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    COVID **files (2)** – ## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx – ## TopicsandArticlesforLitReview.docx **## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx** SUCCINCT TITLE MAX 55 CHARACERS INCLUDING SPACES 1 2 TITLE OF PAPER ## Title Succinctly Desc…

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    **files (2)**

    – ## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx

    – ## TopicsandArticlesforLitReview.docx

    **## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx**

    SUCCINCT TITLE MAX 55 CHARACERS INCLUDING SPACES 1

    2

    TITLE OF PAPER

    ## Title Succinctly Describes the Topic for the Review of Literature

    Your name

    University of Illinois at Chicago

    **Abstract**

    Week 8-This should be the last part you complete after you finish the other components of the paper-TO BE DONE IN WEEK 8. Do not indent the first line of an abstract. An abstract is a concise summary of your topic, what is known and what should be researched in the future. It is written in past tense. The abstract reflects the purpose of the literature review (assigned PICO statement). The overview allows readers to determine if the study is of interest to the reader. Describe the problem in 1-2 sentences. Summarize the implications of the review. Word limits are 150-250 words. This is where you can showcase your ability to write concisely and compact information in a creative way to provide a great deal of information in a few clear sentences. Are you concise enough? Watch that word count (lower left-hand corner of WORD). (The above is exactly 151 words, so you see what size you are looking for!). The format is correct so follow the template as you enter the abstract.

    _Keywords:_ infection, quality, list your key words here

    **Title of Paper Here with Main Words Capitalized-Due Week 1**

    The title should summarize the main theme of the paper. It should be clear without reading anything else. Titles should be 12 words or less if possible. Your paper should have 1” margins, double spacing, use 12pt Times New Roman font, with a running head in all caps and < 50 characters and just page numbers in the upper right-hand corner in the same font as the paper. The template is set up in APA format so follow its guide. Delete instructions in red, as you complete sections of the paper.

    On the first page of your text on the first line, you center the title of your paper in bold with main words capitalized for APA 7th ed. Format. There are no extra spaces before or after the title; just double space everything in APA 7th ed papers. Next, your first 2-3 paragraphs are the introduction.
    **It should not have any heading** as it is assumed the first paragraph is an introduction. The introduction presents the problem being researched in a concise sentence. You should also include information defining what the problem is (here is where you can use the 2 references you need to find for the assignment.

    Next, in a new paragraph, state why the topic is important to study for nursing. You should cite at least two current scholarly sources from the UIC library on why it is important to study the problem. Keep it clear and concise a 3-4 sentence solidly cited paragraph that is less than half a page is what is expected.

    The last sentence should be: “The purpose of this paper is to review the literature related to:” and the PICO statement for the question.

    **Literature Search Methods-Due Week 2**

    This section will explain which databases you searched and the criteria you used to search these, if you were to do so. How many articles did your search produce and how many did you find to be most relevant? Why did you choose these for this paper? This part of the paper should be 1-2 paragraphs. Since you are describing what you did, you would not have references in this area.
    **You are not actually using any articles you find since you are assigned the articles you will be reviewing.**

    **Literature Review-Due Weeks 4, 5 & 6**

    The body of the paper continues with a literature review in a research paper. For this paper you review 2 quantitative studies and 1 qualitative study related to your problem being studied. The goal of a literature review is to state what we currently know about the topic. What does the research say? Week 4 you will include: purpose, design, sample, and data collection for each of the quantitative research articles chosen for the review.

    Week 5, you will add: the reliability and validity information from each instrument used in the studies chosen. The data analyses will also be reviewed including descriptive and inferential statistics for each article along with significance. Here is what you should write:

    1st article (using the same paragraph – do NOT start another paragraph). Reliability was established by consistency of the measurement of xxx and use of the data collection tool of xxx. Validity was ensured due to the use of the data collection tool of xxx which has a proven assurance of accuracy. The statistical data analysis used xx software and involved xxx. The results of the study were xxx.

    2nd article – same wording

    Week 6 you will provide a 1 paragraph summary of the qualitative article reviewed for this paper.

    You need to cite your
    ~~~~ assigned articles in APA format and include them in your reference page. This section should be a minimum of three solid paragraphs (1 per study) You should not be using any direct quotes as you are synthesizing the material.
    ~~~~

    **Discussion-Due Week 7**

    Discuss if the findings are consistent with each other. Can you generalize the findings? If not, address the barriers or concerns. It is perfectly fine to conclude that you need more research and report any potential bias, confounding variables, or data gaps. This is where you take your review of the studies and apply critical thinking! Link the data outcomes to clinical practice. Include supporting citations. This section should be at least two solid paragraphs and demonstrate critical thinking and supported with citations. Be sure to include the next steps in research you suggest based on the findings.

    In a one paragraph summary discuss any study limitations and generally summarize the study’s validity. Address if the study has meaning to the practice of nursing currently. This is your chance to bring it all together. Once the summary is done remember to write your abstract which is a summary of your report including your findings. You should have at least 2 new recent, relevant references to include in this section.

    **References-Ongoing with the assigned three research articles due Week 3**

    Remember to use APA format and include all references you have used (this includes the literature review and articles assigned to your topic)

    **## TopicsandArticlesforLitReview.docx**

    ## TOPICS AND ARTICLES FOR WEEKLY LITERATURE REVIEW ASSIGNMENT (WRITTEN ASSIGNMENT)

    **Team Member 1:**

    **Topic:** In nurses working with leaders who implement inclusiveness versus those who do not will the nursing outcomes be higher?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Lee, S.E. & Seo, J.K. (2024). Effects of nurse managers' inclusive leadership on nurses'

    psychological safety and innovative work behavior: The moderating role of collectivism.
    _Journal of Nursing Scholarship, 54_(4), 554.562.
    [https://doi.org/10.1111/jnu.12965](https://doi.org/10.1111/jnu.12965)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Zeng, D., Wang, B. & Chen, W. (2022). Inclusive leadership can improve nurses’

    psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention.
    _Frontiers in Psychology, 13_.
    [https://doi.org/10.3389/fpsyg.2022.1100172](https://doi.org/10.3389/fpsyg.2022.1100172)

    **Qualitative Article (to be reviewed week 6):**

    Smith, C.M. & Horne, C.E. (2024). Educational and professional experiences of men in

    nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.
    _Journal of Professional Nursing, 53_, 123-130.
    [https://doi.org/10.1016/j.profnurs.2024.05.008](https://doi.org/10.1016/j.profnurs.2024.05.008)

    **Team Member 2:**

    **Topic:** In inpatient heart failure patients will receiving nurse-led education and transitional care, as opposed to not receiving nurse-led education and transitional care lead to lower incidences of rehospitalization and improved overall patient outcomes?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Arjunan, P., & Trichur, R. V. (2020). The impact of nurse-led cardiac rehabilitation on quality of

    quality of life and biophysiological parameters in patients with heart failure: A randomized clinical trial
    _. Journal of Nursing Research, 29_(1).
    [https://doi.org/10.1097/jnr.0000000000000407](https://doi.org/10.1097/jnr.0000000000000407)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Jiang, Y., Koh, K. W., Ramachandran, H. J., Nguyen, H. D., Lim, D. S., Tay, Y. K., Shorey, S.,

    & Wang, W. (2021). The effectiveness of a nurse-led home-based heart failure self-management programme (the hom-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.
    _International Journal of Nursing Studies, 122_, 104026. https://doi.org/10.1016/j.ijnurstu.2021.104026

    **Qualitative Article (to be reviewed week 6):**

    Jepma, P., Latour, C. H., ten Barge, I. H., Verweij, L., Peters, R. J., Scholte op Reimer, W. J., &

    Buurman, B. M. (2021). Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention – a qualitative study.
    _BMC Health Services Research, 21_(1). https://doi.org/10.1186/s12913-021-06719-3

    **Team Member 3:**

    **Topic:** In inpatient older adults will a formalized program to prevent falls versus no program decrease the incidence of falls?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Frith, J., Hunter, A. N., Coffey, S. S., & Khan, Z. (2019). A longitudinal fall prevention study for

    older adults.
    _Journal for Nurse Practitioners, 15(_ 4), 295–300.e1. https://doi.org/10.1016/j.nurpra.2018.10.012

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Noublanche F., Simon R., Ben-Sadoun G., Annweiler C. (2022).

    Physical activity and fall prevention in geriatric inpatients in an acute care unit (AGIR Study): Protocol for a usability study.
    _JMIR Research Protocols, 11_(7):e32288 doi: 10.2196/32288

    **Qualitative Article (to be reviewed week 6):**

    Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A.-M., Kiegaldie, D., Shorr, R. I., & Morris,

    M. E. (2021). Patient perspectives on hospital falls prevention education.
    _Frontiers in Public Health, 9_, 592440–592440.
    [https://doi.org/10.3389/fpubh.2021.592440](https://doi.org/10.3389/fpubh.2021.592440)

    **Team Member 4:**

    **Topic:** In newborn patients will pharmacological versus nonpharmacological interventions have decreased pain?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Gholami A, Karimi F, Ghasempour Z, Abolhassani M, Rabiee N. (2021). Comparison of the

    effect of kangaroo care and infant massage on the level of maternal anxiety and neonatal pain.
    _Journal of Babol University of Medical Sciences, 23 (1)_ :90-97. http://jbums.org/article-1-9473-en.html

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Shukla, V.V., Chaudhari, A. J., Nimbalkar, S.M., Phatak, A.G., Patel, D.V., Archana

    Somashekhar Nimbalkar, A. S. (2021). Skin-to-Skin care by mother vs. father for preterm neonatal pain: A randomized control trial (ENVIRON Trial). International
    _Journal of Pediatrics, 2021_,
    [https://doi.org/10.1155/2021/8886887](https://doi.org/10.1155/2021/8886887)

    **Qualitative Article (to be reviewed week 6):**

    Hassankhani, Negarandeh, R., Abbaszadeh, M., & Jabraeili, M. (2020). The role of mothers

    during painful procedures on neonates: A focused ethnography.
    _Journal of Neonatal Nursing: JNN, 26_(6), 340–343. https://doi.org/10.1016/j.jnn.2020.03.002

    **Team Member 5:**

    **Topic:** In patients diagnosed with COVID-19, does a prone position versus supine decrease the severity of symptoms?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Caputo, N. D., Strayer, R. J., & Levitan, R. (2020). Early self‐proning in awake,

    non‐intubated patients in the Emergency Department: A single Ed's experience during

    the Covid‐19 pandemic.
    _Academic Emergency Medicine, 27_(5): 375-378. doi: 10.1111/acem.13994.

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    O' Donoghue, S. , Church, M. , Russell, K. , Gamboa, K. , Hardman, J. , Sarge, J. , Moskowitz,

    A. , Hayes, M. , Cocchi, M. & DeSanto-Madeya, S. (2021). Development,

    implementation, and impact of a proning team During the COVID-19 Intensive Care

    Unit surge.
    _Dimensions of Critical Care Nursing, 40_ (6), 321-327. doi:

    10.1097/DCC.0000000000000498.

    **Qualitative Article (to be reviewed week 6):**

    Cadge, W., Lewis, M., Bandini, J., Shostak, S., Donahue, V., Trachtenberg, S., Grone, K.,

    Kacmarek, R., Lux, L., Matthews, C., McAuley, M. E., Romain, F., Snydeman, C.,

    Tehan, T., & Robinson, E. (2021). Intensive care unit nurses living through COVID‐19:

    A qualitative study.
    _Journal of Nursing Management, 29_(7), 1965–1973.

    [https://doi.org/10.1111/jonm.13353](https://doi.org/10.1111/jonm.13353)

    **Team Member 6:**

    **Topic:** In nurses working in the inpatient setting does a formalized stress reduction program versus no program decrease stress levels?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Fteropoulli, T., Kalavana, T. V., Yiallourou, A., Karaiskakis, M., Koliou, M., Vryonides, S.,

    Hadjioannou, A., & Nikolopoulos, G. K. (2021). Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic.
    _Journal of Clinical Nursing, 6._ [https://doi.org/10.1111/jocn.15938](https://doi.org/10.1111/jocn.15938)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Kawar, L. N., Radovich, P., Valdez, R. M., & Rondinelli, J. (2019). Compassion fatigue and

    compassion satisfaction among multisite multisystem nurses.
    _Nursing Administration Quarterly, 43(_ 4), 358–369. https://doi-org.proxy.cc.uic.edu/10.1097/NAQ.0000000000000370

    **Qualitative Article (to be reviewed week 6):**

    White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States.
    _Journal of Nursing Management._,
    _29_(6), 1525–1534.
    [https://doi.org/10.1111/jonm.13304](https://doi.org/10.1111/jonm.13304)

    **Team Member 7:**

    **Topic:** In nurses working in the operating room setting does playing music and other environmental distractions versus no distractions impact the surgical count process?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Kertesz, L., Cordella, C. M., Nadera, N. M., Nelson, P. E., Kahil, M., Shim, S.-H., & Holtzman,

    J. S. (2020). No surgical items left behind: A multidisciplinary approach to the surgical count process.
    _Journal of Radiology Nursing, 39_(1), 57–62.
    [https://doi.org/10.1016/j.jradnu.2019.09.004](https://doi.org/10.1016/j.jradnu.2019.09.004).

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Warwick, V.R., Gillespie, B. M., McMurray, A., & Clark-Burg, K. G. (2021). Undertaking the

    surgical count: An observational study.
    _Journal of Perioperative Nursing, 34_(3). https://doi.org/10.26550/2209-1092.1089.

    **Qualitative Article (to be reviewed week 6):**

    Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Carson-Stevens, A., &

    Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: Learning from root cause analysis investigations.
    _International Journal for Quality in Health Care, 32_(3), 184–189.
    [https://doi.org/10.1093/intqhc/mzaa005](https://doi.org/10.1093/intqhc/mzaa005).

    **## TopicsandArticlesforLitReview.docx**

    ## TOPICS AND ARTICLES FOR WEEKLY LITERATURE REVIEW ASSIGNMENT (WRITTEN ASSIGNMENT)

    **Team Member 1:**

    **Topic:** In nurses working with leaders who implement inclusiveness versus those who do not will the nursing outcomes be higher?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Lee, S.E. & Seo, J.K. (2024). Effects of nurse managers' inclusive leadership on nurses'

    psychological safety and innovative work behavior: The moderating role of collectivism.
    _Journal of Nursing Scholarship, 54_(4), 554.562.
    [https://doi.org/10.1111/jnu.12965](https://doi.org/10.1111/jnu.12965)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Zeng, D., Wang, B. & Chen, W. (2022). Inclusive leadership can improve nurses’

    psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention.
    _Frontiers in Psychology, 13_.
    [https://doi.org/10.3389/fpsyg.2022.1100172](https://doi.org/10.3389/fpsyg.2022.1100172)

    **Qualitative Article (to be reviewed week 6):**

    Smith, C.M. & Horne, C.E. (2024). Educational and professional experiences of men in

    nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.
    _Journal of Professional Nursing, 53_, 123-130.
    [https://doi.org/10.1016/j.profnurs.2024.05.008](https://doi.org/10.1016/j.profnurs.2024.05.008)

    **Team Member 2:**

    **Topic:** In inpatient heart failure patients will receiving nurse-led education and transitional care, as opposed to not receiving nurse-led education and transitional care lead to lower incidences of rehospitalization and improved overall patient outcomes?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Arjunan, P., & Trichur, R. V. (2020). The impact of nurse-led cardiac rehabilitation on quality of

    quality of life and biophysiological parameters in patients with heart failure: A randomized clinical trial
    _. Journal of Nursing Research, 29_(1).
    [https://doi.org/10.1097/jnr.0000000000000407](https://doi.org/10.1097/jnr.0000000000000407)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Jiang, Y., Koh, K. W., Ramachandran, H. J., Nguyen, H. D., Lim, D. S., Tay, Y. K., Shorey, S.,

    & Wang, W. (2021). The effectiveness of a nurse-led home-based heart failure self-management programme (the hom-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.
    _International Journal of Nursing Studies, 122_, 104026. https://doi.org/10.1016/j.ijnurstu.2021.104026

    **Qualitative Article (to be reviewed week 6):**

    Jepma, P., Latour, C. H., ten Barge, I. H., Verweij, L., Peters, R. J., Scholte op Reimer, W. J., &

    Buurman, B. M. (2021). Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention – a qualitative study.
    _BMC Health Services Research, 21_(1). https://doi.org/10.1186/s12913-021-06719-3

    **Team Member 3:**

    **Topic:** In inpatient older adults will a formalized program to prevent falls versus no program decrease the incidence of falls?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Frith, J., Hunter, A. N., Coffey, S. S., & Khan, Z. (2019). A longitudinal fall prevention study for

    older adults.
    _Journal for Nurse Practitioners, 15(_ 4), 295–300.e1. https://doi.org/10.1016/j.nurpra.2018.10.012

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Noublanche F., Simon R., Ben-Sadoun G., Annweiler C. (2022).

    Physical activity and fall prevention in geriatric inpatients in an acute care unit (AGIR Study): Protocol for a usability study.
    _JMIR Research Protocols, 11_(7):e32288 doi: 10.2196/32288

    **Qualitative Article (to be reviewed week 6):**

    Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A.-M., Kiegaldie, D., Shorr, R. I., & Morris,

    M. E. (2021). Patient perspectives on hospital falls prevention education.
    _Frontiers in Public Health, 9_, 592440–592440.
    [https://doi.org/10.3389/fpubh.2021.592440](https://doi.org/10.3389/fpubh.2021.592440)

    **Team Member 4:**

    **Topic:** In newborn patients will pharmacological versus nonpharmacological interventions have decreased pain?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Gholami A, Karimi F, Ghasempour Z, Abolhassani M, Rabiee N. (2021). Comparison of the

    effect of kangaroo care and infant massage on the level of maternal anxiety and neonatal pain.
    _Journal of Babol University of Medical Sciences, 23 (1)_ :90-97. http://jbums.org/article-1-9473-en.html

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Shukla, V.V., Chaudhari, A. J., Nimbalkar, S.M., Phatak, A.G., Patel, D.V., Archana

    Somashekhar Nimbalkar, A. S. (2021). Skin-to-Skin care by mother vs. father for preterm neonatal pain: A randomized control trial (ENVIRON Trial). International
    _Journal of Pediatrics, 2021_,
    [https://doi.org/10.1155/2021/8886887](https://doi.org/10.1155/2021/8886887)

    **Qualitative Article (to be reviewed week 6):**

    Hassankhani, Negarandeh, R., Abbaszadeh, M., & Jabraeili, M. (2020). The role of mothers

    during painful procedures on neonates: A focused ethnography.
    _Journal of Neonatal Nursing: JNN, 26_(6), 340–343. https://doi.org/10.1016/j.jnn.2020.03.002

    **Team Member 5:**

    **Topic:** In patients diagnosed with COVID-19, does a prone position versus supine decrease the severity of symptoms?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Caputo, N. D., Strayer, R. J., & Levitan, R. (2020). Early self‐proning in awake,

    non‐intubated patients in the Emergency Department: A single Ed's experience during

    the Covid‐19 pandemic.
    _Academic Emergency Medicine, 27_(5): 375-378. doi: 10.1111/acem.13994.

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    O' Donoghue, S. , Church, M. , Russell, K. , Gamboa, K. , Hardman, J. , Sarge, J. , Moskowitz,

    A. , Hayes, M. , Cocchi, M. & DeSanto-Madeya, S. (2021). Development,

    implementation, and impact of a proning team During the COVID-19 Intensive Care

    Unit surge.
    _Dimensions of Critical Care Nursing, 40_ (6), 321-327. doi:

    10.1097/DCC.0000000000000498.

    **Qualitative Article (to be reviewed week 6):**

    Cadge, W., Lewis, M., Bandini, J., Shostak, S., Donahue, V., Trachtenberg, S., Grone, K.,

    Kacmarek, R., Lux, L., Matthews, C., McAuley, M. E., Romain, F., Snydeman, C.,

    Tehan, T., & Robinson, E. (2021). Intensive care unit nurses living through COVID‐19:

    A qualitative study.
    _Journal of Nursing Management, 29_(7), 1965–1973.

    [https://doi.org/10.1111/jonm.13353](https://doi.org/10.1111/jonm.13353)

    **Team Member 6:**

    **Topic:** In nurses working in the inpatient setting does a formalized stress reduction program versus no program decrease stress levels?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Fteropoulli, T., Kalavana, T. V., Yiallourou, A., Karaiskakis, M., Koliou, M., Vryonides, S.,

    Hadjioannou, A., & Nikolopoulos, G. K. (2021). Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic.
    _Journal of Clinical Nursing, 6._ [https://doi.org/10.1111/jocn.15938](https://doi.org/10.1111/jocn.15938)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Kawar, L. N., Radovich, P., Valdez, R. M., & Rondinelli, J. (2019). Compassion fatigue and

    compassion satisfaction among multisite multisystem nurses.
    _Nursing Administration Quarterly, 43(_ 4), 358–369. https://doi-org.proxy.cc.uic.edu/10.1097/NAQ.0000000000000370

    **Qualitative Article (to be reviewed week 6):**

    White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States.
    _Journal of Nursing Management._,
    _29_(6), 1525–1534.
    [https://doi.org/10.1111/jonm.13304](https://doi.org/10.1111/jonm.13304)

    **Team Member 7:**

    **Topic:** In nurses working in the operating room setting does playing music and other environmental distractions versus no distractions impact the surgical count process?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Kertesz, L., Cordella, C. M., Nadera, N. M., Nelson, P. E., Kahil, M., Shim, S.-H., & Holtzman,

    J. S. (2020). No surgical items left behind: A multidisciplinary approach to the surgical count process.
    _Journal of Radiology Nursing, 39_(1), 57–62.
    [https://doi.org/10.1016/j.jradnu.2019.09.004](https://doi.org/10.1016/j.jradnu.2019.09.004).

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Warwick, V.R., Gillespie, B. M., McMurray, A., & Clark-Burg, K. G. (2021). Undertaking the

    surgical count: An observational study.
    _Journal of Perioperative Nursing, 34_(3). https://doi.org/10.26550/2209-1092.1089.

    **Qualitative Article (to be reviewed week 6):**

    Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Carson-Stevens, A., &

    Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: Learning from root cause analysis investigations.
    _International Journal for Quality in Health Care, 32_(3), 184–189.
    [https://doi.org/10.1093/intqhc/mzaa005](https://doi.org/10.1093/intqhc/mzaa005).

    **## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx**

    SUCCINCT TITLE MAX 55 CHARACERS INCLUDING SPACES 1

    2

    TITLE OF PAPER

    ## Title Succinctly Describes the Topic for the Review of Literature

    Your name

    University of Illinois at Chicago

    **Abstract**

    Week 8-This should be the last part you complete after you finish the other components of the paper-TO BE DONE IN WEEK 8. Do not indent the first line of an abstract. An abstract is a concise summary of your topic, what is known and what should be researched in the future. It is written in past tense. The abstract reflects the purpose of the literature review (assigned PICO statement). The overview allows readers to determine if the study is of interest to the reader. Describe the problem in 1-2 sentences. Summarize the implications of the review. Word limits are 150-250 words. This is where you can showcase your ability to write concisely and compact information in a creative way to provide a great deal of information in a few clear sentences. Are you concise enough? Watch that word count (lower left-hand corner of WORD). (The above is exactly 151 words, so you see what size you are looking for!). The format is correct so follow the template as you enter the abstract.

    _Keywords:_ infection, quality, list your key words here

    **Title of Paper Here with Main Words Capitalized-Due Week 1**

    The title should summarize the main theme of the paper. It should be clear without reading anything else. Titles should be 12 words or less if possible. Your paper should have 1” margins, double spacing, use 12pt Times New Roman font, with a running head in all caps and < 50 characters and just page numbers in the upper right-hand corner in the same font as the paper. The template is set up in APA format so follow its guide. Delete instructions in red, as you complete sections of the paper.

    On the first page of your text on the first line, you center the title of your paper in bold with main words capitalized for APA 7th ed. Format. There are no extra spaces before or after the title; just double space everything in APA 7th ed papers. Next, your first 2-3 paragraphs are the introduction.
    **It should not have any heading** as it is assumed the first paragraph is an introduction. The introduction presents the problem being researched in a concise sentence. You should also include information defining what the problem is (here is where you can use the 2 references you need to find for the assignment.

    Next, in a new paragraph, state why the topic is important to study for nursing. You should cite at least two current scholarly sources from the UIC library on why it is important to study the problem. Keep it clear and concise a 3-4 sentence solidly cited paragraph that is less than half a page is what is expected.

    The last sentence should be: “The purpose of this paper is to review the literature related to:” and the PICO statement for the question.

    **Literature Search Methods-Due Week 2**

    This section will explain which databases you searched and the criteria you used to search these, if you were to do so. How many articles did your search produce and how many did you find to be most relevant? Why did you choose these for this paper? This part of the paper should be 1-2 paragraphs. Since you are describing what you did, you would not have references in this area.
    **You are not actually using any articles you find since you are assigned the articles you will be reviewing.**

    **Literature Review-Due Weeks 4, 5 & 6**

    The body of the paper continues with a literature review in a research paper. For this paper you review 2 quantitative studies and 1 qualitative study related to your problem being studied. The goal of a literature review is to state what we currently know about the topic. What does the research say? Week 4 you will include: purpose, design, sample, and data collection for each of the quantitative research articles chosen for the review.

    Week 5, you will add: the reliability and validity information from each instrument used in the studies chosen. The data analyses will also be reviewed including descriptive and inferential statistics for each article along with significance. Here is what you should write:

    1st article (using the same paragraph – do NOT start another paragraph). Reliability was established by consistency of the measurement of xxx and use of the data collection tool of xxx. Validity was ensured due to the use of the data collection tool of xxx which has a proven assurance of accuracy. The statistical data analysis used xx software and involved xxx. The results of the study were xxx.

    2nd article – same wording

    Week 6 you will provide a 1 paragraph summary of the qualitative article reviewed for this paper.

    You need to cite your
    ~~~~ assigned articles in APA format and include them in your reference page. This section should be a minimum of three solid paragraphs (1 per study) You should not be using any direct quotes as you are synthesizing the material.
    ~~~~

    **Discussion-Due Week 7**

    Discuss if the findings are consistent with each other. Can you generalize the findings? If not, address the barriers or concerns. It is perfectly fine to conclude that you need more research and report any potential bias, confounding variables, or data gaps. This is where you take your review of the studies and apply critical thinking! Link the data outcomes to clinical practice. Include supporting citations. This section should be at least two solid paragraphs and demonstrate critical thinking and supported with citations. Be sure to include the next steps in research you suggest based on the findings.

    In a one paragraph summary discuss any study limitations and generally summarize the study’s validity. Address if the study has meaning to the practice of nursing currently. This is your chance to bring it all together. Once the summary is done remember to write your abstract which is a summary of your report including your findings. You should have at least 2 new recent, relevant references to include in this section.

    **References-Ongoing with the assigned three research articles due Week 3**

    Remember to use APA format and include all references you have used (this includes the literature review and articles assigned to your topic)

    **## TopicsandArticlesforLitReview.docx**

    ## TOPICS AND ARTICLES FOR WEEKLY LITERATURE REVIEW ASSIGNMENT (WRITTEN ASSIGNMENT)

    **Team Member 1:**

    **Topic:** In nurses working with leaders who implement inclusiveness versus those who do not will the nursing outcomes be higher?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Lee, S.E. & Seo, J.K. (2024). Effects of nurse managers' inclusive leadership on nurses'

    psychological safety and innovative work behavior: The moderating role of collectivism.
    _Journal of Nursing Scholarship, 54_(4), 554.562.
    [https://doi.org/10.1111/jnu.12965](https://doi.org/10.1111/jnu.12965)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Zeng, D., Wang, B. & Chen, W. (2022). Inclusive leadership can improve nurses’

    psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention.
    _Frontiers in Psychology, 13_.
    [https://doi.org/10.3389/fpsyg.2022.1100172](https://doi.org/10.3389/fpsyg.2022.1100172)

    **Qualitative Article (to be reviewed week 6):**

    Smith, C.M. & Horne, C.E. (2024). Educational and professional experiences of men in

    nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.
    _Journal of Professional Nursing, 53_, 123-130.
    [https://doi.org/10.1016/j.profnurs.2024.05.008](https://doi.org/10.1016/j.profnurs.2024.05.008)

    **Team Member 2:**

    **Topic:** In inpatient heart failure patients will receiving nurse-led education and transitional care, as opposed to not receiving nurse-led education and transitional care lead to lower incidences of rehospitalization and improved overall patient outcomes?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Arjunan, P., & Trichur, R. V. (2020). The impact of nurse-led cardiac rehabilitation on quality of

    quality of life and biophysiological parameters in patients with heart failure: A randomized clinical trial
    _. Journal of Nursing Research, 29_(1).
    [https://doi.org/10.1097/jnr.0000000000000407](https://doi.org/10.1097/jnr.0000000000000407)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Jiang, Y., Koh, K. W., Ramachandran, H. J., Nguyen, H. D., Lim, D. S., Tay, Y. K., Shorey, S.,

    & Wang, W. (2021). The effectiveness of a nurse-led home-based heart failure self-management programme (the hom-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.
    _International Journal of Nursing Studies, 122_, 104026. https://doi.org/10.1016/j.ijnurstu.2021.104026

    **Qualitative Article (to be reviewed week 6):**

    Jepma, P., Latour, C. H., ten Barge, I. H., Verweij, L., Peters, R. J., Scholte op Reimer, W. J., &

    Buurman, B. M. (2021). Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention – a qualitative study.
    _BMC Health Services Research, 21_(1). https://doi.org/10.1186/s12913-021-06719-3

    **Team Member 3:**

    **Topic:** In inpatient older adults will a formalized program to prevent falls versus no program decrease the incidence of falls?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Frith, J., Hunter, A. N., Coffey, S. S., & Khan, Z. (2019). A longitudinal fall prevention study for

    older adults.
    _Journal for Nurse Practitioners, 15(_ 4), 295–300.e1. https://doi.org/10.1016/j.nurpra.2018.10.012

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Noublanche F., Simon R., Ben-Sadoun G., Annweiler C. (2022).

    Physical activity and fall prevention in geriatric inpatients in an acute care unit (AGIR Study): Protocol for a usability study.
    _JMIR Research Protocols, 11_(7):e32288 doi: 10.2196/32288

    **Qualitative Article (to be reviewed week 6):**

    Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A.-M., Kiegaldie, D., Shorr, R. I., & Morris,

    M. E. (2021). Patient perspectives on hospital falls prevention education.
    _Frontiers in Public Health, 9_, 592440–592440.
    [https://doi.org/10.3389/fpubh.2021.592440](https://doi.org/10.3389/fpubh.2021.592440)

    **Team Member 4:**

    **Topic:** In newborn patients will pharmacological versus nonpharmacological interventions have decreased pain?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Gholami A, Karimi F, Ghasempour Z, Abolhassani M, Rabiee N. (2021). Comparison of the

    effect of kangaroo care and infant massage on the level of maternal anxiety and neonatal pain.
    _Journal of Babol University of Medical Sciences, 23 (1)_ :90-97. http://jbums.org/article-1-9473-en.html

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Shukla, V.V., Chaudhari, A. J., Nimbalkar, S.M., Phatak, A.G., Patel, D.V., Archana

    Somashekhar Nimbalkar, A. S. (2021). Skin-to-Skin care by mother vs. father for preterm neonatal pain: A randomized control trial (ENVIRON Trial). International
    _Journal of Pediatrics, 2021_,
    [https://doi.org/10.1155/2021/8886887](https://doi.org/10.1155/2021/8886887)

    **Qualitative Article (to be reviewed week 6):**

    Hassankhani, Negarandeh, R., Abbaszadeh, M., & Jabraeili, M. (2020). The role of mothers

    during painful procedures on neonates: A focused ethnography.
    _Journal of Neonatal Nursing: JNN, 26_(6), 340–343. https://doi.org/10.1016/j.jnn.2020.03.002

    **Team Member 5:**

    **Topic:** In patients diagnosed with COVID-19, does a prone position versus supine decrease the severity of symptoms?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Caputo, N. D., Strayer, R. J., & Levitan, R. (2020). Early self‐proning in awake,

    non‐intubated patients in the Emergency Department: A single Ed's experience during

    the Covid‐19 pandemic.
    _Academic Emergency Medicine, 27_(5): 375-378. doi: 10.1111/acem.13994.

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    O' Donoghue, S. , Church, M. , Russell, K. , Gamboa, K. , Hardman, J. , Sarge, J. , Moskowitz,

    A. , Hayes, M. , Cocchi, M. & DeSanto-Madeya, S. (2021). Development,

    implementation, and impact of a proning team During the COVID-19 Intensive Care

    Unit surge.
    _Dimensions of Critical Care Nursing, 40_ (6), 321-327. doi:

    10.1097/DCC.0000000000000498.

    **Qualitative Article (to be reviewed week 6):**

    Cadge, W., Lewis, M., Bandini, J., Shostak, S., Donahue, V., Trachtenberg, S., Grone, K.,

    Kacmarek, R., Lux, L., Matthews, C., McAuley, M. E., Romain, F., Snydeman, C.,

    Tehan, T., & Robinson, E. (2021). Intensive care unit nurses living through COVID‐19:

    A qualitative study.
    _Journal of Nursing Management, 29_(7), 1965–1973.

    [https://doi.org/10.1111/jonm.13353](https://doi.org/10.1111/jonm.13353)

    **Team Member 6:**

    **Topic:** In nurses working in the inpatient setting does a formalized stress reduction program versus no program decrease stress levels?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Fteropoulli, T., Kalavana, T. V., Yiallourou, A., Karaiskakis, M., Koliou, M., Vryonides, S.,

    Hadjioannou, A., & Nikolopoulos, G. K. (2021). Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic.
    _Journal of Clinical Nursing, 6._ [https://doi.org/10.1111/jocn.15938](https://doi.org/10.1111/jocn.15938)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Kawar, L. N., Radovich, P., Valdez, R. M., & Rondinelli, J. (2019). Compassion fatigue and

    compassion satisfaction among multisite multisystem nurses.
    _Nursing Administration Quarterly, 43(_ 4), 358–369. https://doi-org.proxy.cc.uic.edu/10.1097/NAQ.0000000000000370

    **Qualitative Article (to be reviewed week 6):**

    White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States.
    _Journal of Nursing Management._,
    _29_(6), 1525–1534.
    [https://doi.org/10.1111/jonm.13304](https://doi.org/10.1111/jonm.13304)

    **Team Member 7:**

    **Topic:** In nurses working in the operating room setting does playing music and other environmental distractions versus no distractions impact the surgical count process?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Kertesz, L., Cordella, C. M., Nadera, N. M., Nelson, P. E., Kahil, M., Shim, S.-H., & Holtzman,

    J. S. (2020). No surgical items left behind: A multidisciplinary approach to the surgical count process.
    _Journal of Radiology Nursing, 39_(1), 57–62.
    [https://doi.org/10.1016/j.jradnu.2019.09.004](https://doi.org/10.1016/j.jradnu.2019.09.004).

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Warwick, V.R., Gillespie, B. M., McMurray, A., & Clark-Burg, K. G. (2021). Undertaking the

    surgical count: An observational study.
    _Journal of Perioperative Nursing, 34_(3). https://doi.org/10.26550/2209-1092.1089.

    **Qualitative Article (to be reviewed week 6):**

    Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Carson-Stevens, A., &

    Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: Learning from root cause analysis investigations.
    _International Journal for Quality in Health Care, 32_(3), 184–189.
    [https://doi.org/10.1093/intqhc/mzaa005](https://doi.org/10.1093/intqhc/mzaa005).

    **## UICNURS312SampleLiteratureReviewPaperTemplate-Updated_10.3.25.docx**

    SUCCINCT TITLE MAX 55 CHARACERS INCLUDING SPACES 1

    2

    TITLE OF PAPER

    ## Title Succinctly Describes the Topic for the Review of Literature

    Your name

    University of Illinois at Chicago

    **Abstract**

    Week 8-This should be the last part you complete after you finish the other components of the paper-TO BE DONE IN WEEK 8. Do not indent the first line of an abstract. An abstract is a concise summary of your topic, what is known and what should be researched in the future. It is written in past tense. The abstract reflects the purpose of the literature review (assigned PICO statement). The overview allows readers to determine if the study is of interest to the reader. Describe the problem in 1-2 sentences. Summarize the implications of the review. Word limits are 150-250 words. This is where you can showcase your ability to write concisely and compact information in a creative way to provide a great deal of information in a few clear sentences. Are you concise enough? Watch that word count (lower left-hand corner of WORD). (The above is exactly 151 words, so you see what size you are looking for!). The format is correct so follow the template as you enter the abstract.

    _Keywords:_ infection, quality, list your key words here

    **Title of Paper Here with Main Words Capitalized-Due Week 1**

    The title should summarize the main theme of the paper. It should be clear without reading anything else. Titles should be 12 words or less if possible. Your paper should have 1” margins, double spacing, use 12pt Times New Roman font, with a running head in all caps and < 50 characters and just page numbers in the upper right-hand corner in the same font as the paper. The template is set up in APA format so follow its guide. Delete instructions in red, as you complete sections of the paper.

    On the first page of your text on the first line, you center the title of your paper in bold with main words capitalized for APA 7th ed. Format. There are no extra spaces before or after the title; just double space everything in APA 7th ed papers. Next, your first 2-3 paragraphs are the introduction.
    **It should not have any heading** as it is assumed the first paragraph is an introduction. The introduction presents the problem being researched in a concise sentence. You should also include information defining what the problem is (here is where you can use the 2 references you need to find for the assignment.

    Next, in a new paragraph, state why the topic is important to study for nursing. You should cite at least two current scholarly sources from the UIC library on why it is important to study the problem. Keep it clear and concise a 3-4 sentence solidly cited paragraph that is less than half a page is what is expected.

    The last sentence should be: “The purpose of this paper is to review the literature related to:” and the PICO statement for the question.

    **Literature Search Methods-Due Week 2**

    This section will explain which databases you searched and the criteria you used to search these, if you were to do so. How many articles did your search produce and how many did you find to be most relevant? Why did you choose these for this paper? This part of the paper should be 1-2 paragraphs. Since you are describing what you did, you would not have references in this area.
    **You are not actually using any articles you find since you are assigned the articles you will be reviewing.**

    **Literature Review-Due Weeks 4, 5 & 6**

    The body of the paper continues with a literature review in a research paper. For this paper you review 2 quantitative studies and 1 qualitative study related to your problem being studied. The goal of a literature review is to state what we currently know about the topic. What does the research say? Week 4 you will include: purpose, design, sample, and data collection for each of the quantitative research articles chosen for the review.

    Week 5, you will add: the reliability and validity information from each instrument used in the studies chosen. The data analyses will also be reviewed including descriptive and inferential statistics for each article along with significance. Here is what you should write:

    1st article (using the same paragraph – do NOT start another paragraph). Reliability was established by consistency of the measurement of xxx and use of the data collection tool of xxx. Validity was ensured due to the use of the data collection tool of xxx which has a proven assurance of accuracy. The statistical data analysis used xx software and involved xxx. The results of the study were xxx.

    2nd article – same wording

    Week 6 you will provide a 1 paragraph summary of the qualitative article reviewed for this paper.

    You need to cite your
    ~~~~ assigned articles in APA format and include them in your reference page. This section should be a minimum of three solid paragraphs (1 per study) You should not be using any direct quotes as you are synthesizing the material.
    ~~~~

    **Discussion-Due Week 7**

    Discuss if the findings are consistent with each other. Can you generalize the findings? If not, address the barriers or concerns. It is perfectly fine to conclude that you need more research and report any potential bias, confounding variables, or data gaps. This is where you take your review of the studies and apply critical thinking! Link the data outcomes to clinical practice. Include supporting citations. This section should be at least two solid paragraphs and demonstrate critical thinking and supported with citations. Be sure to include the next steps in research you suggest based on the findings.

    In a one paragraph summary discuss any study limitations and generally summarize the study’s validity. Address if the study has meaning to the practice of nursing currently. This is your chance to bring it all together. Once the summary is done remember to write your abstract which is a summary of your report including your findings. You should have at least 2 new recent, relevant references to include in this section.

    **References-Ongoing with the assigned three research articles due Week 3**

    Remember to use APA format and include all references you have used (this includes the literature review and articles assigned to your topic)

    **## TopicsandArticlesforLitReview.docx**

    ## TOPICS AND ARTICLES FOR WEEKLY LITERATURE REVIEW ASSIGNMENT (WRITTEN ASSIGNMENT)

    **Team Member 1:**

    **Topic:** In nurses working with leaders who implement inclusiveness versus those who do not will the nursing outcomes be higher?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Lee, S.E. & Seo, J.K. (2024). Effects of nurse managers' inclusive leadership on nurses'

    psychological safety and innovative work behavior: The moderating role of collectivism.
    _Journal of Nursing Scholarship, 54_(4), 554.562.
    [https://doi.org/10.1111/jnu.12965](https://doi.org/10.1111/jnu.12965)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Zeng, D., Wang, B. & Chen, W. (2022). Inclusive leadership can improve nurses’

    psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention.
    _Frontiers in Psychology, 13_.
    [https://doi.org/10.3389/fpsyg.2022.1100172](https://doi.org/10.3389/fpsyg.2022.1100172)

    **Qualitative Article (to be reviewed week 6):**

    Smith, C.M. & Horne, C.E. (2024). Educational and professional experiences of men in

    nursing: An interpretive description study to guide change and foster inclusive environments for men in nursing.
    _Journal of Professional Nursing, 53_, 123-130.
    [https://doi.org/10.1016/j.profnurs.2024.05.008](https://doi.org/10.1016/j.profnurs.2024.05.008)

    **Team Member 2:**

    **Topic:** In inpatient heart failure patients will receiving nurse-led education and transitional care, as opposed to not receiving nurse-led education and transitional care lead to lower incidences of rehospitalization and improved overall patient outcomes?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Arjunan, P., & Trichur, R. V. (2020). The impact of nurse-led cardiac rehabilitation on quality of

    quality of life and biophysiological parameters in patients with heart failure: A randomized clinical trial
    _. Journal of Nursing Research, 29_(1).
    [https://doi.org/10.1097/jnr.0000000000000407](https://doi.org/10.1097/jnr.0000000000000407)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Jiang, Y., Koh, K. W., Ramachandran, H. J., Nguyen, H. D., Lim, D. S., Tay, Y. K., Shorey, S.,

    & Wang, W. (2021). The effectiveness of a nurse-led home-based heart failure self-management programme (the hom-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial.
    _International Journal of Nursing Studies, 122_, 104026. https://doi.org/10.1016/j.ijnurstu.2021.104026

    **Qualitative Article (to be reviewed week 6):**

    Jepma, P., Latour, C. H., ten Barge, I. H., Verweij, L., Peters, R. J., Scholte op Reimer, W. J., &

    Buurman, B. M. (2021). Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention – a qualitative study.
    _BMC Health Services Research, 21_(1). https://doi.org/10.1186/s12913-021-06719-3

    **Team Member 3:**

    **Topic:** In inpatient older adults will a formalized program to prevent falls versus no program decrease the incidence of falls?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Frith, J., Hunter, A. N., Coffey, S. S., & Khan, Z. (2019). A longitudinal fall prevention study for

    older adults.
    _Journal for Nurse Practitioners, 15(_ 4), 295–300.e1. https://doi.org/10.1016/j.nurpra.2018.10.012

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Noublanche F., Simon R., Ben-Sadoun G., Annweiler C. (2022).

    Physical activity and fall prevention in geriatric inpatients in an acute care unit (AGIR Study): Protocol for a usability study.
    _JMIR Research Protocols, 11_(7):e32288 doi: 10.2196/32288

    **Qualitative Article (to be reviewed week 6):**

    Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A.-M., Kiegaldie, D., Shorr, R. I., & Morris,

    M. E. (2021). Patient perspectives on hospital falls prevention education.
    _Frontiers in Public Health, 9_, 592440–592440.
    [https://doi.org/10.3389/fpubh.2021.592440](https://doi.org/10.3389/fpubh.2021.592440)

    **Team Member 4:**

    **Topic:** In newborn patients will pharmacological versus nonpharmacological interventions have decreased pain?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Gholami A, Karimi F, Ghasempour Z, Abolhassani M, Rabiee N. (2021). Comparison of the

    effect of kangaroo care and infant massage on the level of maternal anxiety and neonatal pain.
    _Journal of Babol University of Medical Sciences, 23 (1)_ :90-97. http://jbums.org/article-1-9473-en.html

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Shukla, V.V., Chaudhari, A. J., Nimbalkar, S.M., Phatak, A.G., Patel, D.V., Archana

    Somashekhar Nimbalkar, A. S. (2021). Skin-to-Skin care by mother vs. father for preterm neonatal pain: A randomized control trial (ENVIRON Trial). International
    _Journal of Pediatrics, 2021_,
    [https://doi.org/10.1155/2021/8886887](https://doi.org/10.1155/2021/8886887)

    **Qualitative Article (to be reviewed week 6):**

    Hassankhani, Negarandeh, R., Abbaszadeh, M., & Jabraeili, M. (2020). The role of mothers

    during painful procedures on neonates: A focused ethnography.
    _Journal of Neonatal Nursing: JNN, 26_(6), 340–343. https://doi.org/10.1016/j.jnn.2020.03.002

    **Team Member 5:**

    **Topic:** In patients diagnosed with COVID-19, does a prone position versus supine decrease the severity of symptoms?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Caputo, N. D., Strayer, R. J., & Levitan, R. (2020). Early self‐proning in awake,

    non‐intubated patients in the Emergency Department: A single Ed's experience during

    the Covid‐19 pandemic.
    _Academic Emergency Medicine, 27_(5): 375-378. doi: 10.1111/acem.13994.

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    O' Donoghue, S. , Church, M. , Russell, K. , Gamboa, K. , Hardman, J. , Sarge, J. , Moskowitz,

    A. , Hayes, M. , Cocchi, M. & DeSanto-Madeya, S. (2021). Development,

    implementation, and impact of a proning team During the COVID-19 Intensive Care

    Unit surge.
    _Dimensions of Critical Care Nursing, 40_ (6), 321-327. doi:

    10.1097/DCC.0000000000000498.

    **Qualitative Article (to be reviewed week 6):**

    Cadge, W., Lewis, M., Bandini, J., Shostak, S., Donahue, V., Trachtenberg, S., Grone, K.,

    Kacmarek, R., Lux, L., Matthews, C., McAuley, M. E., Romain, F., Snydeman, C.,

    Tehan, T., & Robinson, E. (2021). Intensive care unit nurses living through COVID‐19:

    A qualitative study.
    _Journal of Nursing Management, 29_(7), 1965–1973.

    [https://doi.org/10.1111/jonm.13353](https://doi.org/10.1111/jonm.13353)

    **Team Member 6:**

    **Topic:** In nurses working in the inpatient setting does a formalized stress reduction program versus no program decrease stress levels?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Fteropoulli, T., Kalavana, T. V., Yiallourou, A., Karaiskakis, M., Koliou, M., Vryonides, S.,

    Hadjioannou, A., & Nikolopoulos, G. K. (2021). Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic.
    _Journal of Clinical Nursing, 6._ [https://doi.org/10.1111/jocn.15938](https://doi.org/10.1111/jocn.15938)

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Kawar, L. N., Radovich, P., Valdez, R. M., & Rondinelli, J. (2019). Compassion fatigue and

    compassion satisfaction among multisite multisystem nurses.
    _Nursing Administration Quarterly, 43(_ 4), 358–369. https://doi-org.proxy.cc.uic.edu/10.1097/NAQ.0000000000000370

    **Qualitative Article (to be reviewed week 6):**

    White, J. H. (2021). A phenomenological study of nurse managers’ and assistant nurse managers’ experiences during the COVID‐19 pandemic in the United States.
    _Journal of Nursing Management._,
    _29_(6), 1525–1534.
    [https://doi.org/10.1111/jonm.13304](https://doi.org/10.1111/jonm.13304)

    **Team Member 7:**

    **Topic:** In nurses working in the operating room setting does playing music and other environmental distractions versus no distractions impact the surgical count process?

    **Quantitative Article 1 (to be reviewed weeks 4 & 5):**

    Kertesz, L., Cordella, C. M., Nadera, N. M., Nelson, P. E., Kahil, M., Shim, S.-H., & Holtzman,

    J. S. (2020). No surgical items left behind: A multidisciplinary approach to the surgical count process.
    _Journal of Radiology Nursing, 39_(1), 57–62.
    [https://doi.org/10.1016/j.jradnu.2019.09.004](https://doi.org/10.1016/j.jradnu.2019.09.004).

    **Quantitative Article 2 (to be reviewed weeks 4 & 5):**

    Warwick, V.R., Gillespie, B. M., McMurray, A., & Clark-Burg, K. G. (2021). Undertaking the

    surgical count: An observational study.
    _Journal of Perioperative Nursing, 34_(3). https://doi.org/10.26550/2209-1092.1089.

    **Qualitative Article (to be reviewed week 6):**

    Hibbert, P. D., Thomas, M. J. W., Deakin, A., Runciman, W. B., Carson-Stevens, A., &

    Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: Learning from root cause analysis investigations.
    _International Journal for Quality in Health Care, 32_(3), 184–189.
    [https://doi.org/10.1093/intqhc/mzaa005](https://doi.org/10.1093/intqhc/mzaa005).

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

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    **files (3)** – ## SMARTGoal.docx – ## HealthPromotionProposalPart14.docx – HealthPromotionpart2.docx **## SMARTGoal.docx** 1 7 **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County** Mirlenys Diaz Florida National University Health Promotion & Role Development in Adv. Nursing Pra…

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    **files (3)**

    – ## SMARTGoal.docx

    – ## HealthPromotionProposalPart14.docx

    – HealthPromotionpart2.docx

    **## SMARTGoal.docx**

    1

    7

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    June 11, 2026

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.

    This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.

    Specific

    It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.

    Measurable

    The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.

    Achievable

    The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.

    Relevant

    This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.

    Time-Bound

    The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.

    Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.

    At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American journal of health promotion : AJHP_,
    _36_(2), 259–268.
    [https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)

    Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
    _Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
    [https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in public health_,
    _12_, 1250152.
    [https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
    _Gastroenterology Clinics of North America, 52_(2), 429–441.
    [https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)

    Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian journal of nursing and midwifery research_,
    _29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **## HealthPromotionProposalPart14.docx**

    2

    **Adult Obesity in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    May 30, 2026

    **Adult Obesity in Miami-Dade County**

    Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.

    Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).

    **Vulnerable Population**

    Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.

    Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.

    **Review of Literature**

    Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.

    Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.

    **Strengths and Weaknesses of Sources**

    There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.

    The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.

    **Theoretical Framework**

    The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.

    Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American Journal of Health Promotion_,
    _36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679

    CDC. (2024, September 12).
    _New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

    Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
    _Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
    _508_(508). https://doi.org/10.15620/cdc/159281

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in Public Health_,
    _12_(12). https://doi.org/10.3389/fpubh.2024.1250152

    Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
    _Preventing Chronic Disease_,
    _16_(16). https://doi.org/10.5888/pcd16.180579

    Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
    _BMC Public Health_,
    _25_(1). https://doi.org/10.1186/s12889-025-23637-9

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
    _Disparities in Access and Quality of Obesity Care_,
    _52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

    Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian Journal of Nursing and Midwifery Research_,
    _29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **HealthPromotionpart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)

    **HealthPromotionpart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)

    **## SMARTGoal.docx**

    1

    7

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    June 11, 2026

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.

    This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.

    Specific

    It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.

    Measurable

    The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.

    Achievable

    The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.

    Relevant

    This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.

    Time-Bound

    The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.

    Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.

    At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American journal of health promotion : AJHP_,
    _36_(2), 259–268.
    [https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)

    Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
    _Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
    [https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in public health_,
    _12_, 1250152.
    [https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
    _Gastroenterology Clinics of North America, 52_(2), 429–441.
    [https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)

    Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian journal of nursing and midwifery research_,
    _29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **## HealthPromotionProposalPart14.docx**

    2

    **Adult Obesity in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    May 30, 2026

    **Adult Obesity in Miami-Dade County**

    Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.

    Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).

    **Vulnerable Population**

    Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.

    Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.

    **Review of Literature**

    Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.

    Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.

    **Strengths and Weaknesses of Sources**

    There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.

    The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.

    **Theoretical Framework**

    The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.

    Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American Journal of Health Promotion_,
    _36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679

    CDC. (2024, September 12).
    _New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

    Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
    _Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
    _508_(508). https://doi.org/10.15620/cdc/159281

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in Public Health_,
    _12_(12). https://doi.org/10.3389/fpubh.2024.1250152

    Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
    _Preventing Chronic Disease_,
    _16_(16). https://doi.org/10.5888/pcd16.180579

    Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
    _BMC Public Health_,
    _25_(1). https://doi.org/10.1186/s12889-025-23637-9

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
    _Disparities in Access and Quality of Obesity Care_,
    _52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

    Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian Journal of Nursing and Midwifery Research_,
    _29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **HealthPromotionpart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)

    **## SMARTGoal.docx**

    1

    7

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    June 11, 2026

    **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**

    Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.

    This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.

    Specific

    It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.

    Measurable

    The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.

    Achievable

    The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.

    Relevant

    This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.

    Time-Bound

    The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.

    Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.

    At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American journal of health promotion : AJHP_,
    _36_(2), 259–268.
    [https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)

    Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
    _Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
    [https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in public health_,
    _12_, 1250152.
    [https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
    _Gastroenterology Clinics of North America, 52_(2), 429–441.
    [https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)

    Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian journal of nursing and midwifery research_,
    _29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **## HealthPromotionProposalPart14.docx**

    2

    **Adult Obesity in Miami-Dade County**

    Mirlenys Diaz

    Florida National University

    Health Promotion & Role Development in Adv. Nursing Practice-

    Dr. Nora Hernandez-Pupo

    May 30, 2026

    **Adult Obesity in Miami-Dade County**

    Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.

    Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).

    **Vulnerable Population**

    Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.

    Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.

    **Review of Literature**

    Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.

    Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.

    **Strengths and Weaknesses of Sources**

    There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.

    The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.

    **Theoretical Framework**

    The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.

    Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.

    **References**

    Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
    _American Journal of Health Promotion_,
    _36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679

    CDC. (2024, September 12).
    _New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html

    Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
    _Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
    _508_(508). https://doi.org/10.15620/cdc/159281

    Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
    _Frontiers in Public Health_,
    _12_(12). https://doi.org/10.3389/fpubh.2024.1250152

    Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
    _Preventing Chronic Disease_,
    _16_(16). https://doi.org/10.5888/pcd16.180579

    Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
    _BMC Public Health_,
    _25_(1). https://doi.org/10.1186/s12889-025-23637-9

    Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
    _Disparities in Access and Quality of Obesity Care_,
    _52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003

    Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
    _Iranian Journal of Nursing and Midwifery Research_,
    _29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22

    **HealthPromotionpart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)

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

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    **files (3)** – ## FinalCapstone.docx – ## CapstoneProject1.docx – Capstonepart2.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This should be a cohesive paper and continuation…

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    Assignment Prompt & Instructions

    **files (3)**

    – ## FinalCapstone.docx

    – ## CapstoneProject1.docx

    – Capstonepart2.docx

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## CapstoneProject1.docx**

    2

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anisleidy Alvarez

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 23, 2026

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).

    Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.

    The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.

    **PICOT**

    The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
    _In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_

    The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.

    The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.

    The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.

    **Vulnerable Population and Setting**

    The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.

    Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).

    Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.

    **Proposal and Intervention Plan**

    The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).

    The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.

    The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.

    Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.

    The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.

    **Theoretical Framework**

    This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.

    The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.

    **Conclusion**

    Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.

    **References**

    Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
    _Cell Reports Medicine_,
    _4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895

    Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
    _Brain Sciences_,
    _13_(2), 256. https://doi.org/10.3390/brainsci13020256

    Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
    _Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627

    Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
    _Psychiatric Annals_,
    _53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02

    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_(2), 85–108. https://doi.org/10.2147/JHL.S289176

    Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
    _Scientific Reports_,
    _11_(1). https://doi.org/10.1038/s41598-021-98736-9

    National Institute of Mental Health. (2024).
    _Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

    Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
    _National Health Statistics Reports_,
    _213_, CS353885. https://doi.org/10.15620/cdc/64018

    U.S Census Bureau. (2025).
    _QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223

    **Capstonepart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565529)

    **Capstonepart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565529)

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## CapstoneProject1.docx**

    2

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anisleidy Alvarez

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 23, 2026

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).

    Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.

    The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.

    **PICOT**

    The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
    _In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_

    The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.

    The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.

    The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.

    **Vulnerable Population and Setting**

    The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.

    Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).

    Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.

    **Proposal and Intervention Plan**

    The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).

    The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.

    The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.

    Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.

    The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.

    **Theoretical Framework**

    This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.

    The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.

    **Conclusion**

    Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.

    **References**

    Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
    _Cell Reports Medicine_,
    _4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895

    Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
    _Brain Sciences_,
    _13_(2), 256. https://doi.org/10.3390/brainsci13020256

    Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
    _Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627

    Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
    _Psychiatric Annals_,
    _53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02

    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_(2), 85–108. https://doi.org/10.2147/JHL.S289176

    Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
    _Scientific Reports_,
    _11_(1). https://doi.org/10.1038/s41598-021-98736-9

    National Institute of Mental Health. (2024).
    _Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

    Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
    _National Health Statistics Reports_,
    _213_, CS353885. https://doi.org/10.15620/cdc/64018

    U.S Census Bureau. (2025).
    _QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223

    **Capstonepart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565529)

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## CapstoneProject1.docx**

    2

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anisleidy Alvarez

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 23, 2026

    **Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**

    Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).

    Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.

    The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.

    **PICOT**

    The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
    _In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_

    The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.

    The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.

    The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.

    **Vulnerable Population and Setting**

    The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.

    Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).

    Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.

    **Proposal and Intervention Plan**

    The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).

    The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.

    The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.

    Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.

    The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.

    **Theoretical Framework**

    This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.

    The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.

    **Conclusion**

    Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.

    **References**

    Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
    _Cell Reports Medicine_,
    _4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895

    Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
    _Brain Sciences_,
    _13_(2), 256. https://doi.org/10.3390/brainsci13020256

    Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
    _Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627

    Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
    _Psychiatric Annals_,
    _53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02

    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_(2), 85–108. https://doi.org/10.2147/JHL.S289176

    Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
    _Scientific Reports_,
    _11_(1). https://doi.org/10.1038/s41598-021-98736-9

    National Institute of Mental Health. (2024).
    _Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

    Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
    _National Health Statistics Reports_,
    _213_, CS353885. https://doi.org/10.15620/cdc/64018

    U.S Census Bureau. (2025).
    _QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223

    **Capstonepart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565529)

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    **files (3)** – ## FinalCapstone.docx – ## MSN_Capstone_Part1_Revised1.docx – Capstonepart2.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This should be a cohesive paper an…

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    **files (3)**

    – ## FinalCapstone.docx

    – ## MSN_Capstone_Part1_Revised1.docx

    – Capstonepart2.docx

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part1_Revised1.docx**

    1

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Alex De Cardenas

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 21, 2026

    **Abstract**

    Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.

    Keywords:
    _muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.

    Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.

    The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.

    **PICOT**

    In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?

    The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.

    Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.

    The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).

    **Vulnerable Population and Setting**

    The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).

    The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).

    Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.

    **Proposal**

    The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.

    The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.

    The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.

    **Theoretical Framework**

    This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.

    In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.

    The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.

    Conclusion

    In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.

    **References**

    Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Graham, A., Zahiri, A., & Konrad, A. (2023). Acute effects of various stretching techniques on range of motion: A systematic review with meta-analysis.
    _Sports Medicine-Open, 9_(1), 107. https://doi.org/10.1186/s40798-023-00652-x

    Bureau of Labor Statistics. (2022).
    _Employer-reported workplace injuries and illnesses — 2021._ U.S. Department of Labor. https://www.bls.gov/news.release/osh.nr0.htm

    Çimen, O. (2023). The efficiency of ergonomics, active break and stretching exercise program in office workers with chronic neck and back pain.
    _Deneysel ve Klinik Tıp Dergisi, 40_(2), 329–332. https://dergipark.org.tr/en/pub/omujecm/issue/79274/1282408

    Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).
    _Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics._ Sigma Theta Tau.

    Florida Department of Health. (2022).
    _Florida musculoskeletal health data and statistics._ https://www.floridahealth.gov

    Theis, K. A., Murphy, L. B., Guglielmo, D., Boring, M. A., Okoro, C. A., Duca, L. M., & Barbour, K. E. (2021). Prevalence of arthritis and arthritis-attributable activity limitation — United States, 2016–2018.
    _Morbidity and Mortality Weekly Report, 70_(40), 1401–1407.
    [https://doi.org/10.15585/mmwr.mm7040a2](https://doi.org/10.15585/mmwr.mm7040a2)

    Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis.
    _BMC Health Services Research_,
    _24_(1), 1–10. https://doi.org/10.1186/s12913-024-11138-1

    Tanaka, M. (2022). Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation.
    _Nursing Forum, 57_(3), 480–485. https://doi.org/10.1111/nuf.12696

    U.S. Census Bureau. (2023).
    _American Community Survey: Health insurance coverage in the United States._ https://www.census.gov/topics/health/health-insurance.html

    United States Bone and Joint Initiative. (2021).
    _The burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost (4th ed.)._ https://www.bmus-ors.org/

    Zvetkova, E., Koytchev, E., Ivanov, I., Ranchev, S., & Antonov, A. (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review.
    _Applied Sciences, 13_(15), 8596. https://doi.org/10.3390/app13158596

    **Capstonepart2.docx**

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    **Capstonepart2.docx**

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    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part1_Revised1.docx**

    1

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Alex De Cardenas

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 21, 2026

    **Abstract**

    Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.

    Keywords:
    _muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.

    Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.

    The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.

    **PICOT**

    In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?

    The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.

    Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.

    The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).

    **Vulnerable Population and Setting**

    The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).

    The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).

    Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.

    **Proposal**

    The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.

    The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.

    The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.

    **Theoretical Framework**

    This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.

    In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.

    The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.

    Conclusion

    In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.

    **References**

    Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Graham, A., Zahiri, A., & Konrad, A. (2023). Acute effects of various stretching techniques on range of motion: A systematic review with meta-analysis.
    _Sports Medicine-Open, 9_(1), 107. https://doi.org/10.1186/s40798-023-00652-x

    Bureau of Labor Statistics. (2022).
    _Employer-reported workplace injuries and illnesses — 2021._ U.S. Department of Labor. https://www.bls.gov/news.release/osh.nr0.htm

    Çimen, O. (2023). The efficiency of ergonomics, active break and stretching exercise program in office workers with chronic neck and back pain.
    _Deneysel ve Klinik Tıp Dergisi, 40_(2), 329–332. https://dergipark.org.tr/en/pub/omujecm/issue/79274/1282408

    Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).
    _Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics._ Sigma Theta Tau.

    Florida Department of Health. (2022).
    _Florida musculoskeletal health data and statistics._ https://www.floridahealth.gov

    Theis, K. A., Murphy, L. B., Guglielmo, D., Boring, M. A., Okoro, C. A., Duca, L. M., & Barbour, K. E. (2021). Prevalence of arthritis and arthritis-attributable activity limitation — United States, 2016–2018.
    _Morbidity and Mortality Weekly Report, 70_(40), 1401–1407.
    [https://doi.org/10.15585/mmwr.mm7040a2](https://doi.org/10.15585/mmwr.mm7040a2)

    Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis.
    _BMC Health Services Research_,
    _24_(1), 1–10. https://doi.org/10.1186/s12913-024-11138-1

    Tanaka, M. (2022). Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation.
    _Nursing Forum, 57_(3), 480–485. https://doi.org/10.1111/nuf.12696

    U.S. Census Bureau. (2023).
    _American Community Survey: Health insurance coverage in the United States._ https://www.census.gov/topics/health/health-insurance.html

    United States Bone and Joint Initiative. (2021).
    _The burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost (4th ed.)._ https://www.bmus-ors.org/

    Zvetkova, E., Koytchev, E., Ivanov, I., Ranchev, S., & Antonov, A. (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review.
    _Applied Sciences, 13_(15), 8596. https://doi.org/10.3390/app13158596

    **Capstonepart2.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565507)

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part1_Revised1.docx**

    1

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Alex De Cardenas

    Florida National University

    MSN Capstone Project-DAX-DL01

    Dr. Carmen Lazo

    May 21, 2026

    **Abstract**

    Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.

    Keywords:
    _muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_

    **Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**

    Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.

    Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.

    The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.

    **PICOT**

    In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?

    The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.

    Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.

    The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).

    **Vulnerable Population and Setting**

    The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).

    The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).

    Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.

    **Proposal**

    The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.

    The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.

    The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.

    **Theoretical Framework**

    This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.

    In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.

    The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.

    Conclusion

    In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.

    **References**

    Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Graham, A., Zahiri, A., & Konrad, A. (2023). Acute effects of various stretching techniques on range of motion: A systematic review with meta-analysis.
    _Sports Medicine-Open, 9_(1), 107. https://doi.org/10.1186/s40798-023-00652-x

    Bureau of Labor Statistics. (2022).
    _Employer-reported workplace injuries and illnesses — 2021._ U.S. Department of Labor. https://www.bls.gov/news.release/osh.nr0.htm

    Çimen, O. (2023). The efficiency of ergonomics, active break and stretching exercise program in office workers with chronic neck and back pain.
    _Deneysel ve Klinik Tıp Dergisi, 40_(2), 329–332. https://dergipark.org.tr/en/pub/omujecm/issue/79274/1282408

    Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).
    _Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics._ Sigma Theta Tau.

    Florida Department of Health. (2022).
    _Florida musculoskeletal health data and statistics._ https://www.floridahealth.gov

    Theis, K. A., Murphy, L. B., Guglielmo, D., Boring, M. A., Okoro, C. A., Duca, L. M., & Barbour, K. E. (2021). Prevalence of arthritis and arthritis-attributable activity limitation — United States, 2016–2018.
    _Morbidity and Mortality Weekly Report, 70_(40), 1401–1407.
    [https://doi.org/10.15585/mmwr.mm7040a2](https://doi.org/10.15585/mmwr.mm7040a2)

    Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis.
    _BMC Health Services Research_,
    _24_(1), 1–10. https://doi.org/10.1186/s12913-024-11138-1

    Tanaka, M. (2022). Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation.
    _Nursing Forum, 57_(3), 480–485. https://doi.org/10.1111/nuf.12696

    U.S. Census Bureau. (2023).
    _American Community Survey: Health insurance coverage in the United States._ https://www.census.gov/topics/health/health-insurance.html

    United States Bone and Joint Initiative. (2021).
    _The burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost (4th ed.)._ https://www.bmus-ors.org/

    Zvetkova, E., Koytchev, E., Ivanov, I., Ranchev, S., & Antonov, A. (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review.
    _Applied Sciences, 13_(15), 8596. https://doi.org/10.3390/app13158596

    **Capstonepart2.docx**

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    **files (3)** – ## FinalCapstone.docx – ## MSN_Capstone_Part_II_Literature_Review.docx – MSNCapstoneProject.edited1.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This sho…

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    **files (3)**

    – ## FinalCapstone.docx

    – ## MSN_Capstone_Part_II_Literature_Review.docx

    – MSNCapstoneProject.edited1.docx

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part_II_Literature_Review.docx**

    **Part II: Review of Literature**

    Yailin Ramirez

    Florida National University

    MSN Capstone Project—DAX-DL01

    Dr. Carmen Lazo

    June 5, 2026

    **Review of Literature**

    Non-adherence to nutrition is one of the most challenging and problematic clinical issues for nephrology nurses, particularly in adult patients with chronic kidney disease (CKD). This problem is exacerbated in a community hospital environment that provides care to adult inpatients and where community factors such as low health literacy, poverty, and access to renal nutrition counseling are present in Spartanburg County, South Carolina. The PICOT question for this capstone project is: For hospitalized adult renal patients who have CKD, is the provision of nurse-led education based on a simplified 1-page renal diet handout compared to usual care (no structured dietary education) associated with increased dietary adherence within 8 weeks? The findings of the synthesis of the available primary research and systematic reviews strongly reflect the effectiveness of structured, nurse-led dietary education in improving adherence outcomes in patients with renal disease and end-stage renal disease (ESRD), as well as highlight some key issues within current practice, missing evidence and conflicting views of the link between patient knowledge and behaviour change.

    There has been ample literature documenting the burden of poor food intake in CKD. In this population, poor self-management and poor adherence to the CKD treatment plan, such as dietary elements, are significant factors for preventable hospital re-admission (Surasura et al., 2024). In 2022, the cost of CKD to Medicare was greater than $86 billion, highlighting the economic need for preventive interventions (NIH, 2025). National and local statistical data further support the need for a structured renal diet education intervention. At the national level, more than 1 in 10 U.S. adults, or approximately 37 million people, are estimated to have chronic kidney disease (CKD), and about 87% of adults with CKD are unaware that they have the condition (Centers for Disease Control and Prevention [CDC], 2026). This burden is highly relevant to hospitalized renal patients because CKD is strongly associated with diabetes and hypertension; approximately 38% of adults with diabetes and 21% of adults with high blood pressure are estimated to have CKD (CDC, 2026). At the state level, South Carolina reported a CKD prevalence of 5.2% among adults in 2024, compared with 4.0% nationally, ranking the state 47th for this measure (America’s Health Rankings, 2026). Locally, the 2024 Spartanburg County Community Health Needs Assessment reported that 12% of Spartanburg County adults were living with diabetes, slightly higher than the U.S. average of 10%, and 14.8% of residents, or 49,977 individuals, lived below the federal poverty level in 2022 (Live Healthy Spartanburg, 2024). These local and national statistics demonstrate that CKD risk factors, poverty, and limited health literacy may interfere with renal diet adherence. Therefore, a nurse-led, plain-language renal diet handout is appropriate for Spartanburg Regional Medical Center because it addresses a measurable health need in the local population.

    Restrictions in CKD are multifaceted, meaning that patients need to restrict sodium, potassium, phosphorus and fluid intake all at once – often a very demanding and difficult set of restrictions for patients who may not have high health literacy. Billany et al. (2023) completed a systematic review showing that there is a significant association between low health literacy and poor self-management behaviors, poor health outcomes, and increased mortality in CKD patients. The findings are directly relevant to the target population in Spartanburg County where educational attainment and access to specialty care is below the national average.

    One of the main variables in the problem is health literacy as well as one of the variables in the proposed solution. Lambert et al. (2024) carried out a quasi-experimental study to compare a health literacy informed approach to care in outpatient nephrology dietetic clinics. The updated model of care consisted of plain language materials, a renal diet question prompt sheet, and teach back techniques. A significant increase in patient understanding, dietary self-management confidence and satisfaction with the educational encounter were identified in the study. These results support the low-literacy, plain-language one-page handout approach recommended in this capstone and confirm the importance of this type of communication to ensure higher rates of patient participation in renal diet recommendations. A systematic review of effectiveness of Teach-Back methodology in patient education in CKD by Jagodage et al. (2023) revealed that teach-back led patient education programs, especially when delivered in a face-to-face format, were found to be effective in improving the dietary adherence and self-management outcomes among CKD patients when compared with non-structured usual care approaches. Both studies suggest the format and delivery that is advocated in this project.

    Several randomized controlled trials (RCTs) have directly shown the effectiveness of the structured, nurse-led education in the CKD and ESRD patient population. Arad et al. (2021) performed an RCT with 66 patients with hemodialysis divided into two groups: those who received a nurse-led education program plus telephone follow-up and those who received usual care. At 1 and 3 months after intervention, results proved statistically significant in the intervention group in terms of dietary adherence, fluid restriction adherence, and laboratory values. The four-domain adherence measure employed was the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which has been validated and is applicable to the outcome measurement suggested in this capstone. Likewise, Dsouza et al. (2023) carried out an RCT study with 160 hemodialysis patients in a tertiary hospital in the southern part of India. The intervention group were given structured education sessions and a printed educational booklet, while the control group were given standard care. Post intervention assessment showed that there was a statistically significant improvement in the intervention group (restriction adherence and dietary adherence) with no change in the control group. Most importantly, the difference in knowledge did not correlate with the difference in adherence in the intervention group in this study, a pattern seen in several studies, with implications for this project.

    One of the ongoing debates in the CKD dietary adherence research literature is whether there is a connection between dietary knowledge acquisition and changes in behavior. There have been several studies that show that patients can be more aware of the restrictions of their diet for the kidneys, but not necessarily change their own diet. This disconnect was noted by Dsouza et al. (2023) and Arad et al. (2021) also reported that the association between knowledge scores and adherence scores was not statistically significant. The available evidence indicates that educational interventions should include behaviour change techniques, including providing simplified information, setting goals and teach back, to have an impact and to produce lasting dietary adherence. This one-page handout is meant to be actionable and not just informational, so this concern is addressed. However, Yu et al. (2021) argued that health literacy, as opposed to knowledge, showed greater predictive power for self-care behaviors in the context of CKD, including diet adherence. Greater scores in each of the health literacy domains (access, understanding, appraisal, and action) were significantly correlated with higher levels of dietary self-management. These results support the need for patient education materials to be tailored to patient health literacy level, as this was key to the design of the simplified handout in this project.

    Nursing profession is the key element in providing and maintaining dietary education to patients with CKD in hospital. Nurses are the first and most common health care professional to encounter hospitalized patients offering an opportunity to provide bedside education that is timely, individualized, and repeated through interaction. In a cluster-randomized controlled trial (cRCT) in community hospitals conducted by Changsieng et al. (2023), a supportive-educative program by a nurse using Orem's theory of self-care was found to be statistically significantly effective in increasing dietary adherence, self-care agency and glycated hemoglobin (HbA1C) reduction. Atraca et al. (2025) also found that nurse-led education that focuses on the self-care of CKD disease yielded tangible outcomes in self-care ability and disease knowledge in various clinical scenarios. There is also literature that supports the feasibility and cost-effectiveness of such interventions. The cost to implement this capstone in the community is estimated to be 30-40 dollars, just for printing the one page handout and questionnaire materials, no additional staff member needed, the intervention will be integrated into routine nursing practice. This makes it very easy and environmentally friendly to implement in community hospitals with limited resources.

    Although the evidence for effective nurse-led educational interventions is sound, there are still a number of limitations and gaps to be addressed. The most rigorous RCTs were conducted abroad, in dialysis centers instead of an inpatient hospital setting, and with populations with socioeconomic and cultural backgrounds that could be significantly different from those of CKD patients in Spartanburg County, SC. This capstone project addresses an important evidence gap – translating results from dialysis populations to pre-dialysis hospitalized inpatients. Furthermore, only a few studies have analyzed the sustainability of adherence improvement over 3-month periods, and issues regarding the long-term effect remain unclear. Although this project has a short time period of 8 weeks, it encompasses immediate and early post-discharge adherence behavior, and will serve as a stepping stone to longer term follow-up investigations. The lack of systematic and personalized education of patients' diet in many community hospitals is not consistent with the evidence and is a correctable gap. The change proposed for this capstone is clear, feasible, and supported by evidence: Providing a brief, nurse-led bedside educational session with a simplified one-page renal diet handout will optimize dietary adherence in the hospitalized adult patient with CKD which will result in fewer preventable readmissions and further evidence-based quality improvement by the advanced practice nurse at Spartanburg Regional Medical Center.

    **References**

    Arad, M., Goli, R., Parizad, N., Vahabzadeh, D., & Baghaei, R. (2021). Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial. BMC Nephrology, 22(1), 119. https://doi.org/10.1186/s12882-021-02319-9

    Atraca, E., Solinho, L., Pires, S., Braga, V., Gomes, I., & Ramos, A. (2025). An educational nursing program to improve self-care in chronic kidney disease: A multiple case study. Journal of Ageing and Longevity, 5(3), 30. https://doi.org/10.3390/jal5030030

    Billany, R. E., Thopte, A., Adenwalla, S. F., March, D. S., Burton, J. O., & Graham-Brown, M. P. M. (2023). Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: A systematic review. Journal of Nephrology, 36(5). https://doi.org/10.1007/s40620-022-01537-0

    Changsieng, P., Pichayapinyo, P., Lagampan, S., & Lapvongwatana, P. (2023). Implementation of self-care deficits assessment and a nurse-led supportive education program in community hospitals for behavior change and HbA1c reduction: A cluster randomized controlled trial. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231181106

    Dsouza, B., Prabhu, R., Unnikrishnan, B., Ballal, S., Mundkur, S. C., Sekaran, V. C., Shetty, A., & Moreira, P. (2023). Effect of educational intervention on knowledge and level of adherence among hemodialysis patients: A randomized controlled trial. Global Health, Epidemiology and Genomics, 2023, 4295613. https://doi.org/10.1155/2023/4295613

    Jagodage, H., McGuire, A., Seib, C., & Bonner, A. (2023). Effectiveness of teach-back for chronic kidney disease patient education: A systematic review. Journal of Renal Care, 50(2). https://doi.org/10.1111/jorc.12462

    Lambert, K., Tulissio, N., & Cosier, D. (2024). Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics. Journal of Human Nutrition and Dietetics, 37(6), 1516–1537. https://doi.org/10.1111/jhn.13373

    NIH. (2025). Healthcare expenditures for persons with CKD. USRDS. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd

    Surasura, A., Kumar, B. G. S. K. P., Chinamanagonda, S., Durga, D., & Gubbala, S. (2024). Understanding hospital readmissions: Insights, patterns, and interventions for improvement in chronic kidney disease. Cureūs. https://doi.org/10.7759/cureus.59524

    Yu, P.-S., Tsai, Y.-C., Chiu, Y.-W., Hsiao, P.-N., Lin, M.-Y., Chen, T.-H., Wang, S.-L., Kung, L.-F., Hsiao, S.-M., Hwang, S.-J., & Kuo, M.-C. (2021). The relationship between subtypes of health literacy and self-care behavior in chronic kidney disease. Journal of Personalized Medicine, 11(6), 447.
    [https://doi.org/10.3390/jpm11060447](https://doi.org/10.3390/jpm11060447)

    America’s Health Rankings. (2026).
    _Chronic kidney disease in South Carolina_. United Health Foundation.
    [https://www.americashealthrankings.org/explore/measures/CKD/SC](https://www.americashealthrankings.org/explore/measures/CKD/SC?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (2026).
    _Chronic kidney disease in the United States_.
    [https://www.cdc.gov/kidney-disease/php/data-research/index.html](https://www.cdc.gov/kidney-disease/php/data-research/index.html?utm_source=chatgpt.com)

    Live Healthy Spartanburg. (2024).
    _Spartanburg County community health needs assessment_.
    [https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf](https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf?utm_source=chatgpt.com)

    **MSNCapstoneProject.edited1.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/msncapstoneproject-edited1-docx-10565519)

    **MSNCapstoneProject.edited1.docx**

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    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part_II_Literature_Review.docx**

    **Part II: Review of Literature**

    Yailin Ramirez

    Florida National University

    MSN Capstone Project—DAX-DL01

    Dr. Carmen Lazo

    June 5, 2026

    **Review of Literature**

    Non-adherence to nutrition is one of the most challenging and problematic clinical issues for nephrology nurses, particularly in adult patients with chronic kidney disease (CKD). This problem is exacerbated in a community hospital environment that provides care to adult inpatients and where community factors such as low health literacy, poverty, and access to renal nutrition counseling are present in Spartanburg County, South Carolina. The PICOT question for this capstone project is: For hospitalized adult renal patients who have CKD, is the provision of nurse-led education based on a simplified 1-page renal diet handout compared to usual care (no structured dietary education) associated with increased dietary adherence within 8 weeks? The findings of the synthesis of the available primary research and systematic reviews strongly reflect the effectiveness of structured, nurse-led dietary education in improving adherence outcomes in patients with renal disease and end-stage renal disease (ESRD), as well as highlight some key issues within current practice, missing evidence and conflicting views of the link between patient knowledge and behaviour change.

    There has been ample literature documenting the burden of poor food intake in CKD. In this population, poor self-management and poor adherence to the CKD treatment plan, such as dietary elements, are significant factors for preventable hospital re-admission (Surasura et al., 2024). In 2022, the cost of CKD to Medicare was greater than $86 billion, highlighting the economic need for preventive interventions (NIH, 2025). National and local statistical data further support the need for a structured renal diet education intervention. At the national level, more than 1 in 10 U.S. adults, or approximately 37 million people, are estimated to have chronic kidney disease (CKD), and about 87% of adults with CKD are unaware that they have the condition (Centers for Disease Control and Prevention [CDC], 2026). This burden is highly relevant to hospitalized renal patients because CKD is strongly associated with diabetes and hypertension; approximately 38% of adults with diabetes and 21% of adults with high blood pressure are estimated to have CKD (CDC, 2026). At the state level, South Carolina reported a CKD prevalence of 5.2% among adults in 2024, compared with 4.0% nationally, ranking the state 47th for this measure (America’s Health Rankings, 2026). Locally, the 2024 Spartanburg County Community Health Needs Assessment reported that 12% of Spartanburg County adults were living with diabetes, slightly higher than the U.S. average of 10%, and 14.8% of residents, or 49,977 individuals, lived below the federal poverty level in 2022 (Live Healthy Spartanburg, 2024). These local and national statistics demonstrate that CKD risk factors, poverty, and limited health literacy may interfere with renal diet adherence. Therefore, a nurse-led, plain-language renal diet handout is appropriate for Spartanburg Regional Medical Center because it addresses a measurable health need in the local population.

    Restrictions in CKD are multifaceted, meaning that patients need to restrict sodium, potassium, phosphorus and fluid intake all at once – often a very demanding and difficult set of restrictions for patients who may not have high health literacy. Billany et al. (2023) completed a systematic review showing that there is a significant association between low health literacy and poor self-management behaviors, poor health outcomes, and increased mortality in CKD patients. The findings are directly relevant to the target population in Spartanburg County where educational attainment and access to specialty care is below the national average.

    One of the main variables in the problem is health literacy as well as one of the variables in the proposed solution. Lambert et al. (2024) carried out a quasi-experimental study to compare a health literacy informed approach to care in outpatient nephrology dietetic clinics. The updated model of care consisted of plain language materials, a renal diet question prompt sheet, and teach back techniques. A significant increase in patient understanding, dietary self-management confidence and satisfaction with the educational encounter were identified in the study. These results support the low-literacy, plain-language one-page handout approach recommended in this capstone and confirm the importance of this type of communication to ensure higher rates of patient participation in renal diet recommendations. A systematic review of effectiveness of Teach-Back methodology in patient education in CKD by Jagodage et al. (2023) revealed that teach-back led patient education programs, especially when delivered in a face-to-face format, were found to be effective in improving the dietary adherence and self-management outcomes among CKD patients when compared with non-structured usual care approaches. Both studies suggest the format and delivery that is advocated in this project.

    Several randomized controlled trials (RCTs) have directly shown the effectiveness of the structured, nurse-led education in the CKD and ESRD patient population. Arad et al. (2021) performed an RCT with 66 patients with hemodialysis divided into two groups: those who received a nurse-led education program plus telephone follow-up and those who received usual care. At 1 and 3 months after intervention, results proved statistically significant in the intervention group in terms of dietary adherence, fluid restriction adherence, and laboratory values. The four-domain adherence measure employed was the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which has been validated and is applicable to the outcome measurement suggested in this capstone. Likewise, Dsouza et al. (2023) carried out an RCT study with 160 hemodialysis patients in a tertiary hospital in the southern part of India. The intervention group were given structured education sessions and a printed educational booklet, while the control group were given standard care. Post intervention assessment showed that there was a statistically significant improvement in the intervention group (restriction adherence and dietary adherence) with no change in the control group. Most importantly, the difference in knowledge did not correlate with the difference in adherence in the intervention group in this study, a pattern seen in several studies, with implications for this project.

    One of the ongoing debates in the CKD dietary adherence research literature is whether there is a connection between dietary knowledge acquisition and changes in behavior. There have been several studies that show that patients can be more aware of the restrictions of their diet for the kidneys, but not necessarily change their own diet. This disconnect was noted by Dsouza et al. (2023) and Arad et al. (2021) also reported that the association between knowledge scores and adherence scores was not statistically significant. The available evidence indicates that educational interventions should include behaviour change techniques, including providing simplified information, setting goals and teach back, to have an impact and to produce lasting dietary adherence. This one-page handout is meant to be actionable and not just informational, so this concern is addressed. However, Yu et al. (2021) argued that health literacy, as opposed to knowledge, showed greater predictive power for self-care behaviors in the context of CKD, including diet adherence. Greater scores in each of the health literacy domains (access, understanding, appraisal, and action) were significantly correlated with higher levels of dietary self-management. These results support the need for patient education materials to be tailored to patient health literacy level, as this was key to the design of the simplified handout in this project.

    Nursing profession is the key element in providing and maintaining dietary education to patients with CKD in hospital. Nurses are the first and most common health care professional to encounter hospitalized patients offering an opportunity to provide bedside education that is timely, individualized, and repeated through interaction. In a cluster-randomized controlled trial (cRCT) in community hospitals conducted by Changsieng et al. (2023), a supportive-educative program by a nurse using Orem's theory of self-care was found to be statistically significantly effective in increasing dietary adherence, self-care agency and glycated hemoglobin (HbA1C) reduction. Atraca et al. (2025) also found that nurse-led education that focuses on the self-care of CKD disease yielded tangible outcomes in self-care ability and disease knowledge in various clinical scenarios. There is also literature that supports the feasibility and cost-effectiveness of such interventions. The cost to implement this capstone in the community is estimated to be 30-40 dollars, just for printing the one page handout and questionnaire materials, no additional staff member needed, the intervention will be integrated into routine nursing practice. This makes it very easy and environmentally friendly to implement in community hospitals with limited resources.

    Although the evidence for effective nurse-led educational interventions is sound, there are still a number of limitations and gaps to be addressed. The most rigorous RCTs were conducted abroad, in dialysis centers instead of an inpatient hospital setting, and with populations with socioeconomic and cultural backgrounds that could be significantly different from those of CKD patients in Spartanburg County, SC. This capstone project addresses an important evidence gap – translating results from dialysis populations to pre-dialysis hospitalized inpatients. Furthermore, only a few studies have analyzed the sustainability of adherence improvement over 3-month periods, and issues regarding the long-term effect remain unclear. Although this project has a short time period of 8 weeks, it encompasses immediate and early post-discharge adherence behavior, and will serve as a stepping stone to longer term follow-up investigations. The lack of systematic and personalized education of patients' diet in many community hospitals is not consistent with the evidence and is a correctable gap. The change proposed for this capstone is clear, feasible, and supported by evidence: Providing a brief, nurse-led bedside educational session with a simplified one-page renal diet handout will optimize dietary adherence in the hospitalized adult patient with CKD which will result in fewer preventable readmissions and further evidence-based quality improvement by the advanced practice nurse at Spartanburg Regional Medical Center.

    **References**

    Arad, M., Goli, R., Parizad, N., Vahabzadeh, D., & Baghaei, R. (2021). Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial. BMC Nephrology, 22(1), 119. https://doi.org/10.1186/s12882-021-02319-9

    Atraca, E., Solinho, L., Pires, S., Braga, V., Gomes, I., & Ramos, A. (2025). An educational nursing program to improve self-care in chronic kidney disease: A multiple case study. Journal of Ageing and Longevity, 5(3), 30. https://doi.org/10.3390/jal5030030

    Billany, R. E., Thopte, A., Adenwalla, S. F., March, D. S., Burton, J. O., & Graham-Brown, M. P. M. (2023). Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: A systematic review. Journal of Nephrology, 36(5). https://doi.org/10.1007/s40620-022-01537-0

    Changsieng, P., Pichayapinyo, P., Lagampan, S., & Lapvongwatana, P. (2023). Implementation of self-care deficits assessment and a nurse-led supportive education program in community hospitals for behavior change and HbA1c reduction: A cluster randomized controlled trial. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231181106

    Dsouza, B., Prabhu, R., Unnikrishnan, B., Ballal, S., Mundkur, S. C., Sekaran, V. C., Shetty, A., & Moreira, P. (2023). Effect of educational intervention on knowledge and level of adherence among hemodialysis patients: A randomized controlled trial. Global Health, Epidemiology and Genomics, 2023, 4295613. https://doi.org/10.1155/2023/4295613

    Jagodage, H., McGuire, A., Seib, C., & Bonner, A. (2023). Effectiveness of teach-back for chronic kidney disease patient education: A systematic review. Journal of Renal Care, 50(2). https://doi.org/10.1111/jorc.12462

    Lambert, K., Tulissio, N., & Cosier, D. (2024). Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics. Journal of Human Nutrition and Dietetics, 37(6), 1516–1537. https://doi.org/10.1111/jhn.13373

    NIH. (2025). Healthcare expenditures for persons with CKD. USRDS. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd

    Surasura, A., Kumar, B. G. S. K. P., Chinamanagonda, S., Durga, D., & Gubbala, S. (2024). Understanding hospital readmissions: Insights, patterns, and interventions for improvement in chronic kidney disease. Cureūs. https://doi.org/10.7759/cureus.59524

    Yu, P.-S., Tsai, Y.-C., Chiu, Y.-W., Hsiao, P.-N., Lin, M.-Y., Chen, T.-H., Wang, S.-L., Kung, L.-F., Hsiao, S.-M., Hwang, S.-J., & Kuo, M.-C. (2021). The relationship between subtypes of health literacy and self-care behavior in chronic kidney disease. Journal of Personalized Medicine, 11(6), 447.
    [https://doi.org/10.3390/jpm11060447](https://doi.org/10.3390/jpm11060447)

    America’s Health Rankings. (2026).
    _Chronic kidney disease in South Carolina_. United Health Foundation.
    [https://www.americashealthrankings.org/explore/measures/CKD/SC](https://www.americashealthrankings.org/explore/measures/CKD/SC?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (2026).
    _Chronic kidney disease in the United States_.
    [https://www.cdc.gov/kidney-disease/php/data-research/index.html](https://www.cdc.gov/kidney-disease/php/data-research/index.html?utm_source=chatgpt.com)

    Live Healthy Spartanburg. (2024).
    _Spartanburg County community health needs assessment_.
    [https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf](https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf?utm_source=chatgpt.com)

    **MSNCapstoneProject.edited1.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/msncapstoneproject-edited1-docx-10565519)

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## MSN_Capstone_Part_II_Literature_Review.docx**

    **Part II: Review of Literature**

    Yailin Ramirez

    Florida National University

    MSN Capstone Project—DAX-DL01

    Dr. Carmen Lazo

    June 5, 2026

    **Review of Literature**

    Non-adherence to nutrition is one of the most challenging and problematic clinical issues for nephrology nurses, particularly in adult patients with chronic kidney disease (CKD). This problem is exacerbated in a community hospital environment that provides care to adult inpatients and where community factors such as low health literacy, poverty, and access to renal nutrition counseling are present in Spartanburg County, South Carolina. The PICOT question for this capstone project is: For hospitalized adult renal patients who have CKD, is the provision of nurse-led education based on a simplified 1-page renal diet handout compared to usual care (no structured dietary education) associated with increased dietary adherence within 8 weeks? The findings of the synthesis of the available primary research and systematic reviews strongly reflect the effectiveness of structured, nurse-led dietary education in improving adherence outcomes in patients with renal disease and end-stage renal disease (ESRD), as well as highlight some key issues within current practice, missing evidence and conflicting views of the link between patient knowledge and behaviour change.

    There has been ample literature documenting the burden of poor food intake in CKD. In this population, poor self-management and poor adherence to the CKD treatment plan, such as dietary elements, are significant factors for preventable hospital re-admission (Surasura et al., 2024). In 2022, the cost of CKD to Medicare was greater than $86 billion, highlighting the economic need for preventive interventions (NIH, 2025). National and local statistical data further support the need for a structured renal diet education intervention. At the national level, more than 1 in 10 U.S. adults, or approximately 37 million people, are estimated to have chronic kidney disease (CKD), and about 87% of adults with CKD are unaware that they have the condition (Centers for Disease Control and Prevention [CDC], 2026). This burden is highly relevant to hospitalized renal patients because CKD is strongly associated with diabetes and hypertension; approximately 38% of adults with diabetes and 21% of adults with high blood pressure are estimated to have CKD (CDC, 2026). At the state level, South Carolina reported a CKD prevalence of 5.2% among adults in 2024, compared with 4.0% nationally, ranking the state 47th for this measure (America’s Health Rankings, 2026). Locally, the 2024 Spartanburg County Community Health Needs Assessment reported that 12% of Spartanburg County adults were living with diabetes, slightly higher than the U.S. average of 10%, and 14.8% of residents, or 49,977 individuals, lived below the federal poverty level in 2022 (Live Healthy Spartanburg, 2024). These local and national statistics demonstrate that CKD risk factors, poverty, and limited health literacy may interfere with renal diet adherence. Therefore, a nurse-led, plain-language renal diet handout is appropriate for Spartanburg Regional Medical Center because it addresses a measurable health need in the local population.

    Restrictions in CKD are multifaceted, meaning that patients need to restrict sodium, potassium, phosphorus and fluid intake all at once – often a very demanding and difficult set of restrictions for patients who may not have high health literacy. Billany et al. (2023) completed a systematic review showing that there is a significant association between low health literacy and poor self-management behaviors, poor health outcomes, and increased mortality in CKD patients. The findings are directly relevant to the target population in Spartanburg County where educational attainment and access to specialty care is below the national average.

    One of the main variables in the problem is health literacy as well as one of the variables in the proposed solution. Lambert et al. (2024) carried out a quasi-experimental study to compare a health literacy informed approach to care in outpatient nephrology dietetic clinics. The updated model of care consisted of plain language materials, a renal diet question prompt sheet, and teach back techniques. A significant increase in patient understanding, dietary self-management confidence and satisfaction with the educational encounter were identified in the study. These results support the low-literacy, plain-language one-page handout approach recommended in this capstone and confirm the importance of this type of communication to ensure higher rates of patient participation in renal diet recommendations. A systematic review of effectiveness of Teach-Back methodology in patient education in CKD by Jagodage et al. (2023) revealed that teach-back led patient education programs, especially when delivered in a face-to-face format, were found to be effective in improving the dietary adherence and self-management outcomes among CKD patients when compared with non-structured usual care approaches. Both studies suggest the format and delivery that is advocated in this project.

    Several randomized controlled trials (RCTs) have directly shown the effectiveness of the structured, nurse-led education in the CKD and ESRD patient population. Arad et al. (2021) performed an RCT with 66 patients with hemodialysis divided into two groups: those who received a nurse-led education program plus telephone follow-up and those who received usual care. At 1 and 3 months after intervention, results proved statistically significant in the intervention group in terms of dietary adherence, fluid restriction adherence, and laboratory values. The four-domain adherence measure employed was the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which has been validated and is applicable to the outcome measurement suggested in this capstone. Likewise, Dsouza et al. (2023) carried out an RCT study with 160 hemodialysis patients in a tertiary hospital in the southern part of India. The intervention group were given structured education sessions and a printed educational booklet, while the control group were given standard care. Post intervention assessment showed that there was a statistically significant improvement in the intervention group (restriction adherence and dietary adherence) with no change in the control group. Most importantly, the difference in knowledge did not correlate with the difference in adherence in the intervention group in this study, a pattern seen in several studies, with implications for this project.

    One of the ongoing debates in the CKD dietary adherence research literature is whether there is a connection between dietary knowledge acquisition and changes in behavior. There have been several studies that show that patients can be more aware of the restrictions of their diet for the kidneys, but not necessarily change their own diet. This disconnect was noted by Dsouza et al. (2023) and Arad et al. (2021) also reported that the association between knowledge scores and adherence scores was not statistically significant. The available evidence indicates that educational interventions should include behaviour change techniques, including providing simplified information, setting goals and teach back, to have an impact and to produce lasting dietary adherence. This one-page handout is meant to be actionable and not just informational, so this concern is addressed. However, Yu et al. (2021) argued that health literacy, as opposed to knowledge, showed greater predictive power for self-care behaviors in the context of CKD, including diet adherence. Greater scores in each of the health literacy domains (access, understanding, appraisal, and action) were significantly correlated with higher levels of dietary self-management. These results support the need for patient education materials to be tailored to patient health literacy level, as this was key to the design of the simplified handout in this project.

    Nursing profession is the key element in providing and maintaining dietary education to patients with CKD in hospital. Nurses are the first and most common health care professional to encounter hospitalized patients offering an opportunity to provide bedside education that is timely, individualized, and repeated through interaction. In a cluster-randomized controlled trial (cRCT) in community hospitals conducted by Changsieng et al. (2023), a supportive-educative program by a nurse using Orem's theory of self-care was found to be statistically significantly effective in increasing dietary adherence, self-care agency and glycated hemoglobin (HbA1C) reduction. Atraca et al. (2025) also found that nurse-led education that focuses on the self-care of CKD disease yielded tangible outcomes in self-care ability and disease knowledge in various clinical scenarios. There is also literature that supports the feasibility and cost-effectiveness of such interventions. The cost to implement this capstone in the community is estimated to be 30-40 dollars, just for printing the one page handout and questionnaire materials, no additional staff member needed, the intervention will be integrated into routine nursing practice. This makes it very easy and environmentally friendly to implement in community hospitals with limited resources.

    Although the evidence for effective nurse-led educational interventions is sound, there are still a number of limitations and gaps to be addressed. The most rigorous RCTs were conducted abroad, in dialysis centers instead of an inpatient hospital setting, and with populations with socioeconomic and cultural backgrounds that could be significantly different from those of CKD patients in Spartanburg County, SC. This capstone project addresses an important evidence gap – translating results from dialysis populations to pre-dialysis hospitalized inpatients. Furthermore, only a few studies have analyzed the sustainability of adherence improvement over 3-month periods, and issues regarding the long-term effect remain unclear. Although this project has a short time period of 8 weeks, it encompasses immediate and early post-discharge adherence behavior, and will serve as a stepping stone to longer term follow-up investigations. The lack of systematic and personalized education of patients' diet in many community hospitals is not consistent with the evidence and is a correctable gap. The change proposed for this capstone is clear, feasible, and supported by evidence: Providing a brief, nurse-led bedside educational session with a simplified one-page renal diet handout will optimize dietary adherence in the hospitalized adult patient with CKD which will result in fewer preventable readmissions and further evidence-based quality improvement by the advanced practice nurse at Spartanburg Regional Medical Center.

    **References**

    Arad, M., Goli, R., Parizad, N., Vahabzadeh, D., & Baghaei, R. (2021). Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial. BMC Nephrology, 22(1), 119. https://doi.org/10.1186/s12882-021-02319-9

    Atraca, E., Solinho, L., Pires, S., Braga, V., Gomes, I., & Ramos, A. (2025). An educational nursing program to improve self-care in chronic kidney disease: A multiple case study. Journal of Ageing and Longevity, 5(3), 30. https://doi.org/10.3390/jal5030030

    Billany, R. E., Thopte, A., Adenwalla, S. F., March, D. S., Burton, J. O., & Graham-Brown, M. P. M. (2023). Associations of health literacy with self-management behaviours and health outcomes in chronic kidney disease: A systematic review. Journal of Nephrology, 36(5). https://doi.org/10.1007/s40620-022-01537-0

    Changsieng, P., Pichayapinyo, P., Lagampan, S., & Lapvongwatana, P. (2023). Implementation of self-care deficits assessment and a nurse-led supportive education program in community hospitals for behavior change and HbA1c reduction: A cluster randomized controlled trial. Journal of Primary Care & Community Health, 14. https://doi.org/10.1177/21501319231181106

    Dsouza, B., Prabhu, R., Unnikrishnan, B., Ballal, S., Mundkur, S. C., Sekaran, V. C., Shetty, A., & Moreira, P. (2023). Effect of educational intervention on knowledge and level of adherence among hemodialysis patients: A randomized controlled trial. Global Health, Epidemiology and Genomics, 2023, 4295613. https://doi.org/10.1155/2023/4295613

    Jagodage, H., McGuire, A., Seib, C., & Bonner, A. (2023). Effectiveness of teach-back for chronic kidney disease patient education: A systematic review. Journal of Renal Care, 50(2). https://doi.org/10.1111/jorc.12462

    Lambert, K., Tulissio, N., & Cosier, D. (2024). Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics. Journal of Human Nutrition and Dietetics, 37(6), 1516–1537. https://doi.org/10.1111/jhn.13373

    NIH. (2025). Healthcare expenditures for persons with CKD. USRDS. https://usrds-adr.niddk.nih.gov/2024/chronic-kidney-disease/6-healthcare-expenditures-for-persons-with-ckd

    Surasura, A., Kumar, B. G. S. K. P., Chinamanagonda, S., Durga, D., & Gubbala, S. (2024). Understanding hospital readmissions: Insights, patterns, and interventions for improvement in chronic kidney disease. Cureūs. https://doi.org/10.7759/cureus.59524

    Yu, P.-S., Tsai, Y.-C., Chiu, Y.-W., Hsiao, P.-N., Lin, M.-Y., Chen, T.-H., Wang, S.-L., Kung, L.-F., Hsiao, S.-M., Hwang, S.-J., & Kuo, M.-C. (2021). The relationship between subtypes of health literacy and self-care behavior in chronic kidney disease. Journal of Personalized Medicine, 11(6), 447.
    [https://doi.org/10.3390/jpm11060447](https://doi.org/10.3390/jpm11060447)

    America’s Health Rankings. (2026).
    _Chronic kidney disease in South Carolina_. United Health Foundation.
    [https://www.americashealthrankings.org/explore/measures/CKD/SC](https://www.americashealthrankings.org/explore/measures/CKD/SC?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (2026).
    _Chronic kidney disease in the United States_.
    [https://www.cdc.gov/kidney-disease/php/data-research/index.html](https://www.cdc.gov/kidney-disease/php/data-research/index.html?utm_source=chatgpt.com)

    Live Healthy Spartanburg. (2024).
    _Spartanburg County community health needs assessment_.
    [https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf](https://www.livehealthyspartanburg.org/s/Live-Healthy-Spartanburg-2024-CHNA.pdf?utm_source=chatgpt.com)

    **MSNCapstoneProject.edited1.docx**

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    **files (4)** – ## FinalCapstone.docx – ## Capstone_Part1.1.docx – Capstone_Part1.1.docx – Capstone_Part2.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This should be a coh…

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    Assignment Prompt & Instructions

    **files (4)**

    – ## FinalCapstone.docx

    – ## Capstone_Part1.1.docx

    – Capstone_Part1.1.docx
    – Capstone_Part2.docx

    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## Capstone_Part1.1.docx**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    The obesity epidemic is a public health problem that disproportionately affects low-income and Hispanic communities, as well as urban communities, and is one of the most crisis-stricken in the United States. These rates are even higher in Miami-Dade County, FL, where more than 67% of adults are either overweight or obese, and need systematic, evidence-based intervention through the primary care channel/Centers for Disease Control and Prevention, 2023). The prevalence of adult obesity nationally has risen to 40.3% from August 2021 to August 2023, and for those who were already overweight, the prevalence of severe obesity was 9.4% over this period (Karam et al., 2025). These figures equate with elevated rates of Type 2 diabetes and cardiovascular disease, and hypertension an economic burden for patients and the healthcare system. The cost associated with obesity is substantial for patients, primary care settings, and the overall health care system. Obesity increases the risk for type 2 diabetes, cardiovascular disease, hypertension, and other chronic conditions that require ongoing medical visits, medications, laboratory testing, and disease management. Nationally, obesity costs the United States health care system nearly $173 billion annually. In addition, adults with obesity have approximately $1,861 more in annual medical costs than adults with a healthy weight, while adults with severe obesity have approximately $3,097 more in annual medical costs (Centers for Disease Control and Prevention [CDC], 2023).Nevertheless, few primary care offices have an obesity-focused education program that is consistent from one office to another, and patients are not knowledgeable enough or equipped to lower their body weight to a healthy level. This is a proposed Capstone project: To implement a structured lifestyle modification education program in PC clinics in Miami-Dade County, which will be administered to overweight and obese adults for 8-12 weeks.

    **PICOT Question**

    The clinical question guiding this project is: In overweight or obese adults attending one Miami-Dade primary care setting (P), how does structured lifestyle modification education (I), compared to no standardized education (C), affect self-reported weight reduction (O) over 8–12 weeks (T)?The population consists of adults who are overweight (BMI ≥ 25) or obese and seek health care in primary care settings in counties with a majority Hispanic and Latino population, and often have challenges with access to nutritious food, health care literacy, and safe recreation areas (Williams et al., 2024). The intervention comprises one-on-one counseling provided by Advanced Practice Registered Nurses (APRNs) on nutrition, portion control, physical activity, behavioral self-monitoring, and goal setting. Comparisons are with the current standard of care the absence of any structured obesity education, with patients only receiving general clinical advice. The target is to lose a clinically significant amount of weight or BMI (around 5% of body weight compared with baseline level). A properly structured behavioural programme, as evidenced, can actively produce measurable anthropometric changes in 8-12 weeks time (Krishnasamy et al., 2024).

    **Vulnerable Population and Setting**

    The target population includes overweight and obese adults in Miami-Dade County, home to nearly 2.5 million residents, the majority identifying as Hispanic or Latino. The intersecting social determinants of food insecurity, low household income, limited English language ability, and lack of affordable, nutritious food make this community vulnerable. Studies have found that racial and ethnic minorities and adults with low SES are at higher risk for obesity and less likely to access quality obesity treatment (Williams et al., 2024). Cultural dietary habits and community access to physical activity also contribute to weight gain and to the progression of chronic diseases. One Miami-Dade primary care setting is an ideal setting because it is often the first point of contact between the patient and the healthcare system, allowing for early detection, frequent monitoring, and reinforcement of healthy behaviors during the intervention period.

    **Review of Evidence**

    There is significant peer-reviewed evidence for the effectiveness of structured lifestyle modification education programs in the primary care setting for weight and BMI reduction. Karam et al. (2025) conducted a review of obesity interventions that utilized primary care settings and identified behavioral therapies, such as motivational interviewing and lifestyle modification counseling, to be consistently associated with clinically significant weight loss, suggesting that APRNs and primary care providers are well-equipped to facilitate these therapies. Krishnasamy et al. (2024) assessed a nurse-led intervention in overweight and obese urban adults and found weight-related outcomes and lifestyle behaviors to be lower at follow-up; participants' perception of the intervention's success was due to the structured educational material and the ongoing nursing care. A systematic review and meta-analysis by García-Rodríguez et al. (2024) showed that nurse-led interventions resulted in an average weight loss of 2.59 kg, with an average BMI reduction of 1.05 kg/m² and a waist circumference reduction of 2.52 cm compared to traditional care, demonstrating that nurse-led education interventions have a consistent and measurable impact on anthropometric changes across diverse patient populations. However, the proposed Capstone project will evaluate outcomes using self-reported weight only and will not include waist circumference or blood pressure measurements Williams et al. (2024) also found that culturally responsive, social determinants of health-focused programming is needed to achieve equity in minority-majority communities like Miami-Dade. Overall, this information demonstrates the viability and efficacy of the intervention selected for the population and intervention setting.

    **Proposed Intervention**

    The intervention will be an eight to twelve-week structured lifestyle modification education program provided in primary care clinics by APRNs and trained nurses. The screening of patients will be done during the routine visits according to the standard BMI evaluation, and patients will be enrolled when their BMI ≥ 25 kg/m². It will consist of at least four, 45-60 minute, individually scheduled sessions focusing on nutrition literacy, caloric balance, physical activity guidelines, portion control, and behavioral self-monitoring strategies every two weeks. To meet the linguistic need of Miami-Dade residents, all educational materials will be available in English and Spanish. For outcome assessment, participants will self-report their baseline weight and follow-up weight at the end of the program. No blood pressure or waist circumference measurements will be collected as part of this Capstone project because those measurements may require additional approval. The outcome will focus on self-reported weight change and participation in the structured lifestyle modification education sessions.at the start and end of the program. The program does not require any specific equipment other than the clinical equipment used in primary care and is designed to be integrated into clinical practice without a large financial investment. The implementation process takes 12 weeks; staff orientation (weeks 1-2), patient education (weeks 3-10) and outcome measurement and documentation (weeks 11-12).

    **Theoretical Framework**

    The project is based on Self-Care Deficit Nursing Theory (Orem, 1971) and Change Theory (Kurt Lewin, 1962). According to Orem's theory, nursing intervention must be implemented when patients don't know or have the ability to participate in needed self-care behaviors. There is a self care deficit in understanding what patients need to do in terms of diet, exercise and behavior modification for obesity management. The educational program proposed explicitly meets this need, and thus helps patients to learn how to manage their weight on their own for the long term. Isik and Fredland (2023) validated that Orem's theory is applicable to the development of self-care behaviors of patients through structured nursing education, which is very relevant to this intervention. Lewin's Change Theory is a model that helps to understand the process of change within behavioral change and how it can be made easier by unfreezing, changing and refreezing. In the unfreeze stage, patients will identify obesity as a risk factor that can be changed and express readiness for change through motivational discussion.Patients will voice readiness for change and recognize obesity as a modifiable risk in the unfreeze stage through motivational discussion. In the transition period, education will provide encouragement of new behaviors and reinforcement of healthier habits. Follow up visits and tools for self monitoring, embedded in the daily routine, continue to increase improvements in the refreezing stage. As such, the application of Lewin's theory in this primary care obesity education program was supported by the work of Amina et al. (2022) who showed that the theory is effective in guiding systematic improvements in healthcare and maintaining patient outcomes in the long-term. These frameworks work together to foster patient empowerment, evidence-based practice, and sustained patient behavior.

    **Conclusion**

    Obesity disproportionately burdens Miami-Dade County residents and contributes to preventable chronic disease, increased healthcare costs, and reduced quality of life. A proposed evidence-based, structured lifestyle modification education program will be investigated as a way to address the critical lack of standardized obesity counseling offered in primary care within one Miami- Dade Primary Care Settings, having been inspired by complementary nutrition theories and strong evidence. This Capstone project is intended to achieve measurable BMI and weight loss within this viable, culturally responsive, APRN-led intervention for vulnerable adults over an 8–12 week period. It represents the critical need for advanced practice nursing to make a major contribution that significantly reduces population-level health disparities through education, advocacy, and evidence-based practice in perhaps the most limited setting possible: the quiet realm of routine primary care.

    **References**

    Amina, S., Khan, M. A., & Patel, M. (2022). Application of Lewin's change theory in healthcare practice improvement: A systematic review.
    _Journal of Nursing Management, 30_(4), 1122–1131.
    [https://doi.org/10.1111/jonm.13571](https://doi.org/10.1111/jonm.13571)

    Centers for Disease Control and Prevention. (2023).
    _Adult obesity facts._ U.S. Department of Health & Human Services.
    [https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)

    García-Rodríguez, R., Vázquez-Rodríguez, A., Bellahmar-Lkadiri, S., Salmonte-Rodríguez, A., Siverio-Díaz, A. R., De Paz-Pérez, P., & García-García, M. (2024). Effectiveness of a nurse-led telehealth intervention to improve adherence to healthy eating and physical activity habits in overweight or obese young adults.
    _Nutrients, 16_(14), 2217.
    [https://doi.org/10.3390/nu16142217](https://doi.org/10.3390/nu16142217)

    Isik, E., & Fredland, N. M. (2023). Orem's self-care deficit nursing theory as a framework for chronic disease self-management: An integrative review.
    _Nursing Science Quarterly, 36_(2), 131–139.
    [https://doi.org/10.1177/08943184231153357](https://doi.org/10.1177/08943184231153357)

    Karam, G., Agarwal, A., Sadeghirad, B., Jalink, M., Hitchcock, C. L., Ge, L., Bhatt, M., Zea, A. M., Milovanovic, M., Choudhuri, S., & Johnston, B. C. (2025). Addressing the challenge of obesity in primary care: A review of effective interventions and implementation strategies.
    _Diabetology & Metabolic Syndrome, 17_(1), 108.
    [https://doi.org/10.1186/s13098-025-01925-z](https://doi.org/10.1186/s13098-025-01925-z)

    Krishnasamy, V., Jayaram, K. M., & Jayaseelan, V. (2024). A qualitative exploration of participants' experiences in a randomized controlled trial of weight reduction through a nurse-led intervention.
    _Journal of Education and Health Promotion, 13_(1), 368. https://doi.org/10.4103/jehp.jehp_1299_23Williams, M. S., McKinney, S. J., & Cheskin, L. J. (2024). Social and structural determinants of health and social injustices contributing to obesity disparities.
    _Current Obe sity Reports, 13_(3), 567–578.
    [https://doi.org/10.1007/s13679-024-00578-9](https://doi.org/10.1007/s13679-024-00578-9)

    **Capstone_Part1.1.docx**

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    **Capstone_Part2.docx**

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    **Capstone_Part2.docx**

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    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## Capstone_Part1.1.docx**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    The obesity epidemic is a public health problem that disproportionately affects low-income and Hispanic communities, as well as urban communities, and is one of the most crisis-stricken in the United States. These rates are even higher in Miami-Dade County, FL, where more than 67% of adults are either overweight or obese, and need systematic, evidence-based intervention through the primary care channel/Centers for Disease Control and Prevention, 2023). The prevalence of adult obesity nationally has risen to 40.3% from August 2021 to August 2023, and for those who were already overweight, the prevalence of severe obesity was 9.4% over this period (Karam et al., 2025). These figures equate with elevated rates of Type 2 diabetes and cardiovascular disease, and hypertension an economic burden for patients and the healthcare system. The cost associated with obesity is substantial for patients, primary care settings, and the overall health care system. Obesity increases the risk for type 2 diabetes, cardiovascular disease, hypertension, and other chronic conditions that require ongoing medical visits, medications, laboratory testing, and disease management. Nationally, obesity costs the United States health care system nearly $173 billion annually. In addition, adults with obesity have approximately $1,861 more in annual medical costs than adults with a healthy weight, while adults with severe obesity have approximately $3,097 more in annual medical costs (Centers for Disease Control and Prevention [CDC], 2023).Nevertheless, few primary care offices have an obesity-focused education program that is consistent from one office to another, and patients are not knowledgeable enough or equipped to lower their body weight to a healthy level. This is a proposed Capstone project: To implement a structured lifestyle modification education program in PC clinics in Miami-Dade County, which will be administered to overweight and obese adults for 8-12 weeks.

    **PICOT Question**

    The clinical question guiding this project is: In overweight or obese adults attending one Miami-Dade primary care setting (P), how does structured lifestyle modification education (I), compared to no standardized education (C), affect self-reported weight reduction (O) over 8–12 weeks (T)?The population consists of adults who are overweight (BMI ≥ 25) or obese and seek health care in primary care settings in counties with a majority Hispanic and Latino population, and often have challenges with access to nutritious food, health care literacy, and safe recreation areas (Williams et al., 2024). The intervention comprises one-on-one counseling provided by Advanced Practice Registered Nurses (APRNs) on nutrition, portion control, physical activity, behavioral self-monitoring, and goal setting. Comparisons are with the current standard of care the absence of any structured obesity education, with patients only receiving general clinical advice. The target is to lose a clinically significant amount of weight or BMI (around 5% of body weight compared with baseline level). A properly structured behavioural programme, as evidenced, can actively produce measurable anthropometric changes in 8-12 weeks time (Krishnasamy et al., 2024).

    **Vulnerable Population and Setting**

    The target population includes overweight and obese adults in Miami-Dade County, home to nearly 2.5 million residents, the majority identifying as Hispanic or Latino. The intersecting social determinants of food insecurity, low household income, limited English language ability, and lack of affordable, nutritious food make this community vulnerable. Studies have found that racial and ethnic minorities and adults with low SES are at higher risk for obesity and less likely to access quality obesity treatment (Williams et al., 2024). Cultural dietary habits and community access to physical activity also contribute to weight gain and to the progression of chronic diseases. One Miami-Dade primary care setting is an ideal setting because it is often the first point of contact between the patient and the healthcare system, allowing for early detection, frequent monitoring, and reinforcement of healthy behaviors during the intervention period.

    **Review of Evidence**

    There is significant peer-reviewed evidence for the effectiveness of structured lifestyle modification education programs in the primary care setting for weight and BMI reduction. Karam et al. (2025) conducted a review of obesity interventions that utilized primary care settings and identified behavioral therapies, such as motivational interviewing and lifestyle modification counseling, to be consistently associated with clinically significant weight loss, suggesting that APRNs and primary care providers are well-equipped to facilitate these therapies. Krishnasamy et al. (2024) assessed a nurse-led intervention in overweight and obese urban adults and found weight-related outcomes and lifestyle behaviors to be lower at follow-up; participants' perception of the intervention's success was due to the structured educational material and the ongoing nursing care. A systematic review and meta-analysis by García-Rodríguez et al. (2024) showed that nurse-led interventions resulted in an average weight loss of 2.59 kg, with an average BMI reduction of 1.05 kg/m² and a waist circumference reduction of 2.52 cm compared to traditional care, demonstrating that nurse-led education interventions have a consistent and measurable impact on anthropometric changes across diverse patient populations. However, the proposed Capstone project will evaluate outcomes using self-reported weight only and will not include waist circumference or blood pressure measurements Williams et al. (2024) also found that culturally responsive, social determinants of health-focused programming is needed to achieve equity in minority-majority communities like Miami-Dade. Overall, this information demonstrates the viability and efficacy of the intervention selected for the population and intervention setting.

    **Proposed Intervention**

    The intervention will be an eight to twelve-week structured lifestyle modification education program provided in primary care clinics by APRNs and trained nurses. The screening of patients will be done during the routine visits according to the standard BMI evaluation, and patients will be enrolled when their BMI ≥ 25 kg/m². It will consist of at least four, 45-60 minute, individually scheduled sessions focusing on nutrition literacy, caloric balance, physical activity guidelines, portion control, and behavioral self-monitoring strategies every two weeks. To meet the linguistic need of Miami-Dade residents, all educational materials will be available in English and Spanish. For outcome assessment, participants will self-report their baseline weight and follow-up weight at the end of the program. No blood pressure or waist circumference measurements will be collected as part of this Capstone project because those measurements may require additional approval. The outcome will focus on self-reported weight change and participation in the structured lifestyle modification education sessions.at the start and end of the program. The program does not require any specific equipment other than the clinical equipment used in primary care and is designed to be integrated into clinical practice without a large financial investment. The implementation process takes 12 weeks; staff orientation (weeks 1-2), patient education (weeks 3-10) and outcome measurement and documentation (weeks 11-12).

    **Theoretical Framework**

    The project is based on Self-Care Deficit Nursing Theory (Orem, 1971) and Change Theory (Kurt Lewin, 1962). According to Orem's theory, nursing intervention must be implemented when patients don't know or have the ability to participate in needed self-care behaviors. There is a self care deficit in understanding what patients need to do in terms of diet, exercise and behavior modification for obesity management. The educational program proposed explicitly meets this need, and thus helps patients to learn how to manage their weight on their own for the long term. Isik and Fredland (2023) validated that Orem's theory is applicable to the development of self-care behaviors of patients through structured nursing education, which is very relevant to this intervention. Lewin's Change Theory is a model that helps to understand the process of change within behavioral change and how it can be made easier by unfreezing, changing and refreezing. In the unfreeze stage, patients will identify obesity as a risk factor that can be changed and express readiness for change through motivational discussion.Patients will voice readiness for change and recognize obesity as a modifiable risk in the unfreeze stage through motivational discussion. In the transition period, education will provide encouragement of new behaviors and reinforcement of healthier habits. Follow up visits and tools for self monitoring, embedded in the daily routine, continue to increase improvements in the refreezing stage. As such, the application of Lewin's theory in this primary care obesity education program was supported by the work of Amina et al. (2022) who showed that the theory is effective in guiding systematic improvements in healthcare and maintaining patient outcomes in the long-term. These frameworks work together to foster patient empowerment, evidence-based practice, and sustained patient behavior.

    **Conclusion**

    Obesity disproportionately burdens Miami-Dade County residents and contributes to preventable chronic disease, increased healthcare costs, and reduced quality of life. A proposed evidence-based, structured lifestyle modification education program will be investigated as a way to address the critical lack of standardized obesity counseling offered in primary care within one Miami- Dade Primary Care Settings, having been inspired by complementary nutrition theories and strong evidence. This Capstone project is intended to achieve measurable BMI and weight loss within this viable, culturally responsive, APRN-led intervention for vulnerable adults over an 8–12 week period. It represents the critical need for advanced practice nursing to make a major contribution that significantly reduces population-level health disparities through education, advocacy, and evidence-based practice in perhaps the most limited setting possible: the quiet realm of routine primary care.

    **References**

    Amina, S., Khan, M. A., & Patel, M. (2022). Application of Lewin's change theory in healthcare practice improvement: A systematic review.
    _Journal of Nursing Management, 30_(4), 1122–1131.
    [https://doi.org/10.1111/jonm.13571](https://doi.org/10.1111/jonm.13571)

    Centers for Disease Control and Prevention. (2023).
    _Adult obesity facts._ U.S. Department of Health & Human Services.
    [https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)

    García-Rodríguez, R., Vázquez-Rodríguez, A., Bellahmar-Lkadiri, S., Salmonte-Rodríguez, A., Siverio-Díaz, A. R., De Paz-Pérez, P., & García-García, M. (2024). Effectiveness of a nurse-led telehealth intervention to improve adherence to healthy eating and physical activity habits in overweight or obese young adults.
    _Nutrients, 16_(14), 2217.
    [https://doi.org/10.3390/nu16142217](https://doi.org/10.3390/nu16142217)

    Isik, E., & Fredland, N. M. (2023). Orem's self-care deficit nursing theory as a framework for chronic disease self-management: An integrative review.
    _Nursing Science Quarterly, 36_(2), 131–139.
    [https://doi.org/10.1177/08943184231153357](https://doi.org/10.1177/08943184231153357)

    Karam, G., Agarwal, A., Sadeghirad, B., Jalink, M., Hitchcock, C. L., Ge, L., Bhatt, M., Zea, A. M., Milovanovic, M., Choudhuri, S., & Johnston, B. C. (2025). Addressing the challenge of obesity in primary care: A review of effective interventions and implementation strategies.
    _Diabetology & Metabolic Syndrome, 17_(1), 108.
    [https://doi.org/10.1186/s13098-025-01925-z](https://doi.org/10.1186/s13098-025-01925-z)

    Krishnasamy, V., Jayaram, K. M., & Jayaseelan, V. (2024). A qualitative exploration of participants' experiences in a randomized controlled trial of weight reduction through a nurse-led intervention.
    _Journal of Education and Health Promotion, 13_(1), 368. https://doi.org/10.4103/jehp.jehp_1299_23Williams, M. S., McKinney, S. J., & Cheskin, L. J. (2024). Social and structural determinants of health and social injustices contributing to obesity disparities.
    _Current Obe sity Reports, 13_(3), 567–578.
    [https://doi.org/10.1007/s13679-024-00578-9](https://doi.org/10.1007/s13679-024-00578-9)

    **Capstone_Part1.1.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstone-part1-1-docx-10565535)

    **Capstone_Part2.docx**

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    **## FinalCapstone.docx**

    Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm

    1.Implementation/Conclusion

    – Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.

    2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.

    3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.

    -Timeline should be presented as a chart or essay format.* Do not use bullet points.

    *Do not use direct implementation of Human Subjects in your proposal. This requires IRB

    approval and CITI training which we will not use for this Capstone.

    4. How would you evaluate the change process?

    -The change must be measurable before and after the implementation.

    -How would you measure or evaluate? Is there a tool to measure?

    5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?

    6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.

    -How will you present the information to your stakeholders? Include cost and budget.

    OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.

    -Use appropriate APA 7th Ed. format

    -Scholarly, peer-reviewed, and research articles cited should be within the last five years.

    -This section should be minimum 3-4 pages long (not including the title and reference page).

    -The final Capstone project should be a minimum of 8 pages.

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

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

    CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
    Implementation of
    the practice change
    20 Points
    Thoroughly
    presented the
    change proposal.
    Included setting,
    time frame,
    population,
    stakeholders, Pros
    and cons/barriers.
    20
    Briefly presented
    the change
    proposal. Briefly
    Included setting,
    time frame,
    stakeholders. Pros
    and cons.
    15
    Vaguely presented
    the change
    proposal. Vaguely
    Included setting,
    time frame,
    stakeholders, Pros
    and cons.
    10
    Did not present the
    change proposal.
    0
    Change proposal
    was measured and
    realistic.
    20 Points
    Thoroughly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    Discussed how it
    will be used and
    implemented.
    20
    Briefly used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    15
    Vaguely used an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    10
    Did not use an
    appropriate
    measurement tool.
    Provided realistic
    outcomes.
    0
    Depth of
    Discussion and
    Cohesiveness
    20 Points
    Thoroughly, In-
    depth discussion
    and elaboration in
    all sections of the
    paper. Follows
    criteria provided in
    addition to
    leadership,
    management,
    budget and
    statistics.
    20
    Briefly, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    15
    Vaguely, In-depth
    discussion and
    elaboration in most
    sections of the
    paper.
    10
    Did not use In-
    depth discussion
    and elaboration in
    most sections of
    the paper.
    0
    Conclusion
    25 Points
    Thoroughly, Ties
    together
    information from all
    sources of Part I,
    II,III. Followed
    feedback and
    comments given
    from faculty.
    25
    Briefly, Ties
    together
    information from all
    sources of Part I,
    II,III
    20
    Vaguely, Ties
    together
    information from all
    sources of Part I,
    II,III
    15
    Does not Tie
    together
    information from all
    sources of Part I,
    II,III
    0
    Spelling and
    Grammar
    5 points
    Fewer than 5
    grammatical,
    spelling,
    capitalization, or
    punctuation errors.
    More than 5 but
    fewer than 10
    grammatical,
    spelling,
    More than 10
    grammatical,
    spelling,
    capitalization &
    punctuation errors
    An unacceptable
    number of spelling
    and/or grammar
    mistakes.

    Required word
    count has been
    met.
    5
    capitalization &
    punctuation errors
    Required word
    count is 25 words
    below the minimum
    required count.
    4
    Required word
    count is 50 words
    below the minimum
    required count.
    3
    Required word
    count is more than
    50 words below the
    minimum required
    count.
    0
    Sources
    5 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
    5 current sources,
    of which at least 2
    are peer-review
    journal articles or
    scholarly books. All
    websites utilized
    are authoritative.
    4
    Fewer than 5
    current sources or
    fewer than 2 of 5
    are peer-reviewed
    journal articles or
    scholarly books. All
    websites utilized
    are credible.
    3
    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.
    0
    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

    **## Capstone_Part1.1.docx**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    **Lifestyle Modification Education for Obesity Management in Primary Care: A Capstone Proposal**

    The obesity epidemic is a public health problem that disproportionately affects low-income and Hispanic communities, as well as urban communities, and is one of the most crisis-stricken in the United States. These rates are even higher in Miami-Dade County, FL, where more than 67% of adults are either overweight or obese, and need systematic, evidence-based intervention through the primary care channel/Centers for Disease Control and Prevention, 2023). The prevalence of adult obesity nationally has risen to 40.3% from August 2021 to August 2023, and for those who were already overweight, the prevalence of severe obesity was 9.4% over this period (Karam et al., 2025). These figures equate with elevated rates of Type 2 diabetes and cardiovascular disease, and hypertension an economic burden for patients and the healthcare system. The cost associated with obesity is substantial for patients, primary care settings, and the overall health care system. Obesity increases the risk for type 2 diabetes, cardiovascular disease, hypertension, and other chronic conditions that require ongoing medical visits, medications, laboratory testing, and disease management. Nationally, obesity costs the United States health care system nearly $173 billion annually. In addition, adults with obesity have approximately $1,861 more in annual medical costs than adults with a healthy weight, while adults with severe obesity have approximately $3,097 more in annual medical costs (Centers for Disease Control and Prevention [CDC], 2023).Nevertheless, few primary care offices have an obesity-focused education program that is consistent from one office to another, and patients are not knowledgeable enough or equipped to lower their body weight to a healthy level. This is a proposed Capstone project: To implement a structured lifestyle modification education program in PC clinics in Miami-Dade County, which will be administered to overweight and obese adults for 8-12 weeks.

    **PICOT Question**

    The clinical question guiding this project is: In overweight or obese adults attending one Miami-Dade primary care setting (P), how does structured lifestyle modification education (I), compared to no standardized education (C), affect self-reported weight reduction (O) over 8–12 weeks (T)?The population consists of adults who are overweight (BMI ≥ 25) or obese and seek health care in primary care settings in counties with a majority Hispanic and Latino population, and often have challenges with access to nutritious food, health care literacy, and safe recreation areas (Williams et al., 2024). The intervention comprises one-on-one counseling provided by Advanced Practice Registered Nurses (APRNs) on nutrition, portion control, physical activity, behavioral self-monitoring, and goal setting. Comparisons are with the current standard of care the absence of any structured obesity education, with patients only receiving general clinical advice. The target is to lose a clinically significant amount of weight or BMI (around 5% of body weight compared with baseline level). A properly structured behavioural programme, as evidenced, can actively produce measurable anthropometric changes in 8-12 weeks time (Krishnasamy et al., 2024).

    **Vulnerable Population and Setting**

    The target population includes overweight and obese adults in Miami-Dade County, home to nearly 2.5 million residents, the majority identifying as Hispanic or Latino. The intersecting social determinants of food insecurity, low household income, limited English language ability, and lack of affordable, nutritious food make this community vulnerable. Studies have found that racial and ethnic minorities and adults with low SES are at higher risk for obesity and less likely to access quality obesity treatment (Williams et al., 2024). Cultural dietary habits and community access to physical activity also contribute to weight gain and to the progression of chronic diseases. One Miami-Dade primary care setting is an ideal setting because it is often the first point of contact between the patient and the healthcare system, allowing for early detection, frequent monitoring, and reinforcement of healthy behaviors during the intervention period.

    **Review of Evidence**

    There is significant peer-reviewed evidence for the effectiveness of structured lifestyle modification education programs in the primary care setting for weight and BMI reduction. Karam et al. (2025) conducted a review of obesity interventions that utilized primary care settings and identified behavioral therapies, such as motivational interviewing and lifestyle modification counseling, to be consistently associated with clinically significant weight loss, suggesting that APRNs and primary care providers are well-equipped to facilitate these therapies. Krishnasamy et al. (2024) assessed a nurse-led intervention in overweight and obese urban adults and found weight-related outcomes and lifestyle behaviors to be lower at follow-up; participants' perception of the intervention's success was due to the structured educational material and the ongoing nursing care. A systematic review and meta-analysis by García-Rodríguez et al. (2024) showed that nurse-led interventions resulted in an average weight loss of 2.59 kg, with an average BMI reduction of 1.05 kg/m² and a waist circumference reduction of 2.52 cm compared to traditional care, demonstrating that nurse-led education interventions have a consistent and measurable impact on anthropometric changes across diverse patient populations. However, the proposed Capstone project will evaluate outcomes using self-reported weight only and will not include waist circumference or blood pressure measurements Williams et al. (2024) also found that culturally responsive, social determinants of health-focused programming is needed to achieve equity in minority-majority communities like Miami-Dade. Overall, this information demonstrates the viability and efficacy of the intervention selected for the population and intervention setting.

    **Proposed Intervention**

    The intervention will be an eight to twelve-week structured lifestyle modification education program provided in primary care clinics by APRNs and trained nurses. The screening of patients will be done during the routine visits according to the standard BMI evaluation, and patients will be enrolled when their BMI ≥ 25 kg/m². It will consist of at least four, 45-60 minute, individually scheduled sessions focusing on nutrition literacy, caloric balance, physical activity guidelines, portion control, and behavioral self-monitoring strategies every two weeks. To meet the linguistic need of Miami-Dade residents, all educational materials will be available in English and Spanish. For outcome assessment, participants will self-report their baseline weight and follow-up weight at the end of the program. No blood pressure or waist circumference measurements will be collected as part of this Capstone project because those measurements may require additional approval. The outcome will focus on self-reported weight change and participation in the structured lifestyle modification education sessions.at the start and end of the program. The program does not require any specific equipment other than the clinical equipment used in primary care and is designed to be integrated into clinical practice without a large financial investment. The implementation process takes 12 weeks; staff orientation (weeks 1-2), patient education (weeks 3-10) and outcome measurement and documentation (weeks 11-12).

    **Theoretical Framework**

    The project is based on Self-Care Deficit Nursing Theory (Orem, 1971) and Change Theory (Kurt Lewin, 1962). According to Orem's theory, nursing intervention must be implemented when patients don't know or have the ability to participate in needed self-care behaviors. There is a self care deficit in understanding what patients need to do in terms of diet, exercise and behavior modification for obesity management. The educational program proposed explicitly meets this need, and thus helps patients to learn how to manage their weight on their own for the long term. Isik and Fredland (2023) validated that Orem's theory is applicable to the development of self-care behaviors of patients through structured nursing education, which is very relevant to this intervention. Lewin's Change Theory is a model that helps to understand the process of change within behavioral change and how it can be made easier by unfreezing, changing and refreezing. In the unfreeze stage, patients will identify obesity as a risk factor that can be changed and express readiness for change through motivational discussion.Patients will voice readiness for change and recognize obesity as a modifiable risk in the unfreeze stage through motivational discussion. In the transition period, education will provide encouragement of new behaviors and reinforcement of healthier habits. Follow up visits and tools for self monitoring, embedded in the daily routine, continue to increase improvements in the refreezing stage. As such, the application of Lewin's theory in this primary care obesity education program was supported by the work of Amina et al. (2022) who showed that the theory is effective in guiding systematic improvements in healthcare and maintaining patient outcomes in the long-term. These frameworks work together to foster patient empowerment, evidence-based practice, and sustained patient behavior.

    **Conclusion**

    Obesity disproportionately burdens Miami-Dade County residents and contributes to preventable chronic disease, increased healthcare costs, and reduced quality of life. A proposed evidence-based, structured lifestyle modification education program will be investigated as a way to address the critical lack of standardized obesity counseling offered in primary care within one Miami- Dade Primary Care Settings, having been inspired by complementary nutrition theories and strong evidence. This Capstone project is intended to achieve measurable BMI and weight loss within this viable, culturally responsive, APRN-led intervention for vulnerable adults over an 8–12 week period. It represents the critical need for advanced practice nursing to make a major contribution that significantly reduces population-level health disparities through education, advocacy, and evidence-based practice in perhaps the most limited setting possible: the quiet realm of routine primary care.

    **References**

    Amina, S., Khan, M. A., & Patel, M. (2022). Application of Lewin's change theory in healthcare practice improvement: A systematic review.
    _Journal of Nursing Management, 30_(4), 1122–1131.
    [https://doi.org/10.1111/jonm.13571](https://doi.org/10.1111/jonm.13571)

    Centers for Disease Control and Prevention. (2023).
    _Adult obesity facts._ U.S. Department of Health & Human Services.
    [https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)

    García-Rodríguez, R., Vázquez-Rodríguez, A., Bellahmar-Lkadiri, S., Salmonte-Rodríguez, A., Siverio-Díaz, A. R., De Paz-Pérez, P., & García-García, M. (2024). Effectiveness of a nurse-led telehealth intervention to improve adherence to healthy eating and physical activity habits in overweight or obese young adults.
    _Nutrients, 16_(14), 2217.
    [https://doi.org/10.3390/nu16142217](https://doi.org/10.3390/nu16142217)

    Isik, E., & Fredland, N. M. (2023). Orem's self-care deficit nursing theory as a framework for chronic disease self-management: An integrative review.
    _Nursing Science Quarterly, 36_(2), 131–139.
    [https://doi.org/10.1177/08943184231153357](https://doi.org/10.1177/08943184231153357)

    Karam, G., Agarwal, A., Sadeghirad, B., Jalink, M., Hitchcock, C. L., Ge, L., Bhatt, M., Zea, A. M., Milovanovic, M., Choudhuri, S., & Johnston, B. C. (2025). Addressing the challenge of obesity in primary care: A review of effective interventions and implementation strategies.
    _Diabetology & Metabolic Syndrome, 17_(1), 108.
    [https://doi.org/10.1186/s13098-025-01925-z](https://doi.org/10.1186/s13098-025-01925-z)

    Krishnasamy, V., Jayaram, K. M., & Jayaseelan, V. (2024). A qualitative exploration of participants' experiences in a randomized controlled trial of weight reduction through a nurse-led intervention.
    _Journal of Education and Health Promotion, 13_(1), 368. https://doi.org/10.4103/jehp.jehp_1299_23Williams, M. S., McKinney, S. J., & Cheskin, L. J. (2024). Social and structural determinants of health and social injustices contributing to obesity disparities.
    _Current Obe sity Reports, 13_(3), 567–578.
    [https://doi.org/10.1007/s13679-024-00578-9](https://doi.org/10.1007/s13679-024-00578-9)

    **Capstone_Part1.1.docx**

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    **Capstone_Part2.docx**

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    **files (1)** – ## NUR670Week1-6discussionasign.pdf **## NUR670Week1-6discussionasign.pdf** Week 1: The PICO Question After studying Module 1: Lecture Materials & Resources, and completing 500 clinical hours, students undoubtedly witness problems or gaps in healthcare. The PICO question Population/ …

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    **files (1)**

    – ## NUR670Week1-6discussionasign.pdf

    **## NUR670Week1-6discussionasign.pdf**

    Week 1: The PICO Question

    After studying Module 1: Lecture Materials & Resources,
    and completing 500 clinical hours, students undoubtedly witness
    problems or gaps in healthcare.  The PICO question Population/
    Patient Problem: (P), Intervention: (I), Comparison: (C), Outcome:
    (O) is to ask a searchable and answerable question that provides
    evidence to improve practice.  In a well-written discussion post
    address, the following:

    • Describe a real-world, current problem in US psychiatric
    care.  This could be a problem that affects clinical decisions
    and may include a broad range of biological, psychological,
    and sociological issues.

    • Formulate a PICO question based on the question chosen in
    the announcement.  You will use this question in each
    discussion for this term.

    • Summarize the reason this PICO question is so important to
    advanced practice nursing.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    [https://stu.instructure.com/courses/53903/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-1-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 2: The Purpose of the
    PICO Question
    After studying Module 2: Lecture Materials & Resources, discuss
    the following:

    • Discuss the purpose defining the purpose of the PICO
    question for the psychiatric mental health nurse practitioner.

    • Explain the purpose of your selected PICO question
    advanced practice psychiatric nurses or the patients or the
    populations they treat.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-2-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 3: Selecting Inclusion/
    Exclusion Criteria
    After studying Module 3: Lecture Materials & Resources, discuss
    the following:

    • Discuss the databases searched to gather the evidence
    based research for your selected PICO question.

    • Describe the inclusion/exclusion criteria used to fine tune
    the evidence-based research for your selected PICO
    question.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-3-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 4 : Creating a Search
    Strategy
    After studying Module 4: Lecture Materials & Resources, discuss
    the following:

    • Compare the reliability of evidence-based research using an
    evidence pyramid.

    • Describe in detail the search strategy used to conduct the
    literature review for your PICO question.  A literature flow
    diagram must be uploaded to this assignment.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-4-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 5: Interpreting the Results
    of the Literature Review
    After studying Module 5: Lecture Materials & Resources, discuss
    the following:

    • Compare the following processes: summarizing the
    literature review and interpreting search results.

    • Describe the process used to interpret the search results of
    your PICO question.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-5-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 6: Methods of
    Dissemination
    After studying Module 6: Lecture Materials & Resources, discuss
    the following:

    • Compare three ways to disseminate research findings.

    • Discuss your plan to disseminate the research findings

    obtained during this course at a state or national platform.
    Include your objective for disseminating the information and
    your target audience.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-6-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 6 Assignment:
    Academic Poster & Presentation
    The purpose of this assignment is to provide the student the
    opportunity to demonstrate competency in performing the role of
    the psychiatric mental health nurse practitioner in a safe
    environment.

    Submission Instructions:

    To complete this assignment, address the following criteria:

    1. Posters should include the following content:

    • A Project title. This should be placed towards the top

    of the poster, including the names of the authors and
    university affiliation.

    • An Introduction section. This should highlight the
    problem addressed in a brief literature review with
    citations and your hypothesis or hypotheses.

    • The Purpose section: The poster states the objectives
    of this inquiry relative to the overall evidence-based
    literature review on this topic.

    • The Methods/Search Strategy section. An overview of
    how you studied your primary source(s): Describe the
    evidence-based solution. How was it developed?
    Include the theoretical framework (if applicable).
    Identify databases searched and inclusion/exclusion
    criteria. A literature flow diagram must be uploaded
    to this assignment.

    • The Results The poster describes the search, the
    number of studies included, and the level of evidence.

    • The Synthesis of Evidence   The poster briefly
    describes the synthesis of the evidence including major
    trends and notable gaps.

    • The Implications for Practice section. The poster
    includes recommendations for practice, education, or
    future research based on the review and synthesis of
    the evidence.

    • A  References section. Make sure your references
    include at least seven references with four primary
    research articles. Primary articles describe studies in
    which the authors collected the data themselves.
    References must be in the current APA format. If you
    cannot fit seven or more references into your poster,
    you should provide the references separately as an
    attached Word document.  For assistance with the
    current APA formatting, please contact BrainFuse
    Online Tutoring link in Canvas or visit the STU library
    at https://www.stu.edu/libraryLinks to an external site.

    Academic Poster Format

    • Present your poster in electronic formatLinks to an external
    site.
    .  Use the linked video as a guide for your assignment.

    • Students may use PowerPoint Poster template.

    will be graded according to the grading rubric below.

    NUR 670 Poster Presentation Rubric (1)
    NUR 670 Poster Presentation Rubric (1)

    Criteria Ratings
    Po
    int
    s

    [https://www.stu.edu/library](https://www.stu.edu/library)

    [https://www.youtube.com/watch?v=_WnhoIbfcoM](https://www.youtube.com/watch?v=_WnhoIbfcoM)

    [https://www.youtube.com/watch?v=_WnhoIbfcoM](https://www.youtube.com/watch?v=_WnhoIbfcoM)

    Project
    Title

    Exemplary

    Thoroughly, accurately, and clearly reflect the content of the presentation.

    5 to >3 pts

    Distinguished

    Reflects content very well but not thoroughly.

    3 to >1 pts

    Novice

    Does not reflect content of the presentation.

    1 to >0 pts

    /5
    pts

    Introducti
    on:

    view longer
    description

    Exemplary

    Identifies a creative, focused, and manageable

    topic that addresses potentially significant and

    previously less explored aspects of the topic,

    problem, and/or project

    5 to >3 pts

    Distinguished

    Project and/or research question moderately described. Moderately clear
    rationale. Purpose was somewhat focused and clear.

    3 to >1 pts

    Novice

    Vaguely described project and/or research question. Weak rationale.
    Purpose was poorly focused and not sufficiently clear.

    1 to >0 pts

    /5
    pts

    Purpose:

    view longer
    description

    Exemplary

    Background information is engaging and leads to a clear purpose statement.
    Relevance to advanced practice nursing and the field of psychiatry is
    articulated well.

    5 to >3 pts

    Distinguished

    Background information is at times unclear or uninteresting. Relevance to
    advanced practice nursing or psychiatry could be more clearly articulated.

    3 to >1 pts

    Novice

    Background information is illogical or unrelated to the topic. There is no
    relevance to advanced practice nursing or the field of psychiatry.

    1 to >0 pts

    /5
    pts

    Search
    Strategy

    view longer
    description

    Exemplary

    Methods are appropriate to address aim/question and connected to the
    purpose of the research; Identifies method used to support thesis or answer
    the research question.

    10 to >6 pts

    Distinguished

    Methods are inappropriate to address research aim or question. Methods are
    unclear or not connected to purpose of research

    6 to >2 pts

    Novice

    Research strategy was not clearly mentioned but implied; or, not appropriate
    for purpose of the research

    2 to >0 pts

    /10
    pts

    Synthesis
    of
    Evidence:

    view longer
    description

    Exemplary

    Thorough comparison and contrast of findings are provided and relate to the
    main discussion points in the order of their appearance in the purpose

    statement. Focus is on research findings rather

    than research methods. Study limitations that might have led to different
    findings are discussed. Gaps and controversies that exist in the literature are
    clearly discussed.

    20 to >13 pts

    Distinguished

    Comparison and contrast of findings are provided but lack thoroughness.
    Discussion of findings could relate better to the main discussion points in

    the purpose statement. Study limitations are discussed, but possible
    connections to differences in findings are not clearly identified. Gaps and
    controversies in the literature are discussed, but clarity could be enhanced.

    13 to >6 pts

    Novice

    Comparison and contrast of findings are lacking.

    Discussion of findings does not relate well to the main discussion points in
    the purpose statement.

    Study limitations are not mentioned. Gaps (what is unknown and needs to be
    researched) and controversies that exist in the literature are not discussed.

    6 to >0 pts

    /20
    pts

    Implicatio
    ns for
    Practice:

    view longer
    description

    Exemplary

    Thorough comparison and contrast

    of findings are provided and relate to

    the main discussion points in the order

    of their appearance in the purpose

    statement.

    � Focus is on research findings rather

    than research methods.

    10 to >6 pts

    Distinguished

    Comparison and contrast of findings are provided but lack thoroughness.
    Discussion of findings could relate better to the main discussion points in

    the purpose statement. Study limitations are discussed, but possible
    connections to differences in findings are not clearly identified. Gaps and
    controversies in the literature are discussed, but clarity could be enhanced.

    6 to >2 pts

    Novice

    Comparison and contrast of findings are lacking. Discussion of findings does
    not relate well to the main discussion points in the purpose statement.

    Study limitations are not mentioned. Gaps (what is unknown and needs to be
    researched) and controversies that exist in the literature are not

    discussed.

    2 to >0 pts

    /10
    pts

    Writing
    and
    Scholarly
    Voice:

    view longer
    description

    Exemplary

    Writing is fluid, precise, and clear; lexicon of the field is clearly explained and
    defined; the tone is professional; vocabulary and syntax are mature; scholarly
    style and format are accurately used;

    the candidate’s ‘voice’ is heard and yields a definitive presence, authority, and
    understanding of the issues being discussed.

    5 to >3 pts

    Distinguished

    Writing is somewhat developed and professional; spelling, punctuation,
    grammar, in general, meet program and institutional standards; dissertation
    formatting is adequate; the lexicon of the respective field is understood and
    used

    properly.

    3 to >1 pts

    Novice

    More work developing academic writing skills

    necessary; syntax or vocabulary may not be well

    developed; a reliance on jargon may be a weakness,

    writing may be difficult to read or understand; tone

    may not exhibit an understanding of the academic writing genre; errors of
    spelling, punctuation

    or formatting may be present; document may have

    formatting problems, the candidate may not have a

    command of the field’s lexicon.

    1 to >0 pts

    /5
    pts

    Oral
    Presentat
    ion

    view longer
    description

    Exemplary

    Narration and/or answering of questions is engaging, thorough, and adds
    greatly to the presentation. Presentation is well-rehearsed. Voice, eye contact
    and pacing hold interest and attention of the audience; introduced self and
    project.

    20 to >12 pts

    Distinguished

    Narration and/or answering of questions is somewhat lacking. Audio-Video
    presentation does not support the content of the presentation. Some difficulty
    communicating ideas. Poor voice projections; some eye contact; no
    introduction; mispronounced a few words; long pauses; appears somewhat
    confused.

    12 to >3 pts

    Novice

    Narration and/or answering of questions is lacking, Audio-Video presentation
    was not submitted or the video was not created using the audio or video
    platform required in the instructions. Great difficulty communicating ideas.
    Poor voice projection; no eye contact; no introduction; mispronounced
    words; stopped or had long pauses; read entirely from notes

    3 to >0 pts

    /20
    pts

    Overall
    Appearan
    ce

    view longer
    description

    Exemplary

    Prominently positions title/authors of paper thoroughly but concisely presents
    main points of introduction, hypotheses/ propositions, research methods,
    results, and conclusions in a well-organized manner.

    Overall visually appealing; not cluttered; colors and patterns enhance
    readability; Uses font sizes/variations which facilitate the organization,
    presentation, and readability of the research

    Graphics (e.g., tables, figures, etc.) are engaging and enhance the text
    content is clearly arranged so that the viewer can understand order without
    narration

    10 to >6 pts

    Distinguished

    Visual appeal is adequate; somewhat cluttered; colors and patterns detract
    from readability

    Use of font sizes/variations to facilitate the organization, presentation, and
    readability of the research is somewhat inconsistent/distractions

    Graphics (e.g., tables, figures, etc.) adequately enhance the text

    Content arrangement is somewhat confusing and does not adequately assist
    the viewer in understanding order without narration

    6 to >2 pts

    Novice

    Not very visually appealing; cluttered; colors and patterns hinder readability

    Use of font sizes/variations to facilitate the organization, presentation, and
    readability of the research is inconsistent/distracting

    Graphics (e.g., tables, figures, etc.) do not enhance the text

    Content arrangement is somewhat confusing and does not adequately assist
    the viewer in understanding order without narration

    2 to >0 pts

    /10
    pts

    APA
    Formattin
    g

    view longer
    description

    Exemplary

    Follows APA guidelines of components: double space, 12 pt. font, abstract,
    level headings, hanging indent and in-text citations. The references contain at
    least the 6-8 required current scholarly academic reference and text
    reference.

    10 to >6 pts

    Distinguished

    References page contains one current or outdated scholarly academic
    resource. Many errors of APA 7th guidelines: double space, 12 pt. font,
    abstract, level headings, hanging indent, and in-text citations

    6 to >2 pts

    Novice

    References page contains no current scholarly academic resources, only
    internet webpages or no reference page. Lack of APA guidelines for
    references provided or in-text citations.

    2 to >0 pts

    /10
    pts

    **## NUR670Week1-6discussionasign.pdf**

    Week 1: The PICO Question

    After studying Module 1: Lecture Materials & Resources,
    and completing 500 clinical hours, students undoubtedly witness
    problems or gaps in healthcare.  The PICO question Population/
    Patient Problem: (P), Intervention: (I), Comparison: (C), Outcome:
    (O) is to ask a searchable and answerable question that provides
    evidence to improve practice.  In a well-written discussion post
    address, the following:

    • Describe a real-world, current problem in US psychiatric
    care.  This could be a problem that affects clinical decisions
    and may include a broad range of biological, psychological,
    and sociological issues.

    • Formulate a PICO question based on the question chosen in
    the announcement.  You will use this question in each
    discussion for this term.

    • Summarize the reason this PICO question is so important to
    advanced practice nursing.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    [https://stu.instructure.com/courses/53903/pages/module-1-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-1-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 2: The Purpose of the
    PICO Question
    After studying Module 2: Lecture Materials & Resources, discuss
    the following:

    • Discuss the purpose defining the purpose of the PICO
    question for the psychiatric mental health nurse practitioner.

    • Explain the purpose of your selected PICO question
    advanced practice psychiatric nurses or the patients or the
    populations they treat.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-2-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-2-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 3: Selecting Inclusion/
    Exclusion Criteria
    After studying Module 3: Lecture Materials & Resources, discuss
    the following:

    • Discuss the databases searched to gather the evidence
    based research for your selected PICO question.

    • Describe the inclusion/exclusion criteria used to fine tune
    the evidence-based research for your selected PICO
    question.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-3-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-3-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 4 : Creating a Search
    Strategy
    After studying Module 4: Lecture Materials & Resources, discuss
    the following:

    • Compare the reliability of evidence-based research using an
    evidence pyramid.

    • Describe in detail the search strategy used to conduct the
    literature review for your PICO question.  A literature flow
    diagram must be uploaded to this assignment.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-4-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-4-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 5: Interpreting the Results
    of the Literature Review
    After studying Module 5: Lecture Materials & Resources, discuss
    the following:

    • Compare the following processes: summarizing the
    literature review and interpreting search results.

    • Describe the process used to interpret the search results of
    your PICO question.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-5-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-5-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 6: Methods of
    Dissemination
    After studying Module 6: Lecture Materials & Resources, discuss
    the following:

    • Compare three ways to disseminate research findings.

    • Discuss your plan to disseminate the research findings

    obtained during this course at a state or national platform.
    Include your objective for disseminating the information and
    your target audience.

    Submission Instructions:

    • Your initial post should be at least 500 words, formatted and
    cited in the current APA style.

    • Provide support for your work from at least five academic
    sources less than 5 years old. Visit Purdue OwlLinks to an
    external site.
    for specific examples on how to create in-text citations and
    cite references using the current APA format.

    • Students will use this PICO question when creating the
    abstract and academic poster.

    • Students may not duplicate the PICO question of another
    student at St. Thomas University.

    • Your initial post is worth 8 points.

    [https://stu.instructure.com/courses/53903/pages/module-6-lecture-materials-and-resources](https://stu.instructure.com/courses/53903/pages/module-6-lecture-materials-and-resources)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    [https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html](https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html)

    Week 6 Assignment:
    Academic Poster & Presentation
    The purpose of this assignment is to provide the student the
    opportunity to demonstrate competency in performing the role of
    the psychiatric mental health nurse practitioner in a safe
    environment.

    Submission Instructions:

    To complete this assignment, address the following criteria:

    1. Posters should include the following content:

    • A Project title. This should be placed towards the top

    of the poster, including the names of the authors and
    university affiliation.

    • An Introduction section. This should highlight the
    problem addressed in a brief literature review with
    citations and your hypothesis or hypotheses.

    • The Purpose section: The poster states the objectives
    of this inquiry relative to the overall evidence-based
    literature review on this topic.

    • The Methods/Search Strategy section. An overview of
    how you studied your primary source(s): Describe the
    evidence-based solution. How was it developed?
    Include the theoretical framework (if applicable).
    Identify databases searched and inclusion/exclusion
    criteria. A literature flow diagram must be uploaded
    to this assignment.

    • The Results The poster describes the search, the
    number of studies included, and the level of evidence.

    • The Synthesis of Evidence   The poster briefly
    describes the synthesis of the evidence including major
    trends and notable gaps.

    • The Implications for Practice section. The poster
    includes recommendations for practice, education, or
    future research based on the review and synthesis of
    the evidence.

    • A  References section. Make sure your references
    include at least seven references with four primary
    research articles. Primary articles describe studies in
    which the authors collected the data themselves.
    References must be in the current APA format. If you
    cannot fit seven or more references into your poster,
    you should provide the references separately as an
    attached Word document.  For assistance with the
    current APA formatting, please contact BrainFuse
    Online Tutoring link in Canvas or visit the STU library
    at https://www.stu.edu/libraryLinks to an external site.

    Academic Poster Format

    • Present your poster in electronic formatLinks to an external
    site.
    .  Use the linked video as a guide for your assignment.

    • Students may use PowerPoint Poster template.

    will be graded according to the grading rubric below.

    NUR 670 Poster Presentation Rubric (1)
    NUR 670 Poster Presentation Rubric (1)

    Criteria Ratings
    Po
    int
    s

    [https://www.stu.edu/library](https://www.stu.edu/library)

    [https://www.youtube.com/watch?v=_WnhoIbfcoM](https://www.youtube.com/watch?v=_WnhoIbfcoM)

    [https://www.youtube.com/watch?v=_WnhoIbfcoM](https://www.youtube.com/watch?v=_WnhoIbfcoM)

    Project
    Title

    Exemplary

    Thoroughly, accurately, and clearly reflect the content of the presentation.

    5 to >3 pts

    Distinguished

    Reflects content very well but not thoroughly.

    3 to >1 pts

    Novice

    Does not reflect content of the presentation.

    1 to >0 pts

    /5
    pts

    Introducti
    on:

    view longer
    description

    Exemplary

    Identifies a creative, focused, and manageable

    topic that addresses potentially significant and

    previously less explored aspects of the topic,

    problem, and/or project

    5 to >3 pts

    Distinguished

    Project and/or research question moderately described. Moderately clear
    rationale. Purpose was somewhat focused and clear.

    3 to >1 pts

    Novice

    Vaguely described project and/or research question. Weak rationale.
    Purpose was poorly focused and not sufficiently clear.

    1 to >0 pts

    /5
    pts

    Purpose:

    view longer
    description

    Exemplary

    Background information is engaging and leads to a clear purpose statement.
    Relevance to advanced practice nursing and the field of psychiatry is
    articulated well.

    5 to >3 pts

    Distinguished

    Background information is at times unclear or uninteresting. Relevance to
    advanced practice nursing or psychiatry could be more clearly articulated.

    3 to >1 pts

    Novice

    Background information is illogical or unrelated to the topic. There is no
    relevance to advanced practice nursing or the field of psychiatry.

    1 to >0 pts

    /5
    pts

    Search
    Strategy

    view longer
    description

    Exemplary

    Methods are appropriate to address aim/question and connected to the
    purpose of the research; Identifies method used to support thesis or answer
    the research question.

    10 to >6 pts

    Distinguished

    Methods are inappropriate to address research aim or question. Methods are
    unclear or not connected to purpose of research

    6 to >2 pts

    Novice

    Research strategy was not clearly mentioned but implied; or, not appropriate
    for purpose of the research

    2 to >0 pts

    /10
    pts

    Synthesis
    of
    Evidence:

    view longer
    description

    Exemplary

    Thorough comparison and contrast of findings are provided and relate to the
    main discussion points in the order of their appearance in the purpose

    statement. Focus is on research findings rather

    than research methods. Study limitations that might have led to different
    findings are discussed. Gaps and controversies that exist in the literature are
    clearly discussed.

    20 to >13 pts

    Distinguished

    Comparison and contrast of findings are provided but lack thoroughness.
    Discussion of findings could relate better to the main discussion points in

    the purpose statement. Study limitations are discussed, but possible
    connections to differences in findings are not clearly identified. Gaps and
    controversies in the literature are discussed, but clarity could be enhanced.

    13 to >6 pts

    Novice

    Comparison and contrast of findings are lacking.

    Discussion of findings does not relate well to the main discussion points in
    the purpose statement.

    Study limitations are not mentioned. Gaps (what is unknown and needs to be
    researched) and controversies that exist in the literature are not discussed.

    6 to >0 pts

    /20
    pts

    Implicatio
    ns for
    Practice:

    view longer
    description

    Exemplary

    Thorough comparison and contrast

    of findings are provided and relate to

    the main discussion points in the order

    of their appearance in the purpose

    statement.

    � Focus is on research findings rather

    than research methods.

    10 to >6 pts

    Distinguished

    Comparison and contrast of findings are provided but lack thoroughness.
    Discussion of findings could relate better to the main discussion points in

    the purpose statement. Study limitations are discussed, but possible
    connections to differences in findings are not clearly identified. Gaps and
    controversies in the literature are discussed, but clarity could be enhanced.

    6 to >2 pts

    Novice

    Comparison and contrast of findings are lacking. Discussion of findings does
    not relate well to the main discussion points in the purpose statement.

    Study limitations are not mentioned. Gaps (what is unknown and needs to be
    researched) and controversies that exist in the literature are not

    discussed.

    2 to >0 pts

    /10
    pts

    Writing
    and
    Scholarly
    Voice:

    view longer
    description

    Exemplary

    Writing is fluid, precise, and clear; lexicon of the field is clearly explained and
    defined; the tone is professional; vocabulary and syntax are mature; scholarly
    style and format are accurately used;

    the candidate’s ‘voice’ is heard and yields a definitive presence, authority, and
    understanding of the issues being discussed.

    5 to >3 pts

    Distinguished

    Writing is somewhat developed and professional; spelling, punctuation,
    grammar, in general, meet program and institutional standards; dissertation
    formatting is adequate; the lexicon of the respective field is understood and
    used

    properly.

    3 to >1 pts

    Novice

    More work developing academic writing skills

    necessary; syntax or vocabulary may not be well

    developed; a reliance on jargon may be a weakness,

    writing may be difficult to read or understand; tone

    may not exhibit an understanding of the academic writing genre; errors of
    spelling, punctuation

    or formatting may be present; document may have

    formatting problems, the candidate may not have a

    command of the field’s lexicon.

    1 to >0 pts

    /5
    pts

    Oral
    Presentat
    ion

    view longer
    description

    Exemplary

    Narration and/or answering of questions is engaging, thorough, and adds
    greatly to the presentation. Presentation is well-rehearsed. Voice, eye contact
    and pacing hold interest and attention of the audience; introduced self and
    project.

    20 to >12 pts

    Distinguished

    Narration and/or answering of questions is somewhat lacking. Audio-Video
    presentation does not support the content of the presentation. Some difficulty
    communicating ideas. Poor voice projections; some eye contact; no
    introduction; mispronounced a few words; long pauses; appears somewhat
    confused.

    12 to >3 pts

    Novice

    Narration and/or answering of questions is lacking, Audio-Video presentation
    was not submitted or the video was not created using the audio or video
    platform required in the instructions. Great difficulty communicating ideas.
    Poor voice projection; no eye contact; no introduction; mispronounced
    words; stopped or had long pauses; read entirely from notes

    3 to >0 pts

    /20
    pts

    Overall
    Appearan
    ce

    view longer
    description

    Exemplary

    Prominently positions title/authors of paper thoroughly but concisely presents
    main points of introduction, hypotheses/ propositions, research methods,
    results, and conclusions in a well-organized manner.

    Overall visually appealing; not cluttered; colors and patterns enhance
    readability; Uses font sizes/variations which facilitate the organization,
    presentation, and readability of the research

    Graphics (e.g., tables, figures, etc.) are engaging and enhance the text
    content is clearly arranged so that the viewer can understand order without
    narration

    10 to >6 pts

    Distinguished

    Visual appeal is adequate; somewhat cluttered; colors and patterns detract
    from readability

    Use of font sizes/variations to facilitate the organization, presentation, and
    readability of the research is somewhat inconsistent/distractions

    Graphics (e.g., tables, figures, etc.) adequately enhance the text

    Content arrangement is somewhat confusing and does not adequately assist
    the viewer in understanding order without narration

    6 to >2 pts

    Novice

    Not very visually appealing; cluttered; colors and patterns hinder readability

    Use of font sizes/variations to facilitate the organization, presentation, and
    readability of the research is inconsistent/distracting

    Graphics (e.g., tables, figures, etc.) do not enhance the text

    Content arrangement is somewhat confusing and does not adequately assist
    the viewer in understanding order without narration

    2 to >0 pts

    /10
    pts

    APA
    Formattin
    g

    view longer
    description

    Exemplary

    Follows APA guidelines of components: double space, 12 pt. font, abstract,
    level headings, hanging indent and in-text citations. The references contain at
    least the 6-8 required current scholarly academic reference and text
    reference.

    10 to >6 pts

    Distinguished

    References page contains one current or outdated scholarly academic
    resource. Many errors of APA 7th guidelines: double space, 12 pt. font,
    abstract, level headings, hanging indent, and in-text citations

    6 to >2 pts

    Novice

    References page contains no current scholarly academic resources, only
    internet webpages or no reference page. Lack of APA guidelines for
    references provided or in-text citations.

    2 to >0 pts

    /10
    pts

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

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    **files (2)** – ## DecisionMaking.docx – ## Outline.docx **## DecisionMaking.docx** Decision Making-DAX-DL01 Nora Hernandez-Pupo Decision Making Process Paper Due 6 pages Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formattin…

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    Assignment Prompt & Instructions

    **files (2)**

    – ## DecisionMaking.docx

    – ## Outline.docx

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## Outline.docx**

    2

    **Outline: Alarm Fatigue and Technology Overload**

    Anisleidy Alvarez

    Florida National University

    Decision Making

    Dr. Nora Hernandez-Pupo

    May 20, 2026

    **Outline: Alarm Fatigue and Technology Overload**

    **I. Introduction**

    1. Background Information: Alarm fatigue refers to a phenomenon where nurses become accustomed to the high frequency of clinical alarms in an acute care environment, potentially compromising patient care at all levels of practice (Michels et al., 2025).

    2. Statement of the Problem: Many of the clinical alarms are not actionable, but nurses must assess each one, resulting in nurse burnout, missed critical events, and suboptimal care (Shaoru et al., 2023; (Hani & Abu (2024).

    3. Thesis Statement: To overcome alarm fatigue, bedside nurses, nurse managers, and advanced practice nurses must work together to integrate evidence-based decision-making processes to decrease the burden of alarms and enhance patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research:**

    1. Alarm fatigue is a known phenomenon that negatively impacts patient safety and nurse health (Michels et al., 2025).

    2. Research has confirmed that high alarm volumes lead to sensory overload and desensitization and delay action on actionable alarms (Ron et al., 2025).

    3. Educational interventions on alarm management knowledge have demonstrated measurable improvement in nurses' behavioural response to alarms (Nyarko et al., 2023).

    **B. Key Theories and Models:**

    1.
    **Shared Decision-Making (SDM) Model:** Involvement of nurses, technology teams and leadership in the development of unit and institutional level alarm management policies.

    2.
    **Clinical Judgment Model (NCSBN):** Offers guidance to bedside nurses on how to identify, interpret, and evaluate the significance of alarms in the context of the unique patient (NCLEX, 2024).

    3.
    **Transformational Leadership Model:** Supports nurse leaders and advanced practice nurses in the facilitation of alarm management changes at a culture or system level (Ystaas et al., 2023).

    **III. Main Body/Discussion**

    **A. Topic 1: Analysis and Context**

    1. Alarm fatigue is caused by multiple exposure to excessive, mostly non-actionable alarms from multiple monitoring devices (Michels et al., 2025).

    **Subpoints:**

    · In intensive care units (ICUs), up to 820 alarms are generated per patient per day (Uçak et al., 2025).

    · The stress and burnout experienced by nurses is directly related to alarm fatigue (Hani & Abu, 2024).

    **B. Second Topic: Comparative Analysis**

    Various models of decision making are relevant at different levels of nursing practice.

    **Subpoints:**

    · Bedside nurses use Clinical Judgment Model to individualize the alarm threshold and decrease non-actional alarms (NCLEX, 2024).

    · Nurse managers use SDM to develop alarm reduction plans for their units in collaboration with the frontline staff.

    · Advanced practice nurses and CNOs use Transformational Leadership to champion institutional policy changes, technology purchases, and interprofessional alarm stewardship initiatives (Ystaas et al., 2023).

    **C. Third Topic: Application and Implications**

    Each of the models for decision making is feasible in all clinical settings to address the issue of alarm fatigue.

    **Subpoints:**

    · Benefits: Decreased nurse burnout, quicker response to critical alarms, enhanced patient safety outcomes (Nyarko et al., 2023).

    · Limitations: Demand for resources, staff resistance to change in protocol, and technology infrastructure limitations.

    · Recommendations: tiered alarm systems, mandatory alarm management education and interprofessional task forces.

    · Funding: HRSA Patient Safety Improvement grants and Sigma Theta Tau International nursing research funding.

    **IV. Conclusion**

    **Point A**

    1. Summary of Key Points – Alarm fatigue is a multi-level nursing problem that requires coordinated evidence-based decision-making processes of bedside nurses, nurse managers, and advanced practice nurses.

    2. Implications and Next Steps: The models of shared decision making, clinical judgment, and transformational leadership provide evidence informed next steps to reduce the burden of alarms, improve patient safety outcomes and inform institutional quality improvement efforts.

    **References**

    Hani, S. B., & Abu, A. (2024). Relationship Between Alarm Fatigue and Stress Among Acute Care Nurses: A Cross-Sectional Study.
    _SAGE Open Nursing_,
    _10_. https://doi.org/10.1177/23779608241292584

    Michels, E. A. M., Gilbert, S., Koval, I., & Wekenborg, M. K. (2025). Alarm fatigue in healthcare: a scoping review of definitions, influencing factors, and mitigation strategies.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03369-2

    NCLEX. (2024).
    _Clinical Judgment Measurement Model_. NCLEX. https://www.nclex.com/clinical-judgment-measurement-model.page

    Nyarko, B. A., Nie, H., Yin, Z., Chai, X., & Yue, L. (2022). The effect of educational interventions in managing nurses’ alarm fatigue: An integrative review.
    _Journal of Clinical Nursing_,
    _32_(13-14). https://doi.org/10.1111/jocn.16479

    Ron, R., Barnett, I., Berger, R., & Sberro-Cohen, S. (2025). Alarm fatigue mitigation through nurse empowerment: a pre-post intervention study in two intensive care units.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03613-9

    Shaoru, C., Zhi, H., Wu, S., Ruxin, J., Huiyi, Z., Zhang, H., & Zhang, H. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review.
    _SAGE Open Nursing_,
    _9_(9). https://doi.org/10.1177/23779608231207227

    Uçak, A., Cebeci, F., & Tat Çatal, A. (2025). Nurses’ Alarm Fatigue Levels in Adult Intensive Care Units and Their Strategies to Reduce Fatigue: A Convergent Parallel Design.
    _Journal of Clinical Nursing_,
    _34_(5). https://doi.org/10.1111/jocn.17644

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients’ outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

    **## Outline.docx**

    2

    **Outline: Alarm Fatigue and Technology Overload**

    Anisleidy Alvarez

    Florida National University

    Decision Making

    Dr. Nora Hernandez-Pupo

    May 20, 2026

    **Outline: Alarm Fatigue and Technology Overload**

    **I. Introduction**

    1. Background Information: Alarm fatigue refers to a phenomenon where nurses become accustomed to the high frequency of clinical alarms in an acute care environment, potentially compromising patient care at all levels of practice (Michels et al., 2025).

    2. Statement of the Problem: Many of the clinical alarms are not actionable, but nurses must assess each one, resulting in nurse burnout, missed critical events, and suboptimal care (Shaoru et al., 2023; (Hani & Abu (2024).

    3. Thesis Statement: To overcome alarm fatigue, bedside nurses, nurse managers, and advanced practice nurses must work together to integrate evidence-based decision-making processes to decrease the burden of alarms and enhance patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research:**

    1. Alarm fatigue is a known phenomenon that negatively impacts patient safety and nurse health (Michels et al., 2025).

    2. Research has confirmed that high alarm volumes lead to sensory overload and desensitization and delay action on actionable alarms (Ron et al., 2025).

    3. Educational interventions on alarm management knowledge have demonstrated measurable improvement in nurses' behavioural response to alarms (Nyarko et al., 2023).

    **B. Key Theories and Models:**

    1.
    **Shared Decision-Making (SDM) Model:** Involvement of nurses, technology teams and leadership in the development of unit and institutional level alarm management policies.

    2.
    **Clinical Judgment Model (NCSBN):** Offers guidance to bedside nurses on how to identify, interpret, and evaluate the significance of alarms in the context of the unique patient (NCLEX, 2024).

    3.
    **Transformational Leadership Model:** Supports nurse leaders and advanced practice nurses in the facilitation of alarm management changes at a culture or system level (Ystaas et al., 2023).

    **III. Main Body/Discussion**

    **A. Topic 1: Analysis and Context**

    1. Alarm fatigue is caused by multiple exposure to excessive, mostly non-actionable alarms from multiple monitoring devices (Michels et al., 2025).

    **Subpoints:**

    · In intensive care units (ICUs), up to 820 alarms are generated per patient per day (Uçak et al., 2025).

    · The stress and burnout experienced by nurses is directly related to alarm fatigue (Hani & Abu, 2024).

    **B. Second Topic: Comparative Analysis**

    Various models of decision making are relevant at different levels of nursing practice.

    **Subpoints:**

    · Bedside nurses use Clinical Judgment Model to individualize the alarm threshold and decrease non-actional alarms (NCLEX, 2024).

    · Nurse managers use SDM to develop alarm reduction plans for their units in collaboration with the frontline staff.

    · Advanced practice nurses and CNOs use Transformational Leadership to champion institutional policy changes, technology purchases, and interprofessional alarm stewardship initiatives (Ystaas et al., 2023).

    **C. Third Topic: Application and Implications**

    Each of the models for decision making is feasible in all clinical settings to address the issue of alarm fatigue.

    **Subpoints:**

    · Benefits: Decreased nurse burnout, quicker response to critical alarms, enhanced patient safety outcomes (Nyarko et al., 2023).

    · Limitations: Demand for resources, staff resistance to change in protocol, and technology infrastructure limitations.

    · Recommendations: tiered alarm systems, mandatory alarm management education and interprofessional task forces.

    · Funding: HRSA Patient Safety Improvement grants and Sigma Theta Tau International nursing research funding.

    **IV. Conclusion**

    **Point A**

    1. Summary of Key Points – Alarm fatigue is a multi-level nursing problem that requires coordinated evidence-based decision-making processes of bedside nurses, nurse managers, and advanced practice nurses.

    2. Implications and Next Steps: The models of shared decision making, clinical judgment, and transformational leadership provide evidence informed next steps to reduce the burden of alarms, improve patient safety outcomes and inform institutional quality improvement efforts.

    **References**

    Hani, S. B., & Abu, A. (2024). Relationship Between Alarm Fatigue and Stress Among Acute Care Nurses: A Cross-Sectional Study.
    _SAGE Open Nursing_,
    _10_. https://doi.org/10.1177/23779608241292584

    Michels, E. A. M., Gilbert, S., Koval, I., & Wekenborg, M. K. (2025). Alarm fatigue in healthcare: a scoping review of definitions, influencing factors, and mitigation strategies.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03369-2

    NCLEX. (2024).
    _Clinical Judgment Measurement Model_. NCLEX. https://www.nclex.com/clinical-judgment-measurement-model.page

    Nyarko, B. A., Nie, H., Yin, Z., Chai, X., & Yue, L. (2022). The effect of educational interventions in managing nurses’ alarm fatigue: An integrative review.
    _Journal of Clinical Nursing_,
    _32_(13-14). https://doi.org/10.1111/jocn.16479

    Ron, R., Barnett, I., Berger, R., & Sberro-Cohen, S. (2025). Alarm fatigue mitigation through nurse empowerment: a pre-post intervention study in two intensive care units.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03613-9

    Shaoru, C., Zhi, H., Wu, S., Ruxin, J., Huiyi, Z., Zhang, H., & Zhang, H. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review.
    _SAGE Open Nursing_,
    _9_(9). https://doi.org/10.1177/23779608231207227

    Uçak, A., Cebeci, F., & Tat Çatal, A. (2025). Nurses’ Alarm Fatigue Levels in Adult Intensive Care Units and Their Strategies to Reduce Fatigue: A Convergent Parallel Design.
    _Journal of Clinical Nursing_,
    _34_(5). https://doi.org/10.1111/jocn.17644

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients’ outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## Outline.docx**

    2

    **Outline: Alarm Fatigue and Technology Overload**

    Anisleidy Alvarez

    Florida National University

    Decision Making

    Dr. Nora Hernandez-Pupo

    May 20, 2026

    **Outline: Alarm Fatigue and Technology Overload**

    **I. Introduction**

    1. Background Information: Alarm fatigue refers to a phenomenon where nurses become accustomed to the high frequency of clinical alarms in an acute care environment, potentially compromising patient care at all levels of practice (Michels et al., 2025).

    2. Statement of the Problem: Many of the clinical alarms are not actionable, but nurses must assess each one, resulting in nurse burnout, missed critical events, and suboptimal care (Shaoru et al., 2023; (Hani & Abu (2024).

    3. Thesis Statement: To overcome alarm fatigue, bedside nurses, nurse managers, and advanced practice nurses must work together to integrate evidence-based decision-making processes to decrease the burden of alarms and enhance patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research:**

    1. Alarm fatigue is a known phenomenon that negatively impacts patient safety and nurse health (Michels et al., 2025).

    2. Research has confirmed that high alarm volumes lead to sensory overload and desensitization and delay action on actionable alarms (Ron et al., 2025).

    3. Educational interventions on alarm management knowledge have demonstrated measurable improvement in nurses' behavioural response to alarms (Nyarko et al., 2023).

    **B. Key Theories and Models:**

    1.
    **Shared Decision-Making (SDM) Model:** Involvement of nurses, technology teams and leadership in the development of unit and institutional level alarm management policies.

    2.
    **Clinical Judgment Model (NCSBN):** Offers guidance to bedside nurses on how to identify, interpret, and evaluate the significance of alarms in the context of the unique patient (NCLEX, 2024).

    3.
    **Transformational Leadership Model:** Supports nurse leaders and advanced practice nurses in the facilitation of alarm management changes at a culture or system level (Ystaas et al., 2023).

    **III. Main Body/Discussion**

    **A. Topic 1: Analysis and Context**

    1. Alarm fatigue is caused by multiple exposure to excessive, mostly non-actionable alarms from multiple monitoring devices (Michels et al., 2025).

    **Subpoints:**

    · In intensive care units (ICUs), up to 820 alarms are generated per patient per day (Uçak et al., 2025).

    · The stress and burnout experienced by nurses is directly related to alarm fatigue (Hani & Abu, 2024).

    **B. Second Topic: Comparative Analysis**

    Various models of decision making are relevant at different levels of nursing practice.

    **Subpoints:**

    · Bedside nurses use Clinical Judgment Model to individualize the alarm threshold and decrease non-actional alarms (NCLEX, 2024).

    · Nurse managers use SDM to develop alarm reduction plans for their units in collaboration with the frontline staff.

    · Advanced practice nurses and CNOs use Transformational Leadership to champion institutional policy changes, technology purchases, and interprofessional alarm stewardship initiatives (Ystaas et al., 2023).

    **C. Third Topic: Application and Implications**

    Each of the models for decision making is feasible in all clinical settings to address the issue of alarm fatigue.

    **Subpoints:**

    · Benefits: Decreased nurse burnout, quicker response to critical alarms, enhanced patient safety outcomes (Nyarko et al., 2023).

    · Limitations: Demand for resources, staff resistance to change in protocol, and technology infrastructure limitations.

    · Recommendations: tiered alarm systems, mandatory alarm management education and interprofessional task forces.

    · Funding: HRSA Patient Safety Improvement grants and Sigma Theta Tau International nursing research funding.

    **IV. Conclusion**

    **Point A**

    1. Summary of Key Points – Alarm fatigue is a multi-level nursing problem that requires coordinated evidence-based decision-making processes of bedside nurses, nurse managers, and advanced practice nurses.

    2. Implications and Next Steps: The models of shared decision making, clinical judgment, and transformational leadership provide evidence informed next steps to reduce the burden of alarms, improve patient safety outcomes and inform institutional quality improvement efforts.

    **References**

    Hani, S. B., & Abu, A. (2024). Relationship Between Alarm Fatigue and Stress Among Acute Care Nurses: A Cross-Sectional Study.
    _SAGE Open Nursing_,
    _10_. https://doi.org/10.1177/23779608241292584

    Michels, E. A. M., Gilbert, S., Koval, I., & Wekenborg, M. K. (2025). Alarm fatigue in healthcare: a scoping review of definitions, influencing factors, and mitigation strategies.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03369-2

    NCLEX. (2024).
    _Clinical Judgment Measurement Model_. NCLEX. https://www.nclex.com/clinical-judgment-measurement-model.page

    Nyarko, B. A., Nie, H., Yin, Z., Chai, X., & Yue, L. (2022). The effect of educational interventions in managing nurses’ alarm fatigue: An integrative review.
    _Journal of Clinical Nursing_,
    _32_(13-14). https://doi.org/10.1111/jocn.16479

    Ron, R., Barnett, I., Berger, R., & Sberro-Cohen, S. (2025). Alarm fatigue mitigation through nurse empowerment: a pre-post intervention study in two intensive care units.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03613-9

    Shaoru, C., Zhi, H., Wu, S., Ruxin, J., Huiyi, Z., Zhang, H., & Zhang, H. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review.
    _SAGE Open Nursing_,
    _9_(9). https://doi.org/10.1177/23779608231207227

    Uçak, A., Cebeci, F., & Tat Çatal, A. (2025). Nurses’ Alarm Fatigue Levels in Adult Intensive Care Units and Their Strategies to Reduce Fatigue: A Convergent Parallel Design.
    _Journal of Clinical Nursing_,
    _34_(5). https://doi.org/10.1111/jocn.17644

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients’ outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## Outline.docx**

    2

    **Outline: Alarm Fatigue and Technology Overload**

    Anisleidy Alvarez

    Florida National University

    Decision Making

    Dr. Nora Hernandez-Pupo

    May 20, 2026

    **Outline: Alarm Fatigue and Technology Overload**

    **I. Introduction**

    1. Background Information: Alarm fatigue refers to a phenomenon where nurses become accustomed to the high frequency of clinical alarms in an acute care environment, potentially compromising patient care at all levels of practice (Michels et al., 2025).

    2. Statement of the Problem: Many of the clinical alarms are not actionable, but nurses must assess each one, resulting in nurse burnout, missed critical events, and suboptimal care (Shaoru et al., 2023; (Hani & Abu (2024).

    3. Thesis Statement: To overcome alarm fatigue, bedside nurses, nurse managers, and advanced practice nurses must work together to integrate evidence-based decision-making processes to decrease the burden of alarms and enhance patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research:**

    1. Alarm fatigue is a known phenomenon that negatively impacts patient safety and nurse health (Michels et al., 2025).

    2. Research has confirmed that high alarm volumes lead to sensory overload and desensitization and delay action on actionable alarms (Ron et al., 2025).

    3. Educational interventions on alarm management knowledge have demonstrated measurable improvement in nurses' behavioural response to alarms (Nyarko et al., 2023).

    **B. Key Theories and Models:**

    1.
    **Shared Decision-Making (SDM) Model:** Involvement of nurses, technology teams and leadership in the development of unit and institutional level alarm management policies.

    2.
    **Clinical Judgment Model (NCSBN):** Offers guidance to bedside nurses on how to identify, interpret, and evaluate the significance of alarms in the context of the unique patient (NCLEX, 2024).

    3.
    **Transformational Leadership Model:** Supports nurse leaders and advanced practice nurses in the facilitation of alarm management changes at a culture or system level (Ystaas et al., 2023).

    **III. Main Body/Discussion**

    **A. Topic 1: Analysis and Context**

    1. Alarm fatigue is caused by multiple exposure to excessive, mostly non-actionable alarms from multiple monitoring devices (Michels et al., 2025).

    **Subpoints:**

    · In intensive care units (ICUs), up to 820 alarms are generated per patient per day (Uçak et al., 2025).

    · The stress and burnout experienced by nurses is directly related to alarm fatigue (Hani & Abu, 2024).

    **B. Second Topic: Comparative Analysis**

    Various models of decision making are relevant at different levels of nursing practice.

    **Subpoints:**

    · Bedside nurses use Clinical Judgment Model to individualize the alarm threshold and decrease non-actional alarms (NCLEX, 2024).

    · Nurse managers use SDM to develop alarm reduction plans for their units in collaboration with the frontline staff.

    · Advanced practice nurses and CNOs use Transformational Leadership to champion institutional policy changes, technology purchases, and interprofessional alarm stewardship initiatives (Ystaas et al., 2023).

    **C. Third Topic: Application and Implications**

    Each of the models for decision making is feasible in all clinical settings to address the issue of alarm fatigue.

    **Subpoints:**

    · Benefits: Decreased nurse burnout, quicker response to critical alarms, enhanced patient safety outcomes (Nyarko et al., 2023).

    · Limitations: Demand for resources, staff resistance to change in protocol, and technology infrastructure limitations.

    · Recommendations: tiered alarm systems, mandatory alarm management education and interprofessional task forces.

    · Funding: HRSA Patient Safety Improvement grants and Sigma Theta Tau International nursing research funding.

    **IV. Conclusion**

    **Point A**

    1. Summary of Key Points – Alarm fatigue is a multi-level nursing problem that requires coordinated evidence-based decision-making processes of bedside nurses, nurse managers, and advanced practice nurses.

    2. Implications and Next Steps: The models of shared decision making, clinical judgment, and transformational leadership provide evidence informed next steps to reduce the burden of alarms, improve patient safety outcomes and inform institutional quality improvement efforts.

    **References**

    Hani, S. B., & Abu, A. (2024). Relationship Between Alarm Fatigue and Stress Among Acute Care Nurses: A Cross-Sectional Study.
    _SAGE Open Nursing_,
    _10_. https://doi.org/10.1177/23779608241292584

    Michels, E. A. M., Gilbert, S., Koval, I., & Wekenborg, M. K. (2025). Alarm fatigue in healthcare: a scoping review of definitions, influencing factors, and mitigation strategies.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03369-2

    NCLEX. (2024).
    _Clinical Judgment Measurement Model_. NCLEX. https://www.nclex.com/clinical-judgment-measurement-model.page

    Nyarko, B. A., Nie, H., Yin, Z., Chai, X., & Yue, L. (2022). The effect of educational interventions in managing nurses’ alarm fatigue: An integrative review.
    _Journal of Clinical Nursing_,
    _32_(13-14). https://doi.org/10.1111/jocn.16479

    Ron, R., Barnett, I., Berger, R., & Sberro-Cohen, S. (2025). Alarm fatigue mitigation through nurse empowerment: a pre-post intervention study in two intensive care units.
    _BMC Nursing_,
    _24_(1). https://doi.org/10.1186/s12912-025-03613-9

    Shaoru, C., Zhi, H., Wu, S., Ruxin, J., Huiyi, Z., Zhang, H., & Zhang, H. (2023). Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review.
    _SAGE Open Nursing_,
    _9_(9). https://doi.org/10.1177/23779608231207227

    Uçak, A., Cebeci, F., & Tat Çatal, A. (2025). Nurses’ Alarm Fatigue Levels in Adult Intensive Care Units and Their Strategies to Reduce Fatigue: A Convergent Parallel Design.
    _Journal of Clinical Nursing_,
    _34_(5). https://doi.org/10.1111/jocn.17644

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients’ outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290. https://doi.org/10.3390/nursrep13030108

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

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    **files (3)** – ## Attemptfeedbac1.docx – ## DecisionMaking.docx – ## ProfessionalPracticeSafetyandWorkforceIssues1.docx **## Attemptfeedbac1.docx** Attempt feedback Topic: Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare You did not adhere to s…

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    – ## ProfessionalPracticeSafetyandWorkforceIssues1.docx

    **## Attemptfeedbac1.docx**

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    Topic:  Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility

    in Healthcare

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    If you exceed the maximum page limit for your final submission- your grade will be severely impacted.

    For the final paper, continue expanding the analytical depth within each section by more clearly explaining how each framework directly influences nursing practice, organizational culture, and patient outcomes related to workplace violence prevention. Some sections would benefit from stronger synthesis between scholarly sources rather than presenting concepts individually. Consider further developing the discussion regarding the practical implementation challenges of resilience training, reporting systems, and transformational leadership initiatives within healthcare organizations. You should also provide additional real-world clinical examples to strengthen the application and implications section and demonstrate how these interventions improve nurse safety and retention outcomes. Be mindful of APA 7 formatting consistency throughout the final manuscript, including punctuation, capitalization, spacing, and citation formatting. Lastly, continue ensuring all in-text citations correspond accurately to the reference list and maintain the use of current evidence-based scholarly literature throughout the paper.

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    **20**

    **Exemplary Submission**

    The topic is exceptionally clear, focused, and thoroughly aligned with nursing decision-making principles. Question is formatted correctly and understood.

    ·
    **Topic Listed is from approved list- number included as instructed**

    5% of total result

    **5**

    **Exemplary Submission**

    Topic Listed is from approved list- number included as instructed – completed on first submission

    ·
    **Depth of Outline Development**

    30% of total result

    **30**

    **Exemplary Submission**

    The outline is comprehensive, well-organized, and includes all necessary components to support a solid paper.

    ·
    **Relevance to Nursing Decision-Making**

    25% of total result

    **25**

    **Exemplary Submission**

    The topic and outline demonstrate deep understanding of the nursing decision-making process and its impact.

    ·
    **Adherence to Submission Guidelines**

    10% of total result

    **5**

    **Satisfactory Submission**

    Submission follows some guidelines but contains several errors impacting readability.

    Criterion Feedback

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    ·
    **APA References**

    5% of total result

    **5**

    **Exemplary Submission**

    5 EBP, scholarly peer-review sources listed on the reference page.

    ·
    **APA adherence and Citation in text citations; Spelling and Grammar**

    5% of total result

    **3.75**

    **Proficient Submission**

    More than 5 but fewer than 10 incomplete citations and/or quotations, and APA format errors. The paper is developed using an introduction APA-approved heading- but no headings within the rest of the paper. More than 5 but fewer than 10 grammatical, spelling, capitalization & punctuation errors The required word count is 25 words below the minimum required count.

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## ProfessionalPracticeSafetyandWorkforceIssues1.docx**

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    Yailin Ramirez

    Florida National University

    Decision Making-DAX-DL01

    Dr. Nora Hernandez-Pupo

    May 21, 2026

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    **I. Introduction**

    **A. Background Information.** In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

    **B. Statement of the Problem.** Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

    **C. Thesis Statement:** Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research.** WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

    **B. Key Theories and Models.**

    1.
    **Shared Decision-Making (SDM) Model**. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

    2.
    **Transformational Leadership Model**. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

    3.
    **Nursing Resilience Interventions**. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

    **III. Main Body/Discussion**

    **A. Section One**

    **Topic Analysis and Context.**

    WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

    **B. Section Two**

    **Comparative Analysis.**

    ·
    _Bedside/Staff Nurse._ Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

    ·
    _Nurse Leader/Manager._ Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

    ·
    _Advanced Practice Nurse._ SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

    **C. Section Three**

    **Application, Implications, and Funding.**

    For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

    **Funding Source:** Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

    **IV. Conclusion**

    **A) Key Point Summary.** Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

    **B. Implications & Next Steps**. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

    **V. Preliminary References**

    Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals.
    _Biological and Clinical Sciences Research Journal_,
    _2024_(1), 956.
    [https://doi.org/10.54112/bcsrj.v2024i1.956](https://doi.org/10.54112/bcsrj.v2024i1.956)

    Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis.
    _Western Journal of Nursing Research_,
    _46_(3), 210–218.
    [https://doi.org/10.1177/01939459241230369](https://doi.org/10.1177/01939459241230369)

    Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories.
    _Journal of Clinical Nursing_,
    _29_(19–20), 3597–3599.
    [https://doi.org/10.1111/jocn.15276](https://doi.org/10.1111/jocn.15276)

    Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review.
    _Journal of Clinical and Translational Research_,
    _8_(5), 421–424.

    Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study.
    _Archives of Psychiatric Nursing_,
    _46_, 83–90.
    [https://doi.org/10.1016/j.apnu.2023.08.008](https://doi.org/10.1016/j.apnu.2023.08.008)

    Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In
    _Oxford textbook of shared decision making in healthcare_ (pp. 288–291).
    [https://doi.org/10.1093/med/9780198897804.003.0057](https://doi.org/10.1093/med/9780198897804.003.0057)

    Luo, Y., Zhang, M., Yu, S., Guan, X., Zhong, T., Wu, Q., & Li, Y. (2024). The impact of psychological violence in the workplace on turnover intention of clinical nurses: The mediating role of job satisfaction.
    _BMC Nursing_,
    _23_(1), 844.
    [https://doi.org/10.1186/s12912-024-02477-9](https://doi.org/10.1186/s12912-024-02477-9)

    Musaed, A. (2023). The relationship between nurse burnout, job satisfaction, and patient care quality.
    _Igm Publication_.
    [https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality](https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality)

    Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.
    _Frontiers in Psychology_,
    _13_, 896156.
    [https://doi.org/10.3389/fpsyg.2022.896156](https://doi.org/10.3389/fpsyg.2022.896156)

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290.
    [https://doi.org/10.3390/nursrep13030108](https://doi.org/10.3390/nursrep13030108)

    **## ProfessionalPracticeSafetyandWorkforceIssues1.docx**

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    Yailin Ramirez

    Florida National University

    Decision Making-DAX-DL01

    Dr. Nora Hernandez-Pupo

    May 21, 2026

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    **I. Introduction**

    **A. Background Information.** In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

    **B. Statement of the Problem.** Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

    **C. Thesis Statement:** Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research.** WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

    **B. Key Theories and Models.**

    1.
    **Shared Decision-Making (SDM) Model**. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

    2.
    **Transformational Leadership Model**. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

    3.
    **Nursing Resilience Interventions**. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

    **III. Main Body/Discussion**

    **A. Section One**

    **Topic Analysis and Context.**

    WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

    **B. Section Two**

    **Comparative Analysis.**

    ·
    _Bedside/Staff Nurse._ Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

    ·
    _Nurse Leader/Manager._ Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

    ·
    _Advanced Practice Nurse._ SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

    **C. Section Three**

    **Application, Implications, and Funding.**

    For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

    **Funding Source:** Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

    **IV. Conclusion**

    **A) Key Point Summary.** Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

    **B. Implications & Next Steps**. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

    **V. Preliminary References**

    Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals.
    _Biological and Clinical Sciences Research Journal_,
    _2024_(1), 956.
    [https://doi.org/10.54112/bcsrj.v2024i1.956](https://doi.org/10.54112/bcsrj.v2024i1.956)

    Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis.
    _Western Journal of Nursing Research_,
    _46_(3), 210–218.
    [https://doi.org/10.1177/01939459241230369](https://doi.org/10.1177/01939459241230369)

    Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories.
    _Journal of Clinical Nursing_,
    _29_(19–20), 3597–3599.
    [https://doi.org/10.1111/jocn.15276](https://doi.org/10.1111/jocn.15276)

    Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review.
    _Journal of Clinical and Translational Research_,
    _8_(5), 421–424.

    Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study.
    _Archives of Psychiatric Nursing_,
    _46_, 83–90.
    [https://doi.org/10.1016/j.apnu.2023.08.008](https://doi.org/10.1016/j.apnu.2023.08.008)

    Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In
    _Oxford textbook of shared decision making in healthcare_ (pp. 288–291).
    [https://doi.org/10.1093/med/9780198897804.003.0057](https://doi.org/10.1093/med/9780198897804.003.0057)

    Luo, Y., Zhang, M., Yu, S., Guan, X., Zhong, T., Wu, Q., & Li, Y. (2024). The impact of psychological violence in the workplace on turnover intention of clinical nurses: The mediating role of job satisfaction.
    _BMC Nursing_,
    _23_(1), 844.
    [https://doi.org/10.1186/s12912-024-02477-9](https://doi.org/10.1186/s12912-024-02477-9)

    Musaed, A. (2023). The relationship between nurse burnout, job satisfaction, and patient care quality.
    _Igm Publication_.
    [https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality](https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality)

    Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.
    _Frontiers in Psychology_,
    _13_, 896156.
    [https://doi.org/10.3389/fpsyg.2022.896156](https://doi.org/10.3389/fpsyg.2022.896156)

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290.
    [https://doi.org/10.3390/nursrep13030108](https://doi.org/10.3390/nursrep13030108)

    **## Attemptfeedbac1.docx**

    Attempt feedback

    Topic:  Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility

    in Healthcare

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    If you exceed the maximum page limit for your final submission- your grade will be severely impacted.

    For the final paper, continue expanding the analytical depth within each section by more clearly explaining how each framework directly influences nursing practice, organizational culture, and patient outcomes related to workplace violence prevention. Some sections would benefit from stronger synthesis between scholarly sources rather than presenting concepts individually. Consider further developing the discussion regarding the practical implementation challenges of resilience training, reporting systems, and transformational leadership initiatives within healthcare organizations. You should also provide additional real-world clinical examples to strengthen the application and implications section and demonstrate how these interventions improve nurse safety and retention outcomes. Be mindful of APA 7 formatting consistency throughout the final manuscript, including punctuation, capitalization, spacing, and citation formatting. Lastly, continue ensuring all in-text citations correspond accurately to the reference list and maintain the use of current evidence-based scholarly literature throughout the paper.

    Show more

    Rubric

    Rubric Result

    **93.75/ 100**

    ·
    **Clarity of Topic Selection**

    20% of total result

    **20**

    **Exemplary Submission**

    The topic is exceptionally clear, focused, and thoroughly aligned with nursing decision-making principles. Question is formatted correctly and understood.

    ·
    **Topic Listed is from approved list- number included as instructed**

    5% of total result

    **5**

    **Exemplary Submission**

    Topic Listed is from approved list- number included as instructed – completed on first submission

    ·
    **Depth of Outline Development**

    30% of total result

    **30**

    **Exemplary Submission**

    The outline is comprehensive, well-organized, and includes all necessary components to support a solid paper.

    ·
    **Relevance to Nursing Decision-Making**

    25% of total result

    **25**

    **Exemplary Submission**

    The topic and outline demonstrate deep understanding of the nursing decision-making process and its impact.

    ·
    **Adherence to Submission Guidelines**

    10% of total result

    **5**

    **Satisfactory Submission**

    Submission follows some guidelines but contains several errors impacting readability.

    Criterion Feedback

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    ·
    **APA References**

    5% of total result

    **5**

    **Exemplary Submission**

    5 EBP, scholarly peer-review sources listed on the reference page.

    ·
    **APA adherence and Citation in text citations; Spelling and Grammar**

    5% of total result

    **3.75**

    **Proficient Submission**

    More than 5 but fewer than 10 incomplete citations and/or quotations, and APA format errors. The paper is developed using an introduction APA-approved heading- but no headings within the rest of the paper. More than 5 but fewer than 10 grammatical, spelling, capitalization & punctuation errors The required word count is 25 words below the minimum required count.

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## ProfessionalPracticeSafetyandWorkforceIssues1.docx**

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    Yailin Ramirez

    Florida National University

    Decision Making-DAX-DL01

    Dr. Nora Hernandez-Pupo

    May 21, 2026

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    **I. Introduction**

    **A. Background Information.** In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

    **B. Statement of the Problem.** Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

    **C. Thesis Statement:** Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research.** WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

    **B. Key Theories and Models.**

    1.
    **Shared Decision-Making (SDM) Model**. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

    2.
    **Transformational Leadership Model**. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

    3.
    **Nursing Resilience Interventions**. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

    **III. Main Body/Discussion**

    **A. Section One**

    **Topic Analysis and Context.**

    WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

    **B. Section Two**

    **Comparative Analysis.**

    ·
    _Bedside/Staff Nurse._ Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

    ·
    _Nurse Leader/Manager._ Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

    ·
    _Advanced Practice Nurse._ SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

    **C. Section Three**

    **Application, Implications, and Funding.**

    For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

    **Funding Source:** Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

    **IV. Conclusion**

    **A) Key Point Summary.** Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

    **B. Implications & Next Steps**. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

    **V. Preliminary References**

    Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals.
    _Biological and Clinical Sciences Research Journal_,
    _2024_(1), 956.
    [https://doi.org/10.54112/bcsrj.v2024i1.956](https://doi.org/10.54112/bcsrj.v2024i1.956)

    Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis.
    _Western Journal of Nursing Research_,
    _46_(3), 210–218.
    [https://doi.org/10.1177/01939459241230369](https://doi.org/10.1177/01939459241230369)

    Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories.
    _Journal of Clinical Nursing_,
    _29_(19–20), 3597–3599.
    [https://doi.org/10.1111/jocn.15276](https://doi.org/10.1111/jocn.15276)

    Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review.
    _Journal of Clinical and Translational Research_,
    _8_(5), 421–424.

    Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study.
    _Archives of Psychiatric Nursing_,
    _46_, 83–90.
    [https://doi.org/10.1016/j.apnu.2023.08.008](https://doi.org/10.1016/j.apnu.2023.08.008)

    Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In
    _Oxford textbook of shared decision making in healthcare_ (pp. 288–291).
    [https://doi.org/10.1093/med/9780198897804.003.0057](https://doi.org/10.1093/med/9780198897804.003.0057)

    Luo, Y., Zhang, M., Yu, S., Guan, X., Zhong, T., Wu, Q., & Li, Y. (2024). The impact of psychological violence in the workplace on turnover intention of clinical nurses: The mediating role of job satisfaction.
    _BMC Nursing_,
    _23_(1), 844.
    [https://doi.org/10.1186/s12912-024-02477-9](https://doi.org/10.1186/s12912-024-02477-9)

    Musaed, A. (2023). The relationship between nurse burnout, job satisfaction, and patient care quality.
    _Igm Publication_.
    [https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality](https://jmscr.igmpublication.org/home/index.php/archive/218-volume-11-issue-11-november-2023/10779-the-relationship-between-nurse-burnout-job-satisfaction-and-patient-care-quality)

    Ramzi, Z. S., Fatah, P. W., & Dalvandi, A. (2022). Prevalence of workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.
    _Frontiers in Psychology_,
    _13_, 896156.
    [https://doi.org/10.3389/fpsyg.2022.896156](https://doi.org/10.3389/fpsyg.2022.896156)

    Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients' outcomes: A systematic review.
    _Nursing Reports_,
    _13_(3), 1271–1290.
    [https://doi.org/10.3390/nursrep13030108](https://doi.org/10.3390/nursrep13030108)

    **## Attemptfeedbac1.docx**

    Attempt feedback

    Topic:  Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility

    in Healthcare

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    If you exceed the maximum page limit for your final submission- your grade will be severely impacted.

    For the final paper, continue expanding the analytical depth within each section by more clearly explaining how each framework directly influences nursing practice, organizational culture, and patient outcomes related to workplace violence prevention. Some sections would benefit from stronger synthesis between scholarly sources rather than presenting concepts individually. Consider further developing the discussion regarding the practical implementation challenges of resilience training, reporting systems, and transformational leadership initiatives within healthcare organizations. You should also provide additional real-world clinical examples to strengthen the application and implications section and demonstrate how these interventions improve nurse safety and retention outcomes. Be mindful of APA 7 formatting consistency throughout the final manuscript, including punctuation, capitalization, spacing, and citation formatting. Lastly, continue ensuring all in-text citations correspond accurately to the reference list and maintain the use of current evidence-based scholarly literature throughout the paper.

    Show more

    Rubric

    Rubric Result

    **93.75/ 100**

    ·
    **Clarity of Topic Selection**

    20% of total result

    **20**

    **Exemplary Submission**

    The topic is exceptionally clear, focused, and thoroughly aligned with nursing decision-making principles. Question is formatted correctly and understood.

    ·
    **Topic Listed is from approved list- number included as instructed**

    5% of total result

    **5**

    **Exemplary Submission**

    Topic Listed is from approved list- number included as instructed – completed on first submission

    ·
    **Depth of Outline Development**

    30% of total result

    **30**

    **Exemplary Submission**

    The outline is comprehensive, well-organized, and includes all necessary components to support a solid paper.

    ·
    **Relevance to Nursing Decision-Making**

    25% of total result

    **25**

    **Exemplary Submission**

    The topic and outline demonstrate deep understanding of the nursing decision-making process and its impact.

    ·
    **Adherence to Submission Guidelines**

    10% of total result

    **5**

    **Satisfactory Submission**

    Submission follows some guidelines but contains several errors impacting readability.

    Criterion Feedback

    You did not adhere to submission guidelines:

    ·
    **Formatting:**

    · Use APA 7th Edition guidelines for heading levels, in-text citations (if applicable), and your reference list.

    · The outline can be presented in a combination of narrative paragraphs and bullet points. Ensure your formatting is clear and easy to follow.

    · Your topic and outline submission may be a concise document (typically 2-3 pages)- DO NOT EXCEED THIS as this is NOT your PAPER- I will STOP reading at PAGE 3 [reference page and cover page DO NOT COUNT].

    ·
    **APA References**

    5% of total result

    **5**

    **Exemplary Submission**

    5 EBP, scholarly peer-review sources listed on the reference page.

    ·
    **APA adherence and Citation in text citations; Spelling and Grammar**

    5% of total result

    **3.75**

    **Proficient Submission**

    More than 5 but fewer than 10 incomplete citations and/or quotations, and APA format errors. The paper is developed using an introduction APA-approved heading- but no headings within the rest of the paper. More than 5 but fewer than 10 grammatical, spelling, capitalization & punctuation errors The required word count is 25 words below the minimum required count.

    **## DecisionMaking.docx**

    Decision Making-DAX-DL01 Nora Hernandez-Pupo

    Decision Making Process Paper Due

    6 pages

    Use at least 10 current scholarly references [not older than 5 years] other than your main text. Uses APA 7th edition formatting
    **with DOI**

    **Decision-Making Process Paper**

    Instructions

    In this assignment, you will be writing a 6–8-page paper identifying [
    **maximum page limit is 8 pages- do not exceed as it will incur a penalty**], comparing and contrasting at least 3 different decision-making approaches of care from a multidisciplinary perspective using a pertinent and significant topic in nursing [The following topics are NOT allowed and will not be approved:  shortage and nurse turnover, nurse staffing ratios, unit closures, and restructuring, use of contract employees (i.e., registry and travel nurse)]. The topic
    **MUST BE APPROVED** **by your nursing instructor before writing the paper. Your topic was approved in week 3- please refer to week 3's approved topic.** You are
    required to use APA 7th edition format, and the page count, appropriate headings, the title page, and the reference page. Reflect on your decision-making practices and the implications this will have regarding differing approaches taken by nursing leaders and staff nurses/clinical practitioners in decision-making regarding issues in practice.  To complete this assignment, do the following:

    1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).

    2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 2 [3 ideal] different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance, one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings, literature, clinical scenarios and other evidence-based and scholarly sources.

    3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.

    4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state, or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details

    5. Use at least
    **10 current scholarly references** [not older than 5 years] other than your main text. Uses APA 7th edition formatting.

    Please see sample APA 7 paper- DO NOT use an Abstract.

    **APA_7_Professional_Paper_Template_June_2020.docx**

    **APA 7 professional-annotated-compressed.pdf**

    Please submit the Decision Making Process Paper in Word [PDF] Format APA 7 formatted (see instructions in the Assignments Tab of Blackboard along with the grading rubric).

    **Submission**

    Text Editor

    _Word count: 0_

    **Drag files here**

    Maximum size: 512 MB

    **or**

    **Details & Information**

    **## ProfessionalPracticeSafetyandWorkforceIssues1.docx**

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    Yailin Ramirez

    Florida National University

    Decision Making-DAX-DL01

    Dr. Nora Hernandez-Pupo

    May 21, 2026

    **Professional Practice, Safety, and Workforce Issues #1: Workplace Violence and Incivility in Healthcare**

    **I. Introduction**

    **A. Background Information.** In the healthcare setting, workplace violence (WPV) is defined by physical assault, threats, verbal harassment and incivility towards patients, families and healthcare professionals. Bedside nurses in acute/ inpatient settings have the highest rate of violence, which is disproportionately high for healthcare workers. Kafle et al. (2022) confirmed WPV as a sustained epidemic in the nursing profession; Ramzi et al. (2022) reported elevated prevalence all over the world during the COVID-19 pandemic; and Amin et al. (2024) reported high prevalence among the nurses in tertiary care hospitals with severe psychological impact on them.

    **B. Statement of the Problem.** Normalization, fear of retaliation, and poor organization protocols are all responsible for the underreporting of WPV. The cascading effect of moral distress, burnout and turnover leads to dangerous staffing levels and lower patient safety. Luo et al. (2024) found that psychological violence had a significant effect on decreased job satisfaction, which in turn predicted turnover intention, while Musaed (2023) found that psychological violence led to nurse burnout, which consequently affected the quality of patient care.

    **C. Thesis Statement:** Shared decision-making model, transformational leadership, and interventions aimed at building nursing resilience can be seen as a multi-disciplinary strategy to address workplace aggression and create a safe environment that will contribute to nurse safety, retention, and better patient outcomes.

    **II. Literature Review/Background**

    **A. Overview of Existing Research.** WPV causes moral distress and staffing shortages, affecting not only bedside nurses, but nurse leaders and advanced practice nurses as well. Boudreau and Rhéaume (2024) showed that work environment factors play significant mediating roles on adverse nurse outcomes, and Lim et al. (2023) showed that the inpatient psychiatric nurses might have experienced persistent aggression and complex emotional consequences which needed immediate systemic and therapeutic response.

    **B. Key Theories and Models.**

    1.
    **Shared Decision-Making (SDM) Model**. According to Lomborg et al. (2025), Shared Decision Making (SDM) model is a decision-making process involving nurse, patient, and family to come up with care decisions, behaviors, and safety.

    2.
    **Transformational Leadership Model**. According to Ystaas et al. (2023), this will lead to improvement of the nursing working environment and patient's outcome because of the use of idealized influence, empowerment, and intellectual stimulation leading to collective vision.

    3.
    **Nursing Resilience Interventions**. According to Henshall et al. (2020), these are some of the interventions that a nurse could adopt to build resilience, adaptive decision making, emotion regulation, and protection when faced with violence or stressful healthcare environment.

    **III. Main Body/Discussion**

    **A. Section One**

    **Topic Analysis and Context.**

    WPV varies by the nursing continuum. During high acuity interventions and basic care activities, bedside nurses face the direct aggression and incivility of patients (Lim et al., 2023). Nurse managers deal with staffing consequences, policy application and post incident debriefing. APN's support institutional policies, risk assessment systems based on evidence, and legislative advocacy at the macro-level to prevent.

    **B. Section Two**

    **Comparative Analysis.**

    ·
    _Bedside/Staff Nurse._ Nursing resilience interventions support nurses in becoming more aware of de-escalation behaviour in earlier stages (Henshall et al., 2020) and to learn how to de-escalate and self-protect. SDM supports patients and their families to draw boundaries along with forming relationships to deliver non-violent care.

    ·
    _Nurse Leader/Manager._ Transformational leadership helps achieve good implementation of a zero tolerance policy at the unit level, provides empowerment to staff through shared governance safety committees and security and training resources (Ystaas et al, 2023)

    ·
    _Advanced Practice Nurse._ SDM can help with the formulation of a full and person-centred evaluation of violence risks and planning around trauma-informed care (Lomborg et al., 2025). Transformational leadership can facilitate building an interprofessional coalition, organizational policy changes and engaging community stakeholders for systemic changes (Ystaas et al., 2023).

    **C. Section Three**

    **Application, Implications, and Funding.**

    For continuity of prevention ecosystem: Behavioural resilience interventions safeguard the immediate safety; SDM strengthen therapeutic trust and adherence; transformational leadership reshapes the organization’s culture around psychological safety. Challenges include resource constraints, state level reporting differences and organizational resistance. It includes the following recommendations: Report incidents electronically in a private and confidential fashion, and standardize it within the organization; conduct a teacher debrief; provide organization-wide education and training; and explicitly model teacher leadership by senior leaders publicly demonstrating their commitment.

    **Funding Source:** Through HRSA, as one of the programs under NEPQR, funding will be made available to implement a unit-based WPV prevention program comprising staff resilience training, environmental safety measures, and an electronic reporting mechanism that facilitates confidential reporting of infections (HRSA, 2024).

    **IV. Conclusion**

    **A) Key Point Summary.** Responses to WPV must be coordinated and addressed on the level of the vertical line, or vertical level. The frameworks cover different nursing roles and come together to support a comprehensive prevention approach – from individual coping to relationship care to systems re-design.

    **B. Implications & Next Steps**. Transformational leadership as the most important systems level intervention supported by SDM and resiliency interventions at the direct-care levels will be emphasized focally within the final paper in order to propose evidence-based and sustainable solutions to workforce safety, nurse retention, assessable increases in patient quality and the improvement of organizational culture.

    **V. Preliminary References**

    Amin, R., Shah, S., Nawaz, N., Altaf, M., & Shehzadi, A. (2024). Prevalence and impact of workplace violence among nurses in tertiary care hospitals.
    _Biological and Clinical Sciences Research Journal_,
    _2024_(1), 956.
    [https://doi.org/10.54112/bcsrj.v2024i1.956](https://doi.org/10.54112/bcsrj.v2024i1.956)

    Boudreau, C., & Rhéaume, A. (2024). Impact of the work environment on nurse outcomes: A mediation analysis.
    _Western Journal of Nursing Research_,
    _46_(3), 210–218.
    [https://doi.org/10.1177/01939459241230369](https://doi.org/10.1177/01939459241230369)

    Henshall, C., Davey, Z., & Jackson, D. (2020). Nursing resilience interventions–A way forward in challenging healthcare territories.
    _Journal of Clinical Nursing_,
    _29_(19–20), 3597–3599.
    [https://doi.org/10.1111/jocn.15276](https://doi.org/10.1111/jocn.15276)

    Kafle, S., Paudel, S., Thapaliya, A., & Acharya, R. (2022). Workplace violence against nurses: A narrative review.
    _Journal of Clinical and Translational Research_,
    _8_(5), 421–424.

    Lim, Z. Y., Idris, D. R., Abdullah, H. M. A. L., & Omar, H. R. (2023). Violence toward staff in the inpatient psychiatric setting: Nurses' perspectives: A qualitative study.
    _Archives of Psychiatric Nursing_,
    _46_, 83–90.
    [https://doi.org/10.1016/j.apnu.2023.08.008](https://doi.org/10.1016/j.apnu.2023.08.008)

    Lomborg, K., Finderup, J., Thorne, S., & Søndergaard, H. (2025). Shared decision making in nursing and advanced practice nursing. In
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