| Course | NURS 8003 Foundations and Essentials in Nursing |
|---|---|
| Week | Week 6 |
| Paper type | Practice problem statement |
| Length | About 590 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8003 Week 6
Practice Problem Statement: POLST Orders That Do Not Travel With Patients Discharged to Skilled Nursing Facilities
Student Name
College of Nursing, Walden University
NURS 8003: Foundations and Essentials in Nursing
Instructor Name
Month Day, Year
Practice Problem Statement: POLST Orders That Do Not Travel With Patients Discharged to Skilled Nursing Facilities
The Statement
On a composite hospitalist service in a community hospital, patients who complete or update a Physician Orders for Life-Sustaining Treatment (POLST) form during admission are frequently discharged to skilled nursing facilities without a current copy of that form reaching the receiving facility with them. Receiving staff then rely on an older form, a verbal report or no orders at all, so the treatment limits the patient chose in the hospital may not guide care in the days after transfer. This gap sits within the discharge process that unit nurses and their leaders own, and closing it is within the reach of a DNP-prepared nurse leader.
Current Practice
From my vantage point as a unit-based nurse leader on the service, current practice looks like this. The hospitalist or palliative team completes a POLST with the patient or surrogate, often in the last days of the stay. The signed original is placed in the paper chart or scanned into the record. At discharge, the nurse prints the discharge packet, which the record assembles automatically; the POLST is not part of that automatic packet. Whether it is sent depends on whether the discharging nurse remembers to print it or the case manager includes it with the transfer paperwork. The receiving facility may already hold an older form from a prior stay. No one checks that the version sent is the current one. I have no local figures yet; the first step of any project will be an audit of recent transfers.
Desired Practice
Desired practice is that every patient discharged to a skilled nursing facility with a POLST completed or updated during admission arrives with the current signed form, and the receiving nurse knows it is current. POLST programs were designed so that portable medical orders would follow patients across settings, and research in nursing facilities found that residents with POLST forms more often received treatment consistent with their documented preferences than residents whose preferences were recorded by traditional methods (Hickman et al., 2010). A companion study found that the care nursing facility residents received generally matched their POLST orders on resuscitation, with less consistency for some other kinds of orders (Hickman et al., 2011); both findings assume the facility has the current form in hand. Oregon's experience suggests that a statewide registry and consistent processes help orders travel reliably, though complexity remains (Tolle & Teno, 2017).
Why This Gap Belongs to a DNP
Three features place the gap within a doctorally prepared nurse's reach. First, it occurs in a nursing-owned process, discharge, rather than in physicians' decisions about the orders themselves. Second, closing it requires changes across systems, the record's discharge packet, case management workflow and communication with receiving facilities, which is the kind of systems work the practice doctorate prepares nurses to lead. Third, it is measurable: an audit can show how often current forms arrive with patients. The gap is uncommon enough in the literature to need careful local measurement, and common enough in daily practice that most nurses on the service can describe a transfer where it happened.
Boundaries
The statement is limited to discharges to skilled nursing facilities, where orders must be acted on quickly and staff often do not know the patient. It excludes discharges home, where the form usually travels with the patient or family, and it does not address whether the orders themselves reflect the patient's wishes, a question about the quality of conversations rather than the reliability of transfer.
References
Hickman, S. E., Nelson, C. A., Moss, A. H., Tolle, S. W., Perrin, N. A., & Hammes, B. J. (2011). The consistency between treatments provided to nursing facility residents and orders on the Physician Orders for Life-Sustaining Treatment form. Journal of the American Geriatrics Society, 59(11), 2091-2099. https://doi.org/10.1111/j.1532-5415.2011.03656.x
Hickman, S. E., Nelson, C. A., Perrin, N. A., Moss, A. H., Hammes, B. J., & Tolle, S. W. (2010). A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the Physician Orders for Life-Sustaining Treatment program. Journal of the American Geriatrics Society, 58(7), 1241-1248. https://doi.org/10.1111/j.1532-5415.2010.02955.x
Tolle, S. W., & Teno, J. M. (2017). Lessons from Oregon in embracing complexity in end-of-life care. New England Journal of Medicine, 376(11), 1078-1082. https://doi.org/10.1056/NEJMsb1612511
The Walden NURS 8003 Week 6 instructions
Problem statements in this course usually build on earlier versions by asking you to state who owns the gap and why it is within a DNP's reach. Keep the whole document to about three pages. Put the statement itself in one short paragraph that names the setting, the population, the gap and its consequence. Describe current practice from your own vantage point, and say what you can and cannot observe. Define desired practice from evidence or policy. Explain ownership: which process the gap sits in, who controls it and why a doctorally prepared nurse can act. Set boundaries that keep the problem manageable, and name the first step, often a baseline audit, that a project would need.
How this NURS 8003 Week 6 example is built
The statement opens the document as a highlighted paragraph ending in a sentence on ownership. A current practice section walks through how the form is completed, stored and left out of the automatic discharge packet. A desired practice section cites Hickman and colleagues' two nursing facility studies and Tolle and Teno on Oregon's statewide approach. A section gives three reasons the gap belongs to a DNP: a nursing-owned process, a systems problem and a measurable gap. A boundaries section limits the problem to skilled nursing facility discharges and sets aside the quality of the conversations themselves. The document never offers a solution, and it says what the first step would be instead.
NURS 8003 Week 6 rubric: what earns full marks
Doctoral problem statements are generally graded on precision, ownership, grounding in evidence and scope. Precision requires a defined setting, population and gap. Ownership is often the distinguishing criterion at this level, rewarded when the writer names the process and explains why a DNP can act on it. Grounding is judged on whether desired practice comes from evidence or policy. Scope earns credit when boundaries are justified. Honesty about the absence of local data is valued. Faculty also look for a gap that is uncommon enough to be interesting and common enough to matter. Concise writing and APA citations complete the typical rubric. Some instructors award separate credit for naming what the statement leaves out.
NURS 8003 Week 6 help: mistakes that cost marks
A doctoral statement loses marks when the problem belongs wholly to another profession, leaving the nurse with no route to act. Another common loss is repeating an earlier statement without adding ownership. Some statements claim local rates that have not been measured. Others set boundaries so wide the problem cannot be addressed in one project. State the gap precisely, describe current practice honestly, ground desired practice in evidence, explain ownership, set boundaries and name the first step. The desk can draft a statement for the gap you have identified. Keep patient and facility details unidentifiable. Write the ownership sentence last, once the rest is settled.
Get a NURS 8003 Week 6 example written to your instructions
Attach the problem statement prompt and rubric, noting any template your section requires, and a statement shaped to them is drafted. First one free, back in 24 to 48 hours. Incidents and discharge records from your workplace stay there; the hospitalist service in this example was invented so that no real organization's gap is on display.
More NURS 8003 papers and DNP samples
- NURS 8003 Week 1: Discussion post
- NURS 8003 Week 2: Role comparison paper
- NURS 8003 Week 3: Essentials analysis
- NURS 8003 Week 4: Scholarly writing exercise
- NURS 8003 Week 5: Self-assessment paper
- NURS 8003 Week 7: Evidence appraisal
- NURS 8003 Week 8: Discussion post
- NURS 8003 Week 9: Development plan
- NURS 8003 Week 10: Portfolio artifact
- NURS 8003 Week 11: Reflection
- NURS 8100 Week 4: Policy Analysis
- NURS 8002 Week 6: Problem significance thread
- DNRS 6800 Week 6: Case formulation
- DNRS 6630 Week 6: Treatment plan
NURS 8003 Week 6 questions, answered
How is this different from a problem statement in an earlier course?
The difference is ownership. Earlier statements often describe a gap and stop. The example devotes its longest section to who controls each part of the process and argues that a gap between departments is within a DNP's responsibility. Your prompt may not use the word ownership, but faculty here generally favor statements that claim the problem rather than point elsewhere.
Can the statement omit local data?
At this stage many sections allow it, and the example describes current practice qualitatively from the author's vantage point. It says clearly what the author can and cannot observe, which prevents overclaiming. If your organization permits you to use internal quality data, even one figure strengthens the statement. The grounding criterion in your rubric shows how strictly local evidence is expected.
Where can I find a free NURS 8003 Week 6 sample paper?
The complete problem statement, current and desired practice, the ownership argument and boundaries, is available here and costs nothing. A statement for your own practice gap can be requested.
Who owns the gap in the NURS 8003 Week 6 statement?
Nursing, because the gap sits in the discharge process that unit nurses and their leaders run, not in the physicians' decisions about the orders themselves.
Why POLST transfer rather than a more common problem in NURS 8003 Week 6?
Because it is a gap in a nursing-owned hand-off that crosses systems and can be measured by audit, which makes the ownership question concrete.