NUR4063 Module 5 Change Proposal Example

Watching the Breath, Not Just the Oxygen: A Change Proposal for Sedation Scoring and Capnography After Surgery

Student Name

American College of Education

NUR4063: Leadership and Management in Healthcare

Module 5 Assignment

Instructor Name

October 5, 2026

What this page is doingThe title states the core idea of the change, ventilation monitoring rather than oxygen alone, and names the practice being proposed, so a grader sees the clinical substance before the management framework. The APA 7 title page carries the course line and module assignment as listed.

The Baseline

The unit is a 32-bed adult surgical unit that receives orthopedic, general and bariatric surgery patients. The unit and its data are composites written for this assignment. Over the past twelve months, nurses gave naloxone seven times to reverse opioid-induced oversedation, about 0.8 events per 1,000 patient days. None of the seven patients died, but two required transfer to intensive care. A review of those seven records found that in five, a sedation level was either not documented or documented only as sleeping in the four hours before the event, and that six of the seven patients had normal oxygen saturation readings on supplemental oxygen at the last check before naloxone was given.

The unit's current practice is to monitor pulse oximetry and record a sedation description in free text at each vital signs check. An audit of 120 required sedation checks on patients receiving opioids in the first 24 hours after surgery found that 65, or 54 percent, used any structured sedation scale. The baseline shows two gaps: nurses are not measuring sedation in a consistent way, and the monitor they rely on can look normal while a patient's breathing is failing.

What this page is doingThe proposal begins with numbers, events, rate per 1,000 patient days, a record review and an audit with its denominator, which is the module's explicit requirement. The observation that six of seven patients had normal oxygen saturation on supplemental oxygen sets up the clinical rationale for capnography.

Why the Current Practice Falls Short

The evidence on postoperative opioid-induced respiratory depression explains both gaps. Lee et al. (2015) reviewed malpractice claims involving respiratory depression after surgery and found that in 77 percent of those events the patient died or was left with severe brain injury, that nearly nine in ten happened on the first postoperative day and that almost all were thought avoidable with closer monitoring and a faster response. Somnolence was documented in 62 percent of the patients before the event, and inadequate nursing assessment or response was a contributing factor in 31 percent. The pattern was not that nurses failed to check on patients; in 42 percent of cases, the last nursing check had been within two hours.

Pulse oximetry detects falling oxygen levels, but a patient receiving supplemental oxygen can maintain normal saturation for some time while ventilation falls and carbon dioxide rises. Sedation usually increases before respiratory depression becomes dangerous, which is why a consistent sedation scale matters. Pain management nursing guidelines recommend a validated sedation scale, such as the Pasero Opioid-Induced Sedation Scale, together with assessment of respiratory rate and depth, and they recommend continuous electronic monitoring of ventilation, such as capnography, for patients at high risk (Jungquist et al., 2020). The current practice asks nurses to watch for a late sign with the wrong tool, and to describe the early sign in words that mean different things to different people.

What this page is doingThe claims study is reported with its key figures and the telling detail that most patients had been checked recently, which points to the method of monitoring rather than its frequency. The guideline recommendation is stated accurately, including that capnography is for high-risk patients rather than everyone, which keeps the proposal proportionate.

The Proposed Change and the Model Behind It

The proposal has two parts. First, every patient receiving opioids in the first 24 hours after surgery will have sedation scored with the Pasero scale at every vital signs check and before every as-needed opioid dose, with a documented rule that opioids are held and the provider notified at a score of 3 or higher. Second, patients meeting defined high-risk criteria, including obstructive sleep apnea, a body mass index of 40 or higher, age 65 or older with an opioid infusion or patient-controlled analgesia, or concurrent sedating medications, will receive continuous capnography for the first 24 hours, in addition to pulse oximetry.

Kotter (2012) lays out eight stages for leading change, beginning with making the need feel urgent and assembling a coalition strong enough to guide the work, moving through a shared vision, its communication and the removal of obstacles to action, and ending with early visible wins, building on them and embedding the new approach in the unit's culture. The model fits this proposal because its first stage has a ready source of urgency, the unit's own seven naloxone events, and because the change depends on many roles acting together, which is what a guiding coalition is for. The model's weakness is that it can make change look linear; in practice, communication and empowerment will overlap with the pilot.

What this page is doingThe change is specified precisely, including the action threshold and the high-risk criteria, so it can be implemented and audited. The change model is summarized in full and then justified for this particular change, with its weakness named, which shows the writer chose the model rather than inserting it.

Owners, Tasks and Dates

The nurse manager is the sponsor and owns the business case, including the purchase of twelve capnography modules compatible with the unit's existing monitors, and presents the baseline to the surgical quality committee by week two. The clinical nurse specialist owns education: a thirty-minute session on the Pasero scale and capnography waveforms for every nurse, with a competency check, completed by week six. The pharmacy clinical coordinator owns the order set, adding the hold-and-notify rule and the high-risk criteria to postoperative opioid orders by week five. An anesthesiologist from the acute pain service owns the alarm thresholds for end-tidal carbon dioxide and respiratory rate, agreed with nursing by week four.

Biomedical engineering owns device setup and testing by week five, and a nurse informaticist owns the documentation fields, replacing the free-text sedation entry with a required Pasero field by week six. Two staff nurse champions, one from each shift, own peer coaching during the first four weeks after go-live and bring concerns to the manager weekly. Go-live is set for week seven. Naming an owner for every task is what separates a change proposal from a wish list, because a task with no owner is a task nobody will be blamed for skipping.

What this page is doingEach role is paired with a specific deliverable and a week, which is exactly what owner by owner means in the module prompt. The inclusion of pharmacy, anesthesia, biomedical engineering and informatics shows an understanding that a nursing practice change depends on other departments.

Resistance and Measures

Two forms of resistance are predictable. Nurses may see the sedation scale as more documentation, and the answer is to make it replace the free-text entry rather than add to it. Nurses may also fear alarm fatigue from capnography, which is a legitimate concern given the number of alarms on the unit already. The answer is to limit capnography to high-risk patients, to have the acute pain service set thresholds that reflect clinically meaningful changes and to review alarm frequency after the first month and adjust.

The change will be judged by three measures defined before go-live. The outcome measure is the rate of naloxone given for opioid-induced oversedation, expressed per 1,000 patient days and set against the baseline of 0.8 over the following twelve months, recognizing that the numbers are small and a single year may not show a clear difference. The process measures are the proportion of required sedation checks documented with the Pasero scale, aiming for 90 percent within three months from a baseline of 54 percent, and the proportion of eligible high-risk patients who receive capnography, with a target of 85 percent. A balancing measure, the number of capnography alarms per monitored patient per day, will track whether the change creates the alarm burden the staff fear.

What this page is doingResistance is anticipated with specific responses rather than generic calls for buy-in. The measures include an outcome, two process measures with baselines and targets, and a balancing measure tied to the main source of resistance. The note that a year of small numbers may not show a clear difference is an honest statistical caution graders reward.

Conclusion

The unit's baseline shows seven naloxone rescues in a year, inconsistent sedation documentation and a monitoring approach that can appear reassuring while ventilation fails. The evidence on postoperative respiratory depression points to structured sedation scoring for all patients and continuous ventilation monitoring for those at high risk. A change model, named owners with deadlines, anticipated resistance and measures fixed in advance give the proposal a realistic path from a committee presentation to a unit where the next patient who is becoming too sedated is noticed before naloxone is needed.

References

Jungquist, C. R., Quinlan-Colwell, A., Vallerand, A., Carlisle, H. L., Cooney, M., Dempsey, S. J., Dunwoody, D., Maly, A., Meloche, K., Meyers, A., Sawyer, J., Singh, N., Sullivan, D., Watson, C., & Polomano, R. C. (2020). American Society for Pain Management Nursing guidelines on monitoring for opioid-induced advancing sedation and respiratory depression: Revisions. Pain Management Nursing, 21(1), 7-25. https://doi.org/10.1016/j.pmn.2019.06.007

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Lee, L. A., Caplan, R. A., Stephens, L. S., Posner, K. L., Terman, G. W., Voepel-Lewis, T., & Domino, K. B. (2015). Postoperative opioid-induced respiratory depression: A closed claims analysis. Anesthesiology, 122(3), 659-665. https://doi.org/10.1097/ALN.0000000000000564

How this NUR 4063 Module 5 example is structured

NUR 4063 Module 5 commonly builds the change proposal, owner by owner, with the baseline stated up front; your classroom's instructions decide the template and whether a change model is required. This example opens with the unit's baseline data, then gives the evidence for the change and the reason the current practice falls short. A change model organizes the plan, and the owners section assigns each task to a role with a deadline. Resistance is anticipated by name, and the measures that will judge the change are defined before it starts, so success cannot be redefined afterward.

NUR4063 Module 5 questions, answered

What does NUR4063 Module 5 usually ask for?

NUR4063 Module 5 commonly asks for a change proposal: a practice problem with baseline data, the evidence for a change, a change model, the people responsible for each part and the measures that will show whether it worked. Your classroom's instructions decide the template, the change model and whether a budget or timeline is required.

Why should a change proposal start with baseline data?

Because without a baseline, nobody can tell whether the change worked, and the case for urgency rests on opinion. State the current rate or compliance level with its numerator, denominator and time period. Baseline data also help decision makers judge whether the problem is large enough to justify the cost of the change.

Which change model should I use?

Kotter's eight stages and Lewin's unfreeze, change and refreeze model are the most common in nursing leadership courses. Choose the one that fits your change and explain why. Kotter suits changes that need a broad coalition across departments, while Lewin's simpler model suits smaller changes within one team.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

NUR4063 Module 5 change proposal example