Capstone Reflective Journal

Geordene D. Johnson

Grand Canyon University: NRS 490

March 29th, 2019




Week 1 (January 21-27)

As my BSN journey drew closer to the end I’m faced with the most anticipated class, my capstone project. As I entered into week 1, I spent a few hours in the classroom making sure I’m going through all my professors’ announcement and gathered all the necessary research information on Identifying two GCU Library scholarly databases that will assist me in finding the best research articles to support my EBP proposal for week 1 DQ. The ISP took hours to complete as it’s a planner for the next 10 weeks ahead. As nervousness sets in I promise myself to stay on path with the all the requirements of this course. I met with my mentor during the week and discussed what is expected throughout the course, she completed and signed all necessary forms needed for her approval, mentor was approved by instructor

Week 2 (January 28- February 3)

During week 2 our priority was to choose our PICOT and submit to individual forum for approval from instructor. The anticipation of presenting my PICOT was here as I’ve been formulating my PICOT statement on educating the adherence for patients who are receiving anticoagulation therapy in the home settings to prevent stroke, PE/DVT etc.. my instructor approved topic which was very exciting for myself and mentor. Prior to this approval I had to change my implementation and add a few things with the feedback from my professor. It was concluded to educate on effectiveness regarding in home adherence, including diet and blood monitoring for older adults receiving anticoagulation therapy over a 6 months period. GCU library was my source to gather much needed peer review articles for this weeks’ assignment and DQ’s. Met with my mentor and went through articles that I gathered to find the best fit for assignment. As I feel I’m getting a hang of what’s expected throughout this course, I reflect on intraprofessional collaboration and its importance in solving concerns associated with improving medicine and technology and increasing the demand for healthcare services. Health care tasks are mostly challenging, complex and multifaceted. One problem may require the input of many health professionals from diverse specialties. It is therefore very important for a nurse to understand that he/she cannot provide quality care alone. I have learned that inter professional collaboration extends further to educational contexts.

Week 3 (February 4-10)

Week 3 required me to submit six of the peer review articles previously researched along with the strength and weakness. We also discussed different methods of evaluating evidence with compare and contrast. The PICOT statement paper was also submitted which I did my best on but was a bit disappointed with the grades. I spoke with my mentor to figure out where I went wrong and came up with different ideas on how to approach papers moving forward. Finding better peer review articles was one of our solution along with narrowing them down to what best fits my PICOT. I also spend some time reflecting on Ethical consideration in Healthcare. Most of the times, nurses struggle due to the ethical challenges associated with patient care. Ethical concerns may come up within any healthcare circumstance whereby moral questions of whether one was right or wrong are asked. As a nurse, I was able to acquire knowledge on the importance of ethical culture in the health facility I was working. Ethical culture can be defined as the way ethical circumstances that develop ethical problems are addressed within a facility. Ethical practices in nursing can be sustained by constantly engaging with ethical experts. The experts play a key role in the collection of code of ethics that have various guidelines and recommendations that indicate how to effectively respond to ethical issues (Char, 2018).


Week 4 (February 11-17)

I had the opportunity to spend a few hours with my mentor in the anticoagulation center. After completing what I was assigned to do for the patients that day, my mentor and I looked over the peer review I choose to complete the literature evaluation table. DQ’s were also done. After a thorough and meaningful research, we narrowed down to eight peer review articles. I decided to reflect upon Health Policy this week. Health policy can be defined as the decisions, plan and actions incorporated to achieve various health care objectives in the society. Health policy decisions in the United States are made at the federal and congress level and also by other healthcare organizations. As a nurse, I have learnt that nurses play a significant role in the formulation of policies that will have great benefits not only in the short run but also in the long run. A majority of nursing agencies encourage nurses to actively participate in policy formulation. As a nurse, I can participate in the policy formulation process by analyzing various healthcare policies and laws, advising policy makers and the general public and also developing and proposing various healthcare policies.

Week 5 (February 18-24)

This week was spent doing DQ’s and meeting up with my mentor to discuss other ways to assist me as I move forward in this course. As I approach the midway of my course my stress levels are soaring high. A completion of 7 hours was logged, no assignment schedule for this week so I took the opportunity to read up on assignment for the following weeks ahead. This week I chose to reflect on Population Health Concern. The main determinant of the health of a community is the environmental factors. Social determinants such as unemployment and food insecurity also have a great impact on population health which is a main component of the Affordable Care Act. As a nurse, I have been able to recognize that social determinants have always been part of nursing. Various nursing institutions have identified the importance of social determinants in enhancing healthcare and have begun developing nurse practitioner programs which will ensure Social determinants of health are a part of the curriculum.

Week 6 (February 25- March 3)

This week assignment requires me to reflect back on article picked weeks ago. It was a challenge and the toughest week so far. The literature review paper had its challenges and complication, both my mentor and I were both confused and how to complete this assignment. We struggled, and it was evident with the grades I received. All DQ’s completed along with other requirement for this week. I decide to reflect on health care delivery and clinical system. Optimal health can only be enjoyed by Americans when they benefit from health care services which are high in quality and properly coordinated. The health care sector in the United States is made up of clinicians, hospitals, insurance plans and health care professionals. Insurance plans play an integral part in healthcare delivery systems because they ensure those who can/cannot afford to pay for various health costs receive quality healthcare. Insurance plans play a significant role in improving the health outcomes of individuals through efficient preventive, screening and chronic disease care. As nurse, I have learnt that clinical perspective services such as medical procedures and tests also play an integral part in healthcare delivery systems. The services are useful in preventing ailments and enhancing health of individuals.

Week 7 (March 4-10)

As I picked myself up from a hard week I decided to meet with mentor at the anticoagulation center and help with the project at hand. We prepared pamphlets and brochures and hand them out to the patients at the INR clinical, patient teaching was also done on an individual level. I felt satisfied to have helped to educate them on the adherence to their therapy. DQ’s completed and I started my planning ahead to meet week 9 assignments. I reflected on Leadership and economic models. The current health care system in the United States is unstainable. All patients have a desire to receive the best care, but it needs to cost less. The healthcare system must therefore be changed to align with the interests of the public in order to regain public trust. The various different stakeholders in the healthcare system have developed challenges in enhancing the value of care. Health care professionals such as doctors and nurses are in a better position to enhance the value of care. As a nurse I have identified servant leadership as the best way for health care facilities to enhance value because it pays attention on the strength of a team, creating trust and serving patients’ needs.

Week 8 (March 11-17)

No assignment due, I completed my DQ’s and truly believe I have a better understanding with what’s expected from my instructor. I spent a total of 6 hours this week on assigned work. As the week drew closer to the end my anxiety level is at its peak, along with work and family stressors. Health disparities is what I reflected on. Despite the fact that it is the responsibility of nurses to ensure health services are easily accessible to all patient populations, enhancing health care equity agenda has faced various barriers. For example, individuals are faced with inequalities based on their race in assessing health care services. Health disparities occur when a certain group of individuals has better access to health care services than the other. This is often illustrated in the differences in death rates among various diverse populations in the United States. The differences in the level of income for various individuals is the main cause of health disparities. For instance, poor blacks may find it difficult to access quality health care services compared to medium class whites (National Center for Health Statistics, 2016). Nurses play a key role in evaluating various health inequalities through a process called selection. Selection can be defined as the tendency of people to group themselves according to social gatherings, age or residential places.

Week 9 (March 18-24)

Even after I started reviewing weeks 9 assignment since week 7, I still became overwhelmed. A mental breakdown was seeping at my feet. I met with my mentor and discussed proposal change necessary for my EPB. My mentor felt we were on the right path with the amount of research completed for this assignment. We also reviewed all feedback from instructor to help formulate this paper in the right direction. A total of 15 hours spent in completion of all tasks. DQ’s were interesting and informative. I decide to reflect on New Practice Approaches. The field of nursing has gone through major transformations in the past few decades. To effectively be able to provide the best care to patients, I have mastered the art of adapting to the transformations. For example, the continuous incorporation of evidence- based practice in nursing has been very crucial in addressing various health conditions such as asthma and diabetes. However, I have come into a conclusion that such principles are not efficiently embraced in the health care setting. The traditional setting paid key attention to improving quality and patient safety through analyzing records to assess the safety concerns of a patient. Currently, nursing has provided key leadership for enhancing care through the employment of the findings in practice. The continuous incorporation of evidence- based practice in nursing has transformed healthcare in various ways. Higher learning institutions have recognized this trend and have begun changing various nursing programs to incorporate evidence-based practice (Burstin, 2016). As a nursing student pursuing a bachelor’s degree in Nursing, it is important to have course materials that are not only meant to enhance the knowledge base of a student but also to stress of the importance of transparency in the profession.

Week 10 (March 25-31)

I took the opportunity to meet with my mentor for a few hours and review the ISP along with other necessary forms due for submission to conclude my capstone project. We had a thorough discussion and reflect on the last 9 weeks and decided that new approached need to understand ways to help patients on anticoagulant therapy better adhere to improve their way of life. As I reflect on the last 9 weeks, EBP may seem simple to many but it requires extensive research and time to incorporate findings among the needed population. I’m reflecting on the role of technology in improving health care outcome. Information technology is the basis of an efficient healthcare system in the current and future generation. The main focus in the development of new concepts in healthcare technology is patient care. Technological advancement in clinical applications has had a significant impact in the healthcare system and will continue to have a key role in the years to come (Gao, 2015). As a nurse, I have come to learn that nursing documentation is a very important element of healthcare information. Information systems are designed for nurses whereby documentation can be used to enhance a nurse’s knowledge regarding quality care. The field of nursing has received significant knowledge on how to improve patient care due to the new concepts that have been developed through information technology






Burstin, H., Leatherman, S., & Goldmann, D. (2016). The evolution of healthcare quality measurement in the United States. Journal of internal medicine, 279(2), 154-159.

Char, D. S., Shah, N. H., & Magnus, D. (2018). Implementing machine learning in health care—addressing ethical challenges. The New England journal of medicine, 378(11), 981.

Gao, Y., Li, H., & Luo, Y. (2015). An empirical study of wearable technology acceptance in healthcare. Industrial Management & Data Systems, 115(9), 1704-1723.

National Center for Health Statistics (US. (2016). Health, United States, 2015: with special feature on racial and ethnic health disparities.