohol, using less screen time, exercising, and creating sleep-friendly bedrooms. Several resources will be required for implementation. These include evaluation tools, printables, educational resources, staff training, and post-evaluation processes. Advanced practice registered nurses, clinic nurses, physicians, and support staff will be included in the healthcare team that will be involved in the project.

The intervention is highly feasible for advanced nursing practice as APRNs regularly deliver nursing coordination and patient education. Learner handouts can be incorporated into current working practices with little disruption and cost. The proposed timeframe starts with staff preparation and educational material development (first 2 weeks). Re-enlistment and baseline sleep evaluations will be performed in weeks 3 and 4. Educational interventions will take place in weeks 5 and 6. Follow-up assessments and outcome evaluation will take place in Weeks. 7 and 8.

**Theoretical Framework and Nursing Theory**

The theory that will be used for this capstone project is the Self-Care Deficit Nursing Theory by Dorothea Orem. According to Orem's theory, people can increase their health and health maintenance through self-care activities when they are given the appropriate education and support (Khademian et al., 2020). This framework is relevant to the proposed project, since the project involves the teaching of behaviours that can contribute to a better sleep quality. Adults who have mild insomnia may require guidance on healthy sleep habits and lifestyle modification that will enhance sleep outcomes.

The capstone project will assess the effectiveness of a brief educational handout about sleep hygiene for sleep quality improvement over a period of eight weeks. This theory will be used in an advanced practice nurse's role to help identify areas of knowledge gaps associated with sleep behaviors and to deliver evidence-based education. Patients will learn to establish regular sleep patterns, cut back on caffeine, avoid using electronic devices before bedtime, and set up a healthy sleep environment. Nurses will foster and instruct patients to encourage independent use of these behaviors. This theory aligns with patient-centered care by encouraging patients to take an active role in their own health care and adopt more sustainable behaviors that can help to enhance sleep quality and health outcomes.

**Conclusion**

Insomnia is a serious medical issue, with implications on the well-being, functioning, and economy of an individual and society. Sleep disturbances cause both physical and psychological problems, along with high utilization of healthcare resources and costs. Educational interventions addressing sleep hygiene issues constitute cost-effective and evidence-based ways to enhance the quality of sleep. The capstone project will assess the effectiveness of providing educational brochures in enhancing sleep outcomes of adult individuals with insomnia within eight weeks. Nursing theories such as Self Care Deficit Nursing Theory, as formulated by Orem, offer a solid basis for implementing interventions like patient education. Advanced practice nurses can improve patient outcomes, promote self-management, and support sustainable from using evidence-based interventions in their practice.

**References**

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare.
_Journal of Healthcare Leadership, 13_, 85–108.
[https://doi.org/10.2147/JHL.S289176](https://doi.org/10.2147/JHL.S289176)

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study.
_International Journal of Community Based Nursing & Midwifery_,
_8_(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

Lim, D. C., Najafi, A., Afifi, L., Bassetti, C. L., Buysse, D. J., Han, F., et al. (2023). The need to promote sleep health in public health agendas across the globe.
_The Lancet Public Health, 8_(10), e820–e826.
[https://doi.org/10.1016/S2468-2667(23)00154-0](https://doi.org/10.1016/S2468-2667(23)00154-0)

Melnyk, B. M., & Fineout Overholt, E. (2023).
_Evidence-based practice in nursing and healthcare: A guide to best practice_ (5th ed.). Wolters Kluwer.

Morin, C. M., Bei, B., Bjorvatn, B., Poyares, D., Spiegelhalder, K., & Wing, Y. K. (2023). World Sleep Society international sleep medicine guidelines position statement endorsement of behavioral and psychological treatments for chronic insomnia disorder in adults.
_Sleep Medicine, 109_, 164–169.
[https://doi.org/10.1016/j.sleep.2023.07.004](https://doi.org/10.1016/j.sleep.2023.07.004)

Pfeiffer, A. M., Triplett, C., & Schaefers, O. (2026). Improving sleep health through sleep hygiene education in adults aged 50–80 years.
_Frontiers in Sleep_,
_4_. https://doi.org/10.3389/frsle.2025.1722557

Zappalà, P., Lentini, M., Ronsivalle, S., Lavalle, S., La Via, L., & Maniaci, A. (2025). The Global Socioeconomic Burden of Obstructive Sleep Apnea: A Comprehensive Review.
_Healthcare_,
_13_(17), 2115. https://doi.org/10.3390/healthcare13172115

**## Attemptfeedbac1.docx**

Attempt feedback

You are on the right track. As per APA, you need to cite references throughout the paragraphs. In your Review of Literature, expand further on the research found.

**## CapstonePartIIintrucctions.docx**

Capstone Part II: Review of Literature

**CAPSTONE: PART II due 10/4/2025 by 11:59pm**

1. Review of Literature:

– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.

3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.

4. Discuss objectives for your practice change, Why is change necessary?

5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.

6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem

NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied

-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.

-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.

-This section should be minimum 4-6 pages long (not including the title and reference page).

-Use proper in-text citations with a properly formatted reference list.

-All papers must be written APA in the 3rd person.

**Rubric Capstone II.docx**

**Submission**

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_Word count: 0_

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**Details & Information**

CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Integration of
Knowledge
25 points
Thoroughly selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
25
Briefly selected and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
20
Vaguely selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
15
Did not select and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
0
Topic Focus
25 points
The health problem
is focused narrowly
enough for the
scope of this
assignment. A topic
statement provides
direction for the
paper. The topic is
consistently well
thought out,
thorough offers
insight into the topic,
and includes cited
evidence to support
the topic.
25
The health problem
is focused but
lacks direction. The
paper is about a
specific topic, but
the writer has not
established a
position. The topic
is somewhat well
thought out, offers
limited insight into
the topic, but does
not include cited
evidence to support
the topic.
20
The health problem
is too broad for the
scope of this
assignment.
15
The health problem
is unclear or
unrelated to the
discussion topic
with little or no
supporting
evidence.
0
Depth of
Discussion and
Cohesiveness
25 points
In-depth discussion
and elaboration in all
sections of the
paper.
Ties together
information from all
sources. Paper flows
from one issue to
the next with no
headings. The
author’s writing
demonstrates an
understanding of the
relationship among
material obtained
from all sources
Mostly, it ties
together information
from all sources.
In-depth discussion
and elaboration in
most sections of
the paper.
Mostly, it ties
together
information from all
sources. Paper
flows with only
some
disjointedness. The
author’s writing
demonstrates an
understanding of
the relationship
among material
obtained from all
sources.
The writer has
omitted content.
Quotations from
others outweigh the
writer’s own ideas
excessively.
Sometimes ties
together
information from all
sources. The paper
does not flow.
Disjointedness is
apparent. The
author’s writing
does not
demonstrate an
understanding of
the relationship
between material
obtained from all
sources.
Cursory discussion
in all the sections
of the paper or brief
discussion in only a
few sections.
It does not tie
together
information. Paper
does not flow and
appears to be
created from
disparate issues.
Headings are
necessary to link
concepts. Writing
does not
demonstrate an
understanding of
any relationship.

25 20
15
0
Spelling and
Grammar
10 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
Required word count
has been met.
8
More than 5 but
fewer than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
6
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 50 words
below the minimum
required count.
5
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
10 points
Over 5 current
sources, of which at
least 3 are peer-
review journal
articles or scholarly
books. Sources
include both general
background sources
and specialized
sources. Special-
interest sources and
popular literature
and acknowledged
as such if they are
cited. All websites
utilized are
authoritative.
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
Citations
5 points
Fewer than 5
incomplete citations
and/or quotations,
and APA format
errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources.

**## CapstonePart1.docx**

2

**Capstone Part I: PICOT Assignment**

Natalia Gomez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo, DNP, MSN, APRN-BC, APN

May 21, 2026

**Capstone Part I: PICOT Assignment**

Sleep has become an important public health problem. The quality of sleep is directly correlated to cognitive function, mood, immune function, and quality of life. However, a significant proportion of adults suffer from sleep failure or insufficient rest, and it is now one of the healthcare problems. According to Lim et al. (2023), sleep falls short of its many responsibilities to health, and untreated sleep disorders have been linked with cardiovascular disease, obesity, depression, anxiety, metabolic disorders, and reduced life expectancy worldwide. Around the world, at least one-third of people don't sleep enough, and approximately 10 percent have chronic insomnia. For the aged, then the sleeping problem is more prevalent. Prevalence of sleep disturbances among adults includes problems getting to sleep, poor-quality sleep, and sleepiness (difficulty falling asleep or staying asleep) occurring in 50 percent, 40 percent, and 30 percent, respectively (Pfeiffer et al., 2026). Poor sleep also leads to poor concentration, limited performance at work, high risk of accidents, and less-than-ideal health.

In addition to the physical and psychological burden, insomnia contributes substantially to healthcare costs and economic losses. In the United States, sleep disorders are estimated to cost billions of dollars annually because of increased healthcare utilization, absenteeism, reduced productivity, workplace accidents, and chronic disease management (Lim et al., 2023). Untreated insomnia frequently increases the risk of emergency department visits, mental health disorders, cardiovascular complications, and medication dependency. At the local level, residents of Miami-Dade County may experience additional barriers to healthy sleep due to socioeconomic disparities, demanding work schedules, shift employment, financial stress, and limited access to preventive healthcare education. Miami-Dade County includes a culturally diverse population with significant healthcare disparities, particularly among underserved and low-income communities, increasing vulnerability to untreated sleep disturbances. Because sleep problems often remain unmanaged in outpatient settings, many individuals attempt self-treatment or fail to recognize the long-term consequences of poor sleep quality.

The aim of the proposed study is to fill this gap with a simple solution, keeping the patients with sleep hygiene educational handouts. The costs will not be substantial as it is basically an educational exercise, which involves preparing teaching materials, expenses for printing the materials, training the hospital personnel, and evaluation after intervention. Educational handouts are more cost-effective than using a medication for the long-term, while experiencing any complications associated with insufficient sleep over time. This project is designed to evaluate the effect of sleep hygiene education on sleep quality among adult insomnia patients in adulthood after 8 weeks of sleep education. The proposed outcome is likely to be realistic because it is possible to assess sleep quality through standardized assessment instruments and patient reports.

The purpose of this capstone project is to evaluate if providing an organized sleep hygiene education handout to people diagnosed with mild insomnia in an outpatient clinic in Miami-Dade County will improve sleep quality over an 8-week period versus usual care. The proposed intervention aims to promote evidence-based behavior changes to improve sleep patterns, decrease symptoms of insomnia and promote long-term health outcomes via patient education. This objective is achievable and measurable using standard measures of sleep quality and patient self-report over the course of the intervention.

**PICOT Question**

PICO proposed is: In adults with mild insomnia, does providing a short educational handout on sleep hygiene, compared to usual care, improve sleep quality within eight weeks?

The target population for this project is adults diagnosed with mild insomnia in their outpatient or primary care settings. Mild insomnia refers to sleep problems that impair waking, but do not need intensive interventions or sleep medicine treatment. The target population is adults who have symptoms that make it hard to fall asleep, or sleep disturbances, or poor sleep quality.

The intervention involves giving patients a structured, educational handout about sleep hygiene, based on the evidence. Sleep hygiene education involves sleep-behavioral strategies that foster good sleep hygiene. They involve having regular sleep habits, avoiding caffeine late in the day, limiting the amount of halogenated light devices used in the evening, establishing sleep-friendly surroundings, and practicing relaxation exercises before sleep.

The comparison intervention is usual care. Typical treatment involves short-term counselling or pharmaceutical treatment alone, not structured/educational treatment. General guideline recommendations may be provided at appointments, but often are either vague and not strengthened by reinforcement, or they are not followed.

The expected outcome involves measurable improvement in sleep quality following implementation of the educational intervention. Sleep quality improvements may include shorter sleep onset periods, fewer nighttime awakenings, improved sleep duration, and increased patient satisfaction with sleep experiences. The timeframe selected for this intervention is eight weeks. This duration allows patients sufficient opportunity to implement behavioral changes and develop consistent sleep practices while permitting healthcare providers to monitor outcomes and assess effectiveness.

**Vulnerable Population and Setting**

The target population for the study is adult patients with mild insomnia treated in the outpatient clinic in Miami-Dade County. This population is at risk as sleep disturbances are often accompanied by a myriad of social and environmental risk factors that adversely affect health. Social determinants of health are important factors in the risk for insomnia among this population. Several factors can disrupt healthy sleep patterns, such as financial instability, work stress, irregular shifts, poor health-care access, and low levels of health literacy. Dual employment or shift work may cause circadian rhythm disturbances that make them more vulnerable to sleep disorders. Circadian rhythm disturbances are common among those who are working two jobs or working at night, making them more susceptible to sleep disorders.

Further, socioeconomic issues may affect access to preventative health education and behavioral interventions. Lower education may cause patients to not understand the importance of sleep hygiene and healthy sleep habits. Other cultural beliefs and family obligations can also affect sleep habits. Chronic stress, anxiety, depression, overconsumption of caffeine, sedentary lifestyle, obesity, and overuse of electronics before bedtime are some of the risk factors linked to mild insomnia. Moreover, sleep disorders were found to be significantly linked to physical and mental health problems, adding to the vulnerability of sleep disorder patients, as noted by Lim et al. (2023). The demand for change in this population is great, as untreated insomnia often worsens to more serious sleep disorders, which negatively impact health and life. Medical complications from poor sleep can add up to the healthcare expenses, affect productivity, and exacerbate chronic health conditions. In Miami-Dade County, there are disparities in health care across diverse populations that can lead to poor preventive care services.

**Evidence-Based Intervention Proposal**

The proposed evidence-based intervention consists of implementing a structured sleep hygiene educational program for adults diagnosed with mild insomnia in outpatient settings. The intervention will include a brief educational handout containing evidence-based behavioral strategies to improve sleep quality. Behavioral interventions are considered first-line approaches for insomnia management because they target modifiable lifestyle factors contributing to sleep disturbances and may reduce unnecessary pharmacologic treatment (Morin et al., 2023).

The educational handout will feature tips on maintaining regular sleep patterns, avoiding caffeine and alcohol, using less screen time, exercising, and creating sleep-friendly bedrooms. Several resources will be required for implementation. These include evaluation tools, printables, educational resources, staff training, and post-evaluation processes. Advanced practice registered nurses, clinic nurses, physicians, and support staff will be included in the healthcare team that will be involved in the project.

The intervention is highly feasible for advanced nursing practice as APRNs regularly deliver nursing coordination and patient education. Learner handouts can be incorporated into current working practices with little disruption and cost. The proposed timeframe starts with staff preparation and educational material development (first 2 weeks). Re-enlistment and baseline sleep evaluations will be performed in weeks 3 and 4. Educational interventions will take place in weeks 5 and 6. Follow-up assessments and outcome evaluation will take place in Weeks. 7 and 8.

**Theoretical Framework and Nursing Theory**

The theory that will be used for this capstone project is the Self-Care Deficit Nursing Theory by Dorothea Orem. According to Orem's theory, people can increase their health and health maintenance through self-care activities when they are given the appropriate education and support (Khademian et al., 2020). This framework is relevant to the proposed project, since the project involves the teaching of behaviours that can contribute to a better sleep quality. Adults who have mild insomnia may require guidance on healthy sleep habits and lifestyle modification that will enhance sleep outcomes.

The capstone project will assess the effectiveness of a brief educational handout about sleep hygiene for sleep quality improvement over a period of eight weeks. This theory will be used in an advanced practice nurse's role to help identify areas of knowledge gaps associated with sleep behaviors and to deliver evidence-based education. Patients will learn to establish regular sleep patterns, cut back on caffeine, avoid using electronic devices before bedtime, and set up a healthy sleep environment. Nurses will foster and instruct patients to encourage independent use of these behaviors. This theory aligns with patient-centered care by encouraging patients to take an active role in their own health care and adopt more sustainable behaviors that can help to enhance sleep quality and health outcomes.

**Conclusion**

Insomnia is a serious medical issue, with implications on the well-being, functioning, and economy of an individual and society. Sleep disturbances cause both physical and psychological problems, along with high utilization of healthcare resources and costs. Educational interventions addressing sleep hygiene issues constitute cost-effective and evidence-based ways to enhance the quality of sleep. The capstone project will assess the effectiveness of providing educational brochures in enhancing sleep outcomes of adult individuals with insomnia within eight weeks. Nursing theories such as Self Care Deficit Nursing Theory, as formulated by Orem, offer a solid basis for implementing interventions like patient education. Advanced practice nurses can improve patient outcomes, promote self-management, and support sustainable from using evidence-based interventions in their practice.

**References**

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare.
_Journal of Healthcare Leadership, 13_, 85–108.
[https://doi.org/10.2147/JHL.S289176](https://doi.org/10.2147/JHL.S289176)

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study.
_International Journal of Community Based Nursing & Midwifery_,
_8_(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

Lim, D. C., Najafi, A., Afifi, L., Bassetti, C. L., Buysse, D. J., Han, F., et al. (2023). The need to promote sleep health in public health agendas across the globe.
_The Lancet Public Health, 8_(10), e820–e826.
[https://doi.org/10.1016/S2468-2667(23)00154-0](https://doi.org/10.1016/S2468-2667(23)00154-0)

Melnyk, B. M., & Fineout Overholt, E. (2023).
_Evidence-based practice in nursing and healthcare: A guide to best practice_ (5th ed.). Wolters Kluwer.

Morin, C. M., Bei, B., Bjorvatn, B., Poyares, D., Spiegelhalder, K., & Wing, Y. K. (2023). World Sleep Society international sleep medicine guidelines position statement endorsement of behavioral and psychological treatments for chronic insomnia disorder in adults.
_Sleep Medicine, 109_, 164–169.
[https://doi.org/10.1016/j.sleep.2023.07.004](https://doi.org/10.1016/j.sleep.2023.07.004)

Pfeiffer, A. M., Triplett, C., & Schaefers, O. (2026). Improving sleep health through sleep hygiene education in adults aged 50–80 years.
_Frontiers in Sleep_,
_4_. https://doi.org/10.3389/frsle.2025.1722557

Zappalà, P., Lentini, M., Ronsivalle, S., Lavalle, S., La Via, L., & Maniaci, A. (2025). The Global Socioeconomic Burden of Obstructive Sleep Apnea: A Comprehensive Review.
_Healthcare_,
_13_(17), 2115. https://doi.org/10.3390/healthcare13172115

**## Attemptfeedbac1.docx**

Attempt feedback

You are on the right track. As per APA, you need to cite references throughout the paragraphs. In your Review of Literature, expand further on the research found.

**## CapstonePartIIintrucctions.docx**

Capstone Part II: Review of Literature

**CAPSTONE: PART II due 10/4/2025 by 11:59pm**

1. Review of Literature:

– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.

2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.

3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.

4. Discuss objectives for your practice change, Why is change necessary?

5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.

6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem

NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied

-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.

-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.

-This section should be minimum 4-6 pages long (not including the title and reference page).

-Use proper in-text citations with a properly formatted reference list.

-All papers must be written APA in the 3rd person.

**Rubric Capstone II.docx**

**Submission**

Text Editor

_Word count: 0_

**Drag files here**

Maximum size: 512 MB

**or**

**Details & Information**

CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Integration of
Knowledge
25 points
Thoroughly selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
25
Briefly selected and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
20
Vaguely selected
and present an
appropriate
Evidence Based
Practice for the
health problem and
change.
15
Did not select and
present an
appropriate
Evidence Based
Practice for the
health problem and
change.
0
Topic Focus
25 points
The health problem
is focused narrowly
enough for the
scope of this
assignment. A topic
statement provides
direction for the
paper. The topic is
consistently well
thought out,
thorough offers
insight into the topic,
and includes cited
evidence to support
the topic.
25
The health problem
is focused but
lacks direction. The
paper is about a
specific topic, but
the writer has not
established a
position. The topic
is somewhat well
thought out, offers
limited insight into
the topic, but does
not include cited
evidence to support
the topic.
20
The health problem
is too broad for the
scope of this
assignment.
15
The health problem
is unclear or
unrelated to the
discussion topic
with little or no
supporting
evidence.
0
Depth of
Discussion and
Cohesiveness
25 points
In-depth discussion
and elaboration in all
sections of the
paper.
Ties together
information from all
sources. Paper flows
from one issue to
the next with no
headings. The
author’s writing
demonstrates an
understanding of the
relationship among
material obtained
from all sources
Mostly, it ties
together information
from all sources.
In-depth discussion
and elaboration in
most sections of
the paper.
Mostly, it ties
together
information from all
sources. Paper
flows with only
some
disjointedness. The
author’s writing
demonstrates an
understanding of
the relationship
among material
obtained from all
sources.
The writer has
omitted content.
Quotations from
others outweigh the
writer’s own ideas
excessively.
Sometimes ties
together
information from all
sources. The paper
does not flow.
Disjointedness is
apparent. The
author’s writing
does not
demonstrate an
understanding of
the relationship
between material
obtained from all
sources.
Cursory discussion
in all the sections
of the paper or brief
discussion in only a
few sections.
It does not tie
together
information. Paper
does not flow and
appears to be
created from
disparate issues.
Headings are
necessary to link
concepts. Writing
does not
demonstrate an
understanding of
any relationship.

25 20
15
0
Spelling and
Grammar
10 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
Required word count
has been met.
8
More than 5 but
fewer than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
6
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
Required word
count is 50 words
below the minimum
required count.
5
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
10 points
Over 5 current
sources, of which at
least 3 are peer-
review journal
articles or scholarly
books. Sources
include both general
background sources
and specialized
sources. Special-
interest sources and
popular literature
and acknowledged
as such if they are
cited. All websites
utilized are
authoritative.
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
Citations
5 points
Fewer than 5
incomplete citations
and/or quotations,
and APA format
errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources.

**## CapstonePart1.docx**

2

**Capstone Part I: PICOT Assignment**

Natalia Gomez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo, DNP, MSN, APRN-BC, APN

May 21, 2026

**Capstone Part I: PICOT Assignment**

Sleep has become an important public health problem. The quality of sleep is directly correlated to cognitive function, mood, immune function, and quality of life. However, a significant proportion of adults suffer from sleep failure or insufficient rest, and it is now one of the healthcare problems. According to Lim et al. (2023), sleep falls short of its many responsibilities to health, and untreated sleep disorders have been linked with cardiovascular disease, obesity, depression, anxiety, metabolic disorders, and reduced life expectancy worldwide. Around the world, at least one-third of people don't sleep enough, and approximately 10 percent have chronic insomnia. For the aged, then the sleeping problem is more prevalent. Prevalence of sleep disturbances among adults includes problems getting to sleep, poor-quality sleep, and sleepiness (difficulty falling asleep or staying asleep) occurring in 50 percent, 40 percent, and 30 percent, respectively (Pfeiffer et al., 2026). Poor sleep also leads to poor concentration, limited performance at work, high risk of accidents, and less-than-ideal health.

In addition to the physical and psychological burden, insomnia contributes substantially to healthcare costs and economic losses. In the United States, sleep disorders are estimated to cost billions of dollars annually because of increased healthcare utilization, absenteeism, reduced productivity, workplace accidents, and chronic disease management (Lim et al., 2023). Untreated insomnia frequently increases the risk of emergency department visits, mental health disorders, cardiovascular complications, and medication dependency. At the local level, residents of Miami-Dade County may experience additional barriers to healthy sleep due to socioeconomic disparities, demanding work schedules, shift employment, financial stress, and limited access to preventive healthcare education. Miami-Dade County includes a culturally diverse population with significant healthcare disparities, particularly among underserved and low-income communities, increasing vulnerability to untreated sleep disturbances. Because sleep problems often remain unmanaged in outpatient settings, many individuals attempt self-treatment or fail to recognize the long-term consequences of poor sleep quality.

The aim of the proposed study is to fill this gap with a simple solution, keeping the patients with sleep hygiene educational handouts. The costs will not be substantial as it is basically an educational exercise, which involves preparing teaching materials, expenses for printing the materials, training the hospital personnel, and evaluation after intervention. Educational handouts are more cost-effective than using a medication for the long-term, while experiencing any complications associated with insufficient sleep over time. This project is designed to evaluate the effect of sleep hygiene education on sleep quality among adult insomnia patients in adulthood after 8 weeks of sleep education. The proposed outcome is likely to be realistic because it is possible to assess sleep quality through standardized assessment instruments and patient reports.

The purpose of this capstone project is to evaluate if providing an organized sleep hygiene education handout to people diagnosed with mild insomnia in an outpatient clinic in Miami-Dade County will improve sleep quality over an 8-week period versus usual care. The proposed intervention aims to promote evidence-based behavior changes to improve sleep patterns, decrease symptoms of insomnia and promote long-term health outcomes via patient education. This objective is achievable and measurable using standard measures of sleep quality and patient self-report over the course of the intervention.

**PICOT Question**

PICO proposed is: In adults with mild insomnia, does providing a short educational handout on sleep hygiene, compared to usual care, improve sleep quality within eight weeks?

The target population for this project is adults diagnosed with mild insomnia in their outpatient or primary care settings. Mild insomnia refers to sleep problems that impair waking, but do not need intensive interventions or sleep medicine treatment. The target population is adults who have symptoms that make it hard to fall asleep, or sleep disturbances, or poor sleep quality.

The intervention involves giving patients a structured, educational handout about sleep hygiene, based on the evidence. Sleep hygiene education involves sleep-behavioral strategies that foster good sleep hygiene. They involve having regular sleep habits, avoiding caffeine late in the day, limiting the amount of halogenated light devices used in the evening, establishing sleep-friendly surroundings, and practicing relaxation exercises before sleep.

The comparison intervention is usual care. Typical treatment involves short-term counselling or pharmaceutical treatment alone, not structured/educational treatment. General guideline recommendations may be provided at appointments, but often are either vague and not strengthened by reinforcement, or they are not followed.

The expected outcome involves measurable improvement in sleep quality following implementation of the educational intervention. Sleep quality improvements may include shorter sleep onset periods, fewer nighttime awakenings, improved sleep duration, and increased patient satisfaction with sleep experiences. The timeframe selected for this intervention is eight weeks. This duration allows patients sufficient opportunity to implement behavioral changes and develop consistent sleep practices while permitting healthcare providers to monitor outcomes and assess effectiveness.

**Vulnerable Population and Setting**

The target population for the study is adult patients with mild insomnia treated in the outpatient clinic in Miami-Dade County. This population is at risk as sleep disturbances are often accompanied by a myriad of social and environmental risk factors that adversely affect health. Social determinants of health are important factors in the risk for insomnia among this population. Several factors can disrupt healthy sleep patterns, such as financial instability, work stress, irregular shifts, poor health-care access, and low levels of health literacy. Dual employment or shift work may cause circadian rhythm disturbances that make them more vulnerable to sleep disorders. Circadian rhythm disturbances are common among those who are working two jobs or working at night, making them more susceptible to sleep disorders.

Further, socioeconomic issues may affect access to preventative health education and behavioral interventions. Lower education may cause patients to not understand the importance of sleep hygiene and healthy sleep habits. Other cultural beliefs and family obligations can also affect sleep habits. Chronic stress, anxiety, depression, overconsumption of caffeine, sedentary lifestyle, obesity, and overuse of electronics before bedtime are some of the risk factors linked to mild insomnia. Moreover, sleep disorders were found to be significantly linked to physical and mental health problems, adding to the vulnerability of sleep disorder patients, as noted by Lim et al. (2023). The demand for change in this population is great, as untreated insomnia often worsens to more serious sleep disorders, which negatively impact health and life. Medical complications from poor sleep can add up to the healthcare expenses, affect productivity, and exacerbate chronic health conditions. In Miami-Dade County, there are disparities in health care across diverse populations that can lead to poor preventive care services.

**Evidence-Based Intervention Proposal**

The proposed evidence-based intervention consists of implementing a structured sleep hygiene educational program for adults diagnosed with mild insomnia in outpatient settings. The intervention will include a brief educational handout containing evidence-based behavioral strategies to improve sleep quality. Behavioral interventions are considered first-line approaches for insomnia management because they target modifiable lifestyle factors contributing to sleep disturbances and may reduce unnecessary pharmacologic treatment (Morin et al., 2023).

The educational handout will feature tips on maintaining regular sleep patterns, avoiding caffeine and alcohol, using less screen time, exercising, and creating sleep-friendly bedrooms. Several resources will be required for implementation. These include evaluation tools, printables, educational resources, staff training, and post-evaluation processes. Advanced practice registered nurses, clinic nurses, physicians, and support staff will be included in the healthcare team that will be involved in the project.

The intervention is highly feasible for advanced nursing practice as APRNs regularly deliver nursing coordination and patient education. Learner handouts can be incorporated into current working practices with little disruption and cost. The proposed timeframe starts with staff preparation and educational material development (first 2 weeks). Re-enlistment and baseline sleep evaluations will be performed in weeks 3 and 4. Educational interventions will take place in weeks 5 and 6. Follow-up assessments and outcome evaluation will take place in Weeks. 7 and 8.

**Theoretical Framework and Nursing Theory**

The theory that will be used for this capstone project is the Self-Care Deficit Nursing Theory by Dorothea Orem. According to Orem's theory, people can increase their health and health maintenance through self-care activities when they are given the appropriate education and support (Khademian et al., 2020). This framework is relevant to the proposed project, since the project involves the teaching of behaviours that can contribute to a better sleep quality. Adults who have mild insomnia may require guidance on healthy sleep habits and lifestyle modification that will enhance sleep outcomes.

The capstone project will assess the effectiveness of a brief educational handout about sleep hygiene for sleep quality improvement over a period of eight weeks. This theory will be used in an advanced practice nurse's role to help identify areas of knowledge gaps associated with sleep behaviors and to deliver evidence-based education. Patients will learn to establish regular sleep patterns, cut back on caffeine, avoid using electronic devices before bedtime, and set up a healthy sleep environment. Nurses will foster and instruct patients to encourage independent use of these behaviors. This theory aligns with patient-centered care by encouraging patients to take an active role in their own health care and adopt more sustainable behaviors that can help to enhance sleep quality and health outcomes.

**Conclusion**

Insomnia is a serious medical issue, with implications on the well-being, functioning, and economy of an individual and society. Sleep disturbances cause both physical and psychological problems, along with high utilization of healthcare resources and costs. Educational interventions addressing sleep hygiene issues constitute cost-effective and evidence-based ways to enhance the quality of sleep. The capstone project will assess the effectiveness of providing educational brochures in enhancing sleep outcomes of adult individuals with insomnia within eight weeks. Nursing theories such as Self Care Deficit Nursing Theory, as formulated by Orem, offer a solid basis for implementing interventions like patient education. Advanced practice nurses can improve patient outcomes, promote self-management, and support sustainable from using evidence-based interventions in their practice.

**References**

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare.
_Journal of Healthcare Leadership, 13_, 85–108.
[https://doi.org/10.2147/JHL.S289176](https://doi.org/10.2147/JHL.S289176)

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study.
_International Journal of Community Based Nursing & Midwifery_,
_8_(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

Lim, D. C., Najafi, A., Afifi, L., Bassetti, C. L., Buysse, D. J., Han, F., et al. (2023). The need to promote sleep health in public health agendas across the globe.
_The Lancet Public Health, 8_(10), e820–e826.
[https://doi.org/10.1016/S2468-2667(23)00154-0](https://doi.org/10.1016/S2468-2667(23)00154-0)

Melnyk, B. M., & Fineout Overholt, E. (2023).
_Evidence-based practice in nursing and healthcare: A guide to best practice_ (5th ed.). Wolters Kluwer.

Morin, C. M., Bei, B., Bjorvatn, B., Poyares, D., Spiegelhalder, K., & Wing, Y. K. (2023). World Sleep Society international sleep medicine guidelines position statement endorsement of behavioral and psychological treatments for chronic insomnia disorder in adults.
_Sleep Medicine, 109_, 164–169.
[https://doi.org/10.1016/j.sleep.2023.07.004](https://doi.org/10.1016/j.sleep.2023.07.004)

Pfeiffer, A. M., Triplett, C., & Schaefers, O. (2026). Improving sleep health through sleep hygiene education in adults aged 50–80 years.
_Frontiers in Sleep_,
_4_. https://doi.org/10.3389/frsle.2025.1722557

Zappalà, P., Lentini, M., Ronsivalle, S., Lavalle, S., La Via, L., & Maniaci, A. (2025). The Global Socioeconomic Burden of Obstructive Sleep Apnea: A Comprehensive Review.
_Healthcare_,
_13_(17), 2115. https://doi.org/10.3390/healthcare13172115