NUR4093 Module 3 Capstone Implementation Plan Example

Senna by Default, Bowels by Shift: The Implementation Plan for a Nurse-Led Bowel Protocol After Joint Replacement

Student Name

American College of Education

NUR4093: Senior Capstone Experience for Nursing

Module 3 Assignment

Instructor Name

March 15, 2027

What this page is doingThe title compresses the two halves of the intervention, a default order and monitoring every shift, into a phrase nurses will remember, then names the deliverable and the population. That makes the plan's content visible before the first paragraph. The APA 7 title page carries the course line and module assignment as listed.

The Intervention

The intervention has three parts, each tied to the evidence appraised in the previous module. First, the postoperative order set for elective hip and knee replacement will be changed so that the default bowel regimen is senna two tablets at bedtime starting on the day of surgery, with docusate removed from the default and available only if a prescriber adds it. An as-needed order for polyethylene glycol 17 grams by mouth will be included in the default set. Senna will be held for two or more loose stools in a shift. This change follows the guideline's position that conventional laxatives are first-line therapy (Crockett et al., 2019), the orthopedic trial showing that senna is effective in this population (Marciniak et al., 2014) and the finding in the previous module that docusate adds little.

Second, nurses will document bowel status on every shift using a new flowsheet row that records the date and time of the last bowel movement and its form on the seven-point stool form scale, rather than the current optional free-text entry. Third, a nurse-led escalation step will apply: if a patient has no bowel movement by the end of the second postoperative day, the nurse will give the as-needed polyethylene glycol and notify the orthopedic physician assistant during daytime rounds on day three if there is still no result. The protocol moves the decision point from day three, when the problem is established, to day two, when a nurse can still prevent it.

What this page is doingThe intervention is described precisely enough to be written as orders, with dose, timing, hold parameters and escalation, and each part is linked to the evidence from Module 2. The highlighted sentence explains the design logic of the escalation, which ties the plan to the baseline definition.

Setting

The plan applies to the 26-bed orthopedic unit that was the source of the baseline, a composite unit described for this capstone. The unit admits about 25 elective hip and knee replacement patients a month, most of whom stay two to four days, and each day-shift nurse typically carries five patients, each night nurse six, with two nursing assistants on every shift. Patients follow an enhanced recovery pathway that begins walking on the day of surgery. The pathway already includes nursing prompts for mobility, incentive spirometry and pain reassessment, which gives the bowel protocol a natural place to sit.

Two features of the setting matter for the plan. The order set is shared with the other orthopedic surgeons' practices in the hospital, so changing it requires approval from the orthopedic section, not only the unit. And most doses of senna will be given by night nurses at bedtime, so night shift must be fully included in education and follow-up rather than treated as an afterthought.

People and Roles

The capstone student leads the project and owns the baseline, the education content, the audit and the report. The nurse manager is the sponsor, securing time for education and presenting the proposal to the orthopedic section. An orthopedic physician assistant who rounds daily on the unit has agreed to be the prescriber champion, presenting the order set change to the surgeons and taking the day-three calls during the pilot. The orthopedic clinical pharmacist will review the order set for doses, hold parameters and interactions and confirm that polyethylene glycol and senna are stocked on the unit.

The clinical informatics nurse will build the new flowsheet row and add a bowel status prompt to the enhanced recovery pathway. The unit educator will co-deliver education sessions, and two staff nurses, one from days and one from nights, will serve as champions who answer questions and remind colleagues during the first month. Patients are included as participants: a one-page handout at the preoperative class will explain why senna is given from the first night and ask them to tell their nurse about each bowel movement.

What this page is doingEvery role is named by function with a specific responsibility, including the prescriber and pharmacy partners that a nursing protocol still depends on. Including patients through the preoperative class shows the plan recognizes that bowel status often depends on what patients report.

Sequence

The plan runs over ten weeks. In weeks one and two, the student presents the baseline and evidence to the nurse manager, the physician assistant champion and the pharmacist, and the order set proposal is drafted. In week three, the physician assistant presents the proposal at the orthopedic section meeting, and the informatics nurse begins building the flowsheet row. In weeks four and five, the order set and flowsheet changes are tested in the training environment, and education is delivered: a fifteen-minute session at every shift huddle over two weeks, including two sessions at 0200 for night staff, with a one-page protocol card for each nurse.

In week six the protocol goes live for all new elective hip and knee replacement admissions. In weeks six through nine, the champions round daily, and the student reviews every eligible patient's record twice a week to catch missed doses or missed escalations while they can still be corrected. Week ten is reserved for the first formal measurement against the baseline, described in the next module. The sequence places approval before education and education before go-live, so that nurses are never taught a protocol they cannot yet use.

Resistance Expected

Grol and Wensing (2004) describe barriers to evidence-based change at several levels, including individual professionals' knowledge and attitudes, the social context of colleagues and patients, and the organizational context of systems and resources, and they argue that implementation plans should target the specific barriers present. Three groups are likely to resist this plan, each for different reasons. Some surgeons may resist removing docusate from the default because it has been in their order sets for years and is seen as harmless. The response is to present the docusate trial directly, emphasize that docusate remains available to add and frame the change as simplifying the default rather than restricting choice.

Some nurses may resist because patients refuse senna, complain of cramping or have loose stools after the first dose. The response is the hold parameter for loose stools, education on explaining the reason for the laxative to patients and a note in the protocol that a refusal should be documented and offered again the next evening. Night nurses may see the new flowsheet row as additional charting. The response is that it replaces the free-text entry rather than adding to it and takes under thirty seconds. Patients may be embarrassed to report bowel movements. The preoperative handout and a direct question from the nurse at each assessment are designed to make the topic routine. Each objection is reasonable from where the person stands, which is why each gets its own answer rather than a general appeal to evidence.

What this page is doingResistance is analyzed with a framework from a named source and then handled group by group, with the objection stated fairly and a specific response built into the plan. That shows the grader the plan anticipates human reactions rather than assuming compliance.

Conclusion

This plan converts the evidence into three concrete changes: senna as the default from the night of surgery, bowel status charted on every shift and a nurse-led escalation on day two. It places the plan in a real setting, assigns every part to a named role, sequences approval, education and go-live over ten weeks and predicts who will resist and why. The problem it addresses remains exactly the one defined in the first module, the proportion of joint replacement patients without a bowel movement by the end of day three, so the next module can measure the plan against the baseline without changing the question.

References

Crockett, S. D., Greer, K. B., Heidelbaugh, J. J., Falck-Ytter, Y., Hanson, B. J., & Sultan, S. (2019). American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology, 156(1), 218-226. https://doi.org/10.1053/j.gastro.2018.07.016

Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. Medical Journal of Australia, 180(S6), S57-S60. https://doi.org/10.5694/j.1326-5377.2004.tb05948.x

Marciniak, C. M., Toledo, S., Lee, J., Jesselson, M., Bateman, J., Grover, B., & Tierny, J. (2014). Lubiprostone vs senna in postoperative orthopedic surgery patients with opioid-induced constipation: A double-blind, active-comparator trial. World Journal of Gastroenterology, 20(43), 16323-16333. https://doi.org/10.3748/wjg.v20.i43.16323

How this NUR 4093 Module 3 example is structured

NUR 4093 Module 3 in many sections writes the plan: setting, people, sequence and the resistance expected; your classroom's instructions decide the template and whether a change model must be named. This example describes the intervention precisely enough to be carried out, then gives the setting, the people and their roles, and the week-by-week sequence their own sections. Resistance is handled last and by group, with a specific response to each objection, because resistance that is predicted by name can be planned for. The plan keeps the same problem, population and day-three definition used in the earlier modules, so the measure in the next module will be comparable.

NUR4093 Module 3 questions, answered

What does NUR4093 Module 3 usually ask for?

NUR4093 Module 3 in many sections asks for the capstone implementation plan: the intervention, the setting, the people involved, the sequence of steps and the resistance expected. Some sections also require a change model or a timeline. Your classroom's instructions decide the template and how much detail is needed for each part.

How detailed should the intervention description be?

Detailed enough that another nurse could carry it out without asking you. For a protocol, include the orders or steps, timing, doses where relevant, hold parameters and exactly when a nurse escalates. Link each part to the evidence you appraised so the grader can see why it was designed that way.

How do I write about resistance in a capstone plan?

Name each group likely to resist, state their objection fairly and build a specific response into the plan, such as an education point, a design change or a champion. A framework for barriers to change can organize the section. General statements that staff will be encouraged to accept the change rarely earn credit.

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.

NUR4093 Module 3 capstone implementation plan example