MSN Capstone Project Proposal Form This is a building a.docx

MSN Capstone Project Proposal Form
This is a building assignment that you will be completing
over Week 1 through Week 9. This is a stepwise project
proposal assignment in which you will complete one (1) section
each week for your MSN Capstone Project Proposal. By the end
of the Week 9, this form will have been filled in completely and
your MSN Capstone Project Proposal will be completed. It is
important that you keep up with the Weekly Assigned Section.
Each
section is graded separately on a weekly basis while the
final completed form will be graded with an overall grade. Each
week the student will receive feedback from the instructor and
the student is expected to incorporate the instructor feedback to
edit and improve the weekly sections. The Week 9 final
Capstone Project Proposal with be based on students
incorporating the instructor’s weekly feedback.
How to use this form.· Must use the same form for all
sections. The purpose is to have a completed the entire form by
the end of the course.· Complete the week’s section with the
requested information.· There are suggested word counts for
each weekly section to provide you with an idea of what is
expected. · You are to write in full sentences, paragraphs,
correct grammar, and spelling.· Use APA formatting with
citations and references list.· Refer to the
MSN Capstone Project Proposal Form Example found in
Week 1 and in the Course Resources tab.
· Do not delete or edit the week section instructions.
· Do not lock the form because that will stop you from editing
and revising within the form.
· Leave NO blank sections. All sections are graded separately.
· You may work ahead; however, the instructor will only grade
the week’s section due for the assigned week and the form

must be submitted each week.
· Read the item descriptions carefully. Items request very
specific information. Be sure you understand what is requested.
· Use primary sources for any references. Textbooks are not
acceptable as references.
Late Assignments: Students will receive a 10-point grade
reduction for each day the assignment is submitted past the due
date. After three (3) days past the due date, students will
receive a zero (0) for that weekly section but must complete for
the final Week 9 grading.
MSN Capstone Project Proposal Form
Student Name
Ralph Marrero
MSN Program
Family Nurse Practitioner
Project Title
Depression in adolescent
Week 1
State Your Clinical Question Comment by Renita: Changes not
made as suggested by Professor
[100 to 150 words]
· State your clinical question or topic for your capstone project
proposal.
· What issue is the question/topic addressing?
· What are the reasons you selected this question/topic?
Comment by Renita: Must list 3 reasons for choosing the
topic
My topic of interest will be focus on the adolescent depression
and how to identify risk factors to prevent suicide. Adolescent
depression is on the rise. Recent surveys indicate that as many

as one in five teens suffers from clinical depression. This
alarming high rate of depression and suicide for adolescents
worldwide is a big concern and it is important to know how to
detect it. Depression can be difficult to diagnose in adolescents
because adults may expect them to act moody. Also, adolescents
do not always understand or express their feelings very well.
They may not be aware of the symptoms of depression and may
not seek help. This proposal addresses an opportunity to
improve providers’ skills to properly identify potential risk
factors and effective treatment tools we can use to better the
life of the depressed adolescent. I chose this topic of interest
because mental health is one of the areas if feel many people
struggle with and they have a stigma against mental health. As a
practitioner want to treat not only the medical condition of my
patients but the mental health side as well.
Week 2
Background Information
[200 to 250 words]

Address the following questions/bullets in completing this
section:· Start at the starting point - What, Where, When, Why,
and How?
· What is known about this topic or what is the evidence on this
topic
(Scoping Search)?
· What is the outcome of interest?
· What are the gaps in our understanding or knowing related to
this topic?
Those who will benefit the most from the evidence given are
the veterans of the age 45 years to 50 years as well as the
primary care providers. One of the greatest impact that would
result from the audience which has been provided is the
participation in the primary care clinics whereby they would
benefit beneficial veterans having suicidal ideations take a
period of 3 months up to a year later. 30 being needed include
the which is said to that should be having mandatory categories
which are provided and answerable. The most appropriate man
who would be of the ages 45 to 50 who are involved in most of
military activities care providers. The benefits which would be
observed for this case would include the possibility of having
measures being established on prevention of suicidal ideation
and any other any other tents which would be provided more
primary care follow-ups and other related depression screening.
Some of the potential risk which would be there would include
having failure to follow ups after 3-month. appointment even
having this person aeration increasing in terms of the
percentages and other attempts of primary care follow-ups
unprofitable. One should understand that barriers would include
having tough times in finding enough what are specific age
group experiencing the suicidal ideations and I want correct
enough data if there would be a decrease in their ideation and
attempts more frequent follow ups.
Week 3

Literature Search Strategies Comment by Renita: Changes not
made as suggested by Professor
[150 to 200 words]
Provide details of your exhaustive search process. Be certain to
list:
· Databases searched.
· All the keywords or search phrases used.
· How many articles in total that were found?
· List the inclusion/exclusion criteria.
· Provide the number of articles that were retained and a
description on why those articles were retained.
· Consider using a flowchart to outline the search process.
The PubMed is considered to be a citation and abstract index
that is from the National center for biotechnology information
are the United States National Library of medicine. Please that I
found to be more user-friendly doubt supportive evidence based
articles on a period duration of 2017 to 2022. The criteria used
on finding these it was by the certain keyword phrases such as
veteran suicide depression in veterans decreasing suicide
whereby I was able to find out over 150 articles. I also used the
South University Library which is noted to be having
diversified information on I'm suicidal help we're by The
Searchers in these articles were made using the keywords such
as suicide prevention measures and also the words such as the
veteran mental health. From this search I found out that 10
articles review consideration in the discussion about mental
health. Customer on the articles that were discussing
interventions all the various strategies that would be used on
reducing the risk of suicide other articles that were discussing
about the various factors that are contributing to increased
instances being reported.
In the United States which side is considered to be a public
health issue disproportionately faced person who are serving

most in the United States military. The US department of
veteran’s affairs has made a number of suicide provisions
measures into top consideration implementation. Veteran affairs
body is committed at having suicide prevention among the
entire population for those who have served in the military
regardless of where they came from benefits they are getting
from the state. Understand that suicide can be prevented by a
number of such as embracing the partners at home, having
friends whom can share issues with and many more. Following a
national strategy the veterans affairs which involves application
of a public health strategy and having the different clinically
based practices and interventions being used.
Week 4
Literature Review Comment by Renita: Changes not made as
suggested by Professor
[500 to 1000 words]
Conduct a review of the literature. Include at least five (5)
research articles and/or evidence-based guidelines. Address the
following questions/bullets in completing this section:
· Conduct a review of the literature.
· Provide the highlights from the research.
· Synthesize the literature on the topic.
· Summarize how the project will contribute to knowledge by
filling in gaps, validating, or testing knowledge.
· Cite references in this section per APA and list the reference
in the References section at the end of the form.
Evaluation of the effectiveness of the safety plans for military
veterans.
the department of the VA has been responding to issues
contributing to high percentages of suicidal rates by having the
provision of safety plans to the veterans having suicidal
thoughts. Also, there have been major research activities on the

efficacy of the SPs but no prior studies have indicated the
degree to which a person would be linked with the outcomes
most relevant on preventing suicidal thoughts/behaviors. The
current studies aims at having more measures of prevention of
suicidal behaviors being established and also being made
effective based on the implementation which is done. The
present study was about examination and the establish on
ensuring that are determined and strategies of reducing the
effects being put in place. Participants who have been involved
in previous studies, whereby most of them are the military
personnel I want other military veterans have been considered
to be much important for the studies.
Team based suicide prevention
This is a strategy that involves the provision of lessons from an
early age based on the collaborative acre provided. one should
understand that the suicidal prevention in any clinical setting is
a very demanding thing as it need coordination of the multiple
clinicians who are having diversity in their skills on handling
issues related to suicidal behaviors. Different challenges and
benefits are experienced by the team approaching to provision
of suicide prevention n the primary care provision whereby a
particular focus for this case is on the veterans. The Veteran
Health Administration is considered to be having both stakes in
the prevention and o the systematic adoption of the different
approaches relating to primary care intervention which would
positively influence the suicidal acre being provided. one
should also understand that the clinical trials a very important
role in the suicidal prevention based on the efforts which are
invested on by the clinicians in ensuring that the whole
activities relating to suicidal prevention would be successfully
initiated positively.
Developing of a practical suicidal risk prediction model for
targeting highly risked patients in the veteran health
administration. The US VHA (Veteran Health Administration) is
noted to have begun on using the predictive modeling in the
identification of the veterans who are at a higher risk of

suffering from mental health and other suicidal targets. There
are different longitudinal studies which have been done on the
risk factors for the suicide attempts amongst the military
veterans who have been involved been on wars outside the
country such as Iraq. Identification of the different factors
which are having great suicidal risk thoughts contribution
amongst the veterans is very important as it helps on reporting
of the informed risk assessment and also having the intervention
targets being reported. Most studies have shown that a huge
number of the veterans normally suffers from the posttraumatic
stress disorder and this is one of the factors contributing into
having depression disease which would bring in the mindset of
suicide. The considered strongest predictors pf suicide attempts
are considered to be the suicidal intent, suicidal ideation,
attempted suicide history, alcohol and substance abuse,
depression and the post-traumatic stress disorder. Thus, one
should understand that, the stated issues are main contributors
of suicidal behaviors and thus one should firstly deal with
measures of stabilizing their effects because that would result
into their effect being limited.
Week 5
PICOt Question
State your PICOt question here. Use the elements of the PICOt
in separate sections below to describe each component.
· Population – Provide the description of the targeted
population.
· Intervention – Describe your evidence-based intervention.
Comment by Renita: Changes not made as suggested by
Professor
· Comparison – What is currently happening?
· Outcomes – List at least two (2) measurable outcomes.
· time – What duration of the study for the project? (e.g.,
usually 6 months or 3 months)

Population(P):
The population being targeted in this case are the military
veterans of the age 45-50 years who are considered to be having
a higher risk of suffering from suicidal ideations, whereby the
PICOT question is noted to be addressing the higher rate of
having suicidal rate to this group of veteran age and thus
attempts at having the incidences of suicide being reduced.
Intervention (I):
Interventions is another terms whereby it would question on the
primary care follow-up on every 3-months duration, whereby
some of the interventions would include primary acre provided
referrals. Also, patients having high scores of risk of suicidal
thoughts needs to be provided with a personal safety plan and
follow us period of not less than three months.
Comparison (C):
Comparisons related to just having annual screenings and also
provision of the safety plan to patients having higher risk of
interpreted appointments on primary care provision
Outcomes (O):
Outcome is noted to be having 2 measurable outcomes either on
decreased suicide attempts and also on the decreasing of
suicidal ideations.
time (t):
Time for this case is considered to be the duration pf study
being done whereby it would translate into follow-ups during
studies being made and thus helping survey done on
establishing the decreased suicidal thoughts strategies within a

three months follow up.
Week 6
P (Target Population)
[75 to 100 words]
section:
· Who is your target population?
· Describe your population, i.e., age, ethnicity, gender,
condition/diagnosis, etc.?
· Describe the setting where this project be implemented?
Rapid Reasoning: Clostridium difficile Colitis
Chief Complaint/History of Present Illness:
Mindy Perkins is a 48-year-old woman who presents to the ED
with 10-15 loose, liquid stools daily for the past two days. She
completed a course of oral Amoxicillin seven days ago for a
dental infection. In addition to loose stools, she complains of
lower abdominal pain that began two days prior. She has not
noted any blood in the stool. She denies vomiting or
fever/chills. She is on Prednisone for Crohn’s disease as well as
Pantoprazole (Protonix) for severe GERD.
© 2012 Keith Rischer/www.KeithRN.com
Past Medical History:
· Crohn’s disease
· GERD
Your Initial VS:

WILDA Pain Scale (5th VS)
Words:
Crampy
Intensity:
7/10
Location:
Generalized throughout RLQ-LLQ
Duration:
Persistent since onset 2 days ago
Aggravate:
Alleviate:
None
Your Initial Nursing Assessment:
T: 100.2 (o)
P: 92

R: 20
BP: 122/78
O2 sats: 98% RA
Ortho BP’s: Lying: 122/78 HR: 92
Standing: 120/70 HR: 114
GENERAL APPEARANCE: appears weak and uncomfortable.
Easily fatigued RESP: breath sounds clear with equal aeration
bilat., non-labored
CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all
extremities NEURO: alert & oriented x4
GI/GU: active BS in all quads, abdominal soft/tender to
palpation in lower abdomen-no rebound tenderness or guarding
MISC: Lips dry, oral mucosa tacky with no shiny saliva present
in the mouth
Nursing Interventions:
· Orthostatic BP’s
(ED standing order)
· Establish PIV
(ED standing order)
· Initiate enteric precautions
(ED standing order)
Physician Orders:
· 0.9% NS 1000 mL IV bolus
· Hydromorphone (Dilaudid) 1 mg IVP
· Stool culture for C. difficile
· BMP, CBC
· Vancomycin 250 mg PO
o 1000 mg/20 mL…determine dosage to administer
· Admit to the medical unit

Lab/diagnostic Results:
· Stool culture for C. difficile: Positive
BMP
Current
High/Low
Sodium
132
Potassium
3.5
Creatinine
1.45
BUN
47
CO2
18
CBC
Current
High/Low
WBC
12.6
HGB
14.5
PLTS
188
Neuts. %

86
Lymphs %
10
1.
What data from the chief complaint, VS & nursing
assessment is RELEVANT that must be recognized as clinically
significant to the nurse?
RELEVANT data: Chief complaint:
VS/assessment:
Rationale:
2.
What lab/diagnostic results are RELEVANT that must
be recognized as clinically significant to the nurse?
RELEVANT Diagnostic results:
Rationale:
3.
What is the most likely primary problem for this
patient?
4.
What is the underlying cause /pathophysiology of the

primary problem?
5.
What nursing priority will guide your plan of care?
6.
What interventions will you initiate based on this
priority?
Nursing Interventions
1.
2.
3.
4.
Rationale:
1.
2.
3.
4.
Expected Outcome:
1.

2.
3.
4.
7.
What is the relationship between the following nursing
interventions/physician orders and your patient’s primary
medical problem?
Nsg. Interventions/MD orders:
Orthostatic BP’s
(ED standing order)
Establish PIV
(ED standing order)
Initiate enteric precautions
(ED standing order)
0.9% NS 1000 mL IV bolus
Hydromorphone (Dilaudid) 1 mg IVP
Stool culture for C. difficile BMP
CBC
Vancomycin 250 mg PO Admit to the medical unit
Rationale:
Expected Outcome:
8.

What body system(s) will you most thoroughly assess
based on the patient’s chief complaint and primary/priority
concern?
9.
What is the worst possible complication to anticipate?
(start with A-B-C priorities)
10.
What nursing assessment(s) will you need to initiate to
identify and respond to quickly if this complication develops?
11.
What is the patient likely experiencing/feeling right
now in this situation?
12.

What can you do to engage yourself with this patient’s
experience and show that they matter to you as a person?
Week 9 & References
In conclusion, the veteran men of the ages 45-50 years, who are
having the risk of having suicidal ideation are noted to be
needing follow up procedures which should be done for a period
of about 3 months and be reinforced by having annual screening
and thus playing an important role on having the risk reduced.
The PICOT question also has been described as very important
in explaining of the alarming rates of having suicide numbers
being reported amongst the military veterans and other
strategies which would be used on ensuring that the risk of
suicide is reduced amongst the veterans ta all the ages. One of
the competencies you would expect to use in the implementation
of this project is leadership skills which is considered to be a
complex and multi-faceted skills. The other one is quality
adherence and assurance whereby this would be observed in the
management plans and also in the products and services which
are offered in the acre provision to person having suicidal
thoughts or ideation. Lastly, is on having ethical observation
and consideration which would be observed in the decision
making, ethical reasoning and the leadership related skills
which should be within the ethics of practice.
The target population for this case are veteran men of age 45-50
years of age who are noted to be on higher risk of suicidal

ideation and even suicidal attempts. These person or age group
of Veterans have been identified to be at a risk by the US
veteran Health Administration via the predictive modelling in
the identification of veterans who are at a higher risk. The
patients who have been enrolled in the VHA benefits are noted
to be seeking care from the considered local veteran’s affair
medical centers.
Week 7
I (Intervention)
[100 to 200 words]
section:
· What are you planning to investigate or implement as a
policy/process or program?
· What are you doing that is different than what is currently
happening?
· List
2-3 potential actions that will be applied in
this practice change.
NOTE: Be very specific in your description.
The plans I am having on implementation of the strict follow up
policies for the different patients normally involves having
them being assessed and also labeled based on the groups
having higher risk of suicidal ideations. The patients would then
be provided with more personalized safety plan and follow up
from a period of 3 months but the current practices would be
varying from about 6months up to one year. These also needs to
be provided the personalized safety plan as the patient families
are also part of the establishment plan as it would help families

on recognizing the suicidal ideations on one of their own and
provided the most needed care.
*For purposes of this Proposal Project Form the assumption will
be that the C (Comparison Group) is ‘traditional care or current
care’
Week 8
O (Outcomes to be measured)
[100 to 150 words]
Every project is required to have an evaluation plan. Address
the following questions/bullets in completing this section:
· Which
2-3 outcomes are expected for your project?
· What outcomes will be measured?
· How do you plan to do this?
· What tool will you be using to measure your outcome(s)?
· What data will be used to validate success of the project?
Be sure your outcomes link to the identified problem.
· How will you know if your intervention resulted in change?
Increasing of the follow-ups with the help of the primary care
givers for a period for a period of three months or more would
be one of the plans which would include having implementation
of the safety plan whereby each of the patient would be
screened or basically there be done the suicide assessment.
Another outcome would on having the deduction of the risk that
is there on having suicidal thoughts and any suicide attempts to
person of aged 45-50 years by having the implementation of the
safety plan, having those of predictive modeling in
identification of veterans at higher risk and also having the
increased follow ups procedures and implementations. The tool

which would be used for this case would be the regression
model which is noted to be predictive meaning that there would
an exploratory analysis being done on the machine learning
algorithms results obtained. One would know an intervention
resulted in a change by having the evidence obtained that there
is a decrease in the suicidal thoughts and also on the actions
based on the follow ups reports which have been reported and
thus indicating either positive or negative success of the
interventions which would have been used.
References
[Provide at least 5 References]
Carroll D, Kearney LK, Miller MA. Addressing Suicide in the
Veteran Population: Engaging Public Health Approach. Front
Psychiatry. 2020 Nov 23;11:569069. doi:
10.3389/fpsyt.2020.569069. PMID: 33329108; PMCID:
PMC7719675.
Jonathan D. Green, Jaclyn C. Kearns, Raymond C. Rosen,
Terence M. Keane, Brian P. Marx, Evaluating the Effectiveness
of Safety Plans for Military Veterans: Do Safety Plans Tailored
to Veteran Characteristics Decrease Suicide Risk?, Behavior
Therapy, Volume 49, Issue 6, 2018, Pages 931-938, ISSN 0005-
7894,
https://doi.org/10.1016/j.beth.2017.11.005.
Kessler, R. C., Hwang, I., Hoffmire, C. A., McCarthy, J. F.,
Petukhova, M. V., Rosellini, A. J., Sampson, N. A., Schneider,
A. L., Bradley, P. A., Katz, I. R., Thompson, C., & Bossarte, R.
M. (2017). Developing a practical suicide risk prediction model
for targeting high-risk patients in the Veterans health
Administration. International Journal of Methods in Psychiatric
Research, 26(3), n/a-N.PAG.
https://doi-org.su.idm.oclc.org/10.1002/mpr.1575

Lee, D. J., Kearns, J. C., Wisco, B. E., Green, J. D., Gradus, J.
L., Sloan, D. M., Nock, M. K., Rosen, R. C., Keane, T. M., &
Marx, B. P. (2018). A longitudinal study of risk factors for
suicide attempts among Operation Enduring Freedom and
Operation Iraqi Freedom veterans. Depression & Anxiety (1091-
4269), 35(7), 609–618.
https://doi-org.su.idm.oclc.org/10.1002/da.22736
Wittink, M. N., Levandowski, B. A., Funderburk, J. S.,
Chelenza, M., Wood, J. R., & Pigeon, W. R. (2020). Team-
based suicide prevention: lessons learned from early adopters of
collaborative care. Journal of Interprofessional Care, 34(3),
400–406.
https://doiorg.su.idm.oclc.org/10.1080/13561820.2019.1697213
CHART or
PICTURE
CHART or
PICTURE
Type Your Title Here
John Smith, MD1; Jane Doe, DNP2; Frederick Smith, APRN,
PhD1,2
1South University, 2Medical Center of Affiliation
Abstract
In this section provide an abstract of your proposal. This is only
a proposal and is not a project to be implemented. Only Provide
the information you have actually completed with is the MSN
Capstone Project Proposal Form.

In this section provide the background information on the
problem. Why is this project important?
In this section provide a review of the literature. What were the
themes?
Theme
xxxxx
xxxxx
Theme
xxxxx

Literature Review
References
Population (P):
Intervention (I):
Comparison (C):
Outcomes (O):
time (t):
PICOt Question
In this section describe the evidence-based intervention. What
will be done?
Evidence-Based Intervention
© 2021 South University. All rights reserved.
In this section provide your outcome measures and definition
Outcome 1 – Survey – used to measure….
Outcome 2 – Compliance Rate is the percent…
Outcome 3 – Fall rate is the overall falls within the last ….
Outcome Measures
NP Adherence to Practice Protocol:
Management of Persistent Pain in Older Adults

George Peraza-Smith, APRN, DNP, FAANP1; DNP Chair2,
GNP, DNP, FAANP
1South University, 2Case Western Reserve University
Abstract
Even though persistent pain is highest among
older adults, they have been insufficiently
represented in clinical trials and studies on the
management of persistent pain. Agism has had
a negative impact on the adequate assessment
and management of pain in older adults.
Evidence has emerged indicating serious risk for
cardiovascular, gastrointestinal and renal
dysfunction with consistent use of NSAIDs and
COX-2 analgesics. Other evidence supports the
efficacious use of opioid analgesic in the
treatment of moderate-to-severe persistent pain
in older adults. Updated guidelines recommend
more reliance on opioid analgesia.. This
proposal aim is to implement an evidence-based
practice protocol on the pharmacological
management of persistent pain in older adults.
An estimated 25% to 50% of older adults living
in the community and up to 80% of those in
nursing homes experience significant pain at
least some of the time. Undertreated persistent
pain in older adults has been linked to
depression, anxiety, cognitive impairment,
delirium, sleep disturbances, functional decline
and increased healthcare utilization and cost.
This project will implement a best practice so
that each older adult in a clinic will be assessed
and treated more effectively.

Persistent pain is a personal emotional and physical
experience.
Untreated or Inadequate Pain Management
• Persistent pain is under-recognized and under-treated
in older adults in many settings.
• Those with dementia have a greater risk for
inappropriate and inadequate pain treatment.
Pain Assessment with Older Adults
• Many older adults under-report their pain so as not to
be a burden.
• Numeric Rating Scale (1-10) has been shown
ineffective with older adults.
•IPT has high validity and reliability.
Opioid Use with Older Adults
• Guidelines support for persistent pain.
• Prescribing practice of opioids in older adults is mixed.
Literature Review
1.GSA. (2009). Pharmacological management of
persistent pain in older persons. Pain
Medicine, 10(6), 1062-1083.
2. Flaherty, E. (2021). Pain assessment for older
adults. ConsultGeri, 7.
https://hign.org/consultgeri/try-this-series/pain-
assessment-older-adults
References
Population (P): NP providers who make rounds in a 50-
bed skilled nursing facility
Intervention (I): Implementation of an evidenced-Based
Protocol on the management of persistent pain in adults

50 years and older
Comparison (C): Current practice of no protocol
Outcomes (O): 20% improvement in self-report pain
relief, 90% compliance rate of providers with protocol,
50% reduction on the use of NSAID with adults 50 years
and older
time (t): 60-days
PICOt Question
Implementation of a best practice protocol from
the American Geriatrics Society on the
pharmacological management of persistent pain
in older adults.
• Standardized pain assessment tool
• Initial treatment – Acetaminophen
• NSIDs and COX-2 used rarely
• For pain scores at moderate or greater, opioid
therapy is considered.
Evidence-Based Intervention
© 2021 South University. All rights reserved.
Outcome 1 – Iowa Pain Thermometer (IPT) self
report on pain intensity related to a thermometer.
Outcome 2 – NP compliance rate with
implementing protocol.
Outcome 3 – Filled NSAIDs per day compared
to prior to implementation of protocol.
Outcome Measures

https://hign.org/consultgeri/try-this-series/pain-assessment-
older-adults

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