NR 560 Week 6 Feasibility and Stakeholder Analysis Example

Feasibility and Stakeholder Analysis: Who Can Withhold What From the Tray-Linked Insulin Change, the Order in Which Approval Must Be Sought and How the Three Named Risks Will Be Managed

Student Name

College of Nursing, Chamberlain University

NR 560: Professional Nursing Capstone

Instructor Name

Month Day, Year

Feasibility and Stakeholder Analysis: Who Can Withhold What From the Tray-Linked Insulin Change, the Order in Which Approval Must Be Sought and How the Three Named Risks Will Be Managed

Purpose of This Section

The proposal asks registered nurses on a 30-bed medical-surgical unit to give rapid-acting mealtime insulin only when the patient has the tray and is eating, rather than during the timed medication pass. This section asks whether the unit can actually do this within the capstone term, and who could stop it. The stakeholders are ranked not by seniority but by what they could withhold: approval, a system change, labor or goodwill. The analysis uses the domains of the Consolidated Framework for Implementation Research as a checklist, looking at the intervention, the inner setting, the individuals and the process (Damschroder et al., 2009).

Stakeholders Ranked by What They Can Withhold

The ranking shows that the hardest parties to move are those with formal authority over the medication system, not those doing the work. Staff nurses rank last not because they matter least, but because they can only slow the change once it is approved, whereas the committee can prevent it from starting.

Table 1. Stakeholders Ranked by What They Can Withhold

The Approval Pathway, in Order

Approval must be sought in a set order, because each step depends on the one before. First, the nurse manager and diabetes resource nurse confirm support, which they have. Second, the unit medical director reviews the proposal and the intake-based dose order, since the pharmacy and therapeutics committee will ask whether physicians agree. Third, the proposal goes to the committee at its monthly meeting, with a one-page summary, the local data and the guidance supporting meal-matched dosing (Umpierrez et al., 2012). Fourth, once approved, pharmacy informatics builds and tests the record changes in the test environment. Fifth, food and nutrition services is informed of the late-cart call. Education begins only after the record changes are ready, so that nurses do not learn a process they cannot yet document.

The critical path runs through the committee's meeting date. If the proposal misses the next meeting, the trial start moves by a month, which would leave too little time to collect eight weeks of data within the term.

Feasibility: Time, Labor and Cost

Time. Nurses already walk to each patient's room for the pre-meal glucose check; the change moves the insulin dose from that visit to a second, shorter visit once eating begins. On a five-patient assignment with two patients on mealtime insulin, this adds two brief visits per meal. The diabetes resource nurse timed a sample of such visits at under three minutes each.

Labor. The technician adds one notification per tray for patients on mealtime insulin. Education requires about 20 minutes per nurse and 10 minutes per technician, delivered in shift huddles.

Cost. The record changes are within the informatics team's routine work. Education is delivered in paid time already scheduled for huddles. There is no equipment cost. The project is therefore feasible without a budget request, which removes one approval step.

Managing the Three Named Risks

Delay during busy mornings. When several trays arrive at once, nurses may be pulled between patients. The response is to allow the dose to be given up to 20 minutes after eating begins, which remains within guidance for rapid-acting insulin if intake is in doubt (Umpierrez et al., 2012), and to let a second nurse give the dose when the assigned nurse is occupied, with a verbal handover.

Forgotten doses. Removing mealtime insulin from the timed pass risks it being missed. The moved late-dose warning will still fire 30 minutes after the tray window closes, and the process measure will show missed doses weekly. Any rise in missed doses will prompt review.

Rising high glucose. Delayed or held doses could raise glucose before the next meal. The balancing outcome, pre-meal readings over 300 mg/dL for each 100 doses, will be reviewed each week against the baseline of 11 episodes over three months. If it rises above an agreed threshold for two consecutive weeks, the team will pause and review.

Readiness of the Inner Setting

Several conditions favor the change. Nurses already recognize the problem, and several wait for trays informally, so the change formalizes a practice some already use. The manager and resource nurse support it. The unit has run small tests before, including a bedside handoff change last year. Against this, the morning is the unit's busiest time, and staffing on some days falls below the usual ratio. Guidance expects hospitals to have hypoglycemia prevention protocols (ElSayed et al., 2025), which gives the committee a reason to approve, and a large systems program lowered hypoglycemia at scale while days of severe hyperglycemia also fell (Maynard et al., 2015).

Conclusion

The change is feasible within the term if the committee approves at its next meeting. The parties who could stop it are few and have been identified, their concerns are known and the answers are ready. The risks are real but manageable with a delay allowance, a moved warning and a weekly check on the balancing outcome.

Communication Plan

Each party hears about the change in the form that suits its role. The committee receives the one-page summary and attends a five-minute presentation. The medical director and hospitalists receive the draft dose order by email with a request for comment within two weeks. Informatics receives a written build request listing the two record changes and the test cases. Food and nutrition services receives a short note from the nurse manager explaining the late-cart call. Staff hear about the change at huddles, and weekly run charts are posted in the break room once the trial starts, so the people doing the work see its results.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., Galindo, R. J., Garg, R., Khunti, K., Lal, R., Lingvay, I., Matfin, G., Pandya, N., Pekas, E. J., Pilla, S. J., Polsky, S., . . . Bannuru, R. R. (2025). 16. Diabetes care in the hospital: Standards of Care in Diabetes-2025. Diabetes Care, 48(Suppl. 1), S321-S334. https://doi.org/10.2337/dc25-S016

Maynard, G., Kulasa, K., Ramos, P., Childers, D., Clay, B., Sebasky, M., Fink, E., Field, A., Renvall, M., Juang, P. S., Choe, C., Pearson, D., Serences, B., & Lohnes, S. (2015). Impact of a hypoglycemia reduction bundle and a systems approach to inpatient glycemic management. Endocrine Practice, 21(4), 355-367. https://doi.org/10.4158/EP14367.OR

Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 97(1), 16-38. https://doi.org/10.1210/jc.2011-2098