The DNP Degree Capstone Experience Conception, Implementation & Data Analysis

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1 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 Enjoy the Ride

2 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

3 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 However, the degree never gained popularity

4 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 Objectives for the degree are as follows

5 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 Reducing disparities in healthcare

6 Current White Paper on the DNP: Current Issues and Clarifying Recommendations Task Force on the Implementation of the DNP August 2015_ White Paper Report-8-15.pdf

7 It is important to remember that the DNP is an academic degree, not a role (AACN, 2015) 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 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)

8 Crossing the Quality Chasm: A New Health System for the 21 st Century (IOM, 2001) A follow-up to: To Err is Human, Proposing Six Specific Aims for Improvement 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.

9 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 challenging demands of society and health care (Marion, et al. 2005)

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11 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

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13 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 VIII. Advanced Nursing Practice

14 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

15 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.

16 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.

17 A retrospective chart review revealed that 23% of BG values were found to be within the established project site BG range of 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)

18 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.

19 Date Start Time - End Time Daily Hours Accumulate d Cumulative Hours DNP Program Outcomes Clinical Activity Narrative 1/5/ ,3,4, 8 Composing s and searching institutional database for managers, (CNS and RN) candidate s contact information sent to potential project participants 1/5/15 1/5/ 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. Assembled and serially coded 100 participant packets 1/5/ ,3 with automatic advancing stamper to maintain confidentiality of participants demographic data and survey results. Poster development Chatham University Residency 1/6/ , 3, 5, 7 depicting the EBP project; Improving Glycemic Control through Education Regarding the Computerized Insulin Infusion Protocol (CIIP). Meeting with nursing education department to review targeted project sites and the information contained in the participant folders. 1/6/ , 2, 8 Phone calls and s to recruit participants in the PACU and Trauma Unit. In-service dates tentatively scheduled for these units. 1/6/ , 3, 8 Preparation participant file folders at Staples Copy Center containing study materials and CIIPEPP for EBP change project. 1/7/ , 5, 7 Meetings with Anesthesia coordinator and PACU manager to assess the need for the CIIPEPP and the project is

20 The Keys to Success For Your EBP Project Conceptual Model: Project Framework: Design: Implementation: Data Analysis: Dissemination of Findings:

21 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 Realistic expectations: KISS

22 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 Patience

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24 Thank You For Your Attention Ω