Presented here: one full NUR 490 Module 2 change proposal on reducing IV treatment of asymptomatic elevated blood pressure in hospitalized adults, covering the problem, evidence, proposed change, change theory, stakeholders and references. Searches like "nur 490 module 2 assignment", "nur490 module 2 change proposal" and "nur 490 module 2 example" land here.
The NUR 490 Module 2 example, in full
The 2:00 a.m. Hydralazine Call: A Change Proposal to Reduce IV Treatment of Asymptomatic Elevated Blood Pressure
[Student Name]
Southern New Hampshire University
NUR 490: Transformational Capstone
Capstone Change Proposal
[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.
The 2:00 a.m. Hydralazine Call: A Change Proposal to Reduce IV Treatment of Asymptomatic Elevated Blood Pressure
The Problem
On the composite 30-bed adult medical unit where this proposal was developed, it is common for a patient admitted for pneumonia, cellulitis or another noncardiac condition to have a blood pressure reading above 170/90 overnight while sleeping comfortably, with no chest pain, headache, neurological change or other sign of organ injury. The nurse calls the covering provider, who often orders an intravenous dose of hydralazine or labetalol. The blood pressure falls, sometimes sharply, and the patient is woken for repeated checks.
A chart review of 240 consecutive patients admitted to the unit with noncardiac diagnoses over three months found that 181 had at least one systolic reading of 160 mmHg or higher. Of those 181 patients, 49, or 27 percent, received at least one intravenous antihypertensive dose, and in 41 of the 49 cases there was no documented symptom or sign of acute organ damage. Six patients had a documented episode of symptomatic low blood pressure within six hours of the dose. The problem is not high blood pressure itself, which is common and usually temporary in hospitalized patients, but a reflex to treat a number rather than a patient.
The Evidence
Evidence suggests that treating asymptomatic elevated blood pressure in the hospital does not help and may harm. In a large cohort study of adults hospitalized for noncardiovascular conditions, 78 percent had at least one elevated reading, and about a third of those were treated. In a propensity-matched comparison, treated patients had higher rates of acute kidney injury and myocardial injury than similar untreated patients, and there was no range of blood pressure in which treated patients did better (Rastogi et al., 2021). The authors concluded that intensifying treatment without signs of organ damage was associated with worse outcomes.
The effects extend beyond the hospital stay. Among older adults hospitalized for noncardiac conditions, those discharged with an intensified antihypertensive regimen had a higher risk of readmission and serious adverse events within 30 days, with no improvement in cardiovascular events or blood pressure control at one year (Anderson et al., 2019).
Change is possible. At an academic medical center, a quality improvement initiative combining education with changes to order sets reduced the use of intravenous antihypertensives for asymptomatic elevated blood pressure among general medicine patients, lowering the adjusted odds of treatment by 38 percent without a change in median systolic pressure or in balancing outcomes (Jacobs et al., 2019). Together, these studies show that the problem is common, the usual response carries risk, and a structured intervention can change practice safely.
The Proposed Change
The proposal has three parts. First, a nurse-driven assessment algorithm for elevated blood pressure in patients without cardiac or neurological admitting diagnoses. When systolic pressure is 160 mmHg or higher, the nurse rechecks it after 15 minutes of rest with the correct cuff size, assesses for symptoms and signs of organ injury, and addresses common reversible causes such as pain, anxiety, a full bladder or missed home medications. The provider is notified urgently only if the reading reaches a defined threshold or symptoms are present; otherwise, the reading is reported at morning rounds. Second, the admission order set will replace open-ended as-needed intravenous antihypertensive orders with an order that specifies the symptoms or thresholds that justify treatment. Third, brief education for nurses and covering providers will share the evidence and the algorithm.
Why Nurses Should Lead This Change
Nurses measure the blood pressure, decide when to call and frame the call, so they shape whether treatment happens. A call that reports a number alone invites an order; a call that reports a number, a repeat reading, the absence of symptoms and the patient's pain score invites judgment. Nurses are also best placed to address the causes of elevated readings at the bedside and to see the harms of rapid lowering, such as dizziness and falls. Leading this change is consistent with the professional expectation that nurses use evidence to protect patients from unnecessary interventions.
Change Theory and Stakeholders
Lewin's three-stage model will guide the change. Unfreezing will involve sharing the unit's chart review and the evidence with nurses and hospitalists at staff meetings. Moving will introduce the algorithm and revised order set, with champions on each shift. Refreezing will build the algorithm into the electronic flowsheet and the order set, so that the new practice becomes the default.
Key stakeholders include staff nurses, charge nurses, hospitalists and covering residents, the pharmacy and therapeutics committee, the informatics team that maintains order sets, and patients, who benefit from fewer interruptions at night. The hospitalist group's support is essential, because the change depends on providers accepting a nurse assessment in place of an automatic order.
Resistance is likely from two directions. Some nurses worry that they will be blamed if a patient with an untreated high reading later has a stroke, and some covering providers prefer to treat rather than risk a second call. Both concerns will be addressed by making the algorithm an approved protocol, documenting each assessment clearly and reviewing any adverse event together rather than attributing it to individuals. Sharing the published evidence that treatment itself carries risk helps reframe caution as safe practice rather than neglect.
What This Proposal Is Not
The proposal does not ask nurses to ignore high blood pressure. Patients with symptoms, signs of organ injury, very high readings or cardiac and neurological conditions will still be escalated immediately. Home antihypertensive medications will continue to be given unless held for a reason. The aim is to replace reflexive treatment of a number with a structured assessment that treats the patient.
Conclusion
Asymptomatic elevated blood pressure is common on the unit, and more than a quarter of affected patients receive intravenous treatment, usually without evidence of organ damage. Research links such treatment to kidney and heart injury and to harm after discharge, while a quality improvement project shows that practice can change safely. A nurse-driven assessment algorithm, revised order sets and focused education offer a practical, evidence-based change that nurses are well placed to lead. Later capstone deliverables will develop the pre-implementation, implementation and evaluation plans.
References
Anderson, T. S., Jing, B., Auerbach, A., Wray, C. M., Lee, S., Boscardin, W. J., Fung, K., Ngo, S., Silvestrini, M., & Steinman, M. A. (2019). Clinical outcomes after intensifying antihypertensive medication regimens among older adults at hospital discharge. JAMA Internal Medicine, 179(11), 1528-1536. https://doi.org/10.1001/jamainternmed.2019.3007
Jacobs, Z. G., Najafi, N., Fang, M. C., Prasad, P. A., Abe-Jones, Y., Auerbach, A. D., & Patel, S. (2019). Reducing unnecessary treatment of asymptomatic elevated blood pressure with intravenous medications on the general internal medicine wards: A quality improvement initiative. Journal of Hospital Medicine, 14(3), 144-150. https://doi.org/10.12788/jhm.3087
Rastogi, R., Sheehan, M. M., Hu, B., Shaker, V., Kojima, L., & Rothberg, M. B. (2021). Treatment and outcomes of inpatient hypertension among adults with noncardiac admissions. JAMA Internal Medicine, 181(3), 345-352. https://doi.org/10.1001/jamainternmed.2020.7501
How this NUR 490 Module 2 example is structured
The proposal is written for a unit practice council that must decide whether to proceed. It opens with the problem as it looks on the unit, including a three-month chart review. The evidence section summarizes three studies, a large cohort study of inpatient hypertension treatment, a study of discharge intensification in older adults and a quality improvement project that reduced IV treatment safely. The proposed change is then stated precisely, followed by the nursing role, a brief application of change theory and the stakeholders whose support is needed. A short section on what the proposal is not, and a conclusion, close the paper.
Get NUR 490 Module 2 written to your instructions
Send your NUR 490 change proposal guidelines and rubric and name the practice problem from your unit. A sample proposal built on it comes back within 24 to 48 hours; 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 490 Module 2 questions, answered
What does the NUR 490 change proposal usually include?
In many versions of the capstone, the first major deliverable is a change proposal: a practice problem from your setting, the evidence supporting a change, the proposed intervention, a change theory, and the stakeholders involved. Later parts of the capstone add pre-implementation, implementation and evaluation plans. Your guidelines list the required components.
Can a change proposal ask nurses to do less rather than more?
Yes. Some of the most valuable changes remove low-value care, such as unnecessary treatments, tests or routines. A proposal to stop a practice still needs evidence of harm or lack of benefit, a clear alternative for nurses, and a plan to protect patients who genuinely need the intervention.
How much evidence does a capstone change proposal need?
Enough to show that the change is supported by more than opinion. A few strong, recent studies that address your specific problem, plus a guideline or quality improvement report, are usually more persuasive than a long list of loosely related sources.