Posted: August 15th, 2023

NUR 4250 Capstone Proposal on problem-focused in a healthcare system

NUR 4250 Capstone Paper: Health Systems Leadership

Capstone Proposal Topic;
Enhancing Early Sepsis Detection in Emergency Rooms through Nurse-Led Screening

Choose a topic that is problem-focused in a healthcare system that you want to learn more about. The milestones in this project are as follows:

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1. Milestone 1: Proposal- Choose a topic of interest.
2. Milestone 2: Literature Review: Complete a thorough literature review about the topic.
3. Milestone 3: Paper- Write a paper discussing the topic and identifying ways to address solutions to the problem based on reliable and valid evidence.

 Milestone 1 (75 points)

What is a Capstone Proposal?

A Capstone proposal gives you the opportunity to briefly outline your topic and conduct preliminary research to make sure the topic is feasible. A topic may not be feasible if it lacks sufficient research or background information. For milestone 1, choose a topic of interest and discuss the following:

1. Explain why you chose to study this issue.
2. What other topics did you consider (if any?)
3. What background information do you have about the issue and what health systems is involved?
4. Why is this issue significant in the current healthcare climate?
5. What key concepts will you use in the literature review to start researching your topic?

Write a Title Page (1 page) in proper APA format.

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Write 2 additional pages answering the above questions.

Include a reference page.

Guidelines for Milestone 1:

• Written using APA format 7th Edition
• 3-4 pages, including the title and reference pages
• Word document
• Submitted on Edverum by due date

Milestone 2 (100 points)

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Literature Review: Complete a thorough literature review about the topic. A literature review is completed by researchers to identify what is truly known about an issue (what is the evidence?). Often, we think we know the answer to a problem, but evidence may or may not support what we think. In Milestone 2, you will conduct a literature search and answer the following questions. The library is a great resource to help with this milestone.

For Milestone 2, conduct a literature review and discuss the following:

1. Describe your search inclusion and exclusion criteria… What “keywords” did you use for the search? How many articles did you find? How did you “limit your search?”
2. How many articles did you review? Why were these articles selected for this research.
3. Begin to summarize your articles. Do a minimum of 2 research articles.

Include the revised Title Page (1 page) in proper APA format from Milestone 1.

Write 3 additional pages answering the above questions.

Include a reference page.

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Guidelines for Milestone 2:

• Written using APA format 7th Edition
• 5-6 pages, including the title and reference pages
• Word document
• Submitted on Edverum by due date

 Milestone 3 (100 points)

Paper- Write a paper discussing the topic and identifying ways to address solutions to the problem based on reliable and valid evidence.

It is now time to put your information together in one capstone proposal. For Milestone 3 include the following:

Title page (1 page)

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Body (6- 8 pages)

Introduction

Motivation

• • • Explain why you chose to study this issue and what you hope to achieve with the solutions presented.

Background and Significance

• • • Provide background information on your chosen health systems issue and connect this to why this is significant in the current healthcare climate.

 

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Search Process

• Describe your search inclusion and exclusion criteria; how many articles you reviewed; why were these articles selected for this research.

Literature Review (6 sections: 1 section per article)

• Investigate the most current research and findings available pertaining to your topic
• Select 6 peer-reviewed scholarly articles published within the past 5 years (or “historic” in nature) to explain
  • Summarize each article
  • Explain how the findings in each article impact possible solutions to the issue
• Analyze common findings amongst studies
• Identify factors not previously considered and researched

 

Summary of the Literature Review

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• Considering the detailed synthesis of literature for the 6 peer-reviewed articles you analyzed:
  • What does the literature say has worked or not worked to resolve the issue?
  • What recommendations would you make to address the issue based on evidence?
  • Identify “next steps” to address the issue
  • What are potential barriers to implementation/resolution?
  • How can these obstacles be overcome?

How could you continue this research in the future?

• What other problems would you like to research?
• How will you apply this knowledge to future professional roles?

Conclusion (1 paragraph)

References

Guidelines for Milestone 3:

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• Written using APA format 7th Edition
• 8-10 pages, including the title and reference pages
• Word document
• Submitted on Edverum by due date

 

Rubric for Milestone 1 Capstone Proposal (75 points)

 

Identification of Main Issue or Problem

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20 Points Possible

 

Undeveloped 0-15 Points	Identifies and demonstrates acceptable understanding of some of the issues/problems/questions.
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Exemplary 19-20 Points	Identifies and demonstrates a sophisticated understanding of the main issues/problems/questions.
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Analysis and Evaluation of Issues/Problems/Questions

25 Points Possible

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Undeveloped 0-17 Points	Presents a superficial or incomplete analysis of some of the identified issues/problems/questions.
Satisfactory 18-22 Points	Presents a thorough analysis of most of the issues/problems/questions identified.
Exemplary 23-25 Points	Presents an insightful and thorough analysis of all identified issues/problems/questions.
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Effective Solutions and Strategies

20 Points Possible

 

Undeveloped 0-15 Points	Little or no action suggested and/or inappropriate solutions proposed to the issues.
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Advanced Written Communication

10 Points Possible

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Undeveloped 0-6 Points	Presentation lacks organization, writing quality, and has grammatical or spelling errors.
Satisfactory 7-8 Points	Presentation provides reference to the literature and contributions are most concise and formatted in an easy-to-read style that has some grammatical or spelling errors.
Exemplary 9-10 Points	Presentation provides an accurate reference to the literature and contributions are clearly written, concise, and formatted in an easy-to-read style that is free of grammatical or spelling errors.
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Rubric for Milestone 2 Capstone Proposal (100 points)

 

Identification of Main Issue or Problem

25 Points Possible

 

Undeveloped 0-17 Points	Identifies and demonstrates acceptable understanding of some of the issues/problems/questions.
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Exemplary 23-25 Points	Identifies and demonstrates a sophisticated understanding of the main issues/problems/questions.
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Analysis and Evaluation of Issues/Problems/Questions

40 Points Possible

 

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Satisfactory 32-37 Points	Presents a thorough analysis of most of the issues/problems/questions identified.
Exemplary 38-40 Points	Presents an insightful and thorough analysis of all identified issues/problems/questions.
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Effective Solutions and Strategies

25 Points Possible

 

Undeveloped 0-17 Points	Little or no action suggested and/or inappropriate solutions proposed to the issues.
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Exemplary 23-25 Points	Supports ideas with strong arguments and well documented evidence; presents a balanced and critical view; interpretation is both reasonable and objective.
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Advanced Written Communication

10 Points Possible

 

Undeveloped 0-6 Points	Presentation lacks organization, writing quality, and has grammatical or spelling errors.
Satisfactory 7-8 Points	Presentation provides reference to the literature and contributions are most concise and formatted in an easy-to-read style that has some grammatical or spelling errors.
Exemplary 9-10 Points	Presentation provides an accurate reference to the literature and contributions are clearly written, concise, and formatted in an easy-to-read style that is free of grammatical or spelling errors.
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Rubric for Milestone 3 Capstone Project (100 points)

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Identification of Main Issue or Problem

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Exemplary 28-30 Points	Identifies and demonstrates a sophisticated understanding of the main issues/problems/questions.
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Analysis and Evaluation of Issues/Problems/Questions

30 Points Possible

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Satisfactory 23-27 Points	Presents a thorough analysis of most of the issues/problems/questions identified.
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Effective Solutions and Strategies

30 Points Possible

 

Undeveloped 0-22 Points	Little or no action suggested and/or inappropriate solutions proposed to the issues.
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Undeveloped 0-6 Points	Presentation lacks organization, writing quality, and has grammatical or spelling errors.
Satisfactory 7-8 Points	Presentation provides reference to the literature and contributions are most concise and formatted in an easy-to-read style that has some grammatical or spelling errors.
Exemplary 9-10 Points	Presentation provides an accurate reference to the literature and contributions are clearly written, concise, and formatted in an easy-to-read style that is free of grammatical or spelling errors.
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NUR 4250 Health Systems Leadership Capstone Proposal Example;

Enhancing Early Sepsis Detection in Emergency Rooms through Nurse-Led Screening

Motivation for Choosing the Topic

Personal experiences during clinical rotations in crowded emergency departments sparked my interest in early sepsis detection through nurse-led screening. I witnessed patients with subtle vital sign changes slip through the cracks, leading to rapid deterioration despite nurses being the first to notice. This gap pushed me to explore how standardized tools can empower nurses to act swiftly, reducing mortality in high-pressure settings. Other topics like nurse burnout in ICUs or pediatric medication errors crossed my mind, but sepsis stood out due to its urgency and the direct role nurses play at triage, aligning with my focus on health systems leadership.

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Alternative Topics Considered

Before settling on sepsis detection, I considered nurse burnout in intensive care units, given its rising impact on staff retention post-pandemic. Pediatric medication errors also drew my attention due to dosing complexities and patient vulnerabilities. However, sepsis detection offered a more immediate, actionable focus. Unlike the broader systemic challenges of burnout or errors, this topic allows for targeted interventions nurses can lead, making it a practical and personally relevant choice for my capstone.

Background Information and Health Systems Involved

Sepsis is a life-threatening condition triggered by infection, causing organ dysfunction if missed early. From my emergency nursing background, I know it often presents with vague signs like altered mentation or rapid breathing, easily overlooked in chaos. Health systems involved include acute care hospitals, where triage, electronic health records (EHRs), and interdisciplinary teams manage cases. Globally, Rudd et al. (2020) report 48.9 million cases and 11 million deaths in 2017, highlighting its burden, especially in overcrowded emergency rooms.

Significance in the Current Healthcare Climate

This issue matters now more than ever. Post-COVID-19, emergency departments face overcrowding, staffing shortages, and heightened infection risks, amplifying the need for rapid sepsis detection. Delays can push mortality risks above 10% even in mild cases (Singer et al., 2016). With healthcare shifting toward value-based care, nurse-led screening supports timely sepsis bundles—fluids, antibiotics, monitoring—that improve outcomes and cut costs. Addressing this now aligns with global efforts to reduce preventable deaths amid evolving pressures.

The Concepts for the Literature Review

Initial research suggests feasibility, with studies on detection tools. Key concepts include quick Sequential Organ Failure Assessment (qSOFA), using criteria like respiratory rate ≥22/min to flag risks without labs; Modified Early Warning Score (MEWS), tracking vitals for subtle changes; nurse-led screening protocols for frontline action; and implementation barriers like EHR alert fatigue. These will guide my search for recent evidence on effectiveness in emergency settings, laying a foundation for deeper analysis.

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Capstone Paper Writing Guide;

Enhancing Early Sepsis Detection in Emergency Rooms through Nurse-Led Screening

NUR 4250 Health Systems Leadership

Motivation

Sepsis hits close to home after seeing patients slip through cracks in busy emergency rooms during my shifts. Still, I picked this topic because nurses often spot subtle shifts first, yet tools like qSOFA and MEWS aren’t always used consistently to catch it early. What I hope to achieve here is clearer paths for nurse-driven protocols that cut down delays in treatment, ultimately saving lives in high-pressure settings. Other ideas crossed my mind, like exploring burnout in intensive care units or medication errors in pediatrics, but sepsis stood out due to its rapid escalation and the direct role nurses play at triage.

Background and Significance

Patients roll into emergency rooms with infections that can turn deadly fast, and sepsis remains a top killer globally, claiming millions each year. Data from recent analyses show around 48.9 million cases and 11 million deaths in 2017 alone, accounting for nearly 20% of all deaths, especially in resource-strapped areas (Rudd et al., 2020). In developed settings, the challenge lies in vague early signs overlapping with other conditions amid chaos, leading to missed opportunities for intervention. Nurse-led screening with standardized scores addresses this by empowering frontline staff to flag risks promptly, tying into broader healthcare pushes for timely care bundles that reduce mortality. With emergency departments overloaded, especially post-pandemic, this issue gains urgency as delays amplify organ damage and costs.

Search Process

Keywords guided the hunt: “early sepsis detection,” “nurse-led screening,” “qSOFA,” “MEWS,” “NEWS2,” “emergency department sepsis.” I limited results to peer-reviewed articles in English from 2019 to 2025, excluding opinion pieces, case reports, or studies outside acute care. Initial searches yielded about 20 hits from databases like PubMed and Google Scholar. After scanning abstracts, I narrowed to 10 for full review, selecting six based on their focus on screening tools’ performance in EDs, relevance to nurse roles, and evidence on outcomes like mortality or escalation. These stood out for offering fresh data on tool comparisons and implementation, aligning with the proposal’s emphasis on qSOFA and MEWS-like systems.

Literature Review

Singer et al. (2016) redefined sepsis as life-threatening organ dysfunction from dysregulated host response to infection, introducing qSOFA as a bedside prompt for non-ICU settings. They analyzed data from over 1.3 million electronic records, finding qSOFA’s three criteria—respiratory rate over 22, altered mentation, systolic pressure under 100 mmHg—predicted poor outcomes better than prior SIRS criteria outside ICUs. For solutions, this supports nurse-led triage by skipping labs, enabling faster protocol activation in EDs, though sensitivity issues mean combining with other scores could strengthen detection. Common threads across studies include qSOFA’s simplicity but lower accuracy in early stages compared to vital-sign heavy tools.

Rudd et al. (2020) mapped sepsis burden using Global Burden of Disease data, estimating 48.9 million incidents and 11 million deaths in 2017, with declines since 1990 but persistent gaps in low-resource areas. They highlighted that half of fatalities occur in previously healthy individuals, underscoring undetected cases. This informs solutions by stressing systematic screening to catch hidden risks, where nurse-led tools like qSOFA could bridge diagnosis lags in EDs, potentially dropping mortality by 10-20% through timely fluids and antibiotics. Analyses show alignment with other research on early intervention’s impact, but reveal underestimation in official records, pushing for better integration in chaotic environments.

Mellhammar et al. (2019) tested NEWS2 against qSOFA in two ED cohorts, one with infections (n=526) and another undifferentiated (n=645), using AUC for detecting sepsis with organ dysfunction or mortality. NEWS2 outperformed with AUCs of 0.80 and 0.70 versus qSOFA’s 0.70 and 0.62, suggesting better sensitivity for nurse monitoring of vitals like oxygen saturation. Impact on solutions: NEWS2’s broader parameters aid nurses in spotting deterioration pre-organ failure, enhancing protocols over qSOFA alone. Shared findings include superior predictive power of aggregated vital scores, though lactate addition didn’t boost qSOFA much.

Verma et al. (2023) compared NEWS2 and qSOFA in 373 Indian ED sepsis patients, finding NEWS2’s AUC 0.781 trumping qSOFA’s 0.729 for in-hospital mortality, with sensitivities 83% versus 77%. In a context of high mortality (35%), NEWS2’s inclusion of temperature and consciousness levels proved key. This bolsters nurse-led approaches by validating a tool for resource-limited EDs, where quick calculations guide escalation, potentially halving delays. Consistent with others, vital-based scores excel in prognostication, but cultural workflow differences highlight training needs.

Hsieh et al. (2024) tracked NEWS2 changes in 11,011 Taiwanese ED sepsis cases from 1998-2020, noting 51% improved scores post-management, linking to lower mortality (38% vs 48%). Adjusted hazard ratios showed 0.89 for improved groups, emphasizing interventions like fluids. For solutions, this endorses serial NEWS2 by nurses to gauge treatment efficacy, individualizing care in dynamic EDs. Patterns echo broader evidence on warning scores’ edge over qSOFA, with comorbidities influencing outcomes, suggesting tailored thresholds.

Nunnally et al. (2024) reviewed a nursing-led sepsis team using POCUS to guide resuscitation, reporting 99% agreement with physicians on fluid decisions in simulations. The model boosts bundle compliance while personalizing IV fluids via ultrasound assessments of IVC and lungs. This advances solutions by empowering nurses beyond scores like qSOFA/MEWS, addressing controversies in fluid overload. Commonalities include frontline nurse roles in early detection, but add tech integration, revealing barriers like training costs yet promising outcome gains.

Summary of the Literature Review

Evidence points to warning scores like NEWS2 consistently outperforming qSOFA in ED sepsis detection, with higher AUCs and sensitivities for mortality prediction, though qSOFA shines in simplicity for initial flags. What hasn’t worked well: standalone qSOFA misses early cases due to limited criteria, and inconsistent implementation leads to alert fatigue. Recommendations include hybrid protocols blending qSOFA for triage with NEWS2/MEWS for monitoring, plus nurse training on serial scoring. Next steps involve piloting these in diverse EDs, measuring compliance via EHR integration. Barriers encompass staff resistance, time constraints, and EHR complexity; overcome them through targeted simulations, user-friendly alerts, and leadership buy-in. To continue, I’d track long-term outcomes in a multi-site trial, perhaps incorporating AI for score automation. Other problems worth researching: antibiotic stewardship in sepsis or mental health impacts on ED staff. In future roles, this knowledge will shape my advocacy for nurse empowerment, ensuring protocols reflect real-world chaos to prevent avoidable deaths.

Conclusion

Nurses hold the key to turning sepsis tides in emergency rooms, armed with tools that detect shifts before crises hit. Evidence builds a case for refined screening, blending quick assessments with ongoing vigilance, to slash mortality amid rising pressures.

References

Hsieh, M.-S., Chiu, K.-C., Chattopadhyay, A., Lu, T.-P., Liao, S.-H., Lee, Y.-C., Lo, W.-E., Hsieh, V. C.-R., Chang, C.-M., Hu, S.-Y. and How, C.-K. (2024) Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from Taiwan 1998–2020. International Journal of Emergency Medicine, 17(1), p. 28. https://doi.org/10.1186/s12245-024-00614-4

Mellhammar, L., Linder, A., Tverring, J., Christensson, B., Boyd, J. H., Sendi, P., Åkesson, P. and Kahn, F. (2019) NEWS2 is superior to qSOFA in detecting sepsis with organ dysfunction in the emergency department. Journal of Clinical Medicine, 8(8), p. 1128. https://doi.org/10.3390/jcm8081128

Nunnally, J., Ko, S. M., Ugale, K., Lowe, T., Bond, J., Kenny, J.-E. S., Fargo, R. A. and Haycock, K. (2024) A nursing-led sepsis response team guiding resuscitation with point-of-care ultrasound: a review and model for improving bundle compliance while individualizing sepsis care. SAGE Open Medicine, 12, p. 20503121241290378. https://doi.org/10.1177/20503121241290378

Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R. … and Naghavi, M. (2020) Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. The Lancet, 395(10219), pp. 200–211. https://doi.org/10.1016/S0140-6736(19)32989-7

Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M. … and Angus, D. C. (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), pp. 801–810. https://doi.org/10.1001/jama.2016.0287

Verma, A., Farooq, A., Jaiswal, S., Haldar, M., Sheikh, W. R., Khanna, P., Vishen, A., Ahuja, R., Khatai, A. A., Prasad, N. (2023) National Early Warning Score 2 is superior to quick Sequential Organ Failure Assessment in predicting mortality in sepsis patients presenting to the emergency department in India. International Journal of Critical Illness and Injury Science, 13(4), pp. 176-182. https://doi.org/10.4103/ijciis.ijciis_43_23

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