Grand Canyon University NRS-490: Capstone Reflective Journal

This reflective journal details a student's experience and learning outcomes from a capstone project focused on the reduction and prevention of neonatal respiratory diseases (NRDs) in the neonatal intensive care unit (NICU). The journal reflects on new practice approaches, emphasizing evidence-based recommendations for treating NRDs, intraprofessional collaboration, healthcare delivery, and clinical systems. Ethical considerations, population health concerns, the role of technology, and health policy are also addressed. The project highlights the importance of family-centered care, multidisciplinary interventions, and nursing leadership. The author discusses strengths, weaknesses, and the application of learned skills in future nursing practice, including adherence to professional standards and competencies related to research analysis, change management, and leadership. The journal concludes with a comprehensive overview of the project's impact on the student's professional development, highlighting the application of project learning in future nursing practice.

Running head: PROFESSIONAL CAPSTONE REFECTIVE JOURNAL
PROFESSIONAL CAPSTONE REFLECTIVE JOURNAL
Name of the Student:
Name of the University:
Author note:

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Introduction
The aim of this reflective journal is to outline the key reflections and experiences
encountered during the 10 week capstone project underlying ‘the reduction and prevention of
neonatal respiratory diseases in the neonatal intensive care unit (NICU).’
Discussion
New Practice Approaches
During my experience in conducting evidence-based research concerning the required
pharmacological strategies for neonatal respiratory diseases (NRDs) in the NICU, I gained new
knowledge in terms of practice approaches for treatment. NRDs like pneumonia has been
traditionally treated using antibiotics like amoxicillin and ciprofloxacin. However, recent
research, based on my findings for this project, suggested the prevalence of side effects like
tendonitis and tendon rupture upon ciprofloxacin administration (Masoumi et al., 2019). Based
on my capstone research, I learned novel practice approaches in terms of evidence-based
recommendations of treating NRDs with amoxicillin as a safer pharmacological strategy for
neonates (Pacifici & Marchini, 2017).
Intraprofessional Collaboration
As a part of the literature review which I undertook for my capstone project, I learned
that a number of interventions by the multidisciplinary care team, can be considered for the
purpose of NRD management such as the treatment of ventilator-associated pneumonia (VAP) at
the NICU. These include: stringent compliance with infection-control protocols such as hand
washing and disinfection by all healthcare professionals, administration of dietary zinc, chest
physiotherapy and inflammatory medications like Mucosolvan, deliverance of a ventilator

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bundle and nebulization with Budesonide (Yang et al., 2017; Min & Tan, 2017). Thus, such
evidence-based findings within my capstone project demonstrate personal learning on the
importance of inter and intraprofessional collaboration underlying VAP prevention and
management.
Healthcare Delivery and Clinical Systems
In addition to the above multidisciplinary interventions, a key aspect which I learned
during my capstone project is how nurses can facilitates the deliverance of healthcare and
clinical systems for NRD management at the NICU. Nurses can indeed play a key role in
improve NRD care delivery via timely administration of hydration and oxygen therapy to the
affected neonates as well a comprehensive nursing assessments of respiratory rate, airway
clearance, risk of infection, pain, antibiotic administration and continuous screening for
pulmonary discomfort (Khanali Mojen et al., 2019). Thus, my capstone project played a key role
in teaching me on improving my future nursing practice in terms of healthcare delivery and NRD
management at the NICU.
Ethical Considerations in Health Care
During my capstone project, in addition to caring for neonates, I also learned that parents
encounter considerable stress as a result of neonatal administration at as a result of NICU. Thus,
as a part of my learning for improved future nursing professional practice, a key ethical
consideration which I must consider during nursing management of NRDs at the NICU, is the
implementation of family centered practice in the form of allowing entry of parents at the NICU,
parental involvement during neonatal treatment and collaboratively communicating with parents
of affected neonates (De Bernardo et al., 2017).

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Population Health Concerns and Health Disparities
Based on my capstone project, I learned that NRDs like pneumonia are a concerning
issue for the global population and has been estimated to contribute to approximately 15% of
deaths across children under the age of 5 years (Goerens et al., 2018). However, there was
limited exploration of underlying healthcare disparities for NRDs – a key limitation of my
capstone project. However, considering the comprehensive multidisciplinary approaches
required for NRD treatment, healthcare disparities may occur across neonates belonging to
remote or rural regions with limited clinical resources (Sivanandan, Agarwal & Sethi, 2017).
Role of Technology
My capstone project also taught me the role of technology in healthcare concerning the
usage of oxygen therapy for NRD management at the NICU. NRD management like pneumonia
is largely linked to oxygen therapy administered via pressure ventilators like Continuous positive
airway pressure (CPAP) as well as extracorporeal membrane oxygenation as a form of lung and
heart support for neonates (Feng & Chunlei, 2016).
Health Policy
A key limitation of my capstone project is the limited exploration of policies which can
be considered for the management and treatment of NRDs across neonates. However, the
importance of multidisciplinary care interventions for NRD management, nevertheless
demonstrates compliance to one of the objectives enlisted by the Council of Australian
Governments (COAG) National Healthcare Agreement on the need ensure equitable healthcare
access for all children (Australian Institute of Health and Welfare, 2020).

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Leadership and Economic Models
Considering my learning on the ways in which nurses can assist clinical care delivery,
facilitate multidisciplinary interventions and engage in advocating for parental collaboration in
NRD management, my capstone project indeed taught on strategies of demonstrating nursing
clinical leadership and supervision at the NICU (Mojen et al., 2019). However, considering the
importance of comprehensive multidisciplinary interventions, a key limitation of my project was
limited exploration of cost-effective solutions of NRD management at the NICU.
Overall Strengths and Weaknesses
Some of the key strengths of my capstone project is its ability to teach me on aspects of
clinical nursing leadership, family centered care and multidisciplinary collaboration at the NICU.
However, I must engage in further research concerning the prevalence of healthcare disparities
and cost effective interventions for NRD management at NICUs.
Additional Resources and Abilities
By addressing the need to practice family centered approaches to care as well as the need
to engage in evidence-based nursing practice and nursing collaboration with the
multidisciplinary team for NRD prevention at the NICU, the additional resources which can be
considered for completion of my capstone project is my ability to adhere to Nursing and
Midwifery Board of Australia (NMBA, 2016), standards 1, 2 and 3. This is because these
standards guide nurses on the need to practice critical thinking skills, patient centered and
evidence based practice and working under the supervision of interdisciplinary health
professionals (NMBA, 2016).

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Addressing Competencies
Thus, by extensively reviewing current literature as well as proposing clinical solutions to
the prevention and management of NRDs at the NICU in my capstone project, I demonstrated
compliance competencies associated with research finding analysis, application of concepts of
change management and leadership as well as application of evidence-based research in future
nursing practice in this course.
Conclusion
Thus, this journal provides a comprehensive insight into the key experiences and
reflections which I encountered as a result of competing my capstone project – which was
centered on the prevention and management of NRDs across neonates admitted at the NICU. To
conclude, this reflective exercise provided me ways in which I can apply my project learning
during future nursing practice.

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References
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De Bernardo, G., Svelto, M., Giordano, M., Sordino, D., & Riccitelli, M. (2017). Supporting
parents in taking care of their infants admitted to a neonatal intensive care unit: a
prospective cohort pilot study. Italian journal of pediatrics, 43(1), 36.
Feng, Q., & Chunlei, L. I. (2016). The effect of normal frequency mechanical ventilation vs.
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