Managing DNP projects in student/faculty groups to facilitate learning with large cohorts.

Despite the initial intent of the 2004 American Association of Colleges of Nursing (AACN) position statement to move all advanced nursing practice education to the doctoral level, many schools remain at the master's degree level. Many schools successfully transitioned their programs but struggled with adequate resources for the growing number of students and the faculty, staff, and preceptor workload associated with the Doctor of Nursing Practice (DNP) project courses. The AACN 2015 taskforce made many recommendations related to quality of DNP projects, but there is little in the literature on best operational practices. The goal of this paper is to describe how one school modified the DNP project courses from a traditional chair and committee driven format to a class driven format with multiple smaller sections to successfully manage large numbers of DNP students across nine specialties. Specifically, a new model with its successes and challenges is described as well as details regarding finances, course coordination, project advisors, project team, annual offerings and grouping of students.

Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects.

BACKGROUND: Quality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects. METHODS: An online survey was completed by 51% (n = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods. RESULTS: Faculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (n = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%). CONCLUSIONS: Gaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.

Lessons Learned Using Logic Models to Design and Guide DNP Projects.

BACKGROUND: A final culminating project that is derived from a practice immersion experience is a critical part of a doctor of nursing practice (DNP) program. PROBLEM: Many schools use well-designed quality improvement (QI) projects to meet this requirement, but there is no consensus on which QI methods and tools are the most effective for DNP students to demonstrate before graduation. APPROACH: One Mid-Atlantic public university began using QI process models, one of which was a logic model, to guide their DNP projects. This led to subsequent changes in the curriculum, faculty preparation, and practice partner responsibilities. OUTCOME: Many benefits and challenges were identified during the logic model implementation that may benefit other schools seeking to increase consistency and rigor. Although the learning process for students and faculty may be challenging, the outcomes included improved project conceptualization, clarity, concision, and feasibility of goal attainment. CONCLUSIONS: Use of logic models expands DNP students' skills to develop and implement a successful project and supports clinical scholarship.

Practice and Quality Improvement Leaders Survey of Expectations of DNP Graduates' Quality Improvement Expertise.

BACKGROUND: Input from practice leaders will improve how doctor of nursing practice (DNP) education is meeting the needs of the employer and improving patient outcomes. PURPOSE: This article describes the expectations practice leaders have of new DNP graduates' ability to contribute to quality improvement (QI) efforts within health care organizations. METHODS: A survey of practice leaders and QI experts investigated the importance and use of QI knowledge and skills. Practice leaders were also asked about the expectations of DNP graduates at the time of hire. RESULTS: The results of this study support the need for nurses pursuing a DNP in advanced nursing practice to have education and training beyond their area of specialization, specifically in QI methods and tools. CONCLUSIONS: Faculty need to provide DNP students education that includes concepts in QI and leadership to meet the expectations of future employers and the needs of a complex and changing health care system.

Development of a DNP measurement grid to increase the rigor of doctor of nursing practice students' data collection and analysis methods.

A key component of the DNP project rigor is the collection and analysis of data or measurement. A Steering Committee at the University of Maryland formed to improve the quality of DNP projects established a workgroup to evaluate the current measurement content in four DNP core courses with the goal of establishing DNP project measurement criteria across the curriculum. The steps included: Step 1: Identify QI Measurement Methods and Tools. Identify the essential QI measurement methods and tools recommended by national organizations. Step 2: Create a DNP Measurement Grid. Define main data methods topics with subtopics. Step 3: Map the DNP core courses. Using the DNP Measurement Grid criteria determine the measurement content included in each course and student mastery level. The level of mastery was ranked from introduced (awareness), to reinforced (knowledge), to demonstrated (application). Step 4: Evaluate and Refine the DNP Measurement Grid Criteria. Adjustments were made in the DNP curriculum to include topics and subtopics at the desired mastery level. The rigor of data measurement and analysis will be evaluated in future DNP projects. The workgroup's four-step process provides a path that facilitated improving curriculum measurement content. This process may provide guidance for others undertaking similar work.

Function Focused Care for Assisted Living Residents With Dementia.

PURPOSE OF THE STUDY: Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. DESIGN AND METHODS: A cluster-randomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. RESULTS: There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. IMPLICATIONS: The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy.

Qualitative evaluation of a standardized patient clinical simulation for nurse practitioner and pharmacy students.

This article describes a qualitative evaluation of an interprofessional educational experience for nurse practitioner and pharmacy students using standardized patients and physicians role-playing physicians in clinical scenarios. This experience included the development of two clinical scenarios; training of standardized patients, providers, and faculty facilitators; pre-briefing preparation; partial facilitator prompting simulations; and facilitated debriefings. Forty-six students participated in the formative simulation. Small groups of students and faculty facilitators worked through two clinical scenarios that were based on the expected emergence of the patient-centered medical homes. The scenarios incorporated different interprofessional communication modes, including in-person, telephonic, and video-conferencing. Time-in/time-out debriefings were incorporated to provide guidance to students about how to engage in interprofessional collaboration. After completion of the scenarios, facilitated group debriefings allowed for reflection on communication strategies and roles. Immediately following the learning activity, 30 volunteer focus group participants provided comments anonymously in a semi-structured format. Conventional content analysis was used to identify overarching themes. Participants expressed improved understanding of individual roles, increased confidence, and a better sense of interprofessional support. The educational experience themes included the benefits of a realistic nature of the simulation and the need for improved student orientation to roles and expectations prior to the clinical simulations.

Changing behavior in senior housing residents: testing of phase I of the PRAISEDD-2 intervention.

PURPOSE: Programs focused on health related behaviors implemented in senior centers, senior housing or churches have not been strongly successful in showing significant improvement in cardiovascular disease (CVD) prevention behaviors or important clinical outcomes such as decreasing blood pressure. The purpose of this study was to consider the feasibility and preliminary efficacy of phase I of the PRAISEDD-2 intervention. PRAISEDD-2 was implemented to increase physical activity, adherence to heart healthy diets and antihypertensive and/or lipid lowering medications. METHOD: This was a single site pre post intervention trial. The 12 week phase I activities included education, motivational interventions and exercise classes two times per week implemented by a lay trainer and nurse. RESULTS: A total of 29 residents were recruited from a single senior housing facility. The majority was Black or African American, female and had at least a high school education. The average age of participants was 74 years of age. At the end of phase I, participants had stronger outcome expectations for exercise, decreased fat and salt intake and decreased pain. There was a non-significant improvement in time spent in physical activity and distance walked in 6 minutes. CONCLUSION: Phase I of the PRAISEDD-2 intervention was feasible based on adherence to study design, training of the interventionists, delivery and receipt, and there was some support for efficacy across some study outcomes.

Optimizing function and physical activity among nursing home residents with dementia: testing the impact of function-focused care.

PURPOSE OF THE STUDY: The purpose of this study was to test the impact of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them. DESIGN AND METHODS: This was a cluster-randomized controlled trial using repeated measures. A total of 103 cognitively impaired residents and 77 nursing assistants were recruited from four nursing homes. For residents, outcome measures included function, physical activity (survey and actigraphy), mood, behavior, and adverse events (falls and hospitalization). Main outcome measures for nursing assistants included knowledge, beliefs, and performance of function focused care. RESULTS: There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and physical function in the treatment group. In addition, there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls (28% vs. 50% in the control group). Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures. IMPLICATIONS: This study provides some evidence that nursing home residents with severe cognitive impairment can safely and successfully be engaged in physical and functional activities.

Developing standardized patient clinical simulations to apply concepts of interdisciplinary collaboration.

Interdisciplinary collaboration and interprofessional education (IPE) are essential for transforming health care. Students in nurse practitioner (NP) programs have limited exposure to IPE. Simulated clinical experiences, based on social learning theory, provide a safe and realistic environment to expose NP students to interdisciplinary collaboration as a step toward developing IPE. Faculty at a large university school of nursing developed a formative standardized patient experience to provide NP students with two opportunities to synthesize a patient assessment, to share patient problem-solving strategies, and to succinctly communicate with other health care professionals. This pilot project provided insight to better develop IPE and identified a growing interest to collaborate in future projects with faculty from other health care disciplines.

Preparing practice scholars: teaching knowledge application in the Doctor of Nursing Practice curriculum.

PURPOSE: The purpose of this article is to explore the scholarship role of the Doctor of Nursing Practice (DNP) and the associated knowledge and skills required for success. DATA SOURCES: There are excellent competencies provided by national organizations that present guidelines for design and application of this practice scholar's contributions. Although evidence-based research translation is known to be essential for the DNP scholar, a consensus does not exist about the required research knowledge and skill levels that are needed. CONCLUSIONS: A model was developed to depict the scholarship roles of the DNP and the Doctor of Philosophy (PhD). This model indicates both DNP and PhD scholars are alike in their enactment of active scholarship but have different areas of expertise. They are different in their major roles that lead to the development of practice science; the DNP is the expert in knowledge application while the PhD is the expert in knowledge generation. IMPLICATIONS FOR PRACTICE: A nurse practice scholar needs to have a fundamental and strong understanding of research design and interpretation in order to appraise and implement research-based evidence into practice and conduct clinical projects.

Peripheral neuropathy: evidence-based treatment of a complex disorder.

Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.

Pilot testing of function-focused care for acute care intervention.

The purpose of this study was to test the feasibility of a function-focused care for acute care intervention and explore the impact of this intervention on nurses' knowledge, beliefs, and behavior associated with engaging patients in functional and physical activities. Pre- and posttesting was performed with 23 nurses, with posttesting at the end of the 6-month intervention period. Pilot testing provided some support for the feasibility of the study and showed a significant improvement in self-efficacy expectations but no change in the other study outcomes.