NRS-465 Topic 1 DQ 2 Study Guide: Brainstorming Clinical Practice Problems for a Nursing Change

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NRS-465 Topic 1 DQ 2 Study Guide

Topic 1 DQ 2 is where your NRS-465 capstone actually begins. The two or three problems you brainstorm here are the seedbed for your evidence-based practice change project; so choosing well now saves you weeks later. This guide shows you how to spot a workable clinical practice problem, how to prove it’s a genuine nursing issue, and how to structure a post that satisfies the RN-BSN Discussion Question Rubric and RN-BSN Participation Rubric; all in your own words.

How to use this guide: This is here to help you recognize and develop your own practice problems; ideally ones you’ve actually seen on your unit, since that’s what makes a capstone project real and defensible. Read it, then write your post yourself.

Topic 1 DQ 2

In preparation for your assignment this week, brainstorm two to three clinical practice problems or issues you can develop into a nursing practice change. What indicates these as clinical issues in nursing practice? Support your discussion with two peer-reviewed journal articles.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

What this DQ is actually asking

There are three parts, and the second one is where most points are won or lost:

Brainstorm two to three clinical practice problems that could each become a nursing practice change. Note the word nursing; these should sit within nursing’s sphere of influence, not be purely medical or administrative.
Explain what indicates each as a clinical issue. This is the analytical heart of the prompt. You’re not just naming problems; you’re showing how you know they’re real issues (data, standards, outcomes), not personal hunches.
Support with two peer-reviewed journal articles. Evidence that these are recognized problems in the literature, not just on your floor.

A post that lists problems but never explains what makes them issues will read as opinion and lose the critical-thinking points.

What counts as a workable “clinical practice problem”

Before you brainstorm, know what you’re aiming for. A strong candidate for a nursing practice change usually meets these tests:

Within nursing’s influence. Nurses can meaningfully change the outcome through their own practice (e.g., catheter care, fall prevention, skin assessment); not something only physicians or facilities control.
Measurable. There’s data you could track before and after a change (infection rates, fall counts, readmissions, compliance percentages).
Has an evidence–practice gap. Best evidence exists, but current practice on the unit doesn’t fully match it. That gap is the opportunity.
Feasible to address. Realistic to pilot on a unit within a capstone’s scope; not “fix the national nursing shortage.”
Tied to patient outcomes, safety, or quality. It matters to patients, not just to workflow convenience.

Run every brainstormed idea through these five tests; the ones that pass are your post.

What “indicates” a problem is a genuine clinical issue

This is the exact word the prompt uses, so address it head-on. A clinical issue announces itself through recognizable markers. Use two or three of these for each problem to prove it’s real:

Measurable frequency or prevalence — it happens often enough on the unit to show up in incident reports, surveillance data, or audits.
An evidence–practice gap — guidelines or studies recommend one approach; actual practice differs.
Adverse patient outcomes — harm, longer stays, complications, or avoidable suffering.
Recognition in quality frameworks — it maps to established indicators, which is powerful evidence it’s a known issue:
- NDNQI nurse-sensitive indicators (falls, pressure injuries, CAUTI, restraint use)
- CMS hospital-acquired conditions (several are non-reimbursed, e.g., CAUTI, CLABSI, some pressure injuries)
- Joint Commission National Patient Safety Goals (alarm management, communication, infection prevention)
Cost or regulatory burden — penalties, non-reimbursement, or excess cost.
Recurring near-misses or staff/patient concern — repeated close calls or documented dissatisfaction.

Naming a marker like “this is an NDNQI nurse-sensitive indicator” instantly elevates your post from anecdote to evidence.

Candidate problem areas to brainstorm from

Here are well-documented, nurse-influenceable problems, each with the indicators that mark it as a clinical issue. Pick from your own setting where you can — but these show you the pattern:

Catheter-associated urinary tract infections (CAUTI). Indicators: a CMS hospital-acquired condition (non-reimbursed since 2008), an NDNQI nurse-sensitive indicator, measurable device-utilization and infection rates, and a clear evidence–practice gap when nurse-driven removal protocols aren’t used.
Patient falls / falls with injury. Indicators: NDNQI nurse-sensitive indicator, incident-report frequency, fall-with-injury rates compared to benchmark, and a Joint Commission safety priority.
Hospital-acquired pressure injuries (HAPIs). Indicators: nurse-sensitive indicator, prevalence-survey data, CMS hospital-acquired condition, and a gap when repositioning/skin-assessment bundles aren’t followed.
Central line–associated bloodstream infections (CLABSI). Indicators: HAI surveillance data, bundle-compliance audits, and high cost/mortality.
Medication administration errors. Indicators: incident and near-miss report data, a top patient-safety concern, and barcode/double-check compliance gaps.
Heart failure 30-day readmissions. Indicators: CMS readmission-reduction penalties, measurable readmission rates, and discharge-teaching gaps nurses can close.
Alarm fatigue. Indicators: a Joint Commission National Patient Safety Goal, alarm-event volume data, and documented missed alarms.

Tip: Brainstorm three, then keep the two with the clearest data and the best evidence base; those are easiest to defend now and to build into your capstone later.

How to support the post with two peer-reviewed articles

The prompt requires two peer-reviewed journal articles. Use them to show your chosen problems are recognized issues with an existing evidence base:

Search the GCU Library databases — CINAHL and MEDLINE are your best starting points for nursing.
Filter for peer-reviewed, ideally within the last 5 years, and prioritize systematic reviews or meta-analyses when you can — they carry the most weight.
Match each article to a problem you named. One article that establishes the problem’s prevalence/outcomes and one that points toward a nurse-led solution is an ideal pairing.
Cite the article where you make the claim, not just in the reference list.

How to structure a 200-word initial post

The rubric rewards a clear answer, scholarly support, critical thinking, and correct APA. Fill this annotated skeleton in your own words — these are slots and word budgets, not a script:

Opening (~25 words): State that you’re identifying clinical practice problems suitable for a nursing change, and name the setting/context you’re drawing from.
Problem 1 (~70 words): Name it, then explain what indicates it’s a clinical issue (use two markers — e.g., data + a quality framework). Cite a source here.
Problem 2 (~70 words): Same structure. A different problem, ideally at a different level of care. Cite your second source here.
(Optional) Problem 3 (~25 words): A brief third candidate if you want to show range.
Close (~15 words): Note which problem you find most promising to develop into a practice change, and why.

That lands around 200–210 words with real substance. Then check it against the rubric language before posting.

Writing peer responses that earn full participation points

Participation responses should be 100–150 words with one reference and should add something. A reliable framework:

Engage specifically (1 sentence): Name the exact problem your peer raised so it’s clearly a reply to their post.
Extend (2–3 sentences): Add a marker they didn’t mention, share a related observation from your own practice, or offer a nurse-led intervention the literature supports.
Support + close (1 sentence + citation): Bring in one reference and end with a forward-looking question.

For example, you might open: “Your point about CAUTI on a long-term unit stood out — on my floor, device-utilization data told the same story before we…” — then develop it and cite a source. Write the full response yourself; that clinical specificity is what scores well.

APA 7 and formatting pitfalls

Two peer-reviewed journal articles — not websites, not the textbook alone. Recent (within ~5 years) and scholarly.
In-text citation at each claim, matched to a full reference entry.
DOIs as live links (e.g., https://doi.org/10.1093/ageing/afac077), APA 7 style.
200 words of your own prose — references and the restated prompt don’t count toward the minimum.
Hanging indents, alphabetical order in the reference list.

Common mistakes to avoid

Naming problems but never explaining what indicates they’re clinical issues (missing the analytical core).
Picking a problem outside nursing’s influence, so it can’t become a nursing practice change.
Choosing something too broad to pilot or measure within a capstone.
Supporting with non-scholarly sources or only one reference.
Treating it as throwaway — these problems feed your actual capstone, so choose ones you’d be glad to live with.

Scholarly sources to get you started

Real, current, and on point. Choose sources that match your chosen problems, and always read and access them through the GCU Library before citing:

Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American Journal of Infection Control, 45(12), 1331–1341. https://doi.org/10.1016/j.ajic.2017.07.020
Morris, M. E., Webster, K., Jones, C., Hill, A.-M., Haines, T., McPhail, S., … Cameron, I. (2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077
Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence-Based Nursing, 19(2), 86–93. https://doi.org/10.1111/wvn.12571

Frequently asked questions

How many clinical problems does NRS-465 Topic 1 DQ 2 ask for? Two to three clinical practice problems that could each be developed into a nursing practice change. For each, explain what indicates it is a clinical issue and support your discussion with two peer-reviewed articles.

What makes something a “clinical practice problem” rather than just a complaint? It sits within nursing’s influence, is measurable, shows an evidence–practice gap, is feasible to address, and connects to patient outcomes, safety, or quality — often mapping to recognized indicators like NDNQI nurse-sensitive measures or CMS hospital-acquired conditions.

What are good examples of nurse-sensitive clinical problems? CAUTI, patient falls, hospital-acquired pressure injuries, CLABSI, medication administration errors, heart failure readmissions, and alarm fatigue are all well-documented and within nursing’s influence.

How long should the post and peer responses be? The initial post is a minimum of 200 words with at least two peer-reviewed references in APA 7. Peer responses are 100–150 words with one reference.

Trying to pin down which clinical problem to build your NRS-465 capstone around — and whether the evidence is strong enough? Message us on WhatsApp: +1 564-544-6924 and we’ll help you pressure-test your own ideas before you commit.