| Course | NURS 8600 DNP Field Experience |
|---|---|
| Week | Week 3 |
| Paper type | As-implemented workflow map |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8600 Week 3
The Plan and the Practice: An As-Implemented Workflow Map of Alcohol Screening and Brief Intervention Four Weeks After Launch
Student Name
College of Nursing, Walden University
NURS 8600: DNP Field Experience
Instructor Name
Month Day, Year
The Plan and the Practice: An As-Implemented Workflow Map of Alcohol Screening and Brief Intervention Four Weeks After Launch
Purpose
Four weeks after the April 1 launch of alcohol screening and brief intervention at the composite rural clinic, this map compares the workflow approved in the project proposal with the workflow staff actually follow. Workflows on paper rarely survive contact with a busy clinic unchanged, and the differences are useful information: some are improvements that staff found, some are gaps that reduce the reach of the change and some are questions the project should test. Reviewing how improvement teams draw and use workflow maps, Antonacci et al. (2018) found the practice common but uneven in quality, and argued that a map is only as useful as the conversation and action that follow it.
How the Implemented Workflow Was Identified
No formal observation was conducted. The implemented workflow was drawn from three sources: short conversations with each medical assistant, both registered nurses and two of the three providers during the third and fourth weeks; a review of 20 randomly selected April charts for annual visits, looking at the order and timing of template entries; and the first monthly report from the new screening template. Where sources disagreed, the chart evidence was preferred, and the conversation was noted as a question for the next staff meeting.
The Planned Workflow
Table 1 reproduces the workflow from the approved proposal, arranged by lane.
Table 1
Planned Workflow by Lane
| Lane | Planned steps |
|---|---|
| Patient | Checks in; is roomed; answers three questions; receives feedback and advice if positive; is offered a counselor introduction if score is high |
| Medical assistant | Asks AUDIT-C questions at rooming, before vitals; flags a positive score |
| Registered nurse | Sees the flag; delivers brief intervention before the provider enters; documents with the note template |
| Provider | Reviews the note; addresses any related clinical issues |
| Counselor | On Tuesdays and Thursdays, receives warm introductions; on other days, receives scheduled appointments |
The Implemented Workflow and Its Divergences
Table 2 lists the points where practice differs from the plan, numbered as they would appear on the swimlane diagram, and sorts each into one of three categories: an improvement to keep, a gap to close or a question to test.
Table 2
Divergences Between Planned and Implemented Workflow
| No. | Lane | What happens in practice | Category |
|---|---|---|---|
| 1 | Medical assistant | Questions asked after vitals, once the door is closed, rather than at the start of rooming | Improvement to keep: more privacy, and staff report patients answer more openly |
| 2 | Medical assistant | Screen skipped when a visit starts more than 15 minutes late | Gap to close |
| 3 | Medical assistant | Patients who decline the questions are not recorded as declining, so they look unscreened | Gap to close: add a declined option to the template |
| 4 | Registered nurse | On days the nurse covers the phone line, brief intervention is often not done | Question to test |
| 5 | Provider | Some providers deliver the brief intervention themselves when the nurse is unavailable, but document it in free text | Question to test, linked to No. 4 |
| 6 | Nurse or provider | Referral offers are rarely made on days the counselor is not on site | Gap to close: first improvement cycle |
The April report is consistent with these divergences: screening was documented at 96 of 140 annual visits, a large rise from the baseline, but brief intervention was documented for 9 of 18 positive screens and a referral offer for 1 of 4 visits meeting the referral criterion. These figures are illustrative, prepared for a composite clinic.
Interpreting the Divergences
A divergence from the plan does not mean the project is failing. Adaptations are expected when an intervention meets a real setting, and recording what changed, who changed it and why helps separate adaptations that preserve the core of an intervention from those that weaken it (Wiltsey Stirman et al., 2019). Divergence 1 is an adaptation that strengthens the change: moving the questions to a private moment fits the intent of respectful screening. Divergences 2, 3 and 6 are gaps that reduce reach and have clear remedies. Divergences 4 and 5 are linked and uncertain. If providers can deliver the brief intervention well and document it in the template, the provider role could become an intended part of the workflow; if not, the nurse's phone duties need another solution.
The Consolidated Framework for Implementation Research lists features of the inner setting, such as available resources and the compatibility of a change with existing workflows, as common influences on implementation (Damschroder et al., 2022). Divergences 2 and 4 are both about resources and timing: when the day runs late or a nurse is pulled to the phone, the new step is the first to go.
Next Steps
Three actions follow. First, the record-system analyst will add a declined option to the template this week, closing divergence 3. Second, the first Plan-Do-Study-Act cycle will test a scripted offer of a scheduled telehealth introduction to the counselor on non-counselor days, addressing divergence 6. Third, the project lead will ask the providers who already deliver brief intervention whether they would test using the note template, gathering evidence on divergences 4 and 5 for a possible later cycle. Divergence 2 will be discussed at the staff meeting, since late starts are a clinic-wide pattern the project cannot solve alone. The map will be redrawn after the next cycle.
The map also changes how the project will report its progress. Rather than presenting the April rise in screening as the headline, the next reports will show each divergence beside the measure it affects, so that readers can see why screening rose quickly while brief intervention and referral lagged. The approved proposal assumed that one flag and one trained nurse would carry a positive screen through to intervention; the map shows that the chain depends on who is free at that moment, and that is the constraint the rest of the project must address.
Limitations of the Map
The map rests on conversations and a small chart sample rather than direct observation, so it may miss steps that staff take without mentioning or recording them. Staff may also describe what they think they should do rather than what they do on a hard day. The chart sample of 20 visits is enough to show patterns but not to estimate how often each divergence occurs. These limits are acceptable for a first map, whose purpose is to point the next improvement cycle in the right direction, but they mean the frequencies in the next report must come from the full monthly data rather than from this sample.
References
Antonacci, G., Reed, J. E., Lennox, L., & Barlow, J. (2018). The use of process mapping in healthcare quality improvement projects. Health Services Management Research, 31(2), 74-84. https://doi.org/10.1177/0951484818770411
Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, Article 75. https://doi.org/10.1186/s13012-022-01245-0
Wiltsey Stirman, S., Baumann, A. A., & Miller, C. J. (2019). The FRAME: An expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Science, 14, Article 58. https://doi.org/10.1186/s13012-019-0898-y
The Walden NURS 8600 Week 3 instructions
Implementation assignments in the third week commonly ask you to compare your intervention as planned with how it is being carried out, and to decide what to do about the differences. Expect three to five pages, often with a process map or swimlane diagram. Draw the planned and actual workflows in the same format so the comparison is direct. Explain how you learned about the actual workflow and how reliable each source is. Number each divergence and sort it by what it means for the project. Treat some differences as improvements rather than failures. Use an implementation framework to explain why the gaps occur. Close with the next actions, including which divergence your first improvement cycle will address.
Inside the NURS 8600 Week 3 example
A purpose section cites Antonacci and colleagues on how improvement teams use process maps. A methods section describes the three sources and how disagreements were settled. Table 1 shows the planned workflow in five lanes. Table 2 lists six divergences with lane, practice and category, followed by April figures consistent with them. An interpretation section cites Wiltsey Stirman and colleagues on recording adaptations and Damschroder and colleagues on the inner setting, and explains why two divergences are linked. Next steps name three actions, including the first improvement cycle. Paragraphs on reporting and limitations close the map. Every divergence carries a number that matches the diagram.
Where the marks sit in the NURS 8600 Week 3 rubric
Workflow comparisons are generally scored on accuracy of the maps, quality of the divergence analysis, use of implementation theory and the link to next actions. Map accuracy depends on clear sources and consistent format. Divergence analysis earns the most when each difference is categorized with a reason, not simply listed. Implementation theory is credited when it explains why gaps occur rather than naming a framework in passing. Linking the analysis to a specific improvement cycle shows the map is being used. Faculty also look for honesty about the limits of informal methods. Diagrams or tables that a reader can follow quickly help, and sources should be cited in APA. Graders often reward a map that treats one staff workaround as an improvement.
NURS 8600 Week 3 help from the desk
Workflow maps lose marks when the planned and actual versions are drawn in different formats, so the reader cannot compare them. Another loss is treating every divergence as staff failure, which misses adaptations worth keeping. Some maps list divergences without saying what the project will do about any of them. Others overstate what a handful of conversations can show. Use one format for both workflows, describe your sources, number and sort each divergence, explain gaps with a framework, name next actions and state your limits. The desk can prepare a map for the workflow in your own project. Collect only the kinds of data your approved plan allows.
Get a NURS 8600 Week 3 example written to your instructions
Paste the prompt and rubric and describe the workflow your proposal laid out, and a two-diagram map comparing plan with practice arrives in 24-48h; the first one is free. Late visits, the phone line and the counselor's days were written for an imagined clinic, and the divergences on your map should come from the practice setting you are studying.
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NURS 8600 Week 3 questions, answered
Is a swimlane diagram required for this kind of map?
Not always, but it suits a workflow shared across several roles. The example uses swimlanes because the divergences mostly occur at hand-offs between lanes. Your rubric may accept a flowchart or a narrative process description instead; whichever you choose, drawing the planned and actual workflows in the same format makes the comparison far easier for a reviewer to follow.
Does a divergence from the plan mean the project failed?
No. Early divergence is expected, and studying it is one reason the implementation course exists. The example treats one divergence as a possible improvement worth keeping. What faculty look for is whether you noticed, analyzed and responded, and whether any adaptation you keep is documented so the final evaluation reflects the workflow that actually ran.
How is the implemented workflow identified without formal observation?
The example relies on conversations with staff and a sample of charts. Your approved plan may allow structured observation or a brief staff survey, and whichever method you use should be described in the document and consistent with what that plan already covers. Collecting new kinds of data your plan never mentioned is best avoided until your faculty confirm it.
Where can I find a free NURS 8600 Week 3 sample paper?
The complete map, both workflow tables, six sorted divergences, interpretation and next steps, is available here free of charge. A map for your own project's workflow can be requested.
Which divergence in the NURS 8600 Week 3 map is kept as an improvement?
Medical assistants asking the questions after vitals with the door closed, instead of at the start of rooming, which gives patients more privacy and, staff report, more open answers.