course material

1. The Impact of Families in the Community during Hospital Closure:
Systematic Revie
The Impact of Families in the Community during Hospital Closure: Systematic RevieThe
Impact of Families in the Community during Hospital Closure: Systematic
ReviewComment:My proposal is approved for my capstone and I need assistance with
writing my last portion. I will email what is needed in the final projectThis is a systematic
reviewwe need secondary data analysis as well, if you can helpPublished Outcomes and
ResearchYou should complete this subsection when conducting a systematic review of
relevant published findings and conclusions from other researchers and scholars. Data and
evidence that have not been analyzed belong in the next sections.List databases and search
engines used to find outcomes and research related to the practice problem.List key search
terms and combinations of search terms used. (More detailed search terms may be included
in an appendix and referenced here, if appropriate).Describe the scope of this review in
terms of years searched, as well as types of literature and sources searched.Clarify how this
search will be exhaustive and comprehensive.Note: This type of systematic review needs to
be a deeper and more thorough exploration of the topic, as discussed in the Context
subsection in Section 2.Archival and Operational DataYou should complete this section for
doctoral projects that will involve analysis of an organization’ s operational data that have
been (or will be) routinely collected in the organizational context (i.e., serves a purpose
other than completion of the doctoral project) but have not yet been analyzed at the time of
proposal approval.Describe the nature of the data, including information on who
contributed them originally.Justify the relevance of these data to the practice problem in
this project.Describe how the data were originally collected by the organization, focusing on
their overall validity as a source of evidence. Note any limitations inherent in the
data.Describe the procedure for gaining access to the evidence, including permissions to
gain access to operational dataIf historical or legal documents are used as a source of
evidence, demonstrate the reputability of the sources and justify why they represent the
best source.Evidence Generated for the Doctoral ProjectYou should complete this section
for evidence and data that will be primarily generated for the purpose the doctoral project,
and not part of the normal operations of the site.Provide a step-by-step description of how
this evidence will be collected, paying specific attention to the following
topics.ParticipantsDescribe the individuals who will contribute evidence to aIDress the
practice-focused question(s), paying attention to:• choice for number of participants,• how

2. they were selected, and• relevance of these participants to the practice-focused
question(s).ProceduresDescribe all tools and/or techniques used to collect that evidence
and their alignment with the constructs in the doctoral project.• For existing measurement
instruments, if applicable, discuss validity and reliability of the scores produced by the
instruments, along with any concepts, constructs, or outcomes measured by them. Discuss
also, in terms of the above, modifications that were made to any instruments.• For tools
that you have created, if applicable, detail must be provided on how they were developed
and what strategies were used to assure the validity of the information produced by
them.Note: Identify any instruments to be used in the a) table of contents, b) text of the
manuscript, and c) appendices.ProtectionsDescribe procedures used to ensure ethical
protection of these participants in the doctoral project.• Discuss strategies for recruiting
and developing working relationships with participants.• Discuss measures taken to ensure
ethical protection of participants, including data retention plans, incentives, consent
process, safeguarding of privacy, and measures to permit participants to withdraw
participation.• Describe the role of the Walden University IRB or other bodies in approving
the doctoral project.Note: The names of individual participants and organizations must be
masked.Analysis and SynthesisDescribe the systems used for recording, tracking,
organizing, and analyzing the evidence—
including any software used for these
purposes.Outline the procedures used to assure the integrity of the evidence, including
approaches to managing outliers and missing information.Describe analysis procedures
used in the doctoral project to aIDress the practice-focused question(s) (e.g., coding,
statistical analyses, etc.).SummarySection 3 should end with a summary emphasizing key
points and transitioning to Section 4.The completion of Section 3 marks the end of the DNP
Doctoral Project Proposal. Completed DNP Doctoral Projects should also include Section 4
(below).Both DNP Doctoral Project Proposals and completed DNP Doctoral Project papers
should be rated in terms of APA style (below – final page of this document).SECTION
4:Findings and RecommendationsChecklist Items Pg/NA Comment
HistoryIntroductionRemind readers of the local problem, the gap-in-practice, the practice-
focused question(s), and the purpose of the doctoral project.Summarize the sources of
evidence, how the evidence was obtained, and the analytical strategies that were
used.Findingsand ImplicationsReport the findings that resulted from analysis and synthesis
of the evidence that was collected (not simply the raw numbers or evidence).Discuss any
unanticipated limitations or outcomes and their potential impact on the findings.Describe
the implications resulting from the findings in terms of individuals, communities,
institutions, and systems.Provide potential implications to positive social
change.RecommendationsDescribe the proposed or recommended solutions that will
potentially aIDress the gap-in-practice, as informed by the findings discussed above (e.g.,
policies, practice guidelines, protocols, standards, etc.); include these recommended
products in appendices and provide any detail needed to understand or use the products.If
applicable, describe any proposed secondary products that will guide the use of the primary
products in practice. Any secondary products should be included in appendices, discussed
in the text of the paper, and referenced so that readers know where to look to find the
actual products.If applicable, describe the recommended implementation and evaluation

3. procedures in sufficient detail that administrative decision makers not involved in
development and planning can assign and supervise them without further
planning.Note:Implementation of the recommendations is not required for completion of
the DNP doctoral project.Contribution of the Doctoral Project Team (if
applicable)Summarize the process of working with the doctoral project team, including the
responsibilities taken by team members.Describe the roles the project team played in
developing the final recommendations and/or product(s).Discuss any plans to extend the
project beyond the DNP doctoral project.Strength and Limitations of the ProjectDiscuss the
strengths and the limitations of the doctoral project.Include recommendations for future
projects aIDressing similar topics and using similar methods.SECTION 5: Dissemination
PlanDescribe the plans to disseminate this work to the institution experiencing the problem
in practice.Based on the nature of the product, clarify the audiences and venues that would
be appropriate for dissemination of the project to the broader nursing profession.Analysis
of SelfProvide an analysis-of-self in the role as practitioner, scholar, and project manager;
drawing connection between this project experience, present state, and long-term
professional goals.Describe the completion of the project, discussing challenges, solutions,
and insights gained on the scholarly journey.Note: This section can be written in the first
person.SummaryThe section/paper should close with a concluding statement about the
doctoral project, making its essential message clear to readers.The Impacts on Families in
the Community during Hospital Closure: A Systematic
ReviewName:Institution:Date:AbstractDespite the significance of hospitals in providing
medical services, some of the facilities are undergoing closure in the rural areas. The closure
of the hospitals directly impacts the health of rural populations while the indirect effects
worsen accessibility of medical services. Therefore, the impacts of hospital closure on
communities need to be identified and the extent of the effects evaluated in order to initiate
efforts which will ensure uninterrupted delivery of healthcare services in the rural areas.
The purpose of this doctoral project is to assess the impacts of hospital closure on the
families in the communities. The practice-focused questions are: (1) What implications
occur on families in the community after closure of a hospital in their locality? (2) To what
extent do the implications of hospital closure affect the families in the community? The
capstone is based on the conflict theory which states that poor people in the society are
underserved with important resources such as health facilities. The PRISMA methodology
will be utilized in data collection and analysis. The sources of evidence will be journal
articles collected from scholarly databases including ProQuest, EBSCOhost, PubMed, and
PMC. Analysis of the articles will involve summarizing information about authors, the study
design, duration of study, the intervention, outcome measure, population, method of data
analysis, and the results. The findings of the capstone will be useful in initiating efforts that
may help in establishing intervention measures for hospital closure.The Impacts on
Families in the Community during Hospital Closure: A Systematic ReviewSection One:
Overview of the Evidence-Based ProjectIntroductionAccording to Hung, Kozhimannil,
Casey, and Moscovice (2016), most hospitals that undergo closure are located in rural areas
placing many patients at risk who may have already had access to care issues due to
distance from the existing facility. One reason for rural hospital closure is the low

4. populations in the area which affects the number of patients that hospitals receive (Hung et
al., 2016; Matsumoto, Ogawa, Kashima, and Takeuchi, 2012). The low turnout of patients
causes a generation of unsustainable revenue for a rural hospital leading to subsequent
closure (Bloom, Propper, Seiler, & Van Reenen, 2015). AIDitionally, the low turnout of
patients may cause the practitioners to search for jobs in areas that can enable them to
practice their careers exhaustively and produce a sustainable personal income. Another
reason for closure of hospitals is the lack of expansion of Medicaid and Medicare (Hsia,
Srebotnjak, Kanzaria, McCulloch, & Auerbach, 2012). Most rural hospitals serve people with
low incomes and older adults who are insured by the government. Therefore, as
governmental reductions in Medicaid and Medicare occur, hospitals which rely on
government finding become financially unsustainable resulting in closure (Hsia et al.,
2012).Closure of hospitals affects the health of the community because it is the locus of
healthcare in the area it is located. The sickness of family members worsens and diseases
may spread within the community after a hospital in their locality is closed. Patients may
seek medical services in hospitals located in other areas, but travelling to the distant places
causes their illnesses to worsen (Matsumoto et al., 2012). According to Kashima,
Matsumoto, Ogawa, Eboshida, and Takeuchi (2012) hospitals are important during
emergency cases, therefore, closure of a hospital in an area may contribute to members of
families losing their life because of delayed accessibility to medical attention. Besides
affecting the health of families in an area, closure of a hospital also impacts the economy of
the community. Hospitals are sources of employment to many people in an area, thus
closure of hospitals affect incomes of families (Henry, 2015).The Doctor of Nursing Practice
(DNP) course requires students to initiate practice change or policy change in their places of
work through evidence-based research (Lloyd, D’ Errico, & Bristol, 2016). This DNP project
is a systematic review of studies conducted on the impacts of hospital closure in the
community. Therefore, the various studies will provide heterogeneous information for the
DNP project which will useful in making credible evidence-based practice change that
enhance existence of community hospitals.Problem StatementHealth care is a basic need for
everyone, and the government has strived to ensure that all citizens assess healthcare
services by instituting the Medicaid and Medicare (Hsia et al. 2012). Though other
healthcare services can be provided in other institutions, hospitals are the main places from
which locals in a rural community access medical attention (Henry, 2015). The hospitals
also employ many residents directly or indirectly, therefore, are a source of income to most
families in an area. In aIDition, hospitals considerably influence the economy of an area they
are located. Hospitals are undergoing closure at a fast rate despite the significance of the
institutions in an area (Henry, 2015). According to Henry (2015), about 20 hospitals have
been closed in New York since 2003, and it is projected that more hospitals may get closed
countrywide. The closure of a hospital has implications on the families in the community
with regards to delivery of healthcare services, the economy, and income, among others.
The capstone project is important in the field of nursing practice because the findings can
be used to initiate efforts which will ensure that communities receive uninterrupted care as
a result of continuous existence of hospitals.Purpose StatementThe purpose of conducting
this project based on systematic review methodology is to assess the impacts of hospital

5. closure on the families in the community. The basic function of hospitals in a community is
to offer healthcare services, however the facilities do not meet the purpose once closed
which causes gap-in-practice. The closure of a hospital may result from financial
unsustainability, lack of personnel, ineffective management, and poor government policies,
among others (Henry, 2015). The hospitals provide healthcare services to people and are
also source of employment and income to families in the area of location. Therefore, the
impacts of hospital closure on the families in the community are many and multifaceted.
Most studies related to impacts of hospital closure on the community have involved
conducting research focusing on a single aspect of the problem (Kashima et al., 2012; Lorch,
Srinivas, Ahlberg, & Small, 2013; Matsumoto et al., 2012; Zimmermann, Carnahan, Paulsey,
& Molina, 2016). The systematic review involves synthesizing information from the
different studies, therefore, the findings can be useful in cases that involve developing
intervention measures to solve hospital closure in the community. The project will be
guided by the following questions in order to meet its purpose and objectives: 1) What
implications occur on families in the community after closure of a hospital in their locality?
2) To what extent do the implications of hospital closure affect the families in the
community?Nature of the Doctoral ProjectThe sources of evidence to be used in developing
the project will be academic journal articles related to the impacts on families in the
community during hospital closure. The journal articles will be obtained online from
academic databases which include ProQuest, EBSCOhost, PubMed, and PMC. The systematic
review process will be based on Systematic Reviews and Meta-Analysis (PRISMA)
methodology. The PRISMA methodology is a widely accepted approach for use in systematic
review by scholars. The methodology offers precise guidance for systematic review, which
will enable credible analysis of the journal articles on impact on families in the community
during hospital closure. The findings of the capstone project will be useful in developing
interventions for hospital closure.SignificanceThe findings of the capstone project will have
impact on stakeholders in the health sector who include the families in the rural
communities, the management of hospitals in the communities, local organizations in the
communities, and government leaders, among others. The capstone involves identifying the
causes and impacts of hospital closure on the families in the communities. In aIDition, the
extent of the implications of hospital closure will be assessed. Therefore, the findings of the
capstone project will initiate the need for intervening hospital closure by the collective
efforts of the stakeholders in order to avoid further implications of the problem on the
community. The capstone project involves systematic review of case studies related to
impacts on the community during hospital closure, therefore, generalizability of the findings
to similar practice areas is viable. The findings of the capstone about impacts of hospital
closure on families will also enable people in the society to appreciate the importance of
hospitals in the community.SummaryThe basic role of a hospital in a community is
provision of healthcare services to families. In aIDition, hospitals are a source of
employment to members of families and are important in stabilizing the economy of an
area. Despite the benefits created by hospitals to the community, closure of the institutions
has been on the increase especially in the rural areas. Some of the reason that lead to
closure of hospitals include financial unsustainability, poor management, inadequate

6. qualified personnel, and poor policies by the government, among others. Though the
reasons of closure of a hospital may be genuine, it has several implications on the families
that depended on it for income and healthcare services. The gap-in-practice which the
capstone project aIDresses is that hospitals in the communities do not meet the intended
purpose of delivering medical services due to closure.The purpose of conducting this
research is to assess the implications of hospital closure on families in the community. The
objectives which will ensure the purpose of the project is met are identification and
evaluation of the impacts of hospital closure on families in the community. The project will
be a systematic review using scholarly journal articles, therefore, it is evidence based and
can offer credible findings which can be generalized or transferred to similar areas of
practice. Some of the major stakeholders which may be impacted by the findings of the
capstone project include families in the rural communities, the management of hospitals in
the communities, local organizations in the communities, and government leaders. The
society will also appreciate the importance of hospitals after learning the implication
hospital closure has on communities.Section 2: Background and
ContextIntroductionHospitals are the main facilities in which families in the community get
medical services and employment. Many hospitals in the communities are being closed
which is affecting the health of the family members in the community as well as their
lifestyle. The purpose of this capstone project is to assess the impacts of hospital closure on
families in the community. In order to meet the purpose, the capstone project will be guided
by the following practice-focused questions: What implications occur on families in the
community after closure of a hospital in their locality? To what extent do the implications of
hospital closure affect the families in the community? The second section on background
and context in this capstone project proposal will contain the following topics: the concepts,
models, and theories; relevance of nursing practice, local background and context, role of
the DNP student, role of the Project team, and the summary.Concepts, Models, and
TheoriesTheoretical framework. The project is founded on conflict theory. According to
Bertram and Celikates (2015), the conflict perspective is based on the assumption that
groupings in the society occur because of differences in power, political representation,
resource allocation, and access to services. In the perspective of health care delivery, the
conflict theory is demonstrated by the inequalities that exist in providing healthcare
services (Bertram & Celikates, 2015). The people in the urban centers who are mostly
wealthier get better healthcare services compared to poor families in communities at the
rural areas. In aIDition, the people at the rural areas in most cases are older adults aged
over 65 years old and those with little income, and are more likely to become ill. Rural areas
are marginalized, therefore, low economic growth is experienced resulting in closure of
hospitals. The hospital closure in the community affects the families because they may not
access healthcare treatment readily causing their sicknesses to worsen (Chen, Xi, Bennett, &
Hibbert, 2015; Hsia et al., 2012).Definition of terms. The following terms used in the
capstone project may have different meanings in other contexts:i. Families: The term
families refers to more than one group of people that consists of parents or guardians and
children who live together in a household (Skinner & Ichii, 2015).ii. Community: A
community is a social unit that comprises several families which share the same cultures,

7. identity, or religion and are living in the same geographical area (Skinner & Ichii, 2015). In
the context of this capstone project, community refers to the families located in rural
areas.iii. Hospital: A hospital is an institution that offers healthcare services to the
community. Hospitals have specialized medical personnel such as nurses and physicians
and medical equipment (Bloom et al., 2015).iv. Hospital closure: Hospital closure happens if
it seizes offering healthcare services to the community. During hospital closure, the
personnel seek job opportunities elsewhere and the equipment are transferred to other
hospitals leaving the structures only (SteelFisher, Martin, Dowal, & Inouye, 2013).Relevance
to Nursing PracticeMost of the hospitals that have undergone closure are located in the
rural areas. Henry (2015) states the reasons for closure of hospitals in the United States
(US) include, bankruptcy, poor management, changes in Medicaid and Medicare payment
procedures, court decision, and failure to meet state requirements, among others. According
to Henry (2015), hospital closure in the rural areas was most prevalent during the 1980s.
Henry (2015) is of the view that most hospitals were closed in the 1980s because of the
impacts of changes in methodologies for Medicare payment, rural outmigration, and shifting
demographics. Hospital are among the leading employers of rural communities, therefore,
closure of the facilities creates an economic gap and the effects may be difficult to reverse
by initiating federal government projects (Countouris, Gilmore, & Yonas, 2014). Most of the
states affected by hospital closure have many counties being located in the rural areas.
According to Henry (2015), by 2015, at least 20 hospitals had been closed in New York since
2003. Other states affected by hospital closure include California, Alabama, Georgia, Texas,
and Mississippi, among others. In aIDition, the rural areas have low populations therefore
are not viable for investing, which causes low number of hospitals being established (Henry,
2015).Closure of hospitals has not only affected the state of health of the families in the
community, but also nursing practice. Hospital closure leads to nurses and other personnel
losing jobs. The nurses also lose experience if they stay for long periods without practicing.
The nursing profession requires the practitioners to offer services in a continuous manner
to enable them gain more experience (Cagliuso, 2014). The loss of experience has led to an
increment in cases related to poor delivery of services in which nurses are blamed by
patients for delays and lack of concern, among others. In order to provide practice, the
hospitals in the rural areas need to remain functional and new facilities established.
Consequently, the nurses will get the place where they will practice the knowledge they
have acquired from classwork if they get employment in the hospitals (Cagliuso, 2014).One
of the reasons for closure of the hospitals is bankruptcy due to the government reducing
expenditure by minimizing expenditure on Medicaid and Medicare (Zimmermann et al.,
2016). Therefore, in order to prevent closure of hospitals in the communities, some states
are increasing Medicaid and Medicare funds to the hospitals (Henry, 2016). In other
communities, the local organizations negotiate with the management of hospitals about
charges which the population can afford. As a result, the hospitals are transitioning from
cost-based reimbursement model to value-based reimbursement model in order to be
financially sustainable in the rural areas (Thomas, DiClemente, & Snella, 2014).The doctoral
project is focused on assessing impacts of hospital closure, but it will first involve
identification of the causes and the effects of closure of the facilities. Nursing practice

8. requires making evidence based decisions by gathering all information related to the
problem being investigated. The capstone project, is useful in advancing nursing practice
because it involves identifying the causes of hospital closure in aIDition to assessing the
impacts of the problem.Local Background and ContextThe basic function of hospitals in a
community is to offer medical services to the people, however, the institutions are also a
source of employment to the locals. According to Thomas et al. (2014), the hospitals are
important in enhancing the economy of a place because people from other regions come for
medical services, therefore, bringing in revenue in the area of location of the hospital. The
hospitals are also important in causing other companies to be developed in an area because
industries interdepend for various services (Thomas et al., 2014). The effects of hospital
closure are many, multifaceted, and vary in extent of implication on families in the
community which depended on the facility. Thus, the first practice-focused question of the
capstone project is will involve identifying the impacts of hospital closure on families in the
community. The second question is related to the extent which hospital closure affects the
families in the community.The institutional context in which the problem exists is the rural
communities. Most literature indicate that the problem of hospital closure is prevalent
among the rural communities. In aIDition, majority of rural families comprise of poor
individuals and older adults who are in most need of medical attention. The state and
federal context in which the problem exists involves leadership at the county levels because
most hospitals in the rural communities are owned by the counties.The main terms used in
this doctoral project include hospital closure, systematic review, community, families, and
impacts. The terms families, community, hospital, and hospital closure have been defined.
Systematic review means analyzing information contained in the journal articles that are
related to the topic of the capstone project (Liberati et al., 2009). The term impacts means
the effects that hospital closure has on the families that depended on it.Role of DNP StudentI
am a nurse who is charged with offering care under the supervision of a physician. My
objective is to be able to practice independently in offering primary care and that is the
reason for my enrollment in for Doctor of Philosophy. The degree program prepares
students for system leadership, quality improvement, and evidence-based practice. The
capstone project which I am conducting meets the objectives of the DNP program because it
is evidence based involving systematic analysis of documented research.One of my roles in
the DNP project involved suggesting the capstone’ s topic to the supervisory committee.
After its approval, I am now developing the capstone through stages including writing the
proposal and later the actual project. The capstone which is based on systematic review will
require me to search online for journal articles which will be source of information for the
project.The health needs for rural populations have not been aIDressed adequately as in
urban centers, yet most of the facilities in the underdeveloped areas are being closed. The
closure of rural hospitals has direct implications on the community, but the indirect effects
may in turn contribute to the worsening of the health status of the families. I feel that
intervention for the problem is needed, and that is why I am conducting an assessment on
impacts of closure of hospitals on communities in order to create awareness. Leaders and
stakeholders in the health sector will realize the extent of effects of hospital closure after
reading my project and realize the urgency of intervening hospital closure.While conducting

9. the project, I may be biased by focusing on studies conducted in particular countries or by
particular authors. I may also biased by avoiding studies with titles that may not pleasing to
me. In order to avoid the biases, I will strictly follow the PRISMA procedure while choosing
the journals to be used in developing the project.SummaryThe main subtopics in the
background and context section included concepts, models, and theories, relevance to
nursing practice, local background and context, and role of DNP student. The capstone
project is based on conflict theory. The perspective of conflict theory is that poor people are
not sufficiently provided with important resources such as hospitals. The findings from the
reviewed literature are consistent with the conflict theory because hospital closure has
been prevalent in the rural areas. The source of motivation for conducting the capstone
project on impacts of hospital closure on families in the communities is to create awareness
among healthcare stakeholders about the need for intervening the problem.Section 3:
Collection and Analysis of EvidenceIntroductionHealthcare is among the universal basic
needs which everyone is entitled. Medicaid and Medicare schemes instituted by the
government help in covering the costs of healthcare services for the poor, disabled, and
older populations in the society. Hospitals are the main centers from which rural
populations access medical services (Thomas et al., 2014). Hospitals also enhance the
livelihood of rural populations by creating both direct and indirect employments from
which families get income. Despite the significance of the hospitals, the facilities are
undergoing closure especially in the rural communities which are in most need. According
to Henry (2016), operation in most hospitals is expected to be shut if the present conditions
causing closure are not intervened. The closure of hospitals in the rural communities may
have more implication on the families besides health. The purpose of this capstone project
is to assess the impacts of hospital closure on the communities. The purpose of the project
involves identifying the impacts of hospital closure then evaluating the extent to which the
communities are affected by the implication of the problem.The project is based on the
conflict theory. According to the theory, different categories of people exist in the society
based on differences in resource allocation, power, and political representation, among
other facto