| Course | NUR 4093 Senior Capstone Experience for Nursing |
|---|---|
| Module | Module 3 |
| Paper type | Capstone implementation plan |
| Length | 1,170 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | RN to BSN |
| Updated | October 2026 |
Free sample paper for NUR 4093 Module 3
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
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.
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.
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.
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
What the NUR 4093 Module 3 instructions ask for
In many sections, the third module of NUR 4093 asks you to turn your evidence into an implementation plan. Expect to describe the intervention in detail, the setting and the people involved with their roles, the sequence of steps with a timeline, the resources needed and the barriers you expect. Many prompts ask for a change model or an implementation framework, and some require approval steps such as manager sign-off or a quality committee. The capstone plan tends to run four to five pages, sometimes with a timeline table attached. Read the Canvas instructions to learn whether a budget is needed and whether you must actually begin implementation or only plan it.
Inside the NUR 4093 Module 3 example
The plan describes the intervention first, as orders: scheduled senna with dose and timing, hold parameters, bowel status charted every shift and escalation on day two, with each part linked to the appraised evidence. The setting section describes the unit's patient flow and the points where the protocol touches it. People and roles are named by function, from bedside nurses and the charge nurse to the prescriber, pharmacy and the preoperative class that prepares patients. The sequence section lays out the weeks from approval to full use. The resistance section uses a barriers framework and takes each group in turn, prescribers, nurses and patients, stating the objection fairly and pairing it with a specific response, before a short conclusion.
NUR 4093 Module 3 rubric: what full marks look like
Implementation plans are commonly scored on the intervention description, stakeholders and roles, timeline, barriers and the use of a framework. Description marks require enough detail for another nurse to carry the plan out. Stakeholder points go to roles with specific responsibilities, including partners outside nursing. Timeline marks reward a realistic sequence with dates or weeks. The barriers criterion often separates the bands, rewarding objections stated fairly with a planned response for each. Framework points depend on a model that actually organizes the plan. Sources and APA 7 make up the rest. Graders often check that the protocol's hold parameters and escalation point are written clearly enough for a night nurse to follow without phoning anyone, since that is the test of a usable plan.
Common NUR 4093 Module 3 mistakes, and how to avoid them
Implementation plans most often describe the intervention too vaguely, such as implement a bowel protocol, so no one could follow it. Another common gap is ignoring the people outside nursing whose cooperation the plan needs. Students also write resistance sections that say staff will be educated without saying about what or by whom. Make every step in the timeline someone's job. Keep the plan within your authority and say who must approve what. If your capstone intervention is a fall bundle, a discharge call or an early mobility protocol, the desk can write an implementation plan for it.
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.
More NUR 4093 and RN to BSN sample papers
- NUR 4093 Module 1: Capstone Problem Statement
- NUR 4093 Module 2: Capstone Evidence Appraisal
- NUR 4093 Module 4: Capstone Evaluation Plan
- NUR 4093 Module 5: Capstone Consistency Review
- NUR 4093 Module 6: Capstone Presentation
- NUR 4033 Module 5: Special Populations Assessment
- NUR 4033 Module 3: Head and Neck Examination Write-Up
- NUR 4083 Module 3: Workflow Analysis
- NUR 4063 Module 6: Quality Improvement PDSA Paper
NUR 4093 Module 3 questions, answered
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.
Where can I find a free NUR 4093 Module 3 sample paper?
Read the bowel protocol implementation plan above in its complete form, covering the intervention as orders, setting, roles, sequence and resistance, with three references and running notes, at no cost.
Do I have to carry out the capstone intervention in NUR 4093?
Sections differ. Some expect a small implementation with results, while others accept a plan with projected outcomes. Read the Canvas course overview and ask your instructor early, since it changes what Modules 4 to 6 must contain.
Which change model fits a nursing capstone?
Lewin's three stages suit small unit changes, Kotter's eight steps suit changes that need several departments, and the Iowa model suits evidence-based practice projects. Pick one and use its stages to organize your timeline.