| Course | NU 476 Nursing Capstone |
|---|---|
| Unit | Unit 5 |
| Paper type | Implementation record |
| Length | About 640 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | RN to BSN |
| Updated | October 2026 |
Free sample paper for NU 476 Unit 5
Implementation Record: Hand Hygiene Observation and Feedback on a 20-Bed Pediatric Unit
Student Name
Department of Nursing, Herzing University
NU 476: Nursing Capstone
Instructor Name
March 18, 2026
Implementation Record: Hand Hygiene Observation and Feedback on a 20-Bed Pediatric Unit
What Was Planned
The plan was a six-week hand hygiene improvement project on 2 South, a 20-bed pediatric medical unit, combining three elements drawn from the evidence on improving compliance, which supports combining education, reminders, and performance feedback rather than relying on any one alone (Gould et al., 2017): a 10-minute education session for all staff; reminder signs at every room entrance; and weekly feedback of observed compliance, posted on the unit board and discussed at huddles. Compliance was to be measured by two trained peer observers auditing 50 opportunities a week, using the moments for hand hygiene defined by the World Health Organization (2009). Baseline compliance, from two weeks of audits before the project, was 61%.
What Happened, by Date
The record below is written as events so a reader can see the project running.
| Date | What was done | Who | Reach |
|---|---|---|---|
| Feb 2 | Observer training: two RNs trained and validated against infection prevention auditor; agreement 92% on 30 opportunities | Student, infection preventionist | 2 observers |
| Feb 3-6 | Education sessions at huddles, all shifts | Student | 41 of 48 staff (85%) |
| Feb 6 | Reminder signs placed at 20 room entrances and 2 treatment rooms | Student, unit secretary | 22 locations |
| Feb 9-13 | Week one audits: 50 opportunities; compliance 70% | Observers | All shifts |
| Feb 13 | First feedback posted; huddle discussion | Nurse manager | Day and night huddles |
| Feb 16-20 | Audits paused for three days: observers pulled to staffing during RSV surge | Nurse manager decision | 31 opportunities only |
| Feb 23 | Makeup education for 7 staff who missed sessions | Student | 6 of 7 reached |
| Feb 23-27 | Audits resumed; third observer added from night shift | Observers | 54 opportunities; 74% |
| Mar 2-6 | Audits; feedback by role added to board | Observers, manager | 50 opportunities; 78% |
| Mar 9-13 | Final audits | Observers | 52 opportunities; 79% |
Departures From the Plan, With Reasons and Authorization
Three departures occurred. First, audits were paused for three days in the third week, because a surge of respiratory syncytial virus admissions required the two observers to work as staff nurses; the nurse manager made that decision, and it was the correct one. That week's figure is based on 31 opportunities instead of 50 and is less reliable. Second, a third observer from night shift was added in week four, with the manager's approval, after I noticed that all audits so far had occurred on day shift, which risked missing a difference between shifts. She was validated against the same auditor before observing. Third, feedback was broken down by role from week five, a change suggested by nursing assistants, who asked to see their own group's result rather than only the unit total; the manager approved it after the practice council agreed that no individual would be identified.
What Staff Said During Implementation
Staff comments were recorded at huddles and in brief conversations, because they explain several of the numbers. In the first week, nurses said the sanitizer dispensers inside two rooms were often empty, which the unit secretary then added to her daily supply check; missed opportunities in those rooms fell afterward. Respiratory therapists said they were rarely on the unit for huddles and had not heard the education, so a copy of the session was sent to their department and discussed at their meeting in week four. Several parents noticed the signs and began reminding staff, which some nurses welcomed and a few found awkward; the manager addressed this at a huddle by thanking families for helping. The most common reason staff gave for a missed moment was entering a room quickly to respond to an alarm, which suggests that the next improvement step, beyond this project, is sanitizer placed at the point of care rather than only at the door.
What the Record Cannot Show
Directly observed hand hygiene tends to be higher when staff know they are being watched, a Hawthorne effect that can be large; in one hospital, compliance measured when auditors were visible was about three times higher than when they were not (Srigley et al., 2014). Our observers were peers in uniform and were probably recognized, so the true compliance rate is likely lower than the audits show, both before and during the project. Because the same method was used throughout, the change from 61% to 79% is more trustworthy as a trend than as a precise level.
Status at the End of Implementation
At the end of six weeks, all planned elements were in place: education reached 47 of 48 staff, signs were present at all locations, and feedback had been posted five times. The observers agreed to continue audits at 25 opportunities a week, a reduced level that the unit can sustain, and that decision is carried forward to the handover plan.
References
Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews, (9), Article CD005186. https://doi.org/10.1002/14651858.CD005186.pub4
Srigley, J. A., Furness, C. D., Baker, G. R., & Gardam, M. (2014). Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: A retrospective cohort study. BMJ Quality & Safety, 23(12), 974-980. https://doi.org/10.1136/bmjqs-2014-003080
World Health Organization. (2009). WHO guidelines on hand hygiene in health care. World Health Organization.
NU 476 Unit 5 instructions, in plain terms
Unit 5 asks you to keep a record of how your capstone was implemented. Expect to state what was planned, record what happened by date, note departures from the plan with reasons and authorization, capture staff comments, acknowledge what the record cannot show and report status at the end. Many versions ask whether to record things that went wrong and why fidelity needs a denominator. Check whether your section expects a log or a narrative. Record departures honestly, since they explain results. Fidelity means how fully the plan was delivered, such as 47 of 48 staff educated, so give numbers. Staff comments add context that counts miss. Name measurement limits such as observer effects.
How the NU 476 Unit 5 example is put together
The record opens with the plan in a short paragraph. The dated section lists events in order, which lets the reader see the project unfold. The departures section records three changes, each with its reason and who approved it, which shows the project adapted responsibly. The staff comments section summarizes what nurses and assistants said and how it shaped later steps. The limits section explains the Hawthorne effect and what it means for the audit numbers. The status section reports fidelity with counts for each element. The record reads as an honest account rather than a success story, which is what makes it useful for the outcome unit that follows. Each claim is dated and counted.
Reading the NU 476 Unit 5 rubric
Herzing's rubric for an implementation record usually covers alignment with the plan, documentation of events, departures and their justification, fidelity, staff input, limits and writing. Departures and fidelity are read closely, since graders want changes explained and delivery measured with numbers. Event documentation points reward dated entries. Staff input criteria look for comments that explain results. Limits earn credit for naming measurement problems. Writing points go to a clear, factual sequence. End status should be reported element by element, so each part of the plan has its own count. Comments from staff that explain a dip or rise in the audit numbers are usually credited because they connect the record to the results. The WHO hand hygiene guidelines and Srigley's Hawthorne study belong in the APA 7 list.
Common NU 476 Unit 5 mistakes, and how to avoid them
Implementation records in Unit 5 often fall short by describing the plan again instead of what happened. Another frequent problem is leaving out departures, which makes results hard to interpret. Students often report fidelity without a denominator. Staff comments are missing. Limits such as the Hawthorne effect are ignored. Dates are absent. The record reads as promotion of the project. Finally, record what went wrong and who approved changes, because graders reward honest implementation records that explain why results look the way they do. Another weak spot is merging the audit results into the implementation record, when results belong in the outcome unit. Keep this record to what was done and how fully. A short note of who carried out each element helps the next unit judge fidelity.
Get a NU 476 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NU 476 classroom, plus what actually happened during your implementation period. We write a custom example recording events, fidelity and departures honestly, returned in 24 to 48 hours. The first custom sample is free. Send the fidelity counts too if you have them.
More NU 476 papers and RN-to-BSN samples
- NU 476 Unit 1: Capstone topic proposal
- NU 476 Unit 2: Practice gap evidenced at the site
- NU 476 Unit 3: Project plan with milestones
- NU 476 Unit 4: Stakeholder and approval map
- NU 476 Unit 6: Outcome measurement
- NU 476 Unit 7: Results presented to the site
- NU 476 Unit 8: Sustainability and handover plan
- NSG 324 Unit 5: Single research article critique
- NU 305 Unit 5: Escalating a clinical concern
- NU 345 Unit 5: Developmental stage applied to assessment
- NSG 321 Unit 5: Resource justification memo
NU 476 Unit 5 questions, answered
Should I record things that went wrong?
Yes, and they strengthen the record rather than weakening it. Every implementation departs from its plan, and a document reporting none reads as edited to anybody who has run a project. Record what happened, what you did about it and whether it affected delivery, and the eventual evaluation becomes far more defensible.
Why does fidelity need a denominator?
Because it decides how a result should be read. Twelve staff trained means one thing on a unit of fourteen and another on a unit of forty, and an outcome that did not move means something different in each case. Report delivered against planned throughout, and the evaluation can distinguish a failed intervention from one that was never fully delivered.
What counts as a departure worth recording?
Anything that differs from what was approved, however sensible. A session moved to a different week, a component shortened, a group excluded because of staffing. Note it, say why and who agreed, and it becomes a documented adjustment rather than something that surfaces later as an inconsistency nobody can explain.
Where can I find a free NU 476 Unit 5 sample paper?
You can read the whole NU 476 Unit 5 hand hygiene implementation record here for free, dated events, departures, staff comments and fidelity counts. A record for a different project can be drafted from your own log.
What is the Hawthorne effect in hand hygiene audits?
Staff often wash hands more when they know they are being watched, so directly observed rates can overstate usual practice. This sample names that limit and explains how it affects the audit results.