Clinical Requirement:
cf_u05a1_intervention_feedback_form.pdf
Intervention Feedback, Assessment 4
1
Intervention Feedback Form
Assessment 4
Note: Please include this feedback in your capstone video.
You do not have to submit the completed feedback form; it’s simply a guide to help you capture
patient, family, or group feedback about your intervention.
1. Meeting date(s).
2. Length of the meeting(s) (in hours).
3. Location(s) of the meeting(s).
4. Describe the problem you were addressing.
5. Why was this a problem for the patient, family, or group?
6. What was your intervention?
7. How will the patient, family, or group apply the intervention?
8. How often will the intervention be used and under what circumstances?
9. How easy was it for the patient, family, or group to use the intervention?
10. Describe any challenges associated with the patient, family, or group’s use of the
intervention.
11. Were instructions necessary?
12. What did the patient, family, or group say about using the intervention?
13. Was the intervention helpful?
14. How will the patient, family, or group continue to use the intervention?
15. Explain how the intervention positively or negatively affected the patient, family, or
group’s life.
16. How can the effect be measured?
17. Update the total number of hours on the NURS-FPX4900 Volunteer Experience Form in
CORE ELMS.
https://corehighered.com/sso/capella/
Intervention Feedback Form
Assessment 4
InterventionPresentationandCapstoneVideoReflectionScoringGuide.pdf
1/24/24, 3:13 AMIntervention Presentation and Capstone Video Reflection Scoring Guide
Page 1 of 2https://a21371-1390074.cluster223.canvas-user-content.com/courses…57&context_type=Course&download=1&id=213710000001390074&inline=1
Intervention Presentation and Capstone Video Reflection Scoring Guide
CRITERIA NON-
PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Assess the
contribution of an
intervention to
patient, family, or
group satisfaction
and quality of life.
Does not
assess the
contribution of
an intervention
to patient,
family, or
group
satisfaction
and quality of
life.
Attempts to
assess the
contribution of
an intervention
to patient,
family, or
group
satisfaction
and quality of
life based on
unfounded
assumptions.
Assesses the
contribution of an
intervention to patient,
family, or group
satisfaction and quality
of life.
Assesses the contribution of an
intervention to patient, family, or
group satisfaction and quality of life.
The assessment is fair, unbiased,
and supported by feedback from the
patient, family, or group.
Describe one's use
of evidence and
peer-reviewed
literature to plan and
implement a
capstone project.
Does not
describe one’s
planning and
implementation
of a capstone
project.
Attempts to
describe one’s
planning and
implementation
of a capstone
project.
Describes one's use of
evidence and peer-
reviewed literature to
plan and implement a
capstone project.
Succinctly describes one's use of
evidence and peer-reviewed
literature to plan and implement a
capstone project. Project planning
and implementation clearly reflect
the influence of evidence-based
practice.
Assess the degree to
which one
successfully
leveraged health
care technology in a
capstone project to
improve outcomes or
communication with
a patient, family, or
group.
Does not
describe how
one used
health care
technology in a
capstone
project.
Attempts to
describe how
one used
health care
technology in a
capstone
project.
Assesses the degree to
which one successfully
leveraged health care
technology in a
capstone project to
improve outcomes or
communication with a
patient, family, or group.
Presents an articulate assessment of
the degree to which one successfully
leveraged health care technology in
a capstone project to improve
outcomes or communication with a
patient, family, or group. Offers keen
insight into prospective
improvements in health care
technology use.
Explain how health
policy influenced the
planning and
implementation of
one’s capstone
project, as well as
any contributions the
project made to
policy development.
Does not
describe
health policies
that influenced
the planning
and
implementation
of one’s
capstone
project and
any
contributions
the project
made to policy
development.
Attempts to
describe
health policies
that influenced
the planning
and
implementation
of one’s
capstone
project and
any
contributions
the project
made to policy
development.
Explains how health
policy influenced the
planning and
implementation of one’s
capstone project, as
well as any
contributions the project
made to policy
development.
Presents an articulate assessment of
how health policy influenced the
planning and implementation of
one’s capstone project, as well as on
any contributions the project made to
policy development. Offers keen
insight into the baccalaureate-
prepared nurse's role in policy
implementation and development.
Explain whether
capstone project
outcomes matched
Does not
describe
capstone
Attempts to
describe
capstone
Explain whether
capstone project
outcomes matched
Provides an articulate and perceptive
explanation of whether capstone
project outcomes matched one's
1/24/24, 3:13 AMIntervention Presentation and Capstone Video Reflection Scoring Guide
Page 2 of 2https://a21371-1390074.cluster223.canvas-user-content.com/courses…57&context_type=Course&download=1&id=213710000001390074&inline=1
one's initial
predictions
and documents the
practicum hours
spent with these
individuals or group
in the Capella
Academic Portal
Volunteer Experience
Form. Document the
completion of nine
hours of practicum
time.
project
outcomes and
does not
document the
completion of
nine practicum
hours in
Capella
Academic
Portal
Volunteer
Experience
Form.
project
outcomes
and/or does
not document
the completion
of nine
practicum
hours in
Capella
Academic
Portal
Volunteer
Experience
Form.
one's initial predictions
and documents the
practicum hours spent
with these individuals or
group in the Capella
Academic Portal
Volunteer Experience
Form. Documents the
completion of nine
hours of practicum time.
initial predictions. Exhibits clear
insight into the generalizability and
best-practice potential of the
intervention. Documents the
practicum hours spent with these
individuals or group in the Capella
Academic Portal Volunteer
Experience Form. Documents the
completion of nine hours of
practicum time.
Assess one’s
personal and
professional growth
throughout a
capstone project and
the RN-to-BSN
program.
Does not
summarize
one’s personal
and
professional
growth
throughout a
capstone
project and the
RN-to-BSN
program.
Summarizes
one’s personal
and
professional
growth
throughout a
capstone
project and the
RN-to-BSN
program.
Assesses one’s
personal and
professional growth
throughout a capstone
project and the RN-to-
BSN program.
Objectively assesses one’s personal
and professional growth throughout
a capstone project and the RN-to-
BSN program. Provides a
comprehensive and detailed
retrospective of one’s overall
performance and growth.
Communicate
professionally in a
clear and well-
organized video.
Does not
communicate
in a video.
Communicates
in a video.
Content
delivery is
hesitant,
unclear, or
read from a
script.
Communicates
professionally in a clear
and well-organized
video.
Communicates professionally in a
clear and well-organized video.
Content delivery is focused, smooth,
and well-rehearsed. Information
sources are credited appropriately.
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