Senna by Default: Cutting Day-Three Constipation After Joint Replacement From 52 to 28 Percent (Capstone Presentation With Speaker Notes)
Student Name
American College of Education
NUR4093: Senior Capstone Experience for Nursing
Module 6 Assignment
Instructor Name
April 5, 2027
Slide 1: More Than Half of Our Joint Replacement Patients Reached Day Three Without a Bowel Movement
On the slide: a single bar showing 37 of 71 patients, 52 percent, with no documented bowel movement by midnight ending postoperative day three, from a review of consecutive elective primary hip and knee replacement patients who stayed through day three on a 26-bed orthopedic unit. Beneath it, one line: senna was ordered as needed for most of these patients and rarely given. A footnote states that the unit and data are a composite prepared for this capstone.
Speaker notes: I start with the number because it surprised the staff when they first saw it. The figure is corrected: the original baseline was 46 percent, but it had counted nine patients discharged on day two as successes, and removing them raised it to 52 percent. The key point is the second line. This is not a problem of missing treatment; the laxative that works was already in the orders.
Slide 2: Guidelines and Trials Point to Senna, Not Docusate
On the slide: three short evidence statements with citations. A national gastroenterology guideline puts ordinary laxatives first for constipation caused by opioids (Crockett et al., 2019). Senna was as effective as lubiprostone in older adults after orthopedic surgery (Marciniak et al., 2014). Adding docusate to senna gave no benefit over adding placebo in a blinded trial (Tarumi et al., 2013).
Speaker notes: None of these studies tested our exact intervention in our exact patients, and I will not pretend otherwise. What they do together is point in one direction. The default on our order set was docusate, which has the weakest support, and the option with the best support was sitting in the as-needed column.
Slide 3: The Protocol Changed Three Things
On the slide: three numbered boxes. One, senna two tablets at bedtime from the evening of surgery, now the default in the order set, with docusate removed from the default. Two, a bowel status row completed by every nurse on every shift, with time of last stool and stool form. Three, polyethylene glycol within one shift if day two ends with no stool, and a call to the physician assistant on day three if there is still none.
Speaker notes: The order set change needed the orthopedic section's approval, and our physician assistant champion presented it. The charting row replaced a free-text field, so it did not add work. The escalation step means a nurse acts a full day before the outcome we measure, while action can still head the problem off.
Slide 4: We Decided How to Measure Before We Started
On the slide: a four-row table. Outcome: percentage with no stool by the end of day three, defined exactly as at baseline. Process: senna given the evening of surgery; bowel row completed each shift; escalation given when due. Balancing: two or more loose stools in 24 hours. Timing: weekly run charts, formal comparison at week eighteen.
Speaker notes: The measures and targets were written down before go-live. That matters because a measure picked after the results can be made to show almost anything. The balancing measure was there to catch the obvious risk of a stronger regimen, loose stools in patients walking with a new joint.
Slide 5: Day-Three Constipation Fell From 52 to 28 Percent
On the slide: two bars, baseline 37 of 71, 52 percent, and post-implementation 21 of 74, 28 percent, with the difference labeled 24 percentage points and the chi-square result, p = .004. Beside the bars, a small run chart of weekly percentages from go-live, showing seven consecutive weeks below the baseline median.
Speaker notes: This is the result, and I want to be clear about what it does and does not show. The comparison is before and after, not a randomized trial, so other changes on the unit could have contributed. The run chart helps: following the rules described by Perla et al. (2011), seven weeks in a row below the median is a signal of real change rather than chance. In practical terms, about one in four patients who would have reached day three without a bowel movement no longer did.
Slide 6: Nurses Followed Most of the Protocol, and One Part Lagged
On the slide: three horizontal bars against their targets. Senna given the evening of surgery: 88 percent, target 90. Bowel row completed per shift: 81 percent, target 85. Escalation given when due: 74 percent, target 80.
Speaker notes: All three process measures came close to target, and the escalation step lagged most. When we looked at the missed escalations, most happened when day two ended on a night shift and the patient was asleep. We have changed the protocol card to say the dose can be given with the 0600 medications, and we will watch whether that closes the gap. The process data also help us believe the outcome: the result came with the protocol being used, not without it.
Slide 7: Loose Stools Rose Slightly and Stayed Under Our Safety Limit
On the slide: the balancing measure, 7 of 74 patients, 9 percent, with two or more loose stools in 24 hours, compared with 4 of 71, 6 percent, at baseline, and the preset review threshold of 15 percent marked as a line.
Speaker notes: This is the cost of the change, and it is small. The hold parameter for loose stools did its job, and no patient had a fall linked to urgency during the project. We will keep tracking this measure, because a protocol that trades one problem for another is not an improvement.
Slide 8: Recommendation: Keep Senna as the Default and Extend the Protocol to Hip Fracture Patients With Their Own Baseline
On the slide: two recommendations and one request. Keep the protocol as the standard for elective primary hip and knee replacement. Extend it to hip fracture patients after a separate baseline, because their needs differ. Request: approval to make the order set change permanent across the orthopedic section.
Speaker notes: I end with what I am asking for. The headline on each slide was written so that someone who reads only the headlines would still follow the argument, an approach Alley and Neeley (2005) recommend because sentence headlines state the point instead of naming the topic. If you remember one thing, it is slide one: the fix was already in the orders, and the protocol simply made sure it reached the patient. The best improvement projects often add nothing new; they make an existing good choice the easy one.
References
Alley, M., & Neeley, K. A. (2005). Rethinking the design of presentation slides: A case for sentence headlines and visual evidence. Technical Communication, 52(4), 417-426.
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
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
Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895
Tarumi, Y., Wilson, M. P., Szafran, O., & Spooner, G. R. (2013). Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. Journal of Pain and Symptom Management, 45(1), 2-13. https://doi.org/10.1016/j.jpainsymman.2012.02.008
How this NUR 4093 Module 6 example is structured
NUR 4093 Module 6 often ends in presentation, where a slide has to argue without the presenter speaking over it; your classroom's instructions decide the number of slides, the format and whether recorded narration is required. This example uses a sentence headline on every slide, so the headlines alone tell the whole story from problem to recommendation. Each slide lists what appears on it and then gives the speaker notes, which add explanation rather than repeating the slide. The slides follow the order of the capstone modules, problem, evidence, intervention, measures, results and recommendation, which lets the audience check each claim against what came before.
NUR4093 Module 6 questions, answered
What does NUR4093 Module 6 usually ask for?
NUR4093 Module 6 often asks students to present the capstone project, usually as slides with speaker notes or a recorded narration, covering the problem, evidence, intervention, measures, results and recommendations. Your classroom's instructions decide the number of slides, the time limit and whether a recording or a written script is submitted.
What is a sentence headline on a slide?
A sentence headline states the slide's point as a full sentence, such as day-three constipation fell from 52 to 28 percent, instead of naming a topic such as results. Reading the headlines alone should tell the whole story. The body of the slide then shows the evidence for that one point.
What should speaker notes add to a capstone presentation?
Speaker notes should explain what the slide cannot: limitations, how a number was calculated, what surprised you and why a result matters in practice. They should not repeat the slide text. Well-written notes also help if the presentation is graded from the file rather than delivered live.
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