Two Unit’s Experience with Senior
Nursing Students Capstone Projects
and Implementation of
Cheryl Anema PhD, RN
Patti Wilson MA, RN, ONC
Phyllis Lawlor-Klean RNC, MS, APN/CNS
Cheryl Anema PhD, RN
Purdue University Calumet
School of Nursing
Assistant Professor of Nursing
Engage in activities that promote the
importance of nursing and professional
nursing roles in creating change in health care
Nursing Roles in Project Development
Working with nursing professionals
Design, implement, and disseminate
knowledge of an evidence based practice
project relevant to nursing in a complex health
Assessor / Explorer
Disseminator - New knowledge
Identification of Need / Problem
Prepare students in the process of project
management, teamwork, and timelines.
Timeline of project
Team member roles & responsibilities
Communication team strategies
Identification of talents / skills of each team member
Openness to constructive criticism
Prepare students in professional communication,
accountability, team meeting planning – agenda
How to run a Committee meeting
Creation of Agenda
Coordination of schedules
Professional Communication & Presentation
Email vs phone vs texting
Notifications of meetings and change of meetings
Time management (start & finish on time)
Arrive early – never late
Bring copies of agenda & items to be discussed (or
provide by email at least a day ahead of meeting)
Stay focused, yet be flexible to needs of group
PICO development (Guides research)
ROL (Review of Literature)
Transparency of search
Further ROL and resources
Hospital interactions, collaborative data collection
Analysis / Statistical analysis (as appropriate)
P – Problem
I – Intervention
C – Comparison
O - Outcome
Student presentation of results to cooperating
Development and implementation of Poster
Highlight key points
Suprapubic Catheter Protocol
Brad Foster, Caitlyn Schalich, & Lauren Skewis
School of Nursing, BSN Capstone Students
Urinary catheterization occurs in up to 25% of all
Suprapubic catheters (SPC) make up 4% of these
Relevant evidence-based research reviewed.
Critical appraisal of each article was completed using the
Joanna Briggs Rapid Appraisal Tools.
Committee meetings with Project Team were held.
SPC are used most commonly in patient requiring long
Supplies and kits from Medical Center were used to create
the equipment list for the protocol.
Care and exchange of SPC are within the scope of
o CINAHL Database
o The Joanna Briggs Institute
practice of a nurse (IL Nurse Practice Act - 2008).
o Cochrane Database
o Medline Database
o Google Scholar
o Wiley Interscience Database
A Tertiary Medical Center in the Midwest is changing the
SPC exchange procedure from a physician task to a
An evidence based protocol for the care and exchange of a
hospitalized adult patient with a SPC was created.
o Silicone catheters are correlated with higher complications of
This Medical Center currently does not have a hospitalbased
nursing protocol for the care and exchange of a
cuffing than latex coated catheters.
o Personal protective equipment (PPE) is necessary for potential
exposure to bodily fluids.
Submit protocol to clinical directors and policy committee
o Dressings are used per patient/doctor preference.
of partnering Medical Center.
o According to the Guidelines for Use of Medical Protocols
o Dressing may indicate recent SPC insertion (4-6 weeks).
Provide training and education sessions about SPC care
(2004) protocols are needed to promote uniformity of
care, and provide expectations of health care staff.
o Assessment and site care should be done every shift.
and exchange for nurses.
Offer SPC care education for patients and family
Our goal was to develop a protocol that provides guidelines for care
and exchange of an adult patient with a suprapubic catheter.
o Normal saline is comparable to tap water for cleaning incision sites.
o Normal saline is preferred over tap water in a hospital setting.
o Providing troubleshooting solutions decreases further
Implement protocol into practice in all adult units.
Evaluate protocol within one year of implementation for
modifications and evidence based practice updates.
o SPC exchange occurs every 6 to 8 weeks as ordered.
o First exchange after insertion is done by physician.
o Sutured SPC are not to be exchanged by a nurse.
o No more than 5 to 10 minutes should elapse between removal and
reinsertion of SPC.
This project was completed in partnership with Advocate Christ Medical Center. We would like to thank:
Cheryl Anema PhD, RN (Faculty Preceptor)
Laura Hogan BSN, RN (ACMC Project Director)
Patricia Wilson BSN, RN, ONC (ACMC Project Team Member)
Cheryl Lefaiver PhD, RN (ACMC Project Team Member)
Elizabeth Kupczyk MSN, RN (ACMC Project Team Member)
WIN – WIN!
Manager Assisted in the Project Director Role
Patti Wilson, MA, RN, ONC
Advocate Christ Medical Center
Manager of Clinical Operations –
Bone & Joint Institute
Manager - Physician rounding
revealed the need for a closer look
at suprapubic catheter (SPC) exchange Investigation by manager revealed no policy
available to nursing.
Inpatient nurses consult Urology
Potential increase in length of stay
Team met to discuss current practice
in reference to SPC exchange.
Revealed Home Health Nurses routinely
Inpatient nurses rarely exchange SPC
Compiled literature from Evidence Based
Research on SPC use and exchange.
Students search for evidence based practice
involving SPC exchange.
Step by Step Process
Discussed findings in comparison to current
Discussion surrounding change in nurse
Reviewed Advocate process for creating NEW
Team began to develop a policy to address SPC
exchange performed by nursing
Developed and Approved
Suprapubic Catheter Care and Exchange
Plan for next group of students to assist in the
roll out of education on new policy
Monitoring of outcomes
Include: Patient Satisfaction
Reduction in Length Of Stay
Student awareness of safe implementation
of new procedures developed from
Evidence Based Practice prepares the
new graduate nurse to focus on
positive patient outcomes.
Education on new practice is paramount to
• Neonatal ICU experiencing an increase in DD
• Prior products/protocols no longer working
Evaluation of all products interfacing with the
diaper area was requested (diapers, diaper
wipes, soap, lotion, diaper rash products).
Diaper rash product list provided by unit PharmD
Reviewed the EBP literature, both nursing and
other disciplines, and Skin Care Standards
related to DD.
This activity was time intensive (literature and
product review) and saved the APN a lot of time.
Hospital Laundry consulted for product or
process change and Facilities for temperature
and humidity numbers for the patient care pods.
Each student spent time in the Neonatal ICU
with the Unit Skin Care Committee Chair to get
a feel for patient care related to DD.
DD concern outlined with the Capstone Team
Protocols, standards, and literature were
accessed and reviewed
Ongoing guidance provided to the team
Liaison between students and interdisciplinary
The students developed a Performance
Improvement data collection tool.
The data collection was facilitated over a three
week time frame and collected by our Assistant
Clinical Managers and Charge Nurses.
Students entered and reviewed the data
Concurrently, the data related to patients with
DD was evaluated
presence of DD, products / feeding used, type of
bed, with or without humidity, if in open crib when
did DD occur
Data analysis showed varying nursing practices
and products related to DD were used.
Data review lead us to look closer at our bed
humidity guidelines and the actual relative
humidity in the rooms.
Some of the humidity evidence-based literature
was reviewed, but not in depth, as we were far
into the semester.
According to Guidelines of Perinatal Care
(2007) room temperature should be 72-78
degrees Fahrenheit and room humidity should
Our Facilities staff educated us on temperature
and humidity readings with a “Fluke”.
The fluke is a hand held device to record temperature and
They also showed us how our pods were divided
into zones by the placement of the thermostats.
With this information, we explored the pod
location of the babies with DD.
The interfacing skin products were appropriate
Provided an evidence-based literature review
on DD and premature and newborn skin care.
No standard DD prevention protocol was found
in the literature.
They thought outside the box regarding other
Impact of room humidity needs more investigation.
Their findings were presented to the Neonatal
A new student Capstone Team is in place focusing on
humidity and diaper dermatitis.
Facilities placed a system in place to provide us with
historical data on temperature and relative humidity in the
They also repaired a thermostat issue in Pod 2.
School of Nursing
The Unit Skin Care Team is working on a DD prevention
They are evaluating different diaper rash products.
All of this is thanks to the Student Capstone Team’s