| Course | NR 730 DNP Project |
|---|---|
| Week | 3 |
| Paper type | Evidence base write-up |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NR 730 Week 3
Evidence Base for STOP-Bang Screening and a High-Risk Pathway in an Ambulatory Surgery Center, Grouped by the Decision Each Source Supports
Student Name
College of Nursing, Chamberlain University
NR 730: DNP Project
Instructor Name
Month Day, Year
Evidence Base for STOP-Bang Screening and a High-Risk Pathway in an Ambulatory Surgery Center, Grouped by the Decision Each Source Supports
What This Write-Up Has to Justify
The project made three design decisions, and the evidence is organized around them: which screening tool to use and at what threshold, what the high-risk pathway should contain, and whether high-risk patients should continue to have same-day surgery at all. The table summarizes the six sources that bear most directly on those decisions, with a setting column that matters more here than any other, because most of the evidence comes from hospital settings and the project runs in a freestanding center where patients go home the same day.
The Synthesis Table
Table 1
Evidence for Preoperative Sleep Apnea Screening and Pathway Design
| Source | Design | Sample and setting | What it supports | Direction or finding |
|---|---|---|---|---|
| Chung et al. (2008) | Development and validation study | Surgical patients seen in preoperative clinics at academic hospitals | Choice of tool | Questionnaire items easy to use preoperatively; adding body measures improved sensitivity |
| Nagappa et al. (2015) | Systematic review and meta-analysis | 17 studies, 9,206 patients, sleep clinic and surgical populations | Choice of threshold | High sensitivity for moderate and severe disease; probability of severe disease rose climbing to roughly 65% at the top scores of 7 or 8 in surgical patients |
| Chung et al. (2016) | Narrative review by the tool's developers | Sleep clinic, surgical and general populations | How to use the score | Score bands for low, intermediate and high risk; higher scores warrant more precaution |
| Chung, Memtsoudis et al. (2016) | Professional society guideline | Adult surgical patients | Whether to screen | Recommends preoperative screening for obstructive sleep apnea |
| American Society of Anesthesiologists Task Force (2014) | Practice guideline | Perioperative patients with known or suspected sleep apnea | Pathway content | Opioid-sparing analgesia, monitoring and discharge criteria for these patients |
| Joshi et al. (2012) | Consensus statement | Adults with sleep apnea scheduled for ambulatory surgery | Whether same-day surgery is appropriate | Suitable if comorbidities are optimized and postoperative pain can be managed mainly without opioids |
Note. Note. Findings summarized from each source's abstract and recommendations. Setting is recorded because most studies come from hospital populations.
How the Sources Were Found and Weighed
The sources were found through a search of PubMed and CINAHL for preoperative screening of obstructive sleep apnea in adults, limited to the tool's validation studies, systematic reviews and professional guidance, and supplemented by the reference lists of the two guidelines. Primary studies were not added beyond the original validation study, because the meta-analysis already pools the screening studies and the project's questions were about design rather than about whether the tool works. Guidelines were weighed as the strongest guidance for pathway content, since they synthesize evidence and expert consensus specifically for perioperative care, while the meta-analysis was weighed most heavily for the threshold. The developers' review was used for practical detail, with the caution that its authors created the tool. No source studied a freestanding center that screens by phone, which is the gap the project's own data must fill, week by week.
Decision One: The Tool and the Threshold
STOP-Bang was chosen because it was designed for quick use in preoperative settings and requires no equipment beyond a tape measure (Chung et al., 2008). Its weakness is specificity: it flags many patients who do not have significant sleep apnea. The meta-analysis shows that the probability of severe disease climbs with the score, which supports using a higher threshold to trigger a resource-intensive response (Nagappa et al., 2015). The project set the high-risk pathway at 5 or more because extended observation costs recovery time, and at 5 the meta-analysis suggests roughly a one-in-three probability of severe disease in surgical patients, high enough to justify the cost. Patients at 3 or 4 are flagged in the record but not placed on the full pathway.
Decision Two: What the Pathway Contains
The pathway's three elements come from the anesthesia practice guideline: notifying the anesthesiologist so the anesthetic plan can account for possible sleep apnea, favoring non-opioid and regional analgesia, and monitoring with continuous pulse oximetry until the patient no longer has respiratory events when left undisturbed (American Society of Anesthesiologists Task Force, 2014). The project adds a fourth, non-clinical element: a letter to the patient's primary care clinician recommending sleep evaluation, so that screening leads somewhere after the day of surgery.
Decision Three: Whether to Keep High-Risk Patients in the Center
The ambulatory consensus statement is the nearest source to this setting, and it supports same-day surgery for patients with suspected sleep apnea when comorbid conditions are optimized and pain can be managed largely without opioids (Joshi et al., 2012). The project therefore does not cancel or transfer high-risk patients on the basis of the score alone. It routes them to anesthesia review, where the anesthesiologist decides whether the planned procedure and analgesia fit same-day discharge.
The Finding That Pulls the Other Way
One part of the evidence argues against the design. Because STOP-Bang has modest specificity, a threshold of 5 will still capture patients without significant sleep apnea, and each one adds about 30 minutes of recovery time. The guideline recommending screening also notes that screening alone does not establish a diagnosis (Chung et al., 2016). A center under pressure to turn over its recovery bays could reasonably argue for screening only patients receiving general anesthesia with intravenous opioids. The project keeps universal screening because the cost of a missed patient going home on opioids outweighs the recovery minutes, but it records recovery time so the cost can be judged. If the extra recovery minutes prove unsustainable, the threshold, not universal screening, is the first thing the project would revisit, because the score bands make a higher cut-off easy to apply.
Transfer, Stated Honestly
Most of the evidence comes from hospital preoperative clinics where patients are measured in person days before surgery. This center screens by phone and measures the neck on arrival, an hour before surgery, which leaves less time to act on a high score. Patients here are healthier on average, and every one of them is expected to go home the same day. The tool's accuracy should transfer, since it depends on patient characteristics rather than setting, but the pathway's feasibility had to be tested locally, which is why the project measures delivery of each element and not only outcomes.
References
American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. (2014). Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology, 120(2), 268-286. https://doi.org/10.1097/ALN.0000000000000053
Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903
Chung, F., Memtsoudis, S. G., Ramachandran, S. K., Nagappa, M., Opperer, M., Cozowicz, C., Patrawala, S., Lam, D., Kumar, A., Joshi, G. P., Fleetham, J., Ayas, N., Collop, N., Doufas, A. G., Eikermann, M., Englesakis, M., Gali, B., Gay, P., Hernandez, A. V., . . . Auckley, D. (2016). Society of Anesthesia and Sleep Medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesthesia & Analgesia, 123(2), 452-473. https://doi.org/10.1213/ANE.0000000000001416
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., & Shapiro, C. M. (2008). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812-821. https://doi.org/10.1097/ALN.0b013e31816d83e4
Joshi, G. P., Ankichetty, S. P., Gan, T. J., & Chung, F. (2012). Society for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery. Anesthesia & Analgesia, 115(5), 1060-1068. https://doi.org/10.1213/ANE.0b013e318269cfd7
Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., Mokhlesi, B., & Chung, F. (2015). Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: A systematic review and meta-analysis. PLOS ONE, 10(12), Article e0143697. https://doi.org/10.1371/journal.pone.0143697
The Chamberlain NR 730 Week 3 instructions
Present the evidence mainly as a synthesis table, with each source's design, sample and setting, what it supports and its finding or direction, and give the setting column real attention. Group the prose by the decisions the evidence justified, not by author or by the order you found the sources. Explain how you found the sources and how you weighed different kinds of evidence, such as guidelines, reviews and single studies. Identify the source nearest to your setting. Report any finding that argues against your design and say how you weighed it. Close with an honest statement of transfer: how your setting differs from the settings studied and what that means for which parts of your design needed local testing.
How this NR 730 Week 3 example is built
The sample states three design decisions and presents a six-row table, noting how little evidence comes from freestanding centers. A section describes the search and how guidelines, the meta-analysis and the developers' review were weighted. Decision one justifies STOP-Bang and a threshold of 5 from the tool's design and the rising probability of severe disease. Decision two draws the pathway's elements from the anesthesia guideline and adds a letter to the patient's clinician. Decision three uses the ambulatory consensus statement to route high scorers to anesthesia review rather than cancel them. A section reports the tool's modest specificity and the cost of extra recovery time as evidence against the design. The transfer section contrasts hospital clinics with phone screening and arrival measurement.
Where the points sit in the NR 730 Week 3 rubric
Most expensive is a paper that appraises for pages and never says what the evidence made the writer do, since the assignment exists to justify design choices. Second is the annotated bibliography shape, one paragraph per study in the order found, with no synthesis. Third is evidence from large academic centers applied to a very different setting without comment. Marks are also lost for leaving out evidence that argues against the design. Write-ups score well when the table carries the comparison, the prose is grouped by decision, the nearest study to the setting is identified, contrary evidence is weighed and transfer to the project's own setting is stated plainly. Naming how each kind of source was weighted adds credibility.
NR 730 Week 3 help: mistakes that cost points
The evidence write-up is easier once you list the decisions your project made and ask which sources justified each one. Share your design choices and the sources behind them, and the write-up can be built around a synthesis table with a careful setting column, prose grouped by decision, a frank account of contrary evidence and an honest statement about how findings transfer to your site. Explaining how you weighed guidelines against single studies is worth a short section. The sources and decisions come from your own project. A table that records setting carefully often does half the arguing for you.
Get a NR 730 Week 3 example written to your instructions
Send the Week 3 prompt, the synthesis table your section requires and the intervention you are actually running, and a custom example is written around that intervention and returned inside 24 to 48 hours. The first one costs nothing, and the rubric helps if your instructor has posted it.
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NR 730 Week 3 questions, answered
How many studies are usually expected?
Sections set their own count and the template normally states it. The number matters less than what the set covers. Eight sources that between them settle the intervention, its frequency, its deliverer and its measure are stronger than twenty that all say the same broad thing. Recency expectations are commonly stated in the assignment itself.
Does the evidence need to match my setting exactly?
Almost nothing does, and pretending otherwise is the error. The write-up says where the studies were run, how those settings differ from yours and what the difference means for the size of effect you can reasonably expect. A mismatch handled openly earns more than a silent one a reader discovers on their own.
What if the evidence does not support what I already implemented?
Then the paper says so, and explains what was adjusted or why the design went ahead anyway with the risk named. Capstone readers see this often, and a project honest about weak support reads better than one dressing thin evidence as strong. The change is already running, and the write-up documents the reasoning behind it.
Where can I find a free NR 730 Week 3 sample paper?
This page holds the full evidence base write-up, synthesis table included, for a surgery center screening project.
What evidence argues against the design in the NR 730 Week 3 sample?
STOP-Bang's modest specificity means a threshold of 5 still flags patients without significant sleep apnea, each adding about 30 minutes of recovery time.