Publication patterns of graduates from a DNP program with submission of a manuscript as a degree requirement.

BACKGROUND: Nurses who earn a Doctor of Nursing Practice (DNP) degree are expected to make essential contributions to the scholarship of practice and the improvement of health care outcomes. The DNP program at Duke University School of Nursing requires that students demonstrate scholarship competence by writing a manuscript based on their DNP project and submitting it for publication. PURPOSE: The purpose of this article is to share an evaluation of the effectiveness of this approach. METHODS: The authors used a bibliometric study design. RESULTS: This study demonstrates that manuscripts authored by students based on the DNP projects they conduct while earning their DNP degree can be published and are cited by other scholars. Additionally, the majority of these authors continue to publish scholarly work in the nursing and broader health-focused literature after they graduate. CONCLUSION: Nurses who developed and submit manuscripts for publication based on their DNP project contribute to the literature and evidence base for practice.

Differentiation and Integration of Research, Evidence-Based Practice, and Quality Improvement.

BACKGROUND: Substantial discrepancies exist in how research, evidence-based practice (EBP), and quality improvement (QI) are taught to nursing students across academic levels. As nursing education programs adopt the new The Essentials: Core Competencies for Professional Nursing Education and move toward competency-based education, prelicensure and advanced nursing students will need to demonstrate research, EBP, and QI competencies; therefore, faculty must possess the knowledge and skills to teach these paradigms' differences and integration. METHOD: An evidence-based approach that builds on the literature and our experience as nurses and educators was used to develop this educational innovation. RESULTS: An innovative representation in table and figure format of the differences and interdependence of research, EBP, and QI is presented herein. CONCLUSION: These documents clarify the evolving differences, similarities, and synergies as a framework for faculty development. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Evidence-Based Practice Quality Improvement Critical Appraisal Tool.

BACKGROUND: Optimal quality improvement in health care is based on research and other types of evidence. Critical appraisal of evidence is a fundamental component of evidence-based practice (EBP) and is also needed to evaluate the quality of quality improvement (QI) projects. PROBLEM: Currently available EBP or QI critical appraisal tools can be challenging for students learning the critical appraisal process and for practicing clinicians who desire access to a standardized EBPQI approach to inform health care decision-making. The currently available tools are incomplete, too brief, or too complicated for ease of use in education and practice. APPROACH: This article introduces the first combined EBP and QI (EBPQI) critical appraisal tool, which is aligned with the new EBPQI mountain model. CONCLUSION: This newly developed appraisal tool may be used in appraising evidence for an EBPQI initiative and to appraise the quality of disseminated EBPQI.

Optimizing Quality Improvement Methods in Practice: A Case Study Approach.

BACKGROUND: Quality improvement (QI) initiatives help ensure patients are receiving high-quality care. Iterative Plan-Do-Study-Act (PDSA) cycles are used to test change. Data are evaluated over time, and tests of change can be modified or discarded as needed. PROBLEM: Health care QI teams lack the flexibility to conduct PDSA cycles, often conducting pre/post quasi-experimental research studies instead. APPROACH: This article reviews a case study of a "personal improvement" initiative as an example of QI methods and data evaluation for an individual trying to lose weight. The purpose of this article is to provide guidance on best practices for conducting QI initiatives; common pitfalls that clinicians may face when leading their own QI initiatives are identified and recommendations to overcome these challenges are discussed. CONCLUSIONS: Concepts from this case study, along with supplemental resources provided, can help clinicians optimize QI methodologies in the health care setting.

The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives.

ABSTRACT: This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.

Consistent scholarship standards among DNP-prepared faculty needed: Actionable insights.

DNP-prepared faculty report challenges and barriers to achieving success in academic roles when criteria for promotion includes scholarship. The purpose of this evidence-based initiative was to explore thoughtful scholarship standards for DNP-prepared faculty which can be adapted and transferred across academic institutions with the goal of elevating faculty scholarship. Given a paucity of available research evidence, a review and synthesis of non-research evidence was conducted. DNP scholarship standards from high-ranking intuitions were critically appraised, and this evidence, along with the diverse and collective expertise of the authors, was translated into recommendations for an inclusive model of rigor for DNP-prepared faculty scholarship. A template for appraising the scholarship of DNP-prepared faculty based on strategic evaluation of impact is included. Academic institutions may use this work to expand the fundamental level of evolving scholarship, determine parameters, and provide clarity and support to DNP-prepared faculty as they seek to progress in rank.

Tailoring African American Faith Community-Based Diabetes Self-Management Education.

ABSTRACT: African Americans (AA) experience a disparate effect of type II diabetes (T2D). For this nurse-led pilot study, a pre-validated 6-week diabetes self-management education (DSME) program was implemented in a faith community setting and tailored to the participants' faith and culture by using short scriptural lessons, prayers, and individual sharing. Participants demonstrated improvements in fasting blood glucose (p = .042), diabetes knowledge (p = .002), and psychosocial self-efficacy (p = .001). Although generalizability of findings is limited, the structure and methods used in tailoring this DSME program could be transferable to other faith-based settings.

CE: Beyond PICO-A New Question Simplifies the Search for Evidence.

ABSTRACT: The framework for the PICO (population, intervention, comparison intervention, outcome) question was developed for use in the field of medicine to help determine the best treatment or intervention for a patient. However, use of the PICO question often fails to make sense when the problem or issue of interest is unrelated to determining the best treatment; in such cases, PICO is a less-than-optimal framework to use in searching for evidence. Nurses undertaking an evidence-based practice quality improvement (EBPQI) initiative must begin with a full understanding of the problem by exploring both external evidence (research) and internal evidence from the local setting to support the initiative. This article presents the framework for an alternative question-PPCO, or problem, population, change, outcome-that simplifies the search for evidence and provides a universal approach to question development for EBPQI initiatives. The PPCO question was developed for use with all nursing issues that need addressing.

Misuse of the P Value: Using Quality Improvement Analyses to Identify Clinically Significant Improvements.

INTRODUCTION: Quantitative research and quality improvement (QI) both seek to improve care provided to patients. However, clinicians often blur the lines between how to appropriately analyze data from these methodologies. Clinicians may inappropriately use statistical analyses for QI initiatives, rather than using run and statistical process control (SPC) charts to analyze improvements in outcomes. OBJECTIVE: The purpose of this article was to address the analytic methods used for QI initiatives in the clinical setting in an effort to show clinicians how to identify meaningful improvements in clinical practice. METHODS: In this article, we provide an example comparing the same evidence-based practice/QI initiative (chlorhexidine gluconate bathing in a medical intensive care unit) using a quasi-experimental pretest/posttest research design with statistical analyses completed with t tests with analyses using run and SPC charts to show the data trended over time. Using a pretest/posttest design, chlorhexidine gluconate bathing compliance improved from 63% to 65%, a nonsignificant change, P = .075. These same data plotted on run and SPC charts, however, show a shift and a trend, indicating clinically significant improvements per QI methodologies. CONCLUSION: The example in this article highlights the pitfall of relying only on statistical analyses and P values to determine the importance of a clinical project, and provides a practical example for how run or SPC charts can be used to identify improvements over time.

Secure Messaging: Demonstration and Enrollment Patient Portal Program: Patient Portal Use in Vulnerable Populations.

Vulnerable populations face challenges gaining access to quality healthcare, which places them at a high risk for poor health outcomes. Using patient portals and secure messaging can improve patient activation, access to care, patient follow-up adherence, and health outcomes. Developing and testing quality improvement strategies to help reduce disparities is vital to ensure patient portals benefit all, especially vulnerable populations. This quality improvement initiative aimed to increase enrollment in a patient portal, use secure messages, and adhere to follow-up appointments. Before the project, no patients were enrolled in the portal at this practice site. Over 8 weeks, 61% of invited patients were enrolled in the patient portal. Eighty-five percent were Medicaid recipients, and the others were underinsured. Eight patients utilized the portal for secure messaging. The follow-up appointment attendance rate was better in the enrolled patients than in those who did not enroll. The majority of survey respondents reported satisfaction in using the patient portal. Patient portal utilization and adoption in vulnerable groups can improve when a one-on-one, hands-on demonstration and technical assistance are provided.

Research on Predatory Publishing in Health Care: A Scoping Review.

BACKGROUND: Predatory publishers and their associated journals have been identified as a threat to the integrity of the scientific literature. Research on the phenomenon of predatory publishing in health care remains unquantified. PURPOSE: To identify the characteristics of empirical studies on predatory publishing in the health care literature. METHODS: A scoping review was done using PubMed/MEDLINE, CINAHL, and Scopus databases. A total of 4967 articles were initially screened; 77 articles reporting empirical findings were ultimately reviewed. RESULTS: The 77 articles were predominantly bibliometric analyses/document analyses (n = 56). The majority were in medicine (n = 31, 40%) or were multidisciplinary (n = 26, 34%); 11 studies were in nursing. Most studies reported that articles published in predatory journals were of lower quality than those published in more reputable journals. In nursing, the research confirmed that articles in predatory journals were being cited in legitimate nursing journals, thereby spreading information that may not be credible through the literature. CONCLUSION: The purposes of the evaluated studies were similar: to understand the characteristics and extent of the problem of predatory publishing. Although literature about predatory publishing is abundant, empirical studies in health care are limited. The findings suggest that individual vigilance alone will not be enough to address this problem in the scholarly literature. Institutional policy and technical protections are also necessary to mitigate erosion of the scientific literature in health care.

Evaluation of DNP program essentials of doctoral nursing education: A scoping review.

BACKGROUND: In 2021, the American Association of Colleges of Nurses revised the core competencies for professional nursing education. The revision includes a call for a transformation from a traditional approach to a competency-based approach for teaching and learning. PURPOSE: The purpose of this systematic scoping review was to provide a fuller understanding of how DNP programs have historically evaluated and documented attainment of the essentials of doctoral nursing education in a summative manner in order to inform developing methods for addressing the newly endorsed advanced-level competencies in nursing education. METHODS: A systematic scoping review was completed using PRISMA for Scoping Reviews Guidelines. Databases searched included PubMed (MEDLINE), CINAHL, Education Full Text, Web of Science, and ProQuest Dissertations and Theses. Included reports needed to discuss student competencies and reflect the summative evaluation of the DNP essentials in a DNP program. Data extracted included title, lead author name, lead author affiliation, type of program, aims, design, process, results, competencies included, and DNP project inclusion. RESULTS: Of the 2729 reports initially identified, five met inclusion criteria. These articles described diverse methods for documenting student attainment of DNP competencies including leadership narratives, electronic portfolios, and clinical logs. CONCLUSION: DNP programs have used summative evaluation methods to document fulfillment of the DNP essentials, but a competency-based education approach requires additional formative evaluations that incrementally support learners' progression toward achieving competencies. Faculty can modify exemplars presented from a review of the literature to serve as summative or formative evaluations of DNP advanced-level nursing competencies.

Dissemination of doctor of nursing practice project findings: Benefits and challenges associated with publishing in healthcare journals.

BACKGROUND: Doctor of Nursing Practice (DNP) programs require a project to improve outcomes in a health care setting. However, dissemination methods vary. PURPOSE: This evaluation examined benefits and challenges associated with submitting project manuscripts to a peer-reviewed health care journal in a DNP program with this requirement. METHODS: Benefits and challenges were assessed with surveys completed by 85 DNP program alumni and 28 DNP mentors and by interviewing 5 faculty who teach in the DNP program and 5 editors of nursing journals. FINDINGS: Benefits of completing a manuscript included sharing knowledge to improve health care outcomes and enhancing nursing scholarship. Among alumni, 81% reported manuscript development was beneficial and 69% published their work. Most students, most faculty, and all editors endorsed the requirement with alternatives for projects lacking rigor or innovation. Challenges included need for faculty involvement and editorial/statistical resources. DISCUSSION: Despite challenges, there are benefits of publishing rigorous and innovative DNP work.

Integrating Maternal Depression Screening Into an Early Intervention Program: An Implementation Evaluation.

BACKGROUND: In all 50 states, early intervention (EI) services to improve long-term child cognitive and academic outcomes are provided to infants and toddlers with suspected or diagnosed developmental delays. When mothers of EI-enrolled children experience depressive symptoms, uptake of EI services can be compromised. AIMS: The purpose of the article is to present a depressive symptom screening intervention for mothers consisting of toolkit development for EI staff and families, symptom screening for mothers and follow-up protocol. To formally evaluate the implementation of the intervention, our research team followed the consolidated framework for implementation research (CFIR). METHODS: Participants were 12 EI service coordinators across two offices. Focus groups and individual interviews were used to develop the toolkit and education module. Through the five CFIR domains, we evaluated the implemented intervention in order to allow other teams to learn from our experiences. RESULTS: Our team successfully partnered with SCs to develop the intended deliverables. Still, the SCs found it challenging to conduct the screenings and reported mixed success. CONCLUSIONS: Preparation of EI SCs to integrate mental health screenings into their existing skillsets requires a high level of support from the research team, resulting in a rich understanding of the barriers-and potential rewards-for staff and families.

NP Role and Patient Outcomes Are Supported by High-Level Evidence. Comment on Almutairi et al. Nurse Practitioner: Is It Time to Have a Role in Saudi Arabia? Nurs. Rep. 2020, 10, 41-47.

This is a letter to the editor in response to the article titled "Nurse Practitioner: Is it Time to Have a Role in Saudi Arabia?" Clarifications on the nurse practitioner role definition and description, educational preparation, and quality and value of care are made and supported with authoritative, high-quality evidence.

The Effects of Shared Decision-Making on Patient Participation in Discharge Meetings in a Behavioral Health Unit.

BACKGROUND: Research suggests that persons diagnosed with behavioral health illnesses can benefit from shared decision-making. On an inpatient behavioral health unit, low Press Ganey scores related to satisfaction with involvement in care triggered a root cause analysis that identified patients did not feel engaged by nursing during their time together; and discharge meetings with the health care team were not required. AIMS: The purpose of this quality improvement project was to improve patient perception of involvement in their care as evidenced by increased Press Ganey scores and increased number of patients involved in discharge meetings. METHODS: Nurses used an evidence-based model for nurse-patient communication: the Seeking information, Engaging in conversation, Exploring options, and Deciding on treatment (SEED) and use of a Control Preferences Scale (CPS) to increase communication about treatment and discharge decisions. RESULTS: A total of 120 patients engaged in the intervention. Patient presence at discharge meetings increased from 39% to 82% (p < .001), and Press Ganey scores evidenced minimal change. CONCLUSIONS: Use of the SEED model and CPS by nurses was effective in increasing patients' involvement in their treatment. Although findings were limited due to COVID-19, the study suggests that improving patient involvement from admission through discharge throughout hospitalization can improve patient experience scores.