Nursing leaders in education and practice incorporate innovative ideas for the 21- century from our socio- technical society. In order to use best practices in NI and innovation, we need quality designs that consider cost saving, and collaboration, bridging the gap of education to practice by use of smart technologies and systems.
The goal of this project was to identify if there was a need for a new web based knowledge management system to provide easy centralized access to EBP from final DNP projects, Creating An Interactive DNP Repository: A Model for Change.
Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information and knowledge to support health care outcomes. This support is accomplished through the use of information structures, information processes, and information technology (ANA, 2008). In evaluating effectiveness of structure, processes and outcomes, in relation to DNP final projects, there is a need for
innovation, creativity, and new systems development to improve integration. Identification of systems, which can monitor quality and effectiveness in nursing and informatics practice need to be developed. The engagement in the development, implementation and evaluation of systems and practice is a functional area for nurse informatics leaders.
The integration of NI in designing an Interactive DNP Repository can facilitate the flow from data- information –knowledge-wisdom- to practice. Enabling the Health Care professional to use EBP more quickly, and redesign interventions based on their practice settings. Innovative systems that store digital sources of information of evidence or knowledge can enhance the dissemination of findings into practice and research.
With the rapid development of the DNP programs across the United States, the question is how can the role of IT aid in disrupting the current healthcare system and create a more
integrated approach to DNP final project storage systems? Is the way data is currently stored on other databases and university websites the best way to disseminate findings? The question of scholarship in practice challenges us to look at how we are conducting business, and evaluating whether is it the best practice. There is growing recognition that there is a gap between research findings and application to practice.
The survey results showed interest from Deans and Directors as to the value for a
centralized information system database for DNP final projects. The awareness was that there is a noteworthy value to a centralized repository for nursing DNP project’s, ease of access links to professional oversight. Some of the ideas acknowledged were further defined when participants responded to a survey question as to how a centralized repository could enhance nursing
education and practice?
Some main themes included the sensible nature of housing projects in one place for others to easily access. In addition, the content of what could be shared in a centralized
repository would include a vehicle for dissemination of knowledge, improving quality of care, and the depth and breadth of innovation occurring among DNP students. It provides value for future students as well, to be able to build on prior research and knowledge obtained by others working in similar practice settings, This is turn can lead to further evidence based practice study and research. Sharing knowledge and skills learned adds to collegiality in the profession,
providing examples of projects can provide ways for others to duplicate a project at multiple settings, building further collaboration. It is a venue for retrieving scholarly reports for clinical practice innovation. The project varies greatly from program to program, it would help build
standard outputs from all programs, and provide a body of knowledge for future research and evaluation of practice. Building collective wisdom about DNP practice and practice outcomes can help solidify original scholarship, and guide system change. The students need to view wide examples on a wide variety of topics as they develop ideas for their projects. Sharing nursing scholarship along with distribution of findings s can build unpublished knowledge, and growing the DNP profession. The Repository can keep updated on the evolving of DNP scholarship across the country, quantifying and qualifying the types of DNP work being conducted.
The question of where the Repository is housed is a question of further discussion and research. Two centralized places had the most interest for survey participants. The AACN website (41.9%), and the DNP LLC (32.3%) website. Further study and collaboration on creating the repository, and system for sharing centrally, will be part of my post-doctoral work.
IT provides other additional tools for interactive methods such as discussion boards, blogs etc., that healthcare leaders can use to share information. Analysis of ways different college and universities store DNP final projects, has led the researcher to believe that an interactive system can be created. For greater effectiveness. The need to identify practices that can incorporate organizational and systems leadership for quality improvement and systems thinking (AACN, 2006) is a high priority. The use of technology and information for improvement and transformation of healthcare can be enhanced by disruptive innovative systems.
A quality repository system using health IT begins with user- centered design principles and adequate testing and quality assurance. This can be integrated with other current modes of social networking available, such as discussion boards, blogs, twitter, face book, online DNP LLC, apps for smart phones. The use of “smart” repository systems combined with socio-
technical trends of today can help deliver information most successfully. Creating systems to allow easy transfer and use of information about the DNP final projects can help enhance EBP and help transform nursing and healthcare. The repository system aids in building nursing knowledge, and can aid in evaluation research by centralizing findings.
The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses to have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of healthcare systems. As a DNP educator, innovation to enhance EBP by creating better informatics systems helps meet recommended standards by professional organizations including the ANA, IOM, AACN, and QSEN groups. The value of a shared repository enhances knowledge transfer, and helps to build quality for EBP translation and/or further research by students or healthcare providers and leaders.
The United States is undergoing a major transformation of its healthcare delivery system, driven by federal health IT investments and healthcare reforms. In healthcare, disruptive
innovation aims to replace the current healthcare model — whose inaccessibility, unaffordability and unsustainability impacts every person in this country — with a more cost-efficient, patient- centric model (HIMMIS, 2012).
While traditional technology developers focus on their own efficiency and effectiveness, disruptive innovators build products that are more convenient to use, easier to access or more affordable to a new set of users who either didn’t have the expertise or funds to buy existing products. As history has shown, new companies lead each wave of decentralization because disruptive innovation occurs in the marketplace’s outer tiers (HIMMIS, 2012).
The rich knowledge and information is building from the DNP final projects from graduating students. As a profession, we need to learn from other disciplines, and apply best practices to nursing. The purpose of the DNP database systemwill be the aggregation, storage and ready dissemination of evidenced-based practice (EBP) projects. The initial users would be a DNP student to catalog their final senior DNP projects in a readily available and accessible format. DNP’s in advanced practice, education and leadership roles in healthcare organizations and universities can provide the direction to their organizations that are capable of helping to bridge practice, education, and research. This will in turn foster leveraging of data and evidence for improving clinical practice, patient outcomes and population health. The goals of creating an innovative platform for DNP final projects using informatics, facilitates the goals of knowledge sharing and translation, also the potential for more rapid adaptation to practice and education. DNP student project findings can be the impetus for new DNP student’s projects that may be looking for practice projects related to their specialty area. They can then in turn adapt, or replicate findings, evidence based practices found effective in their clinical setting. This in turn cans translational practice, and redesigning research based on using evidence based outcomes from prior DNP final projects. In addition, the sharing of best practices with clinicians, educators, administrators and leadership, promotes building the nursing knowledge base and improving the contribution of nursing, by the expertise of DNP students and advanced practitioners.
Access is not convenient nor centralized, thus not reflecting the best utilization of technology and innovation available today. Translation of evidence to practice is a developing science, enhanced by digital evidence, and IT.
Informatics already has a profound effect on how the healthcare industry catalogs and shares information. By creating a more efficient means to aggregate and share information, the use of informatics systems in healthcare education will improve accessibility to critical thinking and provide a shorter pathway to adopting the creative new evidence emerging from DNP senior projects. The purpose of this survey is to identify perceived need of a National electronically accessible databank for DNP final student projects.
Five components are proposed as the building blocks of an informatics infrastructure for evidence-based practice: 1) standardized terminologies and structures (i.e., terminology models), 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Table 1 displays selected examples of how the building blocks sup- port the application of evidence to practice and the generation of evidence from practice.
Tremendous progress in the development of the individual building blocks of an informatics infrastructure for evidence-based practice has occurred. In particular, sources of digital knowledge have rapidly increased. Representative sources are shown in Table 2 (with permission).
However, major challenges remain. These include development of a model that supports disseminate ion of digital sources of evidence, achievement of consensus standards for describes- , organizing, obtaining access to, and archiving electronic information sources Integration of the evidence-based practice infra- structure to support the context of evidence based practice. Development of an interactive component for information sharing and exchange to promote nursing practice and improve healthcare outcomes.
The future development of the database could include other clinical doctoral research, or projects, which can add to the body of evidence-based practice medicine and health care. Due to the limited amount of randomized controlled studies available on DNP Final project evaluation, there is a need to develop a way for more rapid translation of evidence to practice and education A repository would also be useful to begin to evaluate the quality of DNP Final Projects and add to the body of nursing knowledge for future research and adaptation.
Health care Information Technology provides the means to the ends for safety, quality, and efficiency today and into the future. There will be continued need for workflow innovations and health care outcomes based practice and research. It is anticipated there will be more
extensive requirements for both local and global sharing across organizations, more information sharing with consumers themselves, and transparency of organizational scorecards as compared to national benchmarks. This means tackling difficult issues such as interoperability and
portability of electronic records for an institution(s) but regions also. Educators need to take leadership in adopting best innovative systems for information sharing to enhance healthcare outcomes, and educational processes.
My DNP project journey changed from my original goal. I was interested in scholarship, quality, and standards of practice outcomes in relation to the AACN essentials of practice. My analysis was to look at the projects, and compare outcomes across the different DNP programs.
The programs sometimes referred to as the ‘Seven Sisters” included Case Western Reserve; University of Colorado, Columbia University; University of Tennessee; University of South Carolina, Rush.
As I attempted to gain access to findings of final DNP projects done at the varying as academic programs, I found there was a lack of a consistent method for accessing the
information. If you were an affiliate of the University, it might be available. What I found however was no uncomplicated way to look at programs across the United States. After
contacting each of these schools individually, I began to see the lack of consistency in storage of DNP final projects. This made sharing of information limited as a larger body of evidence. As a result of my early research in a project for my own DNP program, the direction of my final project changed. Investigating the need for a DNP database system by utilizing HIT and NI became the focus of my final project.
The nursing informatics leader often serves as a catalyst for developing strategic plans, creating national or system policies and procedures, and serving as champion for complex projects and disparate system users (ANA, 2008).
As schools implement DNP educational programs, student submissions of evidence- based projects has become a standard graduation requirement for most DNP programs These final projects are a valuable collection of original and forward-thinking solutions to a larger variety of healthcare delivery, leadership, and practice issues only available typically through an individual university library website.
Technological tools such as online discussion boards, can promote critical thinking, synthesis and self-directed learning. Translation of evidence via information obtained from DNP abstracts can disseminate information on evidence-based practice and ultimately provide safer client care in an improved healthcare system.
Exploring new technologies that enable efficient and effective written communication and professional collaboration is critical in today’s educational and clinical settings. The US Institute of Medicine [16] recommends that health professionals be trained to use informatics in
order to 'communicate, manage knowledge, mitigate error, and support decision making using information technology'.
These technological tools have an educational value because they are convenient to use, ubiquitous, primarily open-source software, lead to social engagement professional
collaboration, peer feedback and foster a sense of a 'learning community.
The questions are how nurse informaticians can make use of them within their practice, education, or research, and whether applications specific to health informatics can be developed.
The United States is undergoing a major transformation of its healthcare delivery system, driven by federal health IT investments and healthcare reforms. At their joint presentation at the HIMSS12 Annual Conference & Exhibition in Las Vegas in February, Eric Dishman, General Manager of Health Strategy and Solutions at Intel Corporation, and Jason Hwang, MD, executive director of healthcare at the Innosight Institute, presented on the power of “disruptive
innovation” to meet the challenges of transforming the U.S. health sector. Popularized by
Harvard Business School Professor Clayton Christensen, disruptive innovation describes how the rapid introduction of new technologies, products and services can bring greater value at a lower price, engaging new consumers and displacing existing business methods. In healthcare,
disruptive innovation aims to replace the current healthcare model — whose inaccessibility, unaffordability and unsustainability impacts every person in this country — with a more cost- efficient, patient-centric model.
It will take collaboration and disruptive innovation to architect the
interoperability to connect this EBP data of DNP final projects, and to build a 21st century health IT infrastructure. We have to continuously innovate and adopt
technologies to create new models to integrate, translate, and transform findings of evidence by DNP final projects. There are databases available of outcomes of research findings of doctoral students. However, in the 21 century, the use of the most adaptive technology and systems creation, will help transform health care more quickly, and efficiently.Disruptive innovators can build interactive repository systems that are more convenient to use, easier to access and more efficient to users.
Dissemination Plan
Plans for submission to conferences and professional journals are underway. On April 30, 2012, I will present at a Sigma Theta Tau Research meeting at University of San Francisco. I have plans to submit a poster presentation for the 5th National DNP Conference Evidence-Based DNP Education September 19-21, 2012. A plan for developing this project in collaboration with others will put this plan into action.
In addition, I am contributing to a book that has been accepted for publication describing my final DNP project. It is a section in the book; on an example of a DNP project which
demonstrates organizational and systems leadership for quality improvement and advancing nursing practice. This is being published by Jones &Bartlett the Fall 2012.
References
Alliance for Nursing Informatics (2009). Statement to the Robert Wood Johnson Foundation Initiative Future of Nursing: Acute Care, Focusing on the Area of Technology.
Retrieved from http://journals.lww.com/cinjournal/Documents/ ANI%20Response%20to%20RWJIOM%20on%20The%20Future%
American Association of Colleges in Nursing (AACN) (2011). The Doctor of Nursing Practice (DNP). Fact Sheets. Retrieved from: http://www.aacn.nche.edu/media-relations/fact- sheets/dnp
American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Nursebooks.org.
American Organization of Nurse Executives (2012). Position Paper: Nursing Informatics Executive Leader. Chicago.
Bakken, S. (2001). DNP courses and the "essentials:” An informatics infrastructure is essential for evidence-based practice. Journal of the American Medical Informatics Association, 8, 199-201.
Brown-Benedict, D. J. (2008). The Doctor of Nursing Practice degree: Lessons from the history of the professional doctorate in other health disciplines. Journal of Nursing Education,
47 (10), 448-457.
Chism, L. A. (2009). The Doctor of Nursing Practice: A guidebook for role development and professional issues. Sudbury, MA: Jones and Bartlett.
Christensen, C. M., Bohmer, R., & Kenagy, J. (2000). Will disruptive innovations cure health? care? Harvard Business Review.
Transforming nursing practice through technology & informatics. Retrieved from
http://www.himss.org/handouts/HIMSSPositionStatementTransformingNursingPracticeth roughTechnologyInformatics.pdf
Hebda, T., Calderone, T. L. (2010). What nurse educators need to know about the TIGER initiative. Nurse Educator, 35(2), 56-60.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: National Academy Press.
Johnson, V., Velasquez, & Riley. (2011). DNP-prepared nurses as practitioner-researchers: Closing the gap between research and practice. Retrieved from http://
www.doctorsofnursingpractice.org/cmsAdmin/uploads/Vincet_et_al.pdf Leadership Collaborative Report. (n.d.). Retrieved from
http://www.tigersummit.com/uploads/TIGER_Leadership_Collaborative_Report.pdf American Nurses Association, 2008). Nursing Informatics Scope and Standards of Practice, P18. Tolea, B. (2010). The design of a distributed database for doctoral studies management.