Reports of three organizations' members about doctor of nursing practice project experiences and outcomes.

BACKGROUND: Holders of the Doctor of Nursing Practice (DNP) degree were envisioned to improve health and health care outcomes by implementing quality improvement initiatives, applying evidence-based practice changes (EBP), and influencing policy. Little is known about the nature of the DNP project experience and its relationship with subsequent experiences of graduates. Filling these knowledge gaps is important because of the investment of time, faculty and student effort, expense, and the projects' potential long-term effects on the organizations in which they were conducted. PURPOSE: (1) Describe the impetus for foci, outcomes and activities of DNP projects and (2) determine the extent to which project foci are a part of post-graduation experiences. METHODS: A cross-sectional descriptive survey design was used and a via mailed paper and online version was sent with return options to graduates of Doctor of Nursing Practice program. The sampling technique was designed to maximize the capture of DNP graduates. Three mailings were sent to 5,830 nurse members of three national organizations with memberships that included advanced practice registered nurses, nurse administrators and nurse educators. The 1,308 DNP prepared respondents were demographically and geographically representative of organizational members. FINDINGS: Most (65.2%) reported the topic of the project was their own idea and they sought out an organization in which to conduct it. Twenty-five percent indicated not all aspects of the reorganization/initiative/policy change were completed by graduation. Five project foci emerged with the majority reporting an EBP initiative or an EBP project involving reorganization in the setting (57.7%) There was also a wide variation in the number, types and combinations of activities reported to be a part of the project. There was wide variation in the relationship of project foci and activities with reports of post-graduation experience by position title. DISCUSSION/CONCLUSION: Findings suggest potential avenues for innovations during the DNP project experience innovations. Long term effects of projects on organizations in which they were conducted and the relationship of project activities with post-graduation roles should be considered.

DNPs' labor participation, activities, and reports of degree contributions.

BACKGROUND: There is limited information about the careers, roles and views of doctor of nursing practice (DNP) graduates. METHOD: This study describes the labor participation, post-graduation work activities, and perceptions of 1,308 DNP members of three professional nursing organizations who completed a 2017 survey (32% response rate). FINDINGS: More than 70% of respondents reported substantial improvements in quality improvement, evidenced based practice and leadership abilities. Twenty-two percent of respondents noted the degree was required by their employer and most of these held educational positions. Postgraduate participation in activities associated with DNP education, assessment of personal impact and degree necessity varied by position title and organization membership. DISCUSSION: These differences have implications for nursing associations and professional solidarity.

Improving heart failure patient outcomes utilizing guideline-directed therapy.

Heart failure (HF) prevalence continues to rise and remains a significant burden to patients, caregivers, providers, and the healthcare system. Guideline-directed medical therapy with standard neurohormonal blockade has been the cornerstone of medical management for many years. Despite aggressive utilization of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists, HF hospitalizations and readmissions are common and residual mortality remains high. With the development of two novel medical therapies (sacubitril/valsartan and ivabradine), the American College of Cardiology, American Heart Association, and Heart Failure Society of America released a pharmacologic update to provide guidelines for incorporation of these agents into clinical practice. Although effective via different mechanisms of action, both agents now have a prominent role in risk reduction. HF medical regimens often become quite complex, especially when associated with comorbid conditions, and require frequent follow-up. Providers must be proficient in patient monitoring, medication dose titration, and therapy optimization. Individualized patient care strategies such as guideline-directed therapy can promote long-term adherence and quality of life.

Navigating DNP Student Needs: Faculty Advising Competencies and Effective Strategies for Development and Support.

Doctor of nursing practice (DNP) faculty advisers help students navigate academic challenges, professional development, and leadership opportunities while earning a DNP degree. Student needs during DNP education are unique from other programs and require careful advising to address common challenges. This article links student needs with advising competencies and presents strategies for faculty development and support.

Immunosuppressive Therapy in Transplantation.

This article discusses immunosuppressive medications used in organ and hematopoietic stem cell transplantation. Induction, maintenance, and rescue therapy are administered throughout different periods during and after transplantation to modulate the immune system response in the recipient to prevent or treat rejection or graft-versus-host disease. Indications, dosing strategies, required monitoring, complications, adverse events, and concomitant drug interactions associated with immunosuppressive medications are presented. Classes of medications discussed include polyclonal and monoclonal antibodies, calcineurin inhibitors, antiproliferative agents, mammalian target of rapamycin inhibitors, and corticosteroids. Medications having significant interactions with immunosuppression are also examined.