NURS-FPX4900 Assessment 1: Assessing the Problem – Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Course

NURS-FPX4900: Capstone Project for Nursing (BSN level).

Overview

In this first capstone assessment, you identify and clearly define the patient, family, or population health problem that will anchor your practicum project. You then assess this problem through the lenses of leadership, interprofessional collaboration, communication, change management, and relevant policy. The assessment links your practicum experience to current evidence so that later tasks can build toward a coherent, practice-focused capstone intervention.

Assessment Type and Length

• Individual written assessment (academic paper, APA style).

• 5–7 page paper (excluding title page and reference list), double-spaced.

Practicum and Preparation

For this assessment, you will work directly with a patient, family, or group, or with a clearly defined population in your practice setting, to clarify the problem and its context. You are expected to spend approximately 2 direct practicum hours with the selected individual(s) or population and, if appropriate, consult with subject-matter experts such as nurse managers, quality leaders, or community partners. Practicum hours must be documented in the Capella Academic Portal Volunteer Experience Form in line with program requirements.

Suggested Preparation Steps

1. Select a patient, family, or population health problem that is observable in your current or recent practice context (for example, uncontrolled type 2 diabetes in adults, hospital readmissions for heart failure, medication reconciliation errors at discharge, pediatric asthma exacerbations, or low influenza vaccination uptake in a community clinic).

2. Confirm that the problem is feasible for a small-scale capstone project within your available practicum hours and resources.

3. Review recent peer-reviewed literature and clinical guidelines to understand the scope, prevalence, causes, and consequences of the problem.

4. Identify key organizational stakeholders and policies related to this issue (for example, leadership roles, care coordination structures, quality metrics, and regulatory requirements).

5. Schedule and conduct your 2 practicum hours focusing on how leadership, collaboration, communication, change management, and policy shape the problem and current responses to it.

Assignment Instructions

Write a 5–7 page paper that defines your chosen patient, family, or population health problem and assesses it from leadership, collaboration, communication, change management, and policy perspectives. Organize the paper in a clear, logical structure with appropriate headings, scholarly tone, and current APA formatting.

Required Paper Sections

1. Introduction

• Briefly introduce the practice setting and the patient, family, or population group you are focusing on.

• State the specific health problem you have chosen as the focus of your capstone project.

• Summarize why this problem matters for patient outcomes, safety, quality, and costs.

2. Definition and Scope of the Problem

• Define the patient, family, or population health problem precisely, including relevant clinical indicators, diagnostic criteria, or risk factors.

• Describe the epidemiology or local prevalence of the problem, using current evidence to show its impact on health outcomes and healthcare utilization.

• Explain how the problem presents in your specific context (for example, a hospital unit, primary care clinic, long-term care facility, or community program).

3. Leadership Perspective

• Discuss at least one leadership framework or style that is relevant to addressing the problem (for example, transformational, transactional, servant, or shared leadership).

• Explain the current role of nursing and organizational leadership in relation to this problem in your setting.

• Identify gaps in leadership behaviors, structures, or accountability that contribute to the persistence of the problem.

• Outline specific leadership actions you anticipate will be necessary to support change for this problem in your capstone project.

4. Collaboration and Communication Perspective

• Describe the interprofessional team members who are or should be involved in addressing this problem (for example, nurses, physicians, pharmacists, social workers, dietitians, case managers, or community health workers).

• Analyze current patterns of collaboration and communication related to the problem, including coordination across settings or handoffs.

• Identify barriers and facilitators to effective communication and collaboration (for example, hierarchical culture, unclear roles, documentation issues, or technology barriers).

• Discuss collaboration and communication strategies that will be important in your capstone project (for example, huddles, structured communication tools, interdisciplinary rounds, or shared care plans).

5. Change Management Perspective

• Identify the type and scale of change needed to improve outcomes for the selected problem (for example, a workflow change, education initiative, checklist, protocol, or technology enhancement).

• Relate the planned change to at least one change management model or concept (for example, Lewin’s three-stage model, Kotter’s eight-step model, or Rogers’ diffusion of innovation).

• Discuss likely sources of resistance or support among nurses, leaders, and interprofessional team members.

• Describe key strategies required to manage change, such as stakeholder engagement, training, communication planning, and outcome measurement.

6. Policy and Regulatory Considerations

• Identify relevant organizational policies, procedures, or protocols related to the chosen problem.

• Describe external regulations, standards, or guidelines influencing practice (for example, Joint Commission standards, CMS quality measures, or professional association guidelines).

• Analyze how these policies and regulations shape practice, create constraints, or offer opportunities for improvement.

• Explain how your capstone project will align with or advocate for policy changes.

7. Synthesis and Implications for the Capstone Project

• Synthesize insights from leadership, collaboration, communication, change management, and policy perspectives to justify why this problem is suitable for a capstone project.

• Briefly describe the intervention or practice change anticipated in later assessments.

• Highlight the outcomes the project aims to influence, such as readmission rates, symptom control, adherence, patient experience, or cost.

8. Conclusion

• Summarize the significance of the problem, key systems and human factors involved, and the rationale for the capstone focus.

• Reinforce how this analysis will guide subsequent assessments and practicum work.

Practicum Documentation

• Record the 2 direct practicum hours in the Capella Academic Portal Volunteer Experience Form.

• Briefly describe the nature of these interactions in the paper without including identifiable information.

Assessment Criteria (Scoring Rubric)

Criterion 1: Define the Patient, Family, or Population Health Problem (20%)

• Distinguished: Provides a precise, evidence-supported definition with clear population characteristics and contextual factors.

• Proficient: Clearly defines the problem with appropriate evidence.

• Basic: General description with limited evidence.

• Below Basic: Unclear or unsupported problem definition.

Criterion 2: Leadership Perspective (20%)

• Distinguished: Critical analysis linked to leadership frameworks and practice examples.

• Proficient: Describes leadership roles with theoretical connection.

• Basic: General leadership discussion.

• Below Basic: Leadership inadequately addressed.

Criterion 3: Collaboration and Communication (20%)

• Distinguished: Thorough evaluation with justified improvement strategies.

• Proficient: Describes team roles and reasonable strategies.

• Basic: Limited analysis.

• Below Basic: Inadequate discussion.

Criterion 4: Change Management (20%)

• Distinguished: Applies a clear change model with evidence-based strategies.

• Proficient: Links problem to change concepts.

• Basic: Vague reference to change.

• Below Basic: Missing change management perspective.

Criterion 5: Policy and Regulatory Influences (10%)

• Distinguished: Analyzes policy impact and alignment with the capstone project.

• Proficient: Identifies relevant policies.

• Basic: Minimal explanation.

• Below Basic: Incomplete or inaccurate discussion.

Criterion 6: Scholarly Writing and APA Style (10%)

• Distinguished: Clear, well-organized, and accurate APA formatting.

• Proficient: Minor APA or flow issues.

• Basic: Noticeable writing or APA errors.

• Below Basic: Poor organization and frequent errors.

Many adult patients admitted to medical-surgical units with heart failure are discharged without a fully coordinated plan, contributing to avoidable 30-day readmissions. Addressing this issue as a patient, family, and population-level problem requires nurse-led, team-based discharge processes that integrate medication reconciliation, symptom education, and structured follow-up. Transformational nursing leadership can align interdisciplinary teams around shared goals, while standardized communication tools such as teach-back and discharge summaries improve transition safety.

Evidence consistently demonstrates that nurse-led transitional care models significantly improve outcomes for patients with chronic conditions such as heart failure. These models emphasize leadership-driven coordination, proactive communication, and structured follow-up across care settings, leading to reduced hospital readmissions and improved patient self-management (Albert et al., 2021). Integrating such evidence into the capstone project strengthens its alignment with best practices and supports sustainable system-level change.

Reference

Albert, N. M., Barnason, S., Deswal, A., Hernandez, A. F., Kociol, R., Lee, E., Paul, S., Ryan, C. J., White-Williams, C., & American Heart Association. (2021). Transitions of care in heart failure: A scientific statement from the American Heart Association. Circulation: Heart Failure, 14(4), e007800. https://doi.org/10.1161/HHF.0000000000000800

Albert, N. M., Barnason, S., Deswal, A., Hernandez, A. F., Kociol, R., Lee, E., Paul, S., Ryan, C. J., White-Williams, C., & American Heart Association. (2021). Transitions of care in heart failure: A scientific statement from the American Heart Association. Circulation: Heart Failure, 14(4), e007800. https://doi.org/10.1161/HHF.0000000000000800

Albert, N. M., Barnason, S., Deswal, A., Hernandez, A. F., Kociol, R., Lee, E., Paul, S., Ryan, C. J., White-Williams, C., & American Heart Association. (2021). Transitions of care in heart failure: A scientific statement from the American Heart Association. Circulation: Heart Failure, 14(4), e007800. https://doi.org/10.1161/HHF.0000000000000800

Chua, J., & Ayoko, O. B. (2019). Employees’ self-determined motivation, transformational leadership and work engagement. Journal of Management & Organization, 27(3), 523–543. https://doi.org/10.1017/jmo.2018.74

Sullivan, E. J., & Decker, P. J. (2020). Effective leadership and management in nursing (10th ed.). Pearson. https://www.pearson.com/en-us/subject-catalog/p/effective-leadership-and-management-in-nursing/P200000005166/9780134153117

Swindle, T. M., Phelps, J., Kruger, J., & Polhamus, B. (2022). A public health approach to obesity prevention: Addressing systems, sectors, and settings. Annual Review of Public Health, 43, 405–422. https://doi.org/10.1146/annurev-publhealth-052120-021457

World Health Organization. (2023). Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity. WHO. https://apps.who.int/iris/handle/10665/364850