As health care consumers, we all expect quality care and positive outcomes. It is important as professionals that we meet these demands of health care consumers. 

NURS 4220

Capstone Paper Guide

The Capstone Paper is the culminating assignment of your undergraduate-nursing program at Walden University. In this assignment you will identify a quality improvement practice problem, review and synthesize evidence-based practice evidence, and propose an evidence-based quality improvement plan that you will use to address your practice problem.

Capstone Paper Overview

The Capstone Paper is written in sections each week and submitted for grading in two parts.

Capstone Paper: Part I (3-4 pages) includes the Practice Problem; Analysis of Evidence; and Quality Improvement Process sections that are written during the first three weeks of the course. The Capstone Paper, Part I will be submitted for grading at the conclusion of Week 3.

Capstone Paper: Part II (3-4 pages) includes the Evidence-Based Practice Quality Improvement Plan Explanation and Project Resources sections written in weeks 4 and 5. Part II of the capstone paper is submitted for grading at the conclusion of Week 5.

The two parts of the Capstone paper are designed to be combined into one document and used in conjunction with your storyboard to present a quality improvement plan. You may use these documents demonstrate to your employer an understanding of quality improvement processes that improve patient care and/or patient

Assignment Template

You will use the Walden University APA Course Template to complete this Assignment.

· Walden University Writing Center. (n.d.).
Walden templates: General templates.

· Download the APA course paper template with advice.

· Review the webinar on using a template.

· Delete the abstract page in the template. This is not required for this course.

· The template includes the correct font and formatting: 12 pt. Times New Roman font, double spacing, and 1-inch margins on all sides.

Writing Standards

· Note the new expectations for

Use of evidence

Credit to Source

· Review the following websites and webinars on writing:

· Walden University Writing Center. (n.d.).
Scholarly voice: Overview.

· Walden University Writing Center. (n.d.).
Webinars: Scholarly writing.

Page 6 of 6

NURS 4220: Leadership Competencies in Nursing and Healthcare

Full Guide: Practice Experience Quality and Safety Project

Learning Outcomes

· Apply definition of quality to work setting

· Identify a quality improvement practice problem

· Identify measurement standards for a problem identified in healthcare

· Summarize the purpose, methods, and findings from the evidence-based literature that relate to a practice problem

· Apply a quality improvement model to a practice problem

· Apply a quality improvement process to an improvement plan

· Recommend strategies to reduce the cost of care

· Develop a quality improvement storyboard to address a practice problem

Suggestions for Discussions

The more you discuss your project with your group the better it will turn out. Consider posting earlier than Thursday to have a better discussion.  Provide honest, respectful feedback to each other. (
Picture yourself as someone practicing in the other student’s work setting, working with and listening to your colleagues’ ideas weekly (as your read each other’s posts). You are responsible for helping your colleagues make the best decision in class in the same you would be if you were working side-by-side.

Each week’s activities are geared to help you move along with your proposal. Use this time well and utilize some aspect of your capstone paper to support your proposal as well.
ead about the whole project before you start.

Practice Experience Quality and Safety Project

The practice Experience is an active learning experience that provides you with the opportunity to apply nursing knowledge and skills that you are acquiring in NURS 4220 to experiences in a healthcare setting. The practice experience is comprised of selected onsite experiences and weekly practice experience discussions. Throughout your practice experience you will collaborate with leaders and other colleagues, with fellow students in practice experience discussion groups, and with your faculty who serve as preceptors. Each week of the course outlines specific activities or reflections you will engage in during your practice experience as you complete your proposed Practice Experience Quality and Safety Project
. (
Note: The practice problem must be related to patient outcomes, and staffing cannot be your main practice problem for the completion of the capstone project.) A complete description is presented on the Practice Experience discussion page of each week and is included below. A brief outline of the activities is also presented below. The practice experience for NURS 4220 is approximately 72 hours (a time log is not required).


As health care consumers, we all expect quality care and positive outcomes. It is important as professionals that we meet these demands of health care consumers. Consider the work of the major theorists you examined in this week’s Resources and think about how these theories apply to your own experience as a health care customer and/or practitioner.


· Spath, P. (2018). 
Introduction to healthcare quality management (3rd ed.). Health Administration Press.

· Chapter 1, “Focus on Quality” (pp. 1–12)

· Chapter 2, “Quality Management Building Blocks” (pp. 13–34)

· Preview Chapter 3, “Measuring Performance” (pp. 43–46)


· Yoder-Wise, P. S. (2019). 
Leading and managing in nursing (7th ed.). Mosby.

· Chapter 1, “Leading, Managing, and Following” (pp. 1-18)

· Chapter 2, “Clinical Safety: The Core of Leading, Managing and Following” (pp. 19-31)

· QP staff. (2010). 

Guru guide: Six thought leaders who changed the quality world foreverLinks to an external site.

Quality Progress, 43(11), 14–21.



Practice Experience Full Guide (PDF)

Download Practice Experience Full Guide (PDF)



Quality Improvement Storyboard Template (PPT)

Download Quality Improvement Storyboard Template (PPT)



Capstone Paper Assignment Guides (Word Document)

Post your definition of quality, and apply it to the work of one major quality theorist (e.g., Donabedian, Juran, Deming, Triple Aim (IHI) – Berwick). Identify a practice problem that you have had some experience with as a customer or as a practitioner and explain how eliminating wasteful practices could have improved the experience. Include how your definition of quality applies to that experience.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level.

Quality Improvement (QI) Plan: [Insert the QI Model selected e.g. PDSA, FADE,]
[Insert the title of the Capstone Project here] Note: Adjust font size as needed
Quality Improvement Problem Provide a Brief Overview/background of the QI problem
Data to support QI Problem:
Provide the data used to justify why the QI problem was selected; answers the question how many? How often?; How does the data show that a problem exists? Cite sources
Analysis of the Evidence to Support QI Problem:
Discuss the important evidence from research, clinical guidelines, expert opinions with a brief description of important findings. This is the evidence that you used in the project/paper to develop your QI plan include in-text citations in APA format
[Citation fonts may be smaller in size]
QI Plan:
List or summarize the quality improvement plan using the Quality model selected – PDSA, FOCUS PDCA, FADE etc.
Resources to Support the QI Plan:
What materials, who are the persons/department(s) or the title of the persons) needed or used in planning and implementing the QI plan?



Place your reference list here, use APA formatting


Frances Pittman

Quality in healthcare 

Quality in healthcare is a paramount concern and can be defined as the degree to which a product, service, or process meets or exceeds customer or stakeholder expectations and requirements. It encompasses various dimensions such as safety, effectiveness, efficiency, timeliness, patient-centeredness, equity, and accessibility. Achieving and maintaining high-quality outcomes is a fundamental goal in healthcare, as it ensures safe, effective, and patient-centered care delivery. 

Applying Quality Theory to the Work of Donabedian: A major quality theorist in healthcare is Avedis Donabedian. Donabedian developed the framework of quality assessment and improvement, known as the Donabedian model or the structure-process-outcome model. According to Donabedian, the quality of healthcare can be assessed based on three interrelated components: structure, process, and outcomes. The structure refers to the characteristics of the healthcare system, such as resources, facilities, and personnel. The process involves the activities and interactions that take place in healthcare delivery. The outcomes are the effects of healthcare on patients’ health status and satisfaction. 

Wasteful practices 

One practice problem that can be improved by eliminating wasteful practices is excessive documentation in nursing. Excessive documentation can lead to inefficiencies, decreased time spent with patients, and increased nurse workload. To address this issue, evidence-based strategies have been suggested. For example, the use of standardized documentation templates has shown promise in reducing redundancy and unnecessary paperwork (Blackwood et al., 2017). Additionally, effectively utilizing electronic health records (EHRs) and streamlining documentation processes can help optimize workflow and enhance direct patient care (Keenan et al., 2018). 

Streamlining documentation practices not only increase efficiency but also positively affects patient outcomes and satisfaction. Research suggests that excessive documentation can divert nurses’ attention from direct patient care, potentially leading to communication breakdowns and errors. By reducing documentation burdens, nurses can devote more time to patient interaction, assessment, and intervention, resulting in improved patient experiences and outcomes (Scholl et al., 2018). 

In conclusion, addressing wasteful practices in nursing, such as excessive documentation, is crucial for enhancing the quality of patient care. Through the application of strategies like standardized templates and optimized EHR utilization, nurses can streamline documentation processes and allocate more time to direct patient care. Ultimately, this can lead to improved patient outcomes, increased satisfaction, and better utilization of nursing resources. By incorporating evidence-based approac

Csilla Orban Bonacci


I believe quality is a measure of how well we do something in such a way that it adheres to standards of care while having positive outcomes. I think I agree with Donabedian’s approach to measuring healthcare: we need to look at structure, process, and outcomes. It starts with structure and which can affect somewhat process and then the process affects outcomes. I do believe though that even though structure might be affected, process does not mean it has to in every aspect. For example, just because we have 4 nurses instead of 5 working the floor it does not mean that those 4 cannot or should not wash hands before patient care just because there is one less nurse on the floor. I think even if the structure is a bit weak, there are areas where nurses can still do well by adhering to standards of care. I do believe that some structural issues can affect processes, too, but I just believe not all processes should be affected because of structural issues. Process however can greatly affect outcomes. Not using sterile instruments on a patient can lead to infection or sepsis ( Berwick, 2016).

In terms of wasteful practices I have found that a lot of the big hospitals waste a lot of products by not using certain products of using them by mistake by untrained staff. For example, many new nurses do not know the difference between the tubing used for regular IV and those for blood administration. So, he or she picks one up from the clean supplies room and opens the bag in the patient room only to realize it was the wrong tubing. Same thing happens with dressings, gauze, etc. I believe patients should have everything available even if it costs the hospital money. Quality care is given by using enough resources and quality resources; however, waste happens that costs the hospital money when we do not appropriately train staff to recognize products. This is just one example of an area where waste occurs. Then we are out of products we need and we have to make do with other products until the hospital orders more. This can delay appropriate care using the right products, right tools, and right materials. Not using the appropriate medicines, gauze, dressing, etc. can affect patient care; it can affect the quality of care. Donabedian believed that quality is measured by “the end results of healthcare”(Berwick, 2016).


Berwick D, Fox DM. “Evaluating the Quality of Medical Care”: Donabedian’s Classic Article 50 Years Later. Milbank Q. 2016 Jun;94(2):237-41. doi: 10.1111/1468-0009.12189. PMID: 27265554; PMCID: PMC4911723.