BSN Clinical Capstone Project Examples: 10 Worked Models

Example 1. Hourly rounding to reduce falls.

Problem. A 32-bed medical-surgical unit has a fall rate of 4.6 per 1,000 patient days over two quarters, and falls with injury are rising.

PICOT. In adults aged 65 and over on a 32-bed medical-surgical unit (P), does structured hourly rounding with a checklist (I), compared with unstructured rounds (C), reduce falls per 1,000 patient days (O) over a 90-day pilot (T)?

Framework. Iowa Model, prompted by a problem-focused trigger: the rising fall rate.

Intervention. Hourly checks on pain, position, toileting needs and call light placement on day and evening shifts, recorded in the EHR. Staff complete a 30-minute in-service with return demonstration.

Outcome and evaluation. Monthly fall rate against baseline, target a 20% reduction by month 3. Secondary measure: call light use.

Example 2. CAUTI prevention in the ICU.

Problem. A 16-bed medical ICU's CAUTI rate is above its internal target, and daily catheter necessity review is documented on only 62% of catheter days.

PICOT. In adult ICU patients with indwelling urinary catheters (P), does a nurse-completed daily necessity checklist with removal prompting (I), compared with current review (C), reduce CAUTI per 1,000 catheter days (O) over six months (T)?

Framework. PDSA: plan the checklist, run the pilot, study rates and compliance, act to keep or adjust.

Intervention. Nurses check each catheter against standard indications every morning and prompt removal when none apply, using an EHR flowsheet field.

Outcome and evaluation. Monthly CAUTI rate using CDC NHSN definitions, catheter utilization ratio and weekly checklist compliance.

Example 3. Teach-back for heart failure readmissions.

Problem. A community hospital's 30-day heart failure readmission rate is 22%, and staff report inconsistent teaching on daily weights and fluid limits.

PICOT. In adults admitted with heart failure (P), does a structured nurse-led teach-back session before discharge (I), compared with written instructions alone (C), reduce 30-day readmissions (O) over six months (T)?

Framework. Iowa Model, with a knowledge-focused trigger: evidence supporting teach-back.

Intervention. A 20-minute scripted session covering daily weights, fluid restriction, medicines and when to call, with the patient explaining each point back. Each item is recorded as passed or retaught.

Outcome and evaluation. Monthly readmission rate against the six-month pre-implementation baseline, plus teach-back completion.

Example 4. Bedside shift report.

Problem. A 24-bed progressive care unit scores low on the patient experience domain for communication about care, and two medication discrepancies last quarter were traced to handoffs.

PICOT. In adults on a progressive care unit (P), does standardized bedside shift report (I), compared with hallway handoff (C), improve communication scores and reduce handoff-related events (O) over 90 days (T)?

Framework. Lewin's change theory: unfreeze through education on the evidence, move through a coached pilot, refreeze with policy and audits.

Intervention. SBAR-structured report at the bedside with the patient and family invited to take part, after two weeks of training and an observed competency check.

Outcome and evaluation. Quarterly patient experience scores before and after, and monthly review of handoff-related safety reports.

Example 5. PHQ-9 depression screening.

Problem. A community health center completes depression screening at only 34% of eligible adult visits, although the USPSTF recommends screening adults for depression in primary care.

PICOT. In adults attending a primary care clinic (P), does nurse-administered PHQ-9 screening at every visit (I), compared with screening at provider discretion (C), increase documented screening (O) over three months (T)?

Framework. ACE Star Model: from the evidence summary and recommendation through integration into the clinic workflow and evaluation.

Intervention. Nursing staff give the PHQ-9 before the provider visit, in English or Spanish, with an EHR alert for scores of 10 or more. All staff complete a one-hour training session.

Outcome and evaluation. Monthly EHR audit of completion, target 80%, plus the share of positive screens with a documented follow-up plan.

Example 6. Nurse-initiated sepsis screening.

Problem. On a 40-bed medical unit, median time from sepsis recognition to antibiotics exceeds the hospital's three-hour target, and most cases are first identified on medical rounds.

PICOT. In adults on a medical unit (P), does a nurse-initiated sepsis screen with SBAR escalation (I), compared with usual identification (C), reduce median time to antibiotics (O) over six months (T)?

Framework. Iowa Model, problem-focused trigger.

Intervention. Nurses screen every four hours and with abnormal vital signs, using SIRS criteria (such as temperature above 38°C or below 36°C, heart rate above 90, respiratory rate above 20) plus suspected infection. A positive screen triggers a scripted SBAR call.

Outcome and evaluation. Monthly case review of time to identification and to antibiotics, plus screening documentation per shift.

Example 7. Repositioning compliance in the ICU.

Problem. A 20-bed medical ICU's pressure injury rate has risen, and audits show only 58% of ventilated patients are repositioned every two hours, which points to a compliance gap rather than a policy gap.

PICOT. In ventilated adults in a medical ICU (P), does a repositioning audit with real-time documentation and peer review (I), compared with self-reported compliance (C), improve repositioning and reduce hospital-acquired pressure injuries (O) over 60 days (T)?

Framework. PDSA.

Intervention. Two-hourly EHR documentation of position, skin check and Braden reassessment; the charge nurse reviews a compliance dashboard daily and runs a weekly peer chart review.

Outcome and evaluation. Monthly pressure injury rate, weekly compliance and a short staff survey on documentation burden.

Example 8. Smoking cessation with the 5As.

Problem. An outpatient pulmonology clinic documents smoking status at almost every visit, but only 11% of smokers' charts show cessation counseling or referral.

PICOT. In adult smokers attending a pulmonology clinic (P), does a nurse-delivered 5As brief intervention at each visit (I), compared with unstructured counseling (C), increase documented counseling and referral (O) over three months (T)?

Framework. Lewin's change theory.

Intervention. A three-minute intervention at intake: Ask, Advise, Assess readiness, Assist with quitline details and materials, Arrange follow-up within 30 days, with all five steps recorded in the EHR.

Outcome and evaluation. Monthly audit of complete 5As documentation, target 60%, and self-reported quit attempts at follow-up.

Example 9. Alarm fatigue on telemetry.

Problem. A 28-bed telemetry unit produces very high alarm volumes, staff estimate few need action, and three near misses were linked to delayed responses. Alarm safety is a Joint Commission National Patient Safety Goal.

PICOT. In adults on a telemetry unit (P), does nurse-led individualized alarm parameter setting with daily reassessment (I), compared with default settings (C), reduce non-actionable alarms per patient per day (O) over eight weeks (T)?

Framework. Iowa Model, problem-focused trigger.

Intervention. Individual heart rate, respiratory rate and oxygen saturation limits set on admission and reviewed every 12 hours, daily electrode changes and a weekly alarm data review at huddle.

Outcome and evaluation. Weekly alarm data from the monitoring system, with response time to actionable alarms tracked to confirm safety.

Example 10. Teach-back for new type 2 diabetes.

Problem. A chart review on a medical unit finds many patients newly diagnosed with type 2 diabetes return to the ED within 60 days, and teaching is usually documented only as "verbal instructions given".

PICOT. In adults newly diagnosed with type 2 diabetes (P), does structured teach-back on glucose monitoring, insulin use, hypoglycaemia and diet (I), compared with verbal instructions (C), reduce 60-day diabetes-related ED visits (O) over six months (T)?

Framework. Iowa Model, drawing on ADA Standards of Care for diabetes self-management education.

Intervention. A 30-minute scripted session with return demonstration of glucose testing and insulin injection, recognition of hypoglycaemia and one dietary change, each retaught until passed.

Outcome and evaluation. Monthly 60-day ED return rate, teach-back completion and a staff survey on time burden.