CAP 6003 Module 1 Capstone Proposal Example

They Saw It and Waited: A Capstone Proposal on Delayed Escalation of Patient Deterioration Among Fourth-Semester Students in a Composite Arkansas Associate Degree Nursing Program

Student Name

American College of Education

CAP6003: Capstone in Education Specialist

Module 1 Assignment

Instructor Name

October 12, 2026

Introduction

In the last two weeks of their program, fourth-semester students in the associate degree nursing program where I coordinate simulation care for a deteriorating patient in a high-fidelity scenario. Most of them notice that something is wrong. Many of them then wait. This proposal defines that pattern as a problem of practice, presents the local evidence for it, explains why it matters for new graduates and their patients and outlines an Ed.S. capstone that I can lead within my role during one academic year.

Setting

The program is a composite of a public community college in central Arkansas that admits 96 students a year to a four-semester associate degree in nursing. Clinical experiences take place in two regional hospitals and a long-term care center, and every semester includes at least two simulation days in a laboratory with three high-fidelity manikins. Eleven full-time faculty and about 20 adjunct clinical instructors teach in the program. I am a full-time faculty member with release time for simulation, which means I design and run scenarios, train adjuncts in debriefing and keep the simulation records the program uses for course evaluation.

The Problem of Practice

The problem is delayed escalation: students recognize cues of deterioration but do not notify the provider or activate the rapid response team promptly. In the clinical judgment model Tanner (2006) built from research on nurses' reasoning, judgment moves through noticing, interpreting, responding and reflecting. Our students' difficulty sits between interpreting and responding. They chart the falling blood pressure, they say aloud that the patient "looks off" and then they recheck vital signs, reposition the patient or wait for the instructor to prompt them. The gap is not knowledge of what deterioration looks like; it is the step from concern to a call.

Local Evidence

The program's fall 2025 end-of-program scenario presented a postoperative patient developing sepsis, set so that at minute 12 the systolic pressure falls and the pulse climbs. Simulation records show that 51 of 84 students who completed the scenario, or 61%, did not call the provider or rapid response within five minutes of that change, and the median time to a call was nine minutes. Twenty-three students called only after the patient became unresponsive. Debriefing notes repeat the same explanations: "I wanted to be sure first," "I didn't want to bother the doctor" and "I thought my instructor would tell me." Clinical instructors report similar hesitation on the units, though those reports are anecdotal and not recorded systematically.

These figures come from one scenario in one term and describe simulation behavior, not patient outcomes. They are enough to define a problem, not to prove its size in clinical practice, and the capstone will treat them that way.

Why the Problem Matters

The concern reaches beyond one program. At one large academic medical center, Kavanagh and Szweda (2017) tested every new graduate hired over five years, upward of 5,000 nurses, and fewer than one in four, 23%, met the hospital's bar for being ready to practice at entry level, with recognizing and responding to changes in patient condition among the recurring weaknesses. A new graduate who waits nine minutes to call about a septic patient is not a rare figure; it is the pattern our simulation already shows.

Hesitation also has social roots. In a review of research on speaking up among hospital-based health professionals, Okuyama et al. (2014) found that whether staff voiced safety concerns depended on factors such as their perception of risk, their sense that speaking up would make a difference, fear of negative reactions and the hierarchy and climate of the team. Students sit at the bottom of every clinical hierarchy, which helps explain why "I didn't want to bother the doctor" appears so often in our debriefing notes.

Capstone Aim and Questions

The aim of the capstone is to design, implement and evaluate a curriculum thread that shortens the time from noticing deterioration to escalating it among fourth-semester students. The work will follow three questions. What does current evidence say about teaching nursing students to escalate concerns? What combination of instruction, practice and clinical reinforcement fits this program's schedule and resources? How will the program know whether students escalate sooner and more confidently after the change?

Scope and Role

The project is limited to the third and fourth semesters, where students care for higher-acuity patients, and to activities within my authority as simulation coordinator: scenario design, debriefing, a short classroom module and prompts for clinical instructors. Curriculum changes beyond that, such as revising course outcomes, would require faculty committee approval and are outside the capstone. Because the project uses program simulation records already collected for course evaluation and collects no new identifiable data for research purposes, it is a quality improvement project; I will confirm that determination with the college's institutional review office before starting. The project also stops short of judging individual students. Simulation scores in the capstone will be reported only in aggregate, and no student's progression in the program will depend on the new scenarios during the pilot semester, so that students can hesitate, call late or call early without any effect on their grades while the thread is still being tested.

The Approach in Brief

The intervention will be designed in Module 3 from the evidence gathered in Module 2, so it is described here only in outline. It is likely to have three parts. A short classroom module in the third semester would teach a structured way to voice concern, such as the two-challenge rule and the concerned, uncomfortable, safety-issue phrasing used in team training programs, and would let students rehearse the first sentence of a call to a provider. Two deteriorating-patient scenarios, one in each of the last two semesters, would give every student a turn as the nurse who must decide when to call, with debriefing focused on the moment of hesitation. Clinical instructors would receive a one-page prompt card asking students, at least once per clinical day, "What would make you call about this patient, and who would you call?"

None of these parts requires new equipment or extra clinical hours. The main cost is faculty time to revise two scenarios and train adjuncts in a shorter debriefing focus, which I estimate at about 30 hours across the spring semester.

Stakeholders

Students are the primary stakeholders, along with the patients they will care for after graduation. Faculty and adjunct clinical instructors will deliver parts of the thread. The program director must approve schedule changes, and the two partner hospitals' nurse educators have an interest because they orient our graduates. I will meet with each group in the first module and ask the student representative on the curriculum committee to review the plan.

Timeline Across the Capstone

Module 2 will synthesize research on teaching escalation and speaking up. Module 3 will design the intervention. Module 4 will set out the evaluation plan, measures and data sources. Module 5 will report the project, present it to faculty and assemble the portfolio that documents my Ed.S. competencies. Implementation will run during the spring 2027 semester so that the spring end-of-program scenario can serve as the comparison point.

Conclusion

Our students can see deterioration. The capstone is about the minutes after they see it. By defining the problem with program data, placing it in Tanner's model and limiting the project to what a simulation coordinator can change, the proposal sets up a capstone that is narrow enough to finish and important enough to matter on the first night a graduate is alone with a patient who is getting worse.

References

Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57-62. https://doi.org/10.1097/01.NEP.0000000000000112

Okuyama, A., Wagner, C., & Bijnen, B. (2014). Speaking up for patient safety by hospital-based health care professionals: A literature review. BMC Health Services Research, 14, Article 61. https://doi.org/10.1186/1472-6963-14-61

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04