| Course | NURS 8600 DNP Field Experience |
|---|---|
| Week | Week 4 |
| Paper type | PDSA cycle report |
| Length | About 1,010 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 4
PDSA Cycle 1: Testing a Scripted Telehealth Introduction to the Counselor on Her Three Off-Site Days
Student Name
College of Nursing, Walden University
NURS 8600: DNP Field Experience
Instructor Name
Month Day, Year
PDSA Cycle 1: Testing a Scripted Telehealth Introduction to the Counselor on Her Three Off-Site Days
The Three Improvement Questions
The Model for Improvement opens every test of change with three questions, about the aim, the evidence of improvement and the change itself (Langley et al., 2009). The aim: increase the share of patients with higher-range AUDIT-C scores who are offered a behavioral health referral, on all clinic days, not only the two days the counselor is on site. The evidence: the proportion of referral-eligible visits with a documented referral offer, checked weekly during the test. The change: on days the counselor is away, the nurse or provider reads a short scripted invitation to book a video visit with her.
The change responds to divergence 6 on the as-implemented workflow map: in April, referral offers were documented for only one of four eligible visits, and staff said they did not know what to offer when the counselor was not there to meet the patient.
Plan
Change. A two-sentence script added to the brief intervention note template: "Our counselor is not in today, but I can set up a short video visit with her this week so you can meet her. Would that be helpful?" If the patient agrees, the nurse books a 20-minute telehealth slot in the counselor's schedule before the patient leaves.
Scale. One provider team, one physician, one nurse and one medical assistant, for two weeks in mid-May, on the three weekdays the counselor is not on site. Starting small limits the burden if the change fails and lets the team learn quickly (Langley et al., 2009).
Prediction. At least three of every four referral-eligible visits on that team's non-counselor days will have a documented offer; at least one patient will accept; the script will add less than two minutes to the visit.
Why this change rather than another. Staff suggested three options at the April meeting: asking the counselor to come in on more days, giving patients a printed phone number to call the counselor later or offering a booked video visit. The first was not possible within the counselor's contract. The second is common but places the whole burden on the patient, and staff doubted many would call. The third keeps the clinic responsible for the next step while the patient is still in the room, which is closest to the warm introduction the counselor provides in person, so it was chosen for the first test.
Data. The nurse will record each eligible visit on a paper tally, noting whether the offer was made, accepted and scheduled, and the approximate time taken. The project lead will check the tally against the chart at the end of each week.
Do
The test ran for ten clinic days. The team saw three referral-eligible visits on non-counselor days. The nurse made the scripted offer in all three and documented it in the template. Two patients declined, one saying he would "think about it" and one saying she preferred to talk with her own provider at the next visit. One accepted, and the nurse booked a video visit for two days later; the patient attended.
Two problems arose. The counselor's telehealth slots were not visible to the nurse in the scheduling system, so booking required a phone call to the counselor's scheduler, which took about six minutes during one visit. And on one day the nurse was covering the phone line, so the provider made the offer instead, reading the script from the template.
Study
The prediction about offers was met: three of three eligible visits had a documented offer, compared with one of four in April. The prediction about acceptance was met. The prediction about time was met for the script itself, which took under a minute, but not for booking, which added several minutes when the scheduler had to be called. All counts in this report are invented for a composite clinic to illustrate the method, and they are very small. They show that the change can work on this team, not that it improves referral rates across the clinic.
Two unplanned findings matter as much as the prediction. First, the scheduling barrier would make the change unsustainable on busy days. Second, the provider's use of the script on the nurse's phone day showed that providers can deliver part of the workflow, which bears on the separate question of who delivers brief intervention when the nurse is unavailable.
Act
Decision: adapt. The change will be kept and extended to all three provider teams in June, with one modification: the record-system analyst will open two held telehealth slots in the counselor's schedule each non-counselor day that nurses and providers can book directly. The team will run a second cycle after the change spreads to check that the held slots are used and that booking time falls. The provider's role will be raised with the nurse manager as a possible focus for the next cycle.
A systematic review of the Plan-Do-Study-Act method in health care found that many reported projects did not follow its features closely, for example by skipping predictions or running a single cycle and declaring success (Taylor et al., 2014). Reed and Card (2016) argue that PDSA cycles are often misused as a way of implementing a predetermined change rather than as a way of learning. This report tries to avoid both problems: it states a prediction, tests on a small scale, reports what did not work and treats the result as the start of the next cycle rather than the end.
Limitations
With three eligible visits, the cycle cannot estimate how often offers will be made clinic-wide or how many patients will accept. The team that ran the test volunteered for it and may be more motivated than others. The tally relied on the nurse remembering to record each visit, although chart checks matched every entry. These limitations are appropriate for a first small test; the monthly report after the change spreads will show whether the effect holds across teams and on days when the clinic is under pressure.
References
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Reed, J. E., & Card, A. J. (2016). The problem with Plan-Do-Study-Act cycles. BMJ Quality and Safety, 25(3), 147-152. https://doi.org/10.1136/bmjqs-2015-005076
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality and Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862
Reading the NURS 8600 Week 4 instructions
The PDSA report in Week 4 usually asks you to document one small test of change from your project in the standard four-part format. Reports commonly run four to five pages. Begin with the aim, the measure that would show improvement and the change you are testing. In Plan, describe the change, the scale of the test, a specific prediction and how data will be collected. In Do, record what actually happened, including problems. In Study, compare results with each part of the prediction and note what you did not expect. In Act, state a decision to adopt, adapt or abandon, and explain what the next cycle will test. Keep the scale small enough that a failure costs little.
Inside the NURS 8600 Week 4 example
The report opens with the aim, evidence and change, citing Langley and colleagues' improvement guide, and links the change to a divergence on the workflow map. Plan gives the two-sentence script, the options staff considered and why this one was chosen, the scale, a three-part prediction and a tally method. Do reports three eligible visits, three offers, one attended visit and two problems. Study compares results with each prediction and names the scheduling barrier and the provider's use of the script. Act adapts the change with held slots, citing Taylor and colleagues' review of PDSA reporting and Reed and Card on misuse of cycles. A limitations section closes the report.
Reading the NURS 8600 Week 4 rubric
PDSA reports are typically graded on fidelity to the method, quality of the prediction, honesty in the Study phase and the logic of the Act decision. Method fidelity means all four phases are present and in order, with a small-scale test. Predictions earn credit when they are specific enough to be wrong. The Study phase is where many reports lose points, since graders expect results compared with each prediction and surprises reported. The Act decision should follow from the Study findings and set up the next cycle. Evidence about the PDSA method itself strengthens the report. Clear data, even with small numbers, and APA formatting complete the criteria.
NURS 8600 Week 4 help: mistakes that cost marks
PDSA reports lose credit when the prediction is vague, such as expecting improvement, so nothing could disprove it. Another common loss is testing the change on everyone at once, which makes learning slow and failure expensive. Some reports list results without comparing them to the prediction. Others declare success after one cycle and stop. Write a specific prediction, test small, record problems in Do, compare each result in Study, choose adopt, adapt or abandon in Act and plan the next cycle. The desk can draft a report on a test from your own project. Label small numbers as small and avoid percentages that suggest more certainty than three cases allow.
Get a NURS 8600 Week 4 example written to your instructions
Send the cycle report prompt and rubric with a note on the change you tested, and a four-stage report organized around your prediction comes back in 24-48h, the first free. The telehealth introduction and its template trouble were invented to show a cycle's anatomy; the change and results you report stay entirely your own.
More NURS 8600 papers and DNP samples
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- NURS 8600 Week 2: DNP project launch brief
- NURS 8600 Week 3: DNP as-implemented workflow map
- NURS 8600 Week 5: DNP implementation midpoint report
- NURS 8600 Week 6: DNP course-correction memo
- NURS 8600 Week 7: DNP project run chart analysis
- NURS 8600 Week 8: DNP sustainment handoff plan
- NURS 8600 Week 9: DNP final report discussion section
- NURS 8600 Week 10: DNP SQUIRE manuscript outline
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NURS 8600 Week 4 questions, answered
How small should a first test of change be?
Small enough that failure is cheap and learning is quick. The example tests on one provider team for two weeks, in keeping with the IHI model's emphasis on small-scale tests before spread. The right scale for your project depends on your practice setting, but a first cycle involving everyone at once makes it hard to learn anything if the change does not work.
What if the prediction turns out to be wrong?
That is a legitimate result and often a useful one. The example's prediction was partly confirmed and partly not, and the report says so. A wrong prediction reported honestly, along with what it taught, is usually valued above one that suspiciously matches every result. The learning feeds your Act decision and the design of the cycle that follows.
Can a DNP project include several PDSA cycles?
Many do, and a sequence of cycles, each informed by the last, reflects how the model is meant to work. The example plans a second cycle based on the first. Programs differ on whether each cycle is reported separately or several are summarized together; either way, showing how one cycle's decision shaped the next strengthens the account of your implementation.
Where can I find a free NURS 8600 Week 4 sample paper?
The full report, three questions, Plan, Do, Study, Act and limitations, is published here and costs nothing to read. A report on a test from your own project can be requested.
What did the NURS 8600 Week 4 cycle find that was not predicted?
That booking the counselor's video slot required a phone call to her scheduler, and that a provider could use the script on a day the nurse was covering the phone.