Capstone Experience in Health Care: Prevention and Management

This report presents a Capstone Experience in Health Care, focusing on the prevention and management of pressure ulcers, particularly in elderly patients. It begins with an introduction to capstone projects, emphasizing their role in developing critical thinking, problem-solving skills, and research abilities within a healthcare context. The report then delves into the definition, causes (intrinsic and extrinsic factors), and preventive measures for pressure ulcers, including patient relocation, pressure-reducing surfaces, and nutritional support. The core of the report examines the assessment and treatment of pressure ulcers, including documentation, debridement, wound cleansing, and the use of topical and systemic antibiotics. The report further highlights the importance of self-assessment and critical reflection in the capstone experience, detailing the student's self-assessment process, which revealed a need for greater knowledge about pressure ulcers. The student's reflection on the experience emphasizes the development of new skills in teamwork, communication, and understanding patient conditions. Overall, the report provides a comprehensive overview of the capstone experience, highlighting its value in enhancing healthcare knowledge and professional development.

Running head: CAPSTONE EXPERIENCE IN HEALTH CARE
CAPSTONE EXPERIENCE IN HEALTH CARE
Name of the student:
Name of the university:
Author note:

1CAPSTONE EXPERIENCE IN HEALTH CARE
Introduction:
The capstone project which is also known as culminating project, senior exhibition or
capstone experience. It is found to be one of the multidimensional assignment which assists
as an academic and intellectual student experience. These practice is typically performed
during the student’s final semester of any academic program. The concept of capstone
experience is to develop critical thinking in the practitioner in order to enhance challenging
problem solving and also skills development which includes better communication, research
skills, teamwork, literacy, aim setting (Russell, Conley & Hill, 2017).
The idea of emerging various esteemed capstone processes for nursing field is not
difficult; the main secret of nursing project success is to start with the list of your capabilities
and clinical interests letting you approach the subject by having a complete understanding
thereof and elucidate what the zone of your interest is (Miley & Reinisch, 2016).
The next step is to search for the evidence on the related subject – go through the
recent publications, then convince them with some acute insight which are related to what is
crucial in the field of practice. This initial search in the field will provide your ideas on the
further topic’s purifying, and making the study process for the nursing practice change
smoothly (Ross & Carney, 2017).
The Capstone experience was essentially originated in order to be involved with the
contributing and fluctuating knowledge, information, skills, viewpoints that are gained
through any previous project, which will thus be demonstrating program’s results accurately.
It relies on the reflection on the community context, the body of the appropriate literature, or
the theoretical framework on the basis of which the person’s capstone work postures a major
contribution. It helps in bridging the coursework and the subject to the person’s careers after
the particular course. It also aims in preparing the students in their life-long knowledge and

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learning process (Trepanier et al., 2017). The outcome of the capstone experience is a
perceptible product which is to be presented to the public that can be either done as written
work, verbal representation, multimedia creations that can be done using various forms which
are websites, DVDs and CDs. In the study the topics or the field of study are nominated by
the students and are then approved by the respected faculties. The Capstone experiences
comprise of, but are not restricted to senior project, thesis, achievement portfolio, internship,
culminating senior experiences, practicum, comprehensive examination, co-op experience,
field experience, study abroad clinical assignment (Smit & Zeller, 2018).
The capstone exercise is generally practiced at the end of any healthcare based
undergraduate program. It is essential in every course to practice the Capstone experience in
their profession. This following capstone knowledge will help to recognize the appropriate
knowledge within the health care personnel and the other department of healthcare. The
purpose is also to platform the different strategies to reduce the occurrence of any healthcare
error and other risks and issues that are related to inappropriate management in the health
care employees in case of pressure ulcer (Smallheer, Hunt & Smith, 2018). The Capstone
experience can be very helpful when implemented as a capstone progression or capstone
experience which is spread out in various fields and courses in any degree program (Glynn et
al., 2019).
The pressure ulcer is a health condition which is a type of localized injury of the skin or
the underlying tissue, which is usually occurred over the bony prominence, that is an outcome
of unalleviated pressure. The predisposing factors of pressure ulcer are classified as the
intrinsic such as poor nutrition, limited mobility, aging skin and comorbidities or may be
extrinsic which are friction, pressure, moisture and shear (Demarre et al., 2015). The
preventive measures of pressure ulcer include the identification of the at-risk persons and
then the implementation of précised prevention techniques and measures. These measures are

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followed by a patient relocation schedule; these includes keeping the head of the patient of
the bed at the bottommost safe elevation in order to avoid shear; also using the pressure-
reducing exteriors; and the measuring of nutrition and providing appropriate supplementation
as per the requirement of the patient (Bhattacharya & Mishra, 2015). When a pressure ulcer
condition occurs, it is important to prepare proper documentation of each of the ulcer such as
the size, position, granulation tissue and eschar, odour, undermining, exudate, sinus tracts,
and infection and suitable staging which is from I through IV, these are essential factor for
the wound assessment of the patient. The pressure ulcer treatment involves the management
of indigenous and distant infections, elimination of the necrotic tissue, preservation of high
moist environment for the wound healing process, and then possibly the surgery process.
Debridement is found to be indicated when the necrotic tissue is existing (Aziz & Bell‐Syer,
2015). Crucial type of sharp debridement must be accomplished in cases of advanced
cellulitis or sepsis occurrence. There are Automated, enzymatic, and the autolytic
debridement approaches which are distributed under noncurrent treatments. The wound
cleansing process performed rather with normal saline and the appropriate dressings is said to
be the backbone of the treatment for the clean ulcers and also after debridement approach.
The bacterial burden can also be accomplished with the cleansing of the wounds. The usage
of Topical antibiotics is observed to be considered in conditions where there is no sign of
improvement in healing is observed after 14 days. The systemic antibiotics are often used in
case of patients those are advancing osteomyelitis, cellulitis, or systemic infection (Qaseem et
al., 2015). The field of pressure ulcer nursing is a bit complicated as it involves majorly the
older population of a community. Thus it makes it essential to understand and have proper
idea regarding the health condition for providing better healthcare and treatment. the capstone
experience is one of the important step one must take to develop a better knowledge and
understanding about specific health conditions for better service (Norman et al., 2016).

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The capstone process involves various other practice which is found to be very effective
and helpful in assessing one’s own faults and mistakes and to understand the condition in a
much better manner. These practices help in improving and growing in particular fields. One
of the practice in understanding the topics in a better way is Self-assessment which is the
initial step in any career planning and it means the finding out more and more information
and knowledge regarding what you want and seek from the particular work (Van Horn &
Christman, 2017). It involves the analysis of your values, assistances and comforts in order to
find out what you require from your career and filed of practice. The chief goal here is to
figure out the roles which contest with maximum number of one’s personal qualities as
possible (Smallheer, Hunt & Smith, 2016).
The next practice is Critical reflection, which is an action taken through which we can
challenge the rationality and suitability of one’s expectations and principles within one’s
present situation. The reflection on the practice which is found to be revealing the original
expectations, standards, and beliefs which induce a person ability to act as they do in a
specific condition and to understand the activities of another in a precise manner.
Self-assessment statement:
Self-assessment is a process most often use in the healthcare facilities in order to
monitor the quality of the care and treatment that is been provided to the patients and is found
to be an important factor in the developing countries now a day. It is frequently used practice
in clinics and healthcare services in order to make sure that the treatment process and the care
giving in completed within the region of expertise and also to keep the healthcare facilities
and the treatment procedure upgraded. Several educators and researchers have recognized
that self-assessment is a vital part of professional self-regulation (Urden, Stacy & Lough,
2017). The Self-assessment procedure has been stated generally as an involvement process

5CAPSTONE EXPERIENCE IN HEALTH CARE
for learners in order to judge whether or not standards identified by the learners have been
encountered. Self-assessment is low-cost and a reasonable, easy-to-operate tool that can be
used to determine whether the service providers are accomplishing their aims according to
the standards and also for modifying those errors and behaviours which are taken as non-
reliable with the standards (Kennedy et al., 2015). As the practice is attractive because of
their brief and encircling nature, it is a matter of fear as such definitions might build risk
factor by misleading as they might cause some under obligation of the difficulties of the
concept. Self-assessment serves as a mechanism that can be used to identify a person’s
weaknesses and also as a mechanism in order to identify an individual’s strengths. All these
mechanisms can be measured as to have discrete, though complementary, purposes. As a
mechanism that can be used for identifying people’s weaknesses or breaks in a person’s skills
and capabilities, self-assessment is also observed to serve numerous potential purposes
(Naqib et al., 2018).
The self-assessment is build up by various factors that altogether makes it an effective
aspect of providing better care and treatment to the patients. In order to attain a better
capstone experience, as a nurse I took help of a questioner process in order to perform self-
assessment (McDonald, Boulton & Davis, 2018). As I was preparing my questionnaire, I
came to know that I have a very low amount of knowledge regarding the pressure ulcer
condition and this helped me to gain a broad range of information and idea that I was not
aware with. I was very excited and interested about the process as it was helping me highlight
my strengths and weaknesses regarding the topic. It helped me understand the importance of
lessons as it induces awareness regarding the fact that how important it is to understand and
study everything to become competent in one’s profession. It is essential to update proper
skills and information by practicing various other professional steps so that you could keep
yourself updated in the field of your practice. The self-assessment process has helped me in

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understanding my position on the basis of the knowledge I possess, as I had a very less idea
regarding the pressure ulcer. One must thoroughly follow and process on the allocated
guidelines, values and principles, procedure and the standards to obtain professionalism
(McDonald, Boulton & Davis, 2018). The positive thing about self-assessment is that it has
helped in learning various new things throughout the process. Earlier, I had very less idea and
knowledge regarding what pressure ulcers is and what are the factors associated with the
topic, but after the practice of Capstone Experience in Health Care has helped me gain a
better mind-set and idea about what the pressure ulcer condition is and other factors in a
much better manner. This practice helped me enhance my way to taking things, the manner of
studying and practicing, team work, team leading skills and communication skills. As I was
very nervous and was a bit shy while I started working as a team on the field of pressure
ulcer. The Capstone Experience in Health Care has helped me overcome my fear and anxiety
and also enhanced my ability to work as a team (Naqib et al., 2018).
The outcomes and the knowledge that I have learnt throughout the practice of
understanding of pressure ulcer, the reason behind the health condition, treatment process, the
medication and the effective results. I came to know the patient and their conditions and it
helped me in understanding their situation and the difficulties they face. It helped me to
understand them more so that that I can provide a much better care and treatment to them
focusing on their severity.
The Pressure ulcers condition develops as the blood vessels that are supplying the
membrane and the subcutaneous tissues become compacted enough in order to obstruct
perfusion, and that will be leading eventually to the condition of tissue necrosis (Woo et al.,
2017). The high mortality cases are found to be related to with pressure ulcers. There are
several studies that has showed that the mortality rates are high around 60 percent for the
older people with the health condition pressure ulcers within 1 year of their hospital

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discharge. Mostly the pressure ulcers condition does not cause mortality rather the health
condition of pressure ulcer is found to develop just after a consecutive decline in the health
status (Aydin et al., 2015). Hence, the expansion of the pressure ulcers can be stated as a
predictor of death. Several different studies have further recommended that the increment of
skin breakdown post-surgery might lead the elder people to suffer from major functional
impairment after the surgical process. The condition needs delicate care and treatment as it is
associated with the elderly population (Tubaishat et al., 2018). The practice helped me gain
awareness and knowledge about the appropriate and better nursing practice that I need to
focus on.
Critical reflection:
Scholars and the practitioners in any kind of self-regulating health professions are
probable to involve in valid self-assessment and reflective activities. Though, the self-
assessment processes can end up to be defective. People might have very limited
understanding about the critical thinking and it needed to be reflected on their piece of work
and they might over-estimate or also under-estimate their aptitudes (Garneau, 2016). Critical
reasoning is a process of reasoning which is used to express and elaborate one’s personal or
professional experience. It is a process which is based on descriptive, analytical and critical
and it is often articulated in various different manners which can be written, oral or artistic
was of expression. It builds connection between one’s experience and course content in order
to retain better understanding of the situation. The process of reflection is a very useful
practice in nursing or other healthcare facilities in order to learn and understand their errors
and flaws and also to avoid any such occurrence in the future. It helps them avoid any
circumstances of providing wrong care and treatment or any other mistakes. Reflection is
found to be an effective process and plays a vital role in one’s professional and personal life.
it develops a person’s way of thinking, operating and understand the whole condition and the

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field they are working in. it also helps a person to come up with new and effective ideas and
avoid any failure and also plan a better treatment and management plan for the patients
(Sims, Hewitt & Harris, 2015). It provides the person practising reflection an idea about the
problems and the mistakes that occurred and also helps the person to overcome and face the
challenges and mistakes. The critical reflection practice is a professional process which is
based on various different factors, models and components. The major components of the
critical reflective practice are critical analysis, evaluation and then learning and improving
from the errors and mistakes that occurred and also helps to avoid similar errors in future
(Dolvik, 2017). Critical reflection skills are explained as the way of process of thinking and
helps in enhancing the professional and professional development. In health industry, critical
reflection holds and important place as it helps the general practitioner and other health care
staff to improve professionally. It helps in the improvement of the medical standard of
practice. With the help of reflection, common errors that occur in the field of medicine during
the treatment of the patient and based on the errors, strategies and treatment can be modified
further. It is considered as an important part of their professional growth as well as appraisals.
Critical reflection is commonly observed in the field of nursing. It is a method that helps in
connecting knowledge and professional experiences. With the help of reflection, nurses and
other health care staff becomes aware of their strength and weakness and improvise
accordingly. The healthcare staff who use the reflection in their daily life can be positioned
better as compared to others who do not use these skill.
There is different model such as, Driscoll model of reflection, Johns model of
reflection, gibbs model of reflection, kolbs model, and many others used in the reflection.
Each model works according to the framework designed. The framework used in this
assignment is Driscoll model of reflection. Driscoll model of reflection is introduced by the
terry burton in 1970. It is one of the most straightforward method which revolves around the

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three main question which are, what, so what and now. It helps in evaluating the clinical
experience of an individual. In the first part that is, “what”, the event or the incident is
described. With the help of these step, reflection is conducted on the particular aspect of the
incident or experience. In the next step which is, “so what?” a detailed analysis of the event is
occurred. From this step, new learning that has been arose by the critical reflection of the
incident is analysed. In the last step which is, “now what?” action which has been proposed to
deal with the situation sab ben evaluated. In this step, action are taken which affects the
learning gained from the experience. In this step, the procedure by which the action can be
implemented in future.
What:
This is the first element of the reflection model which describes the event in detail. In
this step of the reflection, the capstone project is evaluated in detail (Deslandes et al., 2018).
In this reflection, five question are evaluated which are, what are the characters of the
individual who are involved in the incident? What are the actual problems? third is what
happened? When did it happened? And what are my steps? In this project, the main topic for
my capstone project is pressure ulcer management. To perform the capstone project,
respondents were selected. (Marcoux et al., 2017). The selected respondents were geriatric
patients and the health care staff. After selecting the respondents for the capstone project, the
time frame of the project is set which is 12 months. After that permission is taken from the
higher authorities in order to avoid further legal complications. During the time frame, the
process is observed. The patients, who are suffering from pressure ulcer are observed for 12
months. After the completion of the project it is analysed and processed in future and the
evaluated accordingly. Pressure ulcer is commonly observed in bedridden patients and most
commonly observed in older patients (Bly et al., 2016). It is observed that around 60,000
people in suffer from pressure ulcer and it is most commonly observed in geriatric patient.

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People suffering from pressure ulcer usually shows unusual changes in skin colour, swelling,
pus-like draining and tender areas. The area around the pressure ulcer feels warmer and
cooler to touch. The most common site which is prone to pressure ulcer is shoulder blades,
hip bone, heels, knees and ankles and sides and back of the head. It is mainly caused due to
the constant pressure on a specific place. Due to the constant pressure, the blood flow is
reduced which leads to reduced oxygen in different parts of the body. In the absence of
oxygen, nutrients are reduced (McInnes et al., 2015). Due to which the tissue nearby the site
are damaged. Another reason responsible for the development of pressure ulcer is the friction
that occurs when the skin is rubbed with each other and also due to the shear forces. Risk
factors involved in the development of pressure sores are moving disability which may be
due to spinal cord damage or other causes. It can be due to the lack of sensory deficit.
Hydration and poor nutrition also leads to one of the causer of pressure ulcer. It is also
observed in individual who are suffering from different medical condition where the blood
flow is affected (Ku et al., 2016). It can sometimes be life threatening also hence, to avoid
such complications in future, proper care is to be provided to patient suffering from pressure
ulcer. However, lack of proper knowledge regarding the treatment of pressure ulcer or the
risk factors involved in the treatment of the pressure ulcer leads to worsen level of bedsores.
In the hospitals the pressure ulcer is commonly observed, due to the carelessness of health
care staff. The bed ridden people are not cared properly. As the bed ridden are not able to
move their own, hence it is important to take proper care of them such as, changing the bed
sheet, which creates friction and leads to the occurrence of pressure ulcer. In the time period
of 12 months, the geriatric patients are observed and the risk factor involved are also
observed. We take the observation daily by communicating with the patient and the
healthcare staff (Smith, 2016).
So what?

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It is the second step of the Driscoll model of reflection, where detailed analysis regarding the
event or incident is conducted. Due to the carelessness of healthcare staff, pressure sores are
observed (Golaghaie et al., 2019). It is observed that the most common population affected
by the pressure ulcer are older patients. There are also barrier observed during the capstone
project. In this step of the reflection, certain questions are discussed which are, what was the
actual outcome? what is the learning obtained and what is the importance? The outcome
observed after the completion of the project is the rusk factor or the clinical errors which
causes pressure ulcer. Due to the barrier observed during the project, the time period is
extended for another 4 months (Schwering, 2015). One of the barrier observed is the regular
observation and also the economic complications. Even after facing all the complications, the
project is completed and has been a great success.
Now what?
It is the final component of the reflection model; in this part the future plans are discussed.
This part deals with the question such as, what are the future plan? And what are the action
plan taken? As it is mainly caused due to the carelessness of the health care staff which can
be improved (Junious et al., 2018). Regular monitoring of patients is also done.
ROFESSIONAL PRACTICE PORTFOLIO:
PERSONAL GOAL:
The personal goal of mine is to deliver a better knowledge concerning about the
condition of pressure ulcer administration by the health professionals and the other care and
treatment process. Pressure ulcer health condition are one of the main focuses as they are one
if the major issues with a high risk of mortality in the elderly population (Nuru et al., 2015).
The time frame that will be required in order to achieve the specific goal will be 12 months.
Apart from it, there is another aspect where my focus is. It is to deliver enough amount of