| Course | NUR-4190 Exploring Evidence-Based Practice and Research in Nursing |
|---|---|
| Module | Module 6 |
| Paper type | Practice change proposal |
| Length | About 1,051 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Bachelor of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 4190 Module 6
Cold, Vibration and a Child Who Holds the Switch: An Evidence-Based Practice Change Proposal and Evaluation Plan for a Pediatric Draw Room
Student Name
Bachelor of Science in Nursing, Thomas Edison State University
NUR-4190: Exploring Evidence-Based Practice and Research in Nursing
Mentor Name
Month Day, Year
Cold, Vibration and a Child Who Holds the Switch: An Evidence-Based Practice Change Proposal and Evaluation Plan for a Pediatric Draw Room
Over this course I asked whether a cold and vibration device, added to distraction, reduces venipuncture pain for school-age children in the pediatric rheumatology clinic where I work. The synthesis in the previous module concluded that the evidence supports the device over standard care, with moderate strength and limited direct evidence for an outpatient clinic with repeat patients, and that the device works best as a complement to topical anesthetic rather than a replacement. This paper proposes a practice change based on that verdict, lays out the rollout step by step with the Iowa Model as the guide, and sets out a plan to evaluate it with measures that address the gaps the literature left open.
The Proposed Change
When a child between five and twelve sits down for a monitoring draw with no numbing cream on, the draw room nurse will offer a cold and vibration device together with the clinic's usual distraction. The child will be invited to help place the device and to switch on the vibration, and will be asked whether they want distraction or would rather watch. Children who arrive with topical anesthetic already applied will continue to receive it, and the device will be offered to them as an addition only if they or their parents request it. At each child's first visit under the new approach, the nurse will spend two minutes showing the parent how the device is used so the parent can coach the child at later visits.
Each element traces to the evidence. The device itself rests on the meta-analysis by Ballard et al. (2019) and on the trial by Semerci et al. (2023), which enrolled children of the same age range. Keeping the topical anesthetic for those who have it reflects the finding by Lescop et al. (2021) that the device did not match a lidocaine patch. Inviting the child to switch on the device and choose distraction comes from the qualitative finding by Sørensen et al. (2021) that some children prefer control to distraction, and the brief parent guidance responds to the same study's finding that parents felt unsupported.
Implementation Using the Iowa Model
In its current form (Iowa Model Collaborative, 2017), the Iowa Model walks a team from the trigger that starts a project, through the question and the evidence, to a pilot, and only then to choices about adopting and spreading the change. Our trigger was clinical, a family's request and a pattern of distress at monitoring visits, and the question fits an organizational priority for family experience, which the model treats as a requirement before investing staff time. The evidence was assembled and judged sufficient in the earlier modules. The next step in the model is a pilot, so the change will not be adopted clinic-wide at once.
The pilot will run for twelve weeks in the draw room on two weekdays, which include about eighty venipunctures for children in the target age range. Before the pilot, I will present the evidence summary at a staff meeting, train the three draw room nurses in a fifteen-minute session, and agree with the infection prevention nurse on a cleaning procedure for the reusable device between patients, following the clinic's policy for noncritical equipment that touches intact skin. Two devices will be purchased so that one is always ready while the other is cleaned and its cold pack is refreezing. A laminated card at each station will list the steps, including the questions to ask the child.
Evaluation Plan
Before the pilot starts, the nurses will record pain for four weeks under current practice to create a baseline. Children will rate pain immediately after the needle is removed on the Faces Pain Scale-Revised, a zero to ten scale of six faces whose validation work with school-age children is reported by Hicks et al. (2001). The primary outcome will be the mean self-reported pain score; a secondary outcome will be the proportion of children who rate their pain at four or higher, which is easier for staff to interpret. Fear will be recorded with a single question before the procedure, because the qualitative evidence suggests that anticipation matters to these children as much as the needle itself.
Two balancing measures will watch for side effects of the change. The first is first-attempt success, since a device placed near the site could interfere with vein access; the second is the time from the child sitting down to the end of the procedure, since the draw room runs on a tight schedule. Parents will complete a three-question satisfaction card at the end of the visit. Results will be reviewed with the nurse manager at the end of the pilot. The decision rule is stated in advance: if mean pain falls by at least one point on the ten-point scale without a drop in first-attempt success or an increase of more than two minutes per procedure, the clinic will adopt the change on all weekdays. A result without a pain reduction, or one where success or speed slips, sends the team back to check how faithfully the device was used before any decision is made.
Dissemination
If the pilot succeeds, I will share the results in three ways: at the clinic's monthly staff meeting with a one-page summary, with the hospital's pediatric nursing practice council so that other outpatient areas can consider the change, and in the clinic's family newsletter so parents know what to expect at their child's next visit. I will also report what did not work, since a pilot that changes its procedure halfway through has lessons as useful as its results.
Conclusion
This proposal turns the course's evidence into a specific, time-limited change in one draw room: a cold and vibration device for school-age children without topical anesthetic, offered so the child takes part in starting it and the parent learns to coach. The pilot follows the Iowa Model, and the evaluation measures pain, fear, first-attempt success, time and parent satisfaction against a baseline, with a decision rule fixed before any data are collected. Whether the result is positive or not, the clinic will know more about its own children than the published studies could tell it.
References
Ballard, A., Khadra, C., Adler, S., Trottier, E. D., & Le May, S. (2019). Efficacy of the Buzzy device for pain management during needle-related procedures: A systematic review and meta-analysis. The Clinical Journal of Pain, 35(6), 532-543. https://doi.org/10.1097/AJP.0000000000000690
Hicks, C. L., von Baeyer, C. L., Spafford, P. A., van Korlaar, I., & Goodenough, B. (2001). The Faces Pain Scale-Revised: Toward a common metric in pediatric pain measurement. Pain, 93(2), 173-183. https://doi.org/10.1016/S0304-3959(01)00314-1
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Lescop, K., Joret, I., Delbos, P., Briend-Godet, V., Blanchi, S., Brechet, C., Galivel-Voisine, A., Coudol, S., Volteau, C., Riche, V.-P., & Cartron, E. (2021). The effectiveness of the Buzzy device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study. International Journal of Nursing Studies, 113, 103803. https://doi.org/10.1016/j.ijnurstu.2020.103803
Semerci, R., Akarsu, Ö., & Kılıç, D. (2023). The effect of buzzy and cold spray on pain, anxiety, and fear of children during venipuncture in pediatric emergency department in Turkey: A randomized controlled study. Journal of Pediatric Nursing, 68, e1-e7. https://doi.org/10.1016/j.pedn.2022.08.019
Sørensen, K., Skirbekk, H., Kvarstein, G., & Wøien, H. (2021). I don't want to think about it: A qualitative study of children (6-18 years) with rheumatic diseases and parents' experiences with regular needle injections at home. Pediatric Rheumatology, 19(1), 8. https://doi.org/10.1186/s12969-021-00495-4
What the NUR 4190 Module 6 instructions ask for
NUR-4190 ends by turning your evidence synthesis into a proposed practice change with a plan to put it in place and judge whether it worked. Expect to describe the change and its evidence, choose an implementation framework, name stakeholders and resources, anticipate barriers, set outcome measures and an evaluation schedule and plan how results will be shared. Some sections ask for a poster or slide presentation instead of, or alongside, a paper. Thomas Edison State University posts the format in Moodle, so confirm whether your mentor wants a paper, slides or both, and whether the proposal must name a specific implementation model such as Iowa, Johns Hopkins or ACE Star.
How the NUR 4190 Module 6 example is put together
The proposal restates the verdict from the synthesis and then describes the change in operational terms: who receives it, who delivers it, and what happens at the chair. A paragraph traces each element to a specific source, including the detail of letting the child switch on the device, which came from qualitative evidence. The implementation section follows the Iowa Model from trigger to pilot and gives practical details on training, equipment and cleaning. The evaluation section sets a four-week baseline, a validated self-report measure, a fear question, two balancing measures, parent feedback and a decision rule. Dissemination names three audiences, and the conclusion restates the change and the test it must pass.
NUR 4190 Module 6 rubric: what earns full marks
Mentors tend to grade a practice change proposal on how plainly the change is described, its link to the synthesized evidence, the implementation plan and use of a model, the evaluation plan, dissemination, and writing. The evaluation row is often weighted heavily and is where many proposals lose points, because outcomes are named without a measure, a baseline or a timeline. Mentors also check that the implementation plan is realistic for the setting, with stakeholders, training and resources identified. A proposal that names a model but does not follow its steps tends to score lower than one that uses the model to organize the plan. Clear headings that match the directions help the mentor find each required element quickly.
Common NUR 4190 Module 6 mistakes, and how to avoid them
Final proposals often describe the change so broadly, say adding nondrug pain measures, that no nurse would know what to do differently on the next shift. State who does what, for whom and when. Another frequent issue is an evaluation plan with no baseline or no measure, or outcomes that cannot be collected in practice. Add at least one balancing measure so the plan checks for unintended harm. Students also forget barriers: staff time, equipment, cleaning, cost and buy-in. Pilot before full adoption, and decide before collecting data which result would end the pilot. If you want a proposal drafted around your own synthesis and setting, send the directions and your evidence table to the desk.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4190 Module 6 questions, answered
Where can I find a free NUR 4190 Module 6 sample paper?
Scroll up for the complete proposal, with its implementation plan, evaluation measures, references and margin notes. It closes a project on children's venipuncture pain; use its structure for the change your own synthesis supports.
Which implementation model should I use for the NUR-4190 proposal?
Use the model your directions name, or one your course text covers. Nursing programs commonly teach three of them, the Iowa, Johns Hopkins and ACE Star models. Whichever you pick, use its steps as the outline of your implementation section rather than just naming it.
What is a balancing measure in an evaluation plan?
A balancing measure checks whether the change causes a problem somewhere else. If a new step might slow a procedure or lower success rates, measure those as well. Including one shows the mentor you understand that improvements can have side effects.
Does the practice change have to be implemented for real?
No. Most sections ask for a proposal, not a completed project. Write it so it could be implemented, with realistic staff, time and equipment, and present outcomes as planned measures rather than results.
How long should the evaluation period be?
Long enough to collect a meaningful amount of data in your setting. A pilot of eight to twelve weeks is common for a single unit. State the number of patients you expect in that time and include a baseline period before the change starts.