You are looking at a finished NUR 440 Module 2 Milestone One proposing an EBP project on delayed umbilical cord clamping, with audit data, significance, a PICOT question, an early look at the evidence, a search plan and references. Searches like "nur 440 module 2 assignment", "nur440 module 2 milestone one" and "nur 440 module 2 example" land here.
The NUR 440 Module 2 example, in full
Milestone One: A Proposal to Examine Delayed Umbilical Cord Clamping for Vigorous Term Newborns
[Student Name]
Southern New Hampshire University
NUR 440: Research and Evidence-Based Practice
Final Project Milestone One
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone One: A Proposal to Examine Delayed Umbilical Cord Clamping for Vigorous Term Newborns
The Clinical Problem
On the composite labor and delivery unit that prompted this proposal, about 2,100 babies are born each year. Nurses have noticed that practice around cord clamping varies widely: some obstetricians and midwives wait a minute or more before clamping the umbilical cord of a healthy baby, while others clamp within seconds, particularly during cesarean births and when the delivery room is busy. There is no written unit guideline.
To describe current practice, two staff nurses recorded the time from birth to cord clamping for 80 consecutive term births over three weeks, excluding babies who needed resuscitation. The median time was 15 seconds. Only 17 of the 80 vigorous term newborns, 21 percent, had clamping delayed for 30 seconds or longer, and only 6 of 30 cesarean births did. The audit showed that the practice gap is real and that delay is least common in cesarean births.
Significance
Cord clamping timing affects how much blood moves from the placenta to the baby. When clamping is delayed, more placental blood transfers, increasing the infant's blood volume and iron stores. Iron deficiency in infancy is common and has been linked to effects on development, so a low-cost practice that improves iron stores at birth could benefit many infants.
Professional guidance has moved toward delay. National obstetric guidance recommends delaying cord clamping for at least 30 to 60 seconds after birth in vigorous term and preterm infants (American College of Obstetricians and Gynecologists, 2020). A Cochrane review of trials in term infants found that later clamping was associated with higher hemoglobin concentrations in the first days of life and better iron stores in the months after birth, without an increase in maternal postpartum hemorrhage, although slightly more infants needed phototherapy for jaundice (McDonald et al., 2013). The combination of a clear benefit, low cost and professional endorsement, set against a unit where most babies do not receive the practice, makes this an important question for nursing.
The PICOT Question
In vigorous term newborns born by vaginal or cesarean birth (P), how does delaying umbilical cord clamping for at least 60 seconds (I), compared with clamping within 30 seconds (C), affect infant iron status and anemia, and the need for phototherapy for jaundice (O), during the first six months of life (T)?
The population excludes infants who need immediate resuscitation, because they require different management. The comparison reflects current unit practice. Two outcomes are included on purpose: the expected benefit, iron status, and the known possible harm, jaundice requiring treatment, so that the review weighs both. Framing the question this way follows the structure recommended for clinical questions in evidence-based practice, which makes the later database search more focused (Melnyk & Fineout-Overholt, 2023).
A First Look at the Evidence
A preliminary search suggests that the question has been studied extensively. The Cochrane review includes randomized trials involving thousands of term infants and reports on hemoglobin, ferritin, anemia, jaundice and maternal outcomes (McDonald et al., 2013). The professional guideline summarizes additional evidence and gives practical recommendations for different birth situations (American College of Obstetricians and Gynecologists, 2020). The final project will need to look for newer trials and for studies specifically in cesarean births and in settings like this unit.
Search Plan
The search will use CINAHL Complete, PubMed and the Cochrane Library, available through the university library. Search terms will combine the population and the intervention: newborn, neonate, infant, term birth, combined with umbilical cord clamping, delayed cord clamping, deferred cord clamping and cord clamping timing. Outcome terms such as iron, ferritin, anemia, hemoglobin, hyperbilirubinemia, jaundice and phototherapy will be added to focus the results. Subject headings will be used alongside keywords where each database supports them.
Inclusion criteria will be peer-reviewed studies and guidelines published in English in the past ten years, plus the most recent Cochrane review regardless of date; studies of term infants; and studies reporting iron status, anemia or jaundice outcomes. Studies limited to preterm infants, cord milking without a delayed clamping arm, or infants needing resuscitation will be excluded. The number of records found, screened and included will be documented so that the search can be reproduced.
Why This Question Suits Nursing
Cord clamping is performed by the obstetric provider, so it may seem an unusual topic for a nursing proposal. Nurses, however, shape much of what happens in the first minute after birth. They prepare the warmer, dry and stimulate the baby, position the infant on the mother's abdomen or chest, and often prompt the team about the timing of routine steps. During cesarean births, the circulating nurse coordinates with anesthesia and the pediatric team about when the baby is handed off. A delayed clamping practice depends on these actions happening in a different order, which makes it an interprofessional question in which nursing has a central role.
Nursing also carries responsibility for the possible harm. Newborn nurses assess jaundice, obtain bilirubin levels and manage phototherapy, so any change that could increase jaundice requires nursing surveillance and teaching for parents about feeding and follow-up. Including jaundice as an outcome in the PICOT question reflects that responsibility.
Feasibility and Anticipated Challenges
The project appears feasible. The evidence base is large, the intervention costs nothing beyond time, and the audit method used here can be repeated to measure change. Challenges are also clear. Some providers may worry about delaying care for a baby who seems vigorous at first but then needs help, so a guideline would need clear criteria for when to clamp early. During cesarean birth, concerns about sterile field, temperature and time may need a specific protocol. Finally, the unit will need a way to document timing reliably, since current records do not capture it. The literature review in later milestones will look for evidence on each of these practical questions, not only on infant outcomes.
Next Steps
Milestone Two will produce an annotated bibliography of the most relevant sources identified by this search, with each source summarized and its level of evidence noted. Later milestones will appraise and synthesize the evidence, and the final project will present an integrative review with a recommendation for the unit, including whether a written guideline and staff education are warranted and how practice could be measured afterward.
References
American College of Obstetricians and Gynecologists. (2020). Delayed umbilical cord clamping after birth: ACOG committee opinion, number 814. Obstetrics & Gynecology, 136(6), e100-e106. https://doi.org/10.1097/AOG.0000000000004167
McDonald, S. J., Middleton, P., Dowswell, T., & Morris, P. S. (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, 2013(7), Article CD004074. https://doi.org/10.1002/14651858.CD004074.pub3
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
How this NUR 440 Module 2 example is structured
A Milestone One proposal must show that a real practice gap exists and that the question is answerable, so the paper moves from the unit to the question to the search. It opens with current practice on the unit, measured by a short audit. The significance section explains why cord timing matters for infant iron stores and what professional guidance now recommends. The PICOT question follows, with each element defined. A brief preview of the evidence shows the question has been studied. The search plan names databases, terms, limits and inclusion criteria, and the last section explains how later milestones will build on this one.
Get NUR 440 Module 2 written to your instructions
Send your Milestone One guidelines and rubric for NUR 440 plus the clinical problem you want to use. The desk writes a proposal and PICOT question to that prompt in 24 to 48 hours, and your first sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 440 Module 2 questions, answered
What does NUR 440 Module 2 Milestone One usually ask for?
In many sections the first milestone of the final project is a proposal: identify a clinical problem from practice, explain its significance, write a PICOT question and describe how you will search for evidence. Later milestones build an annotated bibliography, appraise and synthesize the evidence and end in an integrative review with a recommendation.
How do I write a good PICOT question?
Name the population precisely, the intervention you are considering, the comparison, usually current practice, the outcome you care about and, if relevant, the time frame. Keep it answerable: a question about one intervention and one or two outcomes in a defined group can be searched and appraised within a course.
What should a search plan include?
List the databases you will use, the key terms and synonyms for each PICOT element, how you will combine them, and the limits you will apply, such as publication years, language and study types. Stating inclusion and exclusion criteria up front shows that your search is systematic rather than selective.