The DNP Degree Capstone Experience
Conception, Implementation & Data Analysis
Thomas M. Kelly, DNP, CRNA Assistant Director- Assistant Professor
Thomas Jefferson University-Jefferson College of Nursing Nurse Anesthesia Program
Time Line
• 1934: First PhD in Nursing offered by NYU
• 1950: University of Pittsburgh offered a Maternal-Child PhD
• Most doctorate degrees were earned by nurses in the areas of
psychology, sociology and anthropology
• 1960 The Doctor of Nursing Science (DNS) degree originated at
Boston University, which focused on the development of nursing theory for a practice discipline, hence the first practice
discipline doctorate
• The DNS degree and the PhD curriculum requirements were very
similar in content and focus, the AACN deemed the DNS a research degree
The Challenge to Develop a True Practice Focused Doctorate Remained
• 1979: Case Western Reserve University developed the first
Nursing Doctorate (ND) followed by… • The University of Colorado
• Rush University
• South Carolina University
Nursing Practice Degree Conceptualized and Implemented by the American Association of Colleges of Nursing (AACN)
• The 2004 position statement on the Practice Doctorate in
Nursing recommended that the DNP degree would be become the terminal degree for nursing practice by 2015
The DNP degree prepares nurses to meet the challenging demands of today’s health care marketplace by gaining proficiency in the following areas:
• Evaluating evidence based practices (EBP) for improving
patient outcomes • Delivering care
• Developing healthcare policy
• Leading and managing clinical care and health care systems
• Developing intradisciplinary standards
• Solving healthcare dilemmas
Current White Paper on the DNP: Current Issues and Clarifying Recommendations • http://www.aacn.nche.edu/news/articles/2015/dnp-white-paper http://www.aacn.nche.edu/aacn-publications/white-papers/DNP-Implementation-TF-Report-8-15.pdf
Why Now…?
• In 2000, the Institute of Medicine (IOM) published To Err is Human
Findings:
• Preventable adverse events are a leading cause of death in the U.S.
• 33.6 million admissions demonstrated upwards of 100,000
preventable deaths
• Preventable deaths were estimated to be the eighth leading cause
of death in the U. S.
(Centers for Disease Control and Prevention, 1999)
It is important to remember that the DNP is an academic degree, not a role…
• Safe: avoiding injuries to patients from the care that is intended to help them.
• Effective: providing services based on scientific knowledge to all who could benefit, and refraining
from providing services to those not likely to benefit.
• Patient-Centered: providing care that is respectful of and responsive to individual patient preferences,
needs, and values, and ensuring that patient values guide all clinical decisions.
• Timely: reducing waits and sometimes harmful delays for those who receive and those who give care.
• Efficient: avoiding waste, including waste of equipment, supplies, ideas and energy.
• Equitable: providing care that does not vary in quality because of personal characteristics such as
gender, ethnicity, geographic location, and socioeconomic status.
Crossing the Quality Chasm: A New Health System for the 21st Century
(IOM, 2001)
A follow-up to: To Err is Human, Proposing Six Specific Aims for Improvement
Thirteen Percent of Nurses Possess Graduate Degrees, Yet Only 1% Possess Doctoral Degrees (AACN, 2011)
Additional Drivers for the Practice Doctorate in Nursing:
• Robert Wood Johnson Foundation’s Initiative on the Future of Nursing
Committee and the IOM proposed to redefine how health care professionals are educated
• 2005: The National Academy of Sciences recommended the profession of
nursing develop a non-research doctorate in order to fill the need for expert practitioners and faculty
• National Organization of Nurse Practitioner Faculties (NONPF) related that parity with fellow providers with practice doctorates such as audiology,
physical therapy, pharmacy, psychology, dentistry and medicine was lacking • The practice doctorate prepares nurses for the ever changing and increasing
DNP Programs in PENNSYLVANIA Carlow University Chatham University DeSales University Drexel University Duquesne University Gannon University Gwynedd-Mercy College La Salle University Misericordia University Robert Morris University Temple University
Thomas Jefferson University University of Pittsburgh
Villanova University Waynesburg University West Chester University Widener University
Wilkes University
York College of Pennsylvania
http://www.aacn.nche.edu/dnp/program-directory
The Essentials of Doctoral Education for Advanced Nursing Practice
I. Scientific Underpinnings for Practice
II. Organizational and Systems Leadership for Quality Improvement and Systems Thinking III. Clinical Scholarship and Analytical Methods for Evidence-Based Practice
IV. Information Technology and Patient Care Technology for the Improvement and Transformation of Health Care
V. Health Care Policy for Advocacy in Health Care
VI. Interprofessional Collaboration for Improving Patient and Population Health Outcomes VII. Clinical Prevention and Population Health for Improving the Nation’s Health
IMPROVING GLYCEMIC CONTROL THROUGH EDUCATION REGARDING A COMPUTERIZED INSULIN INFUSION PROTOCOL By
Thomas M. Kelly
Capstone Paper submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice
Chatham University April 6, 2015
__________________________________ ____________________________________ Signature Faculty Reader Date
__________________________________ ___________________________________ Signature Program Director Date
Abstract
•The use of computerized software programs by nurses demonstrates increased efficiency in maintaining blood glucose (BG) levels within an identified target range. This technology remains underutilized as these programs are perceived to increase the nurse’s work load.
Nurses also feel these applications may lead to more frequent episodes of dangerous hypoglycemia although the literature demonstrates a reduction in these events (Haigh, 2008).
• A two phase evidence based practice (EBP) change initiative in the form of an educational intervention focused on improving nurse’s
knowledge of a computerized insulin infusion protocol (CIIP) and
glycemic control was conducted in an academic urban setting. The target population were registered nurses working in the critical and transitional areas where the CIIP is utilized for glycemic control in critically ill individuals.
•
A pretest-posttest format was utilized. A statistically
significant difference in test scores before education and
following education was noted (n = 52; p = 0.002).
•
The Phase I findings indicated that a significant increase
in nurse’s knowledge occurred following the education
component of the project regarding glycemic control
and the safe application of the CIIP.
•
The Phase II findings were used as a measure of nurse’s
adherence to the use of the protocol. Patient’s BG
levels were retrospectively reviewed via the EMR.
• A retrospective chart review revealed that 23% of BG values were found to be within the established project site BG range of
140-180 mg/dL.
• The benchmark established in 2011 demonstrated that of 30% of
BG values were found to be in range. The analysis revealed that 23% fewer BG values were found to be within range during the initiative compared to the 2011 benchmark.
• Sample size was a limitation of this project particularly with regard to Phase II findings (n = 14) …
DNP Clinical Log
Each DNP Student is required to complete a minimum of 125 hours in NUR 702, a minimum of 125 hours in NUR 704 and a minimum of 250 hours in NUR 799. All completed clinical hours must be documented on this log. A different log should be maintained for each course.
All clinical activities must relate to the DNP program outcomes. The Program Outcomes are:
1. Applies interprofessional collaboration concepts for improving patient and population health outcomes.
2. Synthesizes nursing research and integration of best practice for change in professional practice based on scientific underpinnings for practice.
3. Integrates clinical scholarship and analytical methods for evidence-based practice.
4. Impacts health care outcomes through clinical prevention and population health for improving the nation’s health. 5. Integrates nursing science as the basis for the highest level of nursing practice.
6. Develops and evaluates new practice approaches based on nursing theory and theories borrowed from other disciplines. 7. Provides clinical nursing change through organizational and systems leadership for quality improvement and systems
thinking.
8. Utilizes information systems/technology and patient care technology to improve and transform health care. 9. Integrates health policy and ethics to improve health care outcomes through advocacy roles.
Date Start Time - End Time Daily Hours Accumulate d Cumulative Hours DNP Program Outcomes
Clinical Activity Narrative
1/5/15 700-0900 2 2 2,3,4, 8 Composing emails and searching institutional database
for managers, (CNS and RN) candidate’s contact information sent to potential project participants
1/5/15 0930-1530 6 8 2 Lay out and preparation participant file folders at
Staples Copy Center. Purchase purple folders and labels and advancing stamper in order to serialize the folders for confidentiality.
1/5/15 1600-1900 3 11 4 Assembled and serially coded 100 participant packets
with automatic advancing stamper to maintain
confidentiality of participants’ demographic data and survey results.
1/5/15 1930-2330 4 15 2,3 Poster development Chatham University Residency
depicting the EBP project; Improving Glycemic Control through Education Regarding the Computerized Insulin Infusion Protocol (CIIP).
1/6/15 0830- 1030 2 17 2, 3, 5, 7 Meeting with nursing education department to review
targeted project sites and the information contained in the participant folders.
1/6/15 1200-1400 2 19 1, 2, 8 Phone calls and emails to recruit participants in the PACU
and Trauma Unit. In-service dates tentatively scheduled for these units.
1/6/15 1500-2000 5 24 2, 3, 8 Preparation participant file folders at Staples Copy
Center containing study materials and CIIPEPP for EBP change project.
1/7/15 900-1130 2.5
.
26.5 1, 5, 7 Meetings with Anesthesia coordinator and PACU manager
to assess the need for the CIIPEPP and the project is clearly supported by management.
The Keys to Success For Your EBP Project • Conceptual Model: • Project Framework: • Design: • Implementation: • Data Analysis: • Dissemination of Findings:
What You Will Need in Addition to the Faculty Advisor
:
• Your support network: coach, editor and inspiration
• Family and significant other’s understanding of the process
• Create buy-in from the clinical nursing staff and administration • Statistical support person
• Supportive colleagues in the work place
• Creativity
• Positive attitude
What You Will Need in Addition to the Faculty Advisor (continued…)
• Command of finances
• Work schedule flexibility • Research librarian support
• Printer for project poster support • Courage
• Perseverance • Focus