| Course | NUR-8050 Scholarly Inquiry The Basis for Evidence-Based Practice |
|---|---|
| Module | Module 4 |
| Paper type | Project design and methods |
| Length | About 1,032 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for NUR 8050 Module 4
Twelve Months Before, Twelve Months After: Design and Methods for a Quality Improvement Project on Oral Care and Non-Ventilator Pneumonia
Student Name
Doctor of Nursing Practice, Thomas Edison State University
NUR-8050: Scholarly Inquiry: The Basis for Evidence-Based Practice
Mentor Name
Month Day, Year
Twelve Months Before, Twelve Months After: Design and Methods for a Quality Improvement Project on Oral Care and Non-Ventilator Pneumonia
Introduction
My two appraisals ended in the same place: brushing to prevent pneumonia in unventilated patients makes biological sense, costs little and has expert backing, yet its proof so far comes from single-site comparisons of one year against the next. My project cannot run a randomized trial on one unit. What it can do is outdo a plain one-year-versus-the-next comparison. This paper sets out that design and the methods for carrying it out.
Quality Improvement, Not Research
The project aims to improve care on one unit by implementing an evidence-based practice and measuring its effect locally, not to produce generalizable knowledge. That makes it quality improvement. The distinction matters because research with human subjects requires institutional review board approval and often informed consent, while quality improvement usually does not. That label is not mine to assign. A project summary goes to the hospital's review board first, and no data will be gathered until its written ruling is back. The SQUIRE 2.0 guidelines (Ogrinc et al., 2016) set the reporting standard for improvement work, so the plan is organized to provide what they ask for: context, intervention, measures, analysis and ethical considerations.
Design
I will use an interrupted time series. Monthly rates of pneumonia will be calculated for 12 months before the protocol begins, using records already collected by infection prevention, and for 12 months after. Penfold and Zhang (2013) rank it near the top of designs without randomization, since it can tell a real effect from a drift already under way, which two snapshots never can. By their account, eight measurements on each side are about the least that a statistical test of the change can work with. Twelve on each side meets that minimum and covers a full year of seasonal variation in respiratory illness. A run chart and control chart will display the data monthly, and a segmented regression will test for a change in level and slope at the start of the protocol.
Setting and Population
The project runs on my own unit: 34 adult medical-surgical beds in a central New Jersey community hospital, roughly 11,700 patient-days in a year. Every adult who stays on the unit during the project counts toward the outcome. Patients who are intubated during their stay are excluded from the pneumonia measure, which by definition covers patients never ventilated, but they still receive oral care under existing protocols.
The Intervention
The protocol calls for toothbrushing with a soft brush and fluoride toothpaste after breakfast and at bedtime, with denture care for patients who wear them. Patients who can brush themselves are set up and reminded; those who cannot are brushed by a nursing assistant or nurse. Patients with a positive dysphagia screen are brushed with a suction toothbrush, with the head of the bed raised. Supplies are stocked in every room on admission. The electronic record's single oral care checkbox is replaced with two entries that record who brushed and whether the patient was independent or assisted. Staff complete a 20-minute education session and a practical check with a unit champion before launch.
Measures
The outcome uses the same surveillance definition and the same infection preventionist for every month, before and after, so that case finding does not change with the intervention. Baker and Quinn (2018) found rates ranging widely across hospitals, partly because of differences in case finding, which is why holding the method constant matters more than matching any national benchmark.
The bedside audit addresses a weakness of documentation: a checked box does not prove that brushing happened. Auditors will check a sample of patients each week for a used toothbrush and ask patients able to answer whether their teeth were brushed.
| Type | Measure | Source |
|---|---|---|
| Outcome | Pneumonia in never-ventilated patients, rate per 1,000 bed-days | Monthly infection prevention report |
| Process | Percentage of patient-days with two documented brushings | Electronic record |
| Process | Percentage of audited patients with brushing verified at the bedside | Weekly audit of 10 patients |
| Balancing | Aspiration events during oral care | Safety reports |
| Balancing | Nursing assistant overtime hours | Staffing records |
Data Collection and Management
Monthly pneumonia counts and patient-days will be obtained from infection prevention without patient identifiers. Audit data will be recorded on a paper tool and entered into a spreadsheet stored on the hospital's secure drive, with patients identified only by room number and date. No data will leave the hospital's systems.
Expected Size of the Change
With about 14 cases a year, the unit sees roughly one case a month, and monthly rates will bounce around a great deal by chance. A month with no cases and a month with three are both ordinary at this level. That variability shapes the plan in two ways. First, the analysis will look at the pattern across many months rather than at any single month. Second, the proposal will be honest that a modest reduction, for example from 1.2 to 0.9 per 1,000 patient-days, might not reach statistical significance in one year on one unit even if it is real. The process measures therefore carry more weight than usual: if brushing becomes reliable and the outcome moves in the expected direction, the project will recommend continuing and spreading the protocol while collecting more data.
Timeline
Baseline data for the previous 12 months are retrieved in month one, education and supply changes take place in months two and three, the protocol starts at the beginning of month four and monthly measurement continues for 12 months after.
Ethical Considerations
The intervention is standard care that the hospital's own policy already requires; the project makes it reliable. Patients receive no experimental treatment. Staff participation in education is part of normal work. Risks are minimal and center on aspiration during brushing, which the dysphagia pathway addresses and the balancing measure monitors.
Conclusion
The project will use an interrupted time series with twelve monthly points on each side of the change, a fixed case-finding method and process, outcome and balancing measures. This design answers the main weakness in the existing evidence while remaining feasible on one unit. The next module sets out how the data will be analyzed.
References
Baker, D., & Quinn, B. (2018). Hospital Acquired Pneumonia Prevention Initiative-2: Incidence of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control, 46(1), 2-7. https://doi.org/10.1016/j.ajic.2017.08.036
Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality and Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411
Penfold, R. B., & Zhang, F. (2013). Use of interrupted time series analysis in evaluating health care quality improvements. Academic Pediatrics, 13(6 Suppl.), S38-S44. https://doi.org/10.1016/j.acap.2013.08.002
Reading the NUR 8050 Module 4 assignment instructions
Research design, research methods and project implementation are named in the NUR-8050 catalog entry, and as TESU posts no syllabus for the course, this fourth module is placed on the methods section of a practice change project. Expect a paper that classifies the project as research or quality improvement, chooses and justifies a design, describes the setting, population, intervention, measures and data collection, and addresses ethics and the review board determination. Many classrooms ask for this section in the format of a DNP project proposal chapter. Check the required headings and whether a timeline or budget belongs here or in a later chapter. Every measure should have a definition, a data source and a schedule, and your design should answer the weaknesses you found in the evidence.
How the NUR 8050 Module 4 example is put together
The paper begins by tying the design choice to the earlier appraisals. Early on, the paper argues the work is improvement and hands the final call to the review board, naming SQUIRE 2.0 for the report. The design section justifies an interrupted time series with twelve monthly points on each side, citing the minimum of eight. Setting, population and exclusions follow. The protocol is written down to the brush type, with the swallowing-risk route and the two new charting fields. Five measures fill a table with their sources; then come the reasons case finding stays fixed and audits happen at the bedside, how data are stored, the ethics of a care-standard change, and a short close.
Reading the NUR 8050 Module 4 grading rubric
A methods chapter is read for three things: a design that answers the question and the weakness found earlier, measures that each have a definition, a source and a schedule, and an intervention spelled out well enough for another unit to copy. Mentors look for a correct classification of the project and an accurate statement about who determines it. Process measures that show whether the intervention was delivered, and balancing measures that watch for harm, are expected at the DNP level. Data security and ethics should be specific. Cite where the design and the reporting standard come from, in APA, to secure the final marks. A table of measures is almost always credited, and a realistic statement of how large a change the project could detect shows statistical maturity.
NUR 8050 Module 4 help from the desk
The most common weakness in methods papers is a design chosen without explanation, often a simple before and after comparison. Justify your design against the alternatives. Students also define outcomes loosely or forget the denominator. Another frequent gap is the absence of process measures, which leaves the project unable to say whether a null result means the intervention failed or was never delivered. Never declare your own project exempt; write that you will ask the board and wait for its answer. Describe the intervention so another unit could copy it. Include balancing measures. Share your project idea and the NUR-8050 template, and a methods chapter shaped to both comes back; the opening draft is free.
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 8050 Module 4 questions, answered
Where can I find a free NUR 8050 Module 4 sample paper?
This page carries the full paper. It designs an oral care practice change as quality improvement with an interrupted time series and process, outcome and balancing measures.
Is a DNP project research or quality improvement?
Most are quality improvement, aimed at improving local care rather than producing generalizable knowledge. The institutional review board makes the formal determination.
What is an interrupted time series?
Many repeated measurements on both sides of a change, so that a sudden step or a bend in the line can be told apart from a drift that was already happening.
How many time points does an interrupted time series need?
At least eight before and eight after is a common minimum for statistical testing. Twelve monthly points on each side also covers seasonal variation.
What is a balancing measure?
A count kept to spot harm the change itself might cause; on this unit, choking during brushing and assistants' overtime.