NURS-FPX4900 Assessment 2: Assessing the Problem – Quality, Safety, and Cost Considerations

Course

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

Overview

This second capstone assessment extends the problem you defined in Assessment 1 by examining how it affects care quality, patient safety, and costs for both the health system and the individual. You will use practicum experience and current evidence to analyze the consequences of the problem, identify relevant quality and safety indicators, and consider economic implications that will shape your later intervention design.

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

Continue working with the same patient, family, or population and practice setting selected in Assessment 1. Plan to spend approximately 2 direct practicum hours exploring how the problem influences quality of care, patient safety outcomes, and costs. When appropriate, consult with subject-matter experts such as quality leaders, case managers, finance staff, or data analysts. Document practicum time in the Capella Academic Portal Volunteer Experience Form in alignment with program requirements.

Suggested Preparation Steps

1. Review feedback from Assessment 1 and refine your problem statement so it is specific and measurable.

2. Identify quality and safety indicators relevant to your problem, such as readmission rates, hospital-acquired conditions, adverse drug events, length of stay, emergency department revisits, or patient experience scores.

3. Gather current evidence on how this problem affects quality, safety, and costs at organizational, system, and patient levels.

4. Clarify what “cost” means for this problem, including avoidable utilization, additional procedures, lost productivity, out-of-pocket expenses, and indirect costs.

5. Use practicum hours to observe workflows, review local data where available, and discuss quality metrics and resource use with key stakeholders.

Assignment Instructions

Write a 5–7 page paper that analyzes how the patient, family, or population health problem identified in Assessment 1 influences quality of care, patient safety, and costs for both the healthcare system and individuals. Organize the paper with clear headings, support analysis with current scholarly sources, and follow current APA style guidelines.

Required Paper Sections

1. Introduction and Problem Restatement

• Restate the practice setting, population, and health problem from Assessment 1.

• Explain why the problem is clinically important and how it relates to quality, safety, and cost concerns.

• Conclude with a clear purpose statement focused on quality, safety, and cost considerations.

2. Impact of the Problem on Quality of Care

• Describe how the problem influences care quality using examples from the practicum setting.

• Link the issue to specific quality indicators or benchmarks.

• Explain where current practices fall short of evidence-based standards.

• Support the discussion with recent peer-reviewed literature and quality frameworks.

3. Impact of the Problem on Patient Safety

• Analyze how the problem increases patient safety risks such as medication errors, preventable complications, or unsafe transitions.

• Reference de-identified safety reports, near-misses, or sentinel events when appropriate.

• Connect the analysis to patient safety concepts such as just culture, high-reliability organizations, or safety culture.

• Use evidence to demonstrate the relationship between the problem and adverse safety outcomes.

4. Cost Implications for the Health System

• Discuss how the problem affects direct and indirect system costs, including repeated admissions, prolonged stays, diagnostics, and staffing needs.

• Present available data on cost burden where applicable.

• Distinguish between avoidable and unavoidable costs.

• Relate findings to value-based care and payment models.

5. Cost Implications for Patients and Families

• Describe financial burdens for patients and families, including out-of-pocket costs, lost income, transportation, and caregiving time.

• Examine how insurance status and social determinants of health influence these costs.

• Explain how financial strain can worsen disparities and reduce adherence.

6. Quality, Safety, and Cost Trade-Offs

• Analyze tensions between improving quality and safety while managing costs.

• Identify opportunities where better quality and safety also reduce costs.

• Discuss the role of nurses and interprofessional teams in advocating for high-value care.

7. Implications for the Capstone Intervention

• Synthesize findings to identify priorities for the capstone intervention.

• Identify at least two measurable quality or safety outcomes and one cost-related outcome.

• Explain how this analysis will guide intervention design and evaluation.

8. Conclusion

• Summarize the most critical quality, safety, and cost issues related to the problem.

• Reinforce how this assessment informs future capstone work.

Practicum Documentation

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

• Briefly describe how practicum time was used without including identifiable information.

Frequent 30-day readmissions for older adults with heart failure reflect persistent quality and safety gaps related to discharge education, medication reconciliation, and follow-up coordination. Nurses can address these issues through structured transitional care interventions that improve patient understanding, reduce safety risks at home, and lower costly readmissions for both health systems and patients experiencing financial strain.

Improving quality and safety outcomes while controlling costs requires health systems to adopt high-value, evidence-based care models that emphasize prevention and coordination. Research demonstrates that investments in patient safety and quality improvement initiatives yield long-term cost savings by reducing adverse events, unnecessary utilization, and avoidable hospitalizations, reinforcing the economic and ethical imperative to prioritize quality and safety in capstone interventions (Slawomirski et al., 2017).

1. Toukhsati, S. R., Driscoll, A., & Hare, D. L. (2019). Patient self-management in chronic heart failure: A systematic review of interventions and outcomes. Heart Failure Reviews, 24(3), 359–372. https://doi.org/10.1007/s10741-018-0978-9

2. Slawomirski, L., Auraaen, A., & Klazinga, N. (2017). The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level. OECD Health Working Papers. https://doi.org/10.1787/5a9858cd-en

3. National Academies of Sciences, Engineering, and Medicine. (2018). Crossing the Global Quality Chasm: Improving Health Care Worldwide. National Academies Press. https://doi.org/10.17226/25152

4. Institute for Healthcare Improvement. (2021). IHI triple aim for populations. http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

5. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, (360), 1–8. https://www.cdc.gov/nchs/products/databriefs/db360.htm

6. NEW REFERENCE
   Slawomirski, L., Auraaen, A., & Klazinga, N. (2017). Investing in patient safety: A value-based approach to improving health system performance. OECD Health Policy Studies. https://doi.org/10.1787/9789264267787-en