| Course | N415 Research / Evidence-Based Practices |
|---|---|
| Module | Module 7 |
| Paper type | Implementation and evaluation plan |
| Length | About 1,041 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Pre-licensure BSN |
| Updated | September 2026 |
Free sample paper for N415 Module 7
Taking the Bottle Off the Flowmeter: An Implementation and Evaluation Plan for Dry Low-Flow Oxygen on a Medical Unit
Student Name
Pre-licensure BSN Program, Aspen University
N415: Research / Evidence-Based Practices
Instructor Name
Month Day, Year
Taking the Bottle Off the Flowmeter: An Implementation and Evaluation Plan for Dry Low-Flow Oxygen on a Medical Unit
Evidence changes practice only when someone plans the change. Earlier modules found that routine bubble humidification of low-flow oxygen brings no measurable comfort benefit and some risk of contamination (Wen et al., 2017), and that in a randomized trial, patients on low flows given dry oxygen were no worse off for comfort by the 24-hour mark (Poiroux et al., 2018). This paper plans how a composite 32-bed medical unit, 4 West, would stop routine humidification for adults on nasal cannula oxygen at those flows and how the unit would know whether the change worked. It is organized around the 2017 revision of the Iowa Model (Iowa Model Collaborative, 2017).
The Practice Change and Its Boundaries
For adults receiving oxygen by nasal cannula at 4 liters a minute or less, humidifiers will no longer be attached by default. Three boundaries keep the change safe. It does not apply to high-flow nasal oxygen, masks, tracheostomies or flows above 4 liters, where evidence is weaker or different. A patient who reports nasal or throat dryness that bothers them can have humidification restored after assessment by the nurse or respiratory therapist. And the change removes equipment, not attention: nurses will ask about nasal comfort and look at the nose at each assessment. The British Thoracic Society guideline already advises against humidifying oxygen given at low flows (O'Driscoll et al., 2017), so the unit is aligning with national guidance rather than moving ahead of it.
Trigger, Priority and Team
Two triggers start this project in Iowa Model terms: a knowledge-focused one, new evidence, combined with a problem-focused one, the cost and contamination risk of equipment used on nearly every oxygen patient. The nurse manager has agreed that the question is a priority because it touches most patients, costs little to test and aligns with the hospital's supply reduction goals. The team includes a day-shift and a night-shift staff nurse, a respiratory therapist, an infection preventionist, the unit educator and a patient advisor, and it reports to the unit practice council.
Anticipating Resistance
Stopping a habit meets different barriers from starting a new practice. When a children's hospital discontinued bubble humidification for low-flow oxygen in 2024, a survey of 132 nurses and respiratory therapists three months later found that 45% were indifferent to the change, 35% disagreed and 57% were concerned about patients, most often about nasal dryness and nosebleeds (Neal-Rice et al., 2026). A scoping review of de-adopting low-value practices found that clinicians' beliefs, habits and fear of harm are common barriers, and that education, audit and feedback, reminders and local champions are the strategies most often used (Niven et al., 2015). The plan therefore gives staff the evidence in short form, names a champion on each shift, keeps a simple way to restore humidification and reports patient comfort data back to staff every two weeks.
Education Content
Education will take ten minutes per huddle and cover four points. First, what the evidence shows: pooled trials found no difference in nasal dryness or nosebleeds without humidification at low flows, and a randomized trial found dry oxygen no worse for comfort at 4 liters or less after a day (Poiroux et al., 2018; Wen et al., 2017). Second, why cold bubble humidifiers add little moisture at room temperature and can grow bacteria. Third, what does not change: nurses still assess the nose, ask about comfort and chart both. Fourth, how to restore humidification when a patient asks or the nurse judges it helpful, without needing a new order. The same points will appear on a one-page summary kept at the nurses' station.
Pilot Timeline
The pilot runs on 4 West for 16 weeks, with a baseline period before any change.
| Period | Activities |
|---|---|
| Weeks 1 and 2 (baseline) | Audit humidifier use and document nasal comfort for all nasal cannula patients; staff survey on beliefs |
| Weeks 3 and 4 (preparation) | Ten-minute huddle education on each shift; one-page evidence summary; champions named; respiratory therapy agrees supply changes |
| Weeks 5 to 16 (pilot) | Humidifiers removed by default at 4 liters or less; comfort question and nasal check each shift; biweekly feedback posted |
| End of pilot | Team reviews data against decision rules and reports to the practice council |
Evaluation Plan
Evaluation combines process, outcome and balancing measures, each with a source and a comparison to baseline.
| Measure | Type | Source | Target |
|---|---|---|---|
| Share of nasal cannula patients at 4 liters or less without a humidifier | Process | Daily equipment audit | At least 90% by the end of the pilot |
| Patient-rated nasal and throat dryness, 0 to 10, at 24 hours | Outcome | Bedside question documented in the flowsheet | Mean no higher than baseline |
| Nosebleeds documented while on oxygen | Balancing | Nursing documentation review | No increase from baseline |
| Requests to restore humidification | Balancing | Respiratory therapy log | Tracked; reasons reviewed |
| Humidifier units used and their cost | Outcome | Supply records | Reduction from baseline |
| Staff agreement with the change | Process | Repeat staff survey | Rise from baseline |
Decision Rules
The practice council will adopt the change unit-wide if at least 90% of eligible patients are managed without a humidifier, patient-rated dryness does not rise, and nosebleeds do not increase. If dryness rises in a subgroup, such as patients near 4 liters, the council will adapt the boundary rather than abandon the change. If nosebleeds or complaints rise across the board, the pilot will stop and the team will review the cases. These rules are set before the data arrive, which protects the evaluation from being bent to fit hopes.
Sustaining the Change
If adopted, the change will be written into the oxygen policy and the order set, humidifiers will be removed from the default supply cart, and the audit will continue monthly for six months and then quarterly. The Iowa Model ends with dissemination, and the results will be shared with other units and with respiratory therapy leadership, which the next module plans.
Conclusion
Removing a bottle from a flowmeter is a small change that meets real resistance, because staff believe it protects patients. This plan sets clear boundaries, prepares for disagreement with evidence and a route back to humidification, measures comfort as well as compliance, and fixes its decision rules in advance.
References
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Neal-Rice, H., Thomas, H., Willis, L. D., & Berlinski, A. (2026). Attitudes regarding de-implementation of bubble humidification for low-flow oxygen delivery in a children's hospital. Respiratory Care. Advance online publication. https://doi.org/10.1177/19433654261466961
Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: A scoping review. BMC Medicine, 13, Article 255. https://doi.org/10.1186/s12916-015-0488-z
O'Driscoll, B. R., Howard, L. S., Earis, J., & Mak, V. (2017). BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax, 72(Suppl. 1), ii1-ii90. https://doi.org/10.1136/thoraxjnl-2016-209729
Poiroux, L., Piquilloud, L., Seegers, V., Le Roy, C., Colonval, K., Agasse, C., Zinzoni, V., Hodebert, V., Cambonie, A., Saletes, J., Bourgeon, I., Beloncle, F., & Mercat, A. (2018). Effect on comfort of administering bubble-humidified or dry oxygen: The Oxyrea non-inferiority randomized study. Annals of Intensive Care, 8, Article 126. https://doi.org/10.1186/s13613-018-0472-9
Wen, Z., Wang, W., Zhang, H., Wu, C., Ding, J., & Shen, M. (2017). Is humidified better than non-humidified low-flow oxygen therapy? A systematic review and meta-analysis. Journal of Advanced Nursing, 73(11), 2522-2533. https://doi.org/10.1111/jan.13323
What the N415 Module 7 instructions ask for
Implementation and evaluation are part of the N415 description in Aspen's catalog, and the example is built on that part because students outside the course cannot see the module prompt. A plan like this usually asks you to describe the practice change, choose an evidence-based practice model, identify the team and stakeholders, anticipate barriers, set a timeline, and design an evaluation with measurable outcomes. Instructors may require a specific model, a table of measures or a budget. Check whether the plan should cover a pilot only or full adoption, whether balancing measures are expected, and how the plan should connect to the evidence you appraised earlier in the course. If your unit is a composite, say so plainly and keep its details consistent throughout.
How this N415 Module 7 example is built
The plan contains about 1,035 words in ten sections and two tables. The introduction recalls the evidence and names the model. The change and its boundaries define who is included and how humidification can be restored. Trigger, priority and team apply the model's first steps. Resistance draws on a staff survey and a review of de-adopting low-value practices. An education section lists four huddle points. The pilot timeline table covers baseline, preparation and 12 pilot weeks. The evaluation table lists six measures with types, sources and targets. Decision rules, sustainment and a conclusion complete the plan. The model's steps are applied in the order the Iowa Model gives them, from trigger to integration.
N415 Module 7 rubric: what earns full marks
Implementation plans are often assessed on how well the change is defined, the fit of the model, attention to barriers and the quality of evaluation. The change is defined with clear exclusions and a route back, which a margin note links to safety. The model's steps are applied, not only named. Barriers are grounded in published data rather than guesses. The evaluation table pairs every measure with a type, source and target, and the balancing measures show that harm is being watched. Decision rules set in advance protect the evaluation from bias, a point instructors reward. APA citations for six sources and readable tables secure the presentation marks. A realistic timeline also earns credit, since plans that promise change in a week rarely convince.
N415 Module 7 help: mistakes that cost marks
Plans most often fall short on evaluation. Students name outcomes without saying how they will be measured, by whom or against what baseline. Build a table. Another common weakness is ignoring resistance, especially when the change removes something staff believe protects patients; cite evidence about attitudes and plan for them. Some plans apply a model in name only, listing its steps without tying each to the unit. Others forget balancing measures, which show you are watching for harm. Finally, set your decision rules before the data arrive. Deciding afterward what counts as success invites the team to read results the way it hoped. Keep the route back simple enough to use at 3 a.m.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More N415 and Pre-licensure BSN sample papers
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- N415 Module 2: Critique of a Randomized Oxygen Trial
- N415 Module 3: Critique of a Qualitative Oxygen Study
- N415 Module 4: PICOT Question and Documented Search
- N415 Module 5: Levels of Evidence and a Review Appraisal
- N415 Module 6: Failure to Rescue as a Quality Indicator
- N415 Module 8: Disseminating Evidence and Informatics
- N420 Module 6: Burn Fluid Resuscitation and Monitoring
- N455A Module 5: The Clinical Judgment Model Behind NGN Items
- N410 Module 7: The Nurse's Role in Acute Ischemic Stroke
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N415 Module 7 questions, answered
What does N415 Module 7 usually ask for?
Aspen's N415 description covers implementation and evaluation, so a plan for introducing an evidence-based change on a unit and measuring its effect is a common assignment. Check your classroom for the required model.
What is a balancing measure?
A measure that watches for unintended harm from a change, such as nosebleeds after removing humidifiers. It shows the plan protects patients as well as tracking success.
Which evidence-based practice model should I use?
The Iowa Model, the Johns Hopkins model and the ACE Star model are common. Use the one your course names and show how each step applies to your unit.
Where can I find a free N415 Module 7 sample paper?
The complete implementation and evaluation plan, with its pilot and measures tables and margin notes, is posted here for anyone to read. It is the seventh of eight N415 samples and precedes the dissemination paper.
What measures belong in an N415 Module 7 evaluation plan?
Process measures showing the change happened, outcome measures showing whether patients benefited, and balancing measures watching for harm; give every measure its source, its starting value and the level you aim to reach.