Posted: March 12th, 2023
DNP- 802 ROLE DEVELOPMENT
Please use the attached Timeline & Outline Project Plan with ROL Template to complete this assignment.
Please make sure to use 6-7 Articles within the last 5 years to complete the assignment. Articles must target Home-Based Patients
VERY IMPORTANT: THE NEW PICOT: Please note that the PICOT has changed DO NOT USE the one in the attached paper. Please use the following NEW PICOT:
• NEW PICOT Question: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?
*Please note that a draft form of this assignment for faculty feedback prior to final assignment submission is required for this course.*
In week 13, your timeline and outline of your project will be due. At this point, you have been working with your faculty advisor to gather ideas and work through the specifics of your project. The purpose of this assignment is to explain your ideas to ensure you are on the right track before starting on the Timeline and Outline.
INSTRUCTIONS
1. Include your PICO(T) question. State the issue and explain why this issue is of interest. Include background information showing the need for this project.
2. Show at least some of your review of the literature (ROL) so we can get an idea of how you are synthesizing the information. The more you have the better. You should have some information from your matrix assignment in 816 that you can use here.
3. Next, briefly explain what your project is. Include where you plan to conduct your project, who you plan to collaborate with for your project (who the key participants will be to ensure the success of your project), and approximately how long your project will last. Also include sampling information, any intervention that you propose as well as the design you will be using.
4. Last, discuss what tools you plan to use for your project. If you will be using a survey to measure the results, you will need to include the name of the survey and identify the creator. If you plan on using an established teaching tool as your intervention, again you will need to identify the originator of that tool. Any established tools will need permission to use before you initiate your intervention
5. Begin to think about the budget that you will need to carry out this project.
6. These are not all the details- if you want more details- review the rubric for the document and see the template below.
7. The Review of Literature MUST be 2 Pages.
8. State why the model and design were chosen.
9. Explain the Data Analysis Software used.
10. Project requires 6-7 Articles within the last 5 years. Must target Home-Based Patients
MY INFORMATION FOR THIS PROJECT
My PICOT Question
• PICOT Question: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?
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Matrix Table and Summary
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Northern Kentucky University
DNP 816 Analysis and Application of Health Data for APRN Practice
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DNP 618 Article Matrix and Analysis
Student Name:
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PICO Question: In adolescent patients seen in primary care setting (P) what is the effect of Ask Suicide Screening Question toolkit (I)compared to those not screened (C) on preventing self-harming behavior/suicide (O) in 3 months (T)
Search process: Database was searched utilizing Northern Kentucky University Library and the National Library of Medicine. The articles were peer reviewed and published within the last five years. The articles were narrowed down based on the criterial listed.
Search terms: Ask Suicide Screening Questions toolkit, suicide screening and prevention, suicide in patients, how to improve the mental health of patients or students
Databases: MEDLINE, CINHAL
Total number of articles obtained from search results: N = 1767
Number of articles initially excluded based on abstract reading: N= 30 (out of first 100 relevant)
Number of articles reviewed: N= 8
Number of articles excluded based on criteria: N= 1611
Inclusion criteria: must be in English, full text only, publishedin2017orlater, peer-reviewed articles, include adolescent, depression, and suicide as the subject, be discoverable in a reputable database
Exclusion Criteria: Article published prior to 2017, language other than English, no full text link, obtained from a non-reputable source.
Number of systematic reviews or meta-analyses used in Matrix- N = 1
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Author, year; Credentials Article #1 |
Aguinaldo, L. D. (MD), Sullivant, S. (MD), Lanzillo, E. C. (MD), Ross, A. (MD), He, J. P. (MD), Bradley-Ewing, A., Bridge, J. A. (MD), Horowitz, L. M. (MD), & Wharff, E. A (MD) (2021) Published in General Hospital Psychiatry |
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Article Focus/Title |
Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics |
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Research Design/Intervention (describe intervention) |
Cross-sectional study: Nonintervention |
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Level of Evidence and model used to grade evidence |
‘Level IV: Johns Hopkins’. |
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Evaluation Tool (CASP or others- identify tool used) |
JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, 8/8 |
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Sample/# of subjects, how recruited, power analysis? |
Five hundred and fifteen young persons (10-21 years old) who were able to speak with clinic staff in English were surveyed. Overall, 918 patients were screened for inclusion in the study, and after determining that 827 of them were qualified, 525 were formally invited to take part and given the opportunity to do so with their informed consent. Seven patients who were fully engaged in the study after giving their consent attended their outpatient specialty or primary care session but did not complete the study interview for various reasons and were therefore excluded from the analysis. The Research Associate (RA) made a mistake while collecting data via research survey or RED Cap, and as a result, three participants were left out of the analysis. Additionally, the remaining 515 patients were considered.. |
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Data Collection Procedure |
After receiving written or verbal feedback from patients 18 or older and parents/guardians of those younger than 18, the Suicidal Ideation Questionnaire and Demographic/Clinical Variables Questionnaire were administered. |
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Instruments and Reliability/validity of instruments |
Both the SIQ/SIQ Jr. and the ASQ were utilized; the SIQ/SIQ Jr. is a short version of the SIQ, which has been shown to have good reliability (SIQ: r = 0.97; SIQ-JR: r =0.94), validity, and predictive power when compared to the gold standard of the Suicidal Behavior Interview. |
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Data Analysis- id statistics, LOM, findings |
Multivariate binary logistic regression modeling was used to examine associations between ASQ-detected suicide risks and demographic, clinical, and other characteristics . The coefficients of the multivariate logistic regression were exponentiated to calculate the adjusted odds ratios. The level of statistical significance was set at P = 0.05. |
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Results |
The ASQ revealed that 45 people out of 335 had considered suicide. Only four people tested positive on the ASQ. A positive ASQ screen was 11.4 times more likely to be observed in the suicide-at-risk population compared to the general population . When comparing the SIQ/SIQ Jr. to the 4-item ASQ screen, there was substantial agreement between the two measures. |
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Discussion/ Significance of findings |
The ASQ appears to be a valid instrument for use in identifying patients at greater suicide risk in pediatric outpatient specialty or primary care clinics, and it compares favorably to the gold standard SIQ/SIQ Jr. This study’s findings provide further evidence that the ASQ has sufficient content validity, supporting the earlier conclusion. The ASQ was created as a primary screening tool to assist doctors in identifying which individuals require further diagnostic workup. |
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Reliability and Validity of study, limitations |
Little, if any, justification exists to question the veracity of the data presented. This is because the ASQ is being used in both general pediatric practices and those specializing in treating children with mental health issues. Associations with suicide risk as measured by the ASQ were investigated using multivariate binary logistic regression modeling. Both data preparation and analysis were carried out. Appropriate consent was obtained from the patient. The National Institute of Mental Health and the local research institutions both gave their stamp of approval to the study. Our convenience sample may not be representative of young people in general who seek medical care in more typical outpatient settings, which is one of the study’s weaknesses. Participation in the trial may have affected patients’ responses to suicide risk screenings (i.e., before or after their clinic appointment in outpatient specialty care). Researchers speculate that persistent questioning about suicidal thoughts has worn people down. |
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Helpful/Reliable Compared to other articles |
The study’s findings were helpful since they confirmed that this screening tool is useful for identifying young people at risk for suicide in an outpatientprimary care context. The authors, however, should have broadened their focus to include metropolitan tertiary care centers.. |
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Author, year; Credentials Article #2 |
Farrer, L. M. (Registered Psychologist), Gulliver, A. (Research Fellow), Katruss, N. (Research Assistant), Bennett, K. (credential not identified), Bennett, A. (credential not identified), Ali, K. (PhD research student), & Griffiths, K. M. (Emeritus Professor) (2020). Published in the British Journal of Guidance & Counselling |
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‘Development of the Uni Virtual Clinic: an online program for improving the mental health of university students’. |
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A participatory research method was used for this study. There was reduced burden on university resources thanks to the implementation of evidence-based online therapies for students who were typically underserved or socially isolated. |
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‘Level I: (Dearholt et al., 2017)’. |
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The CASP for qualitative checklist 9/10 |
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Four focus groups with undergrads (n = 5, 5, 4, 5) constituted the bulk of the qualitative methodologies used. Twenty persons participated in three sessions of prototype testing, a workshop for student leaders, and an assessment of the pilot UVC. In order to determine what kinds of resources various student groups at the university would benefit from, the project team held a number of in-person talks with representatives from those groups. |
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The present evidence for technologies that promoted the mental health of college students was investigated through systematic reviews. Quantitative and qualitative research approaches were used to investigate the effectiveness of peer-to-peer support interventions, as well as to collect the views and opinions of key stakeholders. Quantitative approaches included a survey of university faculty and staff who were directly involved in student instruction and supervision, and a separate poll of the students themselves. |
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Methods including surveys and in-person conversations or focus groups were employed. The researcher can receive a clear picture of the product’s reception, as well as the customers’ real thoughts, opinions, and impressions, thanks to the use of focus groups, which are considered credible. The dependability of surveys is demonstrated by their consistently reproducing comparable results. |
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Percentages were used to record all of the information gathered. Positive attitudes about involvement were evident, with all 19 positive questions having average scores above 0, suggesting agreement. |
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All 19 positive questions had average values over zero, suggesting agreement, and the majority of respondents (M = 0.96, SD = 0.24) agreed with the assertion that attitudes toward involvement were typically positive. All 13 of the negative categories were rated below 0, suggesting disagreement. Ratings above 0 , showed the strongest agreement. |
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The needs of the UVC’s target demographic could not have been met without the use of participatory design methods during development. Universities can play an important role in creating mentally healthy environments to learn and live if UVC’s work to reduce the prevalence of mental health problems among at-risk children and the negative outcomes associated with them is successful. |
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Students’ input into the design process helped the team take into account students’ changing needs, the dynamic nature of academic institutions, and the dynamic nature of web design and development approaches to e-mental health care. There were drawbacks to the study, such as the fact that it would add significant time and effort to the content creation and website development processes if end users were included in the development process. Since disagreements arose frequently concerning the nature and operation of UVC, it was challenging to reach a consensus on the final program. |
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Validating the promise of Uni Virtual Clinic to help institutions of higher education better meet the psychiatric needs of their students. The study’s findings were straightforward and simple to comprehend. |
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Author, year; Credentials Article #3 |
‘LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020)’. The authors credentials are not identified. Published by Elsevier Inc.” |
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Article Focus/Title |
The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit |
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Quasi experiment research design. Ask Suicide-Screening Questions was used to conduct a suicide screening with patients who presented for routine and sick visits; patients who tested positive for suicidal ideation were then subjected to additional screening using the same instrument. |
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‘Level III: Johns Hopkins’ |
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CASP for Qualitative checklist, score 9/10 |
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The baseline sample included 274 patients. Patients consented electronically. A 2 phased design was used to collected date from patients who presented for routine or sick visit in a rural primary care clinic. Electronic medical records for patients 18 or older were collected, this data was logged and identified by the clinician into spread sheet. |
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As part of an online survey, patients were asked to complete both the ASQ and a shorter, 5-item Screening Opinions Questionnaire. The primary care physician conducted a brief suicide risk assessment using the BSSA as a guide, and then provided disposition planning for patients who screened positive for suicide risk. The patient’s risk profile was then documented in their electronic medical record. In this study, the researcher accessed the EMR to collect data. |
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Ask Suicide-Screening Questions (ASQ) questionnaires were utilized. In young and adult inpatients, it has shown both high sensitivity and strong specificity. |
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All data was uploaded to SPSS 26 for analysis. Descriptive statistics were utilized to evaluate the aforementioned viability markers. Chi-square analysis followed by Fisher’s exact test was utilized to evaluate the two time periods’ client testing and suicide risk assessment procedure rates. |
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Intervention period reports of suicide risk screening were significantly higher than baseline period reports ( P 0.001). In addition, 6.2% of cases showed signs of suicidal ideation throughout the intervention phase, whereas only 0.7% did so during the baseline phase ( P 0.001). |
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Preliminary results from this study indicate that the ASQ and BSSA can be helpful in identifying persons in rural areas who are at risk for suicide and are seeking primary care. Rural primary care settings are ideal for implementing suicide risk screening programs. |
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Before beginning the study, the university obtained complete permission from its institutional oversight board for all study methods. The ASQ Toolkit has been found to increase the rate of risk identification in adults receiving primary care, while maintaining the validity and reliability of the research. Pilot in nature, with participants being of the same race seeing the same rural primary care doctor, the study had several inherent limitations. As this was a two-part study, there were additional variations between the study’s initial and final stages. |
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These results are comparable with those of earlier empirical research, which have shown that suicide risk screening is possible and acceptable to most patients. |
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Author, year; Credentials Article #4 |
Men, V. Y., Emery, C. R., & Yip, P. S. F. (2021). Credentials are not listed. All the authors have affiliation with Department of Social Work and Social Administration, The University of Hong Kong. Published in Psycho‐ Oncology Journal |
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‘Characteristics of cancer patients who died by suicide’. |
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Cross-sectional study: No intervention |
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‘Level IV: Johns Hopkins’ |
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‘JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, 8/8’. |
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Researchers were able to determine that 14,446 people committed suicide in the years 2003 to 2017 by analyzing data from previous records. The cases were divided into cancer and non-cancer categories based on the provided medical records. Of the 14,446 people who took their own lives, 1,461 (10%) had been diagnosed with cancer before. |
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Information from archives was used, the Coroner’s Court reports. The cases were divided into cancer and non-cancer categories based on the provided medical records. Details about the victim’s socioeconomic status and the circumstances surrounding the suicide were among the information gleaned from the reports. |
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A report from the coroner’s court was used to compile the information. The study variables of interest were compared between the cancer and non-cancer groups using independent t-tests or chi-square testing. |
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Univariate analyses, as well as general and subgroup multiple logistic regressions, were used to compare characteristics of the two cohorts. The level of significance was set at 0.05. |
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The results showed that retired people and those in committed relationships had a far higher chance of being diagnosed with cancer than those who were not. Most people (54.3%) who took their own lives after being diagnosed with cancer did so by leaping from a great height. On the other side, 27.6% of those who committed suicide did so by hanging themselves, 6.6% of them chose toxic methods. |
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We discovered that cancer-related suicides in Hong Kong are distinct from those induced by other conditions, and these distinctions widen as the patient ages. The senior cancer patient is more likely to commit suicide, more likely to seek help for suicidal thoughts, and less likely to have cognitive and emotional issues. Cancer patients’ quality of life could be greatly enhanced if more attention were paid to determining what factors contributed to their decisions to take their own lives. |
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The dataset has excellent validity because of the little potential for misclassification. Those with cancer were compared to those without the disease in order to draw conclusions about their personalities and motivations for taking their own lives. Suicide was then broken down into its component acts, such as hanging, cutting, driving into a wall, setting fire to oneself, suffocating oneself, and taking other nonviolent means. Study limitations include the lack of thorough information on the medical history of the cancer patients and the absence of information in the Coroner’s Court reports due to reasons such as the incapacity of family members to submit them. Details on the patients’ cancers, including their types, stages, and diagnosis dates. This study has some limitations, including the authors’ inability to conduct additional analyses exploring suicide decision pathways or the temporal and causal correlations between various risk variables for suicide. |
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An improvement over previous methods in terms of practicality, accuracy, and dependability, with results that can be trusted even when subjected to statistical analysis, shows the study’s reliability. To my knowledge, this is the first article to directly compare cancer suicide rates to those of other prevalent diseases in the Asian community. |
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Author, year; Credentials Article #5 |
Lindstrom, A. C. (DNP, APRN), & Earle, M. (DNP, RN) (2021). Published in the Journal of Doctoral Nursing Practice |
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‘Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult nonbehavioral Health Units’. |
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Randomized control trial. Targeted intervention that includes nursing education, easier electronic medical record (EMR) workflow for documentation of suicide screening, was needed to improve identification and provide safety of patients at risk for suicidal. |
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“Level I: ( Dearholt et al., 2017)’ |
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CASP for qualitative checklist score 8/10 |
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In total, 6,229 adults were admitted to the hospital for treatment of non-behavioral health issues. A total of 6,210 people were screened for suicidal ideation. Patients were chosen at random.. |
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An examination of the literature on the early deployment of suicide screening and the results of focus groups with key stakeholders, such as bedside nurses, guided the development of interventions. |
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The electronic medical record was modified by adding an additional answer to the suicide screening question and mandating its documentation following focus group discussions, the development of nursing protocols, data on compliance monitoring, nursing education, pre- and post-nursing assessments, and other interventions. The project was greenlit by the IRB, the issue was identified and quantified, potential solutions were evaluated and executed, and a control plan was created to assure the initiative’s long-term viability. |
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Patient records were audited to ensure accurate order entry and screening procedures. The audit found that within 24 hours of admission, 76.2% of patients had gotten assistance from a clinician and 82.5% of patients had taken safety actions that were documented. |
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With 91.5% of all registered nurses having completed the program, and with 89.2% of the pretest questions properly answered, it is evident that the trainees entered the program with a solid grounding in the subject matter. Between the two tests, there was a 2.9% improvement in accuracy, with 92.1% accurate answers on the second test. 20.6% more people were screened. |
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The nurses’ training was extensive, covering everything from patient intake through discharge. In order to improve universal suicide ideation screening and thereby boost patient safety, nurses need access to clear policies, standardized protocols, and education.. |
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The researchers in this study identified several elements at the medical center where the research was done that contributed to a culture of compliance. Results cannot be generalized to other areas because this study was conducted in only one. What’s more, the study began two months before the hospital encountered the COVID-19 outbreak. |
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In addition to being a legitimate study, the study’s usefulness stems from the fact that no literature was located on how to enhance screening compliance once a method had been devised. |
Summary
Suicide is a significant health problem in the world. The percentage of teenagers experiencing major depressive disorder (MDD) symptoms has nearly doubled, from 8.3% in 2008 to 14.4% in 2018 (Sekharet al., 2021). Thus, screening for suicide risk and suicidal behavior is an essential first step toward preventing suicide in young people. High-risk groups in optimal settings are the focus of effective screening programs. This research focuses on screening for suicide risk in medical settings because of its importance. Although there are a number of tools used to assess whether or not a patient is at risk for suicide ideation or behavior, the Ask Suicide-Screening Questions (ASQ) kit was developed with this particular context in mind.
The articles reviewed in this matrix include two level IV evidence, two-level I evidence, and one level III evidence articles.The two cross sectional studies were valid according to the JBI checklist for cross sectional studies. The quasi and randomized control trials were valid according to CASP checklist. Questionnaires were used in three of the articles and past records were used in two of the articles. Four of the results of the study were reliable. One study was done in before months before Covid 19 and All articles utilized showed suicidal screening is feasible and helps improve patient safety, and more importantly several articles showed utilization of the Ask Suicide-Screening Questions Toolkit has potential to improve suicide risk assessment (LeCloux et al., 2020).
The articles have improved my knowledge on my chosen topic. There is no change been considered at this time. I was able to find sufficient literature, government information, and education on the screening tool I have chosen. However, future studies measuring the impact of suicide risk screening with youth in outpatient specialty and primary care clinics on outcomes such as linkage with mental health services and future suicidal behavior are warranted (Aguinaldo et al., 2021). Gaps in screening of patients with suicidal thoughts exist because of lack of education, clear policies, and protocols for screening in these settings.
References
Aguinaldo, L. D., Sullivant, S., Lanzillo, E. C., Ross, A., He, J. P., Bradley-Ewing, A., Bridge, J. A., Horowitz, L. M., & Wharff, E. A. (2021). Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics.
General hospital psychiatry,
68, 52–58.
https://doi.org/10.1016/j.genhosppsych.2020.11.00
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https://doi.org/10.1016/j.genhosppsych.2020.11.00
Dearholt, S., Dang, D., & Sigma Theta Tau International. (2012). Johns Hopkins nursing evidence-based practice: Models and
guidelines.
https://libguides.ohsu.edu/ld.php?content_id=16277844
Farrer, L. M., Gulliver, A., Katruss, N., Fassnacht, D. B., Kyrios, M., & Batterham, P. J. (2019). A novel multi-component online intervention to improve the mental health of university students: Randomized controlled trial of the Uni Virtual Clinic.
Internet interventions,
18, 100276.
https://doi.org/10.1016/j.invent.2019.100276
LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020). The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit.
Psychosomatics,
61(6), 698–706.
https://doi.org/10.1016/j.psym.2020.05.002
Lindstrom, A. C., & Earle, M. (2021). Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult Nonbehavioral Health Units.
Journal of doctoral nursing practice, JDNP-D-20-00049. https://doi.org/10.1891/JDNP-D-20-00049
Men, V. Y., Emery, C. R., & Yip, P. S. F. (2021). Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records.
Psycho-oncology,
30(7), 1051–1058.
https://doi.org/10.1002/pon.5634
Sekhar, D. L., Schaefer, E. W., Waxmonsky, J. G., Walker-Harding, L. R., Pattison, K. L., Molinari, A., Rosen, P., & Kraschnewski, J. L. (2021). Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial.
JAMA network open,
4(11), e2131836. https://doi.org/10.1001/jamanetworkopen.2021.31836
Fall 10.2020
2
DNP Role Assignment
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Northern Kentucky University
DNP 802 Role Development
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DATE
Introduction
A Doctor of Nursing Practice (DNP) and Doctor of Philosophy in Nursing (PhD) are advanced nursing degrees that involve significant knowledge of the nursing field. PhD-prepared nurses are essential to developing the research base needed to support evidence-based practice and advance nursing knowledge, and DNP-trained nurses play a key role in translating evidence into practice and educating nursing students in practice basics (National Academies of Sciences, Engineering, and Medicine, 2021). In addition, the DNP degree also enables a nursing practitioner to assume leadership roles in healthcare to ensure quality, safe, and satisfying care services are provided to the patient population. While there is a significant difference, it is important to recognize that while the DNP is framed with clinical competencies, it is viewed as separate but equal to research doctorate. This paper will focus on the appropriateness of having a PhD/DNP prepared nurses as a nurse educator at University level.
Background and Significance
Nursing practitioners play a crucial role within the health care delivery system. Rapid changes in healthcare delivery, financial constraints and consumer demand have impacted the practice of all healthcare providers and are critical factors in the emergence of the role of advanced practice in nursing. Nursing education have evolved over the years, however the process of educating and preparing healthcare providers has faced many challenges throughout history (Groccia & Ford, 2020). The education of nursing practitioners has grown to prepare nurses to identify social determinants of health (SDOH), improve population health, and promote health equity (National Academies of Sciences, Engineering, and Medicine, 2021). Nurse educators play a significant role in ensuring that student nurses are adequately prepared to achieve the course outcome and understand the curriculum. Additionally, nurse educators offer inspiration, mentorship and teach the next generation of nurses about the safe approach to future patient care. Having a DNP as a nursing school faculty member is essential because DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNS, and other research-focused nursing doctorates (American Association of Colleges of Nursing, 2022). In addition, the evolving demands of the nation’s complex healthcare environment require the highest levels of scientific knowledge and hands-on experience to ensure high-quality patient outcomes; the Institute of Medicine, the Joint Commission, the Robert Wood Johnson Foundation and other agencies have called for a redesign of the educational programs that prepare today’s health workers (American Association of Colleges of Nursing, 2022).
The DNP Essentials take the current MSN Essentials and expand them to include a focus on population health; The practice doctorate also addresses the gaps previously identified in master ‘s programs such as practice management, health policy, information technology, risk management, utilization and translation of evidence based practice, and advanced diagnosis and management (Flanagan et al., 2021). According to McCauley et al., 2020, BSN prepared nurses without healthcare experience are enrolling in DNP programs to become system leaders and those with health care experience and are enrolling in DNP programs to become APRNs, who better to prepare them than DNP prepared nurses. (Giardino, 2014)
Literature Review
Nurse educators with the DNP degree are trained to develop a connection between nursing education and nursing practice. Bellini et al., (2012) argues that to ensure academic nursing progression and active clinical practice are achieved, nursing schools need to have a DNP or PhD as a faculty member as they tend to have the ability to infuse extensive nursing practice knowledge in the nursing curriculum, and this can make a significant contribution towards elevating the gap between nursing education and the nursing practice. Furthermore, Carollo & Mason (2017) also asserts that DNP prepared nurses tend to be appropriately positioned to offer nursing education to students and to encourage them to assume various role in nursing practice following their significant experience in multiple academic and clinical education settings. This affirms the advantage nursing schools have in utilizing a DNP prepared nurse as a faculty member. Other advantages include educator’ ability to emphasize the use of evidence-based approach, an extensive perspective regarding the systems-based issues, nursing experience and other related aspects which aid in preparing the nursing students for various challenges and rigours within the nursing roles and responsibilities (Carollo & Mason, 2017).
Edwards et al. (2018) also affirm that the National nursing organization advocates that the DNP is the preferred educator to prepare nurses for clinical leadership, practice, healthcare system restructuring and research translation into the clinical setting. This is mainly because, despite their specialty, the DNP also tend to have core competencies that tend to align with clinical leadership, health policy, health finance, organizational systems, informatics and the integration of evidence-based practice. Furthermore, Edwards et al. (2018). also identify that the ability to design and assess an innovative patient care model, cost-effectiveness relating to the patient’s care approach and the influence of the health policies in different healthcare levels holds significant knowledge to prepare new nurses to offer quality, safe and satisfactory health care services. McNelis et al. (2018) also supports the notion by affirming that evidence-based practice tends to be a thread throughout the DNP education, and as a result, it tends to strengthen the implementation of research-based interventions which are often utilized in the improvement of patient outcomes. The knowledge of evidence-based practice and its importance in healthcare delivery may be passed from one nursing generation to another by having DNP as a faculty member (McNelis et al., 2018).
Marrocco & El-Masri (2019) on the other hand argues that the constant increase in the population of DNP graduates in relation to the shortage of PhD-prepared nurses has majorly contributed to hiring DNP into higher education with minimal differentiation in the role of DNP and PhD. Additionally, the shift within the faculty mix is expected to increase and, as a result, create enormous confusion, which may, in future, threaten the PhD education investments if the special mandate between the DNP and the PhD, educations are not adequately addressed. Further, the nursing practice tends to be in need of the DNP to be able to effectively resolve various nursing issues. On the other hand, the nursing practice also tends to be in need of the PhD to be in a position to develop and also perform innovative research within the nursing field (Marrocco & El-Masri, 2019). Thus, the belief that nursing education has the potential to tremendously benefit from the recruitment and incorporation of DNPs is guaranteed if the recruitment tends to identify the role of the DNP in the nursing practice. Furthermore in, research conducted by McNelis et al. (2018) identified that nursing DNP and PhD graduates pointed out that the knowledge attained from the degrees significantly enhanced and increased confidence in relation to their ability to perform research but also had limited confidence in incorporating the achieved research concepts in their teaching. This pointed out that there is a significant need for the DNPs and PhD to be provided with additional academic knowledge to enable them to effectively fulfil the teaching role. In general, to ensure that the essential nursing knowledge is effectively passed from one nurse generation to another, it is important to make sure that the PhD or DNP nurses in nursing schools are offered adequate knowledge to enhance their teaching skills (McNelis et al., 2018).
Swot Analysis
The SWOT analysis below offers an effective presentation of the various strengths and weaknesses that are linked to having a DNP nurse as a faculty member in a nursing school. Additionally, it will also identify the various opportunities and threats which are linked to having DNP as a faculty member and the other benefits or risks that may impact nursing education and the nursing practice.
Strengths
· Allows the promotion of evidence-based practice knowledge among new nurses, which contributes to promoting quality care (National Academies of Sciences, Engineering, and Medicine., 2021).
· DNPs tend to have considerable experience within the clinical setting, and this may function as an excellent guide to prepare the new nurses to overcome the various challenges within the nursing practice.
· Having a DNP as a faculty member will ensure that the new nursing students are able to effectively understand the different policies and how they may utilize them to achieve quality and positive health outcomes.
Weaknesses
· If the concept of DNP and PhD is not adequately addressed, they may be increased confusion on the ultimate role each nurse has within the nursing field.
· Increased recruitment of DNP in nursing education may contribute to threatening the future education investment of the PhD as it may be regarded to be irrelevant in the field of nursing (National Academies of Sciences, Engineering, and Medicine., 2021).
Opportunities
· Enormous clinical and nursing educational knowledge among the DNP nurses will prepare the new nurses to meet the nursing goals when they are recruited as faculty members.
· Having a DNP as a faculty member in a nursing school also promotes a better understanding of the role that nursing practitioners play within the healthcare delivery system (National Academies of Sciences, Engineering, and Medicine., 2021)
Threats
· Increased recruitment of DNP in nursing education will lead to confusion regarding the key role that a DNP plays in the nursing field for new nurses (Zaccagnini & White, 2021).
PEST Analysis
Pest analysis has been conducted to offer a prediction of how the role of a DNP as a faculty member in a nursing school will benefit nursing education, the nursing field, and the general healthcare delivery system. The PEST analysis will focus on addressing the various external aspects that will impact the overall performance of the nursing practice.
Political
· The incorporation of DNP nurses as faculty members in a nursing school will influence the effectiveness of the health systems. DNP students develop skills related to policy analysis and policy development. According to Milstead and Short (2019) Nurses study the basics of how bills become laws in the baccalaureate programs , but in graduate school an extension of focus on legislative issues is provided as this help nurses learn to participate in a range of governmental and political activities.
· The laws that govern nursing practice are set by each state and can vary widely. In some states, DNPs have the authority to practice independently, while in others they must have a formal agreement with a physician. The influence of DNPs on these laws can come from advocacy by professional organizations, educational institutions, and the DNPs themselves.
· The role of DNPs as primary care providers has implications for reimbursement policies. NPs, including DNPs, are reimbursed by Medicare and private insurance for the services they provide. However, reimbursement rates for NPs are often lower than those for physicians, and this can be a barrier to the full utilization of NPs in the health care system.
Economic
· Understanding the role of nursing practice aids in promoting effective health systems, health economics and health insurance by contributing to clinical practice.
· Promotes cost-effectiveness through assessing the patient care strategies and quality care improvement teams’ coordination.
· Promotes reduced care costs as the new nurses will be offered adequate nursing knowledge, which contributes to reduced patient stay in hospitals and minimal cases of readmission.
· The significant DNP’s knowledge and experience setting may promote positive patient health outcomes when passed on to new nurses.
Social
· The new nurses will achieve exposure to evidence-based practice and understand the essentialness of evidence-based practice in the health care delivery.
· Attaining knowledge from DNP nurses will ensure that new nurses are able to differentiate themselves and demonstrate their contribution towards enhancing the health care delivery system.
· DNPs can also advocate for policies and programs that address non-medical factors affecting that impact the health of patients. This includes advocating for affordable housing, access to healthy food, and other initiatives that improve the overall health and well-being of communities.
· DNPs can play a critical role in coordinating care for patients with complex health needs, They can work with other health care providers, social service agencies, and community organizations to address disparities that impact the health of patients. According to Office of Disease Prevention and Health Promotion (ODPHP, n.d.). Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life.
Technological
· Promotes the ability of nursing students to collect and analyse data.
· Promotes the ability to impact media and the nursing profession integrity central to nursing excellence.
· Increase in knowledge and sharing of skills and Advanced Practice philanthropy using access to resources and communication devices.
· DNPs use nursing informatics and the technology of EHRs to support clinical decision making and improve patient outcomes. They have the skills to analyse data from EHRs and other sources to inform clinical decisions and make evidence-based recommendations.
· Nursing informatics provide opportunities for nurses to monitor and track the quality of care they provide and identify areas for improvement by using EHRs to track patient outcomes and monitor clinical performance.
Implementation Strategies
The need to have a DNP-prepared nurse be a faculty member in nursing school is crucial in ensuring that the various roles and responsibilities that have constantly increased due to healthcare delivery trends are adequately addressed. Doctoral level knowledge and skills in these areas are consistent with nursing and health care goals to eliminate health disparities and to promote patient safety and excellence in practice (American Association of Colleges of Nursing, 2022). The DNP-prepared nurse is able to emphasize evidence-based practice as the basic approach towards enhancing the quality of health care delivery. Additionally, as a faculty member, a DNP-prepared nurse will have the opportunity of helping nursing students achieve leadership skills, understand the essentialness of evidence-based practice, affect changes in nursing practice, nursing education and government regulations.
Stakeholder Support
For the role implementation to be successful, it is essential to achieve the stakeholders’ support, as this will promote open communication, sharing of ideas and a more collaborative decision-making approach. Having support from both internal and external stakeholders is crucial as it influences the need to have DNP-prepared nurses as faculty members. Attaining individual opinions from both internal and external stakeholders ensures that the role is beneficial to all parties before implementing it (Zaccagnini & White, 2021)
The key stakeholders in the implementation of DNPs (Doctor of Nursing Practice) can include:
· Nurses – DNPs are advanced practice registered nurses (APRNs) who provide high-level care to patients.
· Patients – DNPs are involved in direct patient care and therefore, patients are a crucial stakeholder group in the implementation of DNPs.
· Employers – Health care organizations and hospitals are employers of DNPs, and they play a vital role in the implementation of DNPs by providing resources, support, and recognition of the role.
· Government agencies – Federal and state governments regulate the practice of nursing and have a role in the implementation of DNPs by setting standards and licensing requirements.
· Professional organizations – National and international organizations for nursing, such as the American Nurses Association and Sigma Theta Tau International, play a role in the implementation of DNPs by advocating for the role, promoting best practices, and offering education and professional development opportunities.
· Universities and academic institutions – These institutions play a crucial role in educating and preparing future DNPs, and they also have a role in the ongoing development and recognition of the role.
Financial Implication
Cost-benefit analysis may be used as a tool that identifies the essentials of having DNP-prepared nurses as a requirement for being a faculty member in a nursing school. Essential 11 requires DNP graduates have the ability to evaluate the cost effectiveness of care and use principles of economics and finance to redesign effective and realistic care delivery strategies (American Association of Colleges of Nursing, 2022). DNP prepared faculty members have positive impact on health care costs by making sure that new nurses are provided with adequate nursing practice training. This in turn promotes enhanced patient care, develops a healthy working environment, and establishes a cheerful outlook towards the nursing practice. In general, the financial implication of having a DNP as a requirement for one to be a faculty member in a nursing school tends to outweigh the negative implication within the nursing practice.
Evaluations and Measurement
To determine the essentialness of having a DNP to be a requirement for one to qualify as a faculty member in a nursing school, it is important to utilize dependable a valid tool. This will ensure credibility, hence promoting continuous action as support from the stakeholders. An appropriate approach for evaluating and measuring the requirement for having DNP to be a faculty member is through tracking data. This approach will review nurse-sensitive information which is correlated to patient harm, and poor care services, among other related information. This information tends to be crucial for reporting, intervention and action planning which are crucial to promoting quality care improvement and positive patient outcome.
Summary
DNPs develop a connection between nursing education and the nursing practice. Overall, clinical knowledge changes rapidly, which often leads to a disconnect between the clinical world and the nurse academics. In addition to ensuring nursing academic progression and active clinical practice are achieved, the nursing schools need to have an individual with DNP or PhD as a faculty member as they have the ability to infuse extensive nursing practice knowledge in the nursing curriculum, According to the American Association of Colleges of Nursing (2021), In universities it is increasingly difficult to develop the kind of clinical scholarship and maintain the kind of credibility necessary for first rate programs without a higher level of education among our faculty. Moreover, having a DNP or PhD as a nursing school faculty member is essential and necessary in supervising nursing students during clinical rotations, providing enlightening information to nursing students on the various key aspects to positive healthcare outcomes such as coordination, effective communication, and collaboration.
References
American Association of Colleges of Nursing (2022). Fact Sheet: The Doctor of Nursing
Practice. https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet
Bellini, S., McCauley, P., & Cusson, R. M. (2012). The Doctor of Nursing practice graduate as faculty member.
Nursing Clinics of North America,
47(4), 547-556.
https://doi.org/10.1016/j.cnur.2012.07.004
Carollo, S., & Mason, A. (2017). Doctor of nursing practice curricula redesign: Challenge, change and collaboration.
The Journal for Nurse Practitioners,
13(4), e177-e183.
https://doi.org/10.1016/j.nurpra.2016.11.011
Edwards, N. E., Coddington, J., Erler, C., & Kirkpatric, J. (2018). The Impact of the Role of Doctor of Nursing Practice Nurses on Healthcare and Leadership.
Medical Research Archives,
6(4).
http://journals.ke-i.org/index.php/mra
Flanagan, J., Turkel, M.C., Roussel, L., & Smith, M. (2021). Nursing Knowledge in the
Doctor of Nursing Practice Curriculum.
Nursing Science Quarterly. 34(3), 268-274.
doi:10.1177/08943184211010458
Giardino, A.P.(2014). Collaboration with the Advanced Practice Nurse: Role, Teamwork and
Outcomes. Nova.
Graves, L. Y., Tamez, P., Wallen, G. R., & Saligan, L. N. (2021). Defining the role of
individuals prepared as a doctor of nurse practice in symptoms science research.
Nursing Outlook,
69(4), 542-549.
https://doi.org/10.1016/j.outlook.2021.01.013
Groccia, J. E., & Ford, C. R. (2020). Preparing the Academy for the Evolution of Healthcare
Education.
New Directions for Teaching and Learning,
162, 13–30.
Marrocco, A., & El-Masri, M. M. (2019). Doctor of nursing practice in academia: Lessons from the American experience.
Canadian Journal of Nursing Research,
51(2), 51-52.
https://doi.org/10.1177/0844562118825326
McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.
Nursing outlook,
68(4), 494–503. https://doi.org/10.1016/j.outlook.2020.03.008
McNelis, A. M., Dreifuerst, K. T., & Schwindt, R. (2018). Doctoral education and preparation for nursing faculty roles.
Nurse Educator,
44(4), 202-206.
https://doi.org/10.1097/nne.0000000000000597
Milstead, J., & Short, N. (2019).
Health Policy and Politics : A Nurse’s Guide. Jones & Bartlett Learning
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a Path to Achieve Health Equity.
The National Academies Press.
https://doi.org/10.17226/25982
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Zaccagnini, & White, K. (2021).
The Doctor of Nursing practice essentials (4th ed.). Jones & Bartlett Publishers.
2
Running head:
TIMELINE AND ROL
2
TIMELINE AND ROL
Timeline and Review of Literature –
Supporting Perioperative Nurse Interns through Mentorship: A Pilot Study
DNP Student- used with permission
Northern Kentucky University
Timeline and Review of Literature
Supporting Perioperative Nurse Interns through Mentorship: A Pilot Study
As perioperative nursing is highly specialized, it can take years to develop into a highly skilled perioperative nurse particularly when working in large academic medical centers caring for high-acuity patients with multiple surgical specialties. Training programs for perioperative nurses involve a six-month perioperative nurse internship before entry-level competency is achieved. Training occurs in both the classroom and clinical environment under the guidance of nurse educators and nurse preceptors (Fitzgerald, 2009). Despite this level of training, there remains a high turnover rate among new perioperative staff worldwide, and research has connected the low retention rate to the competency and confidence of new perioperative nurses (Whelan et al., 2016). Consistent with trends, the nurse intern program at a midwestern facility currently experiences a high amount of turnover during the first year of employment with 40% of nurse news choosing to leave the department within the first year of employment. The majority of these nurses are new graduates (T. Thomas, personal communication, August 26, 2019). According to Ball et al. (2015), the cost to orient a nurse to the operating starts at $59,000 not including the recruiting, interviewing, and hiring process.
Factors influencing nursing turnover have been studied extensively. As Zhang et al. (2016) relates, new nurses often experience high levels of stress during the first year of nursing practice which can result in high rates of turnover. New nurses report feeling overwhelmed, are unprepared for the clinical responsibilities faced in today’s healthcare environment and are frequently met with inhospitable workplace cultures. Research has shown an effective strategy to support the transition to practice for new nurses is implementation of a nurse mentorship program (Zhang et al., 2016). At the midwestern facility, the nurse interns train with nurse preceptors throughout the six-month training program. However, perioperative services lack a formal mentorship program to support the interns’ transition to practice within the department to become a fully, socialized member of the perioperative team.
PICOT
For newly hired perioperative nurses (P), how will implementation of a nursing mentorship program (I) compared with the traditional onboarding process (C) impact self-efficacy (O) and employee retention (O) during the first six months of hire (T)? The target population is the nurse interns. The independent variable is the mentorship program and dependent variables are self-efficacy and employee retention.
Intervention
The project plan is to introduce a mentorship program into the perioperative intern program at a Midwest healthcare facility. The key participants will be the perioperative interns, perioperative nurse mentors, DNP student, perioperative leadership and educators to support integration of mentors into the perioperative intern program. The pilot study will be 12 months, but the intention is the pilot study will develop into a full-time mentorship program for the department.
Review of Literature
The Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Medline/PubMed, Scopus/Elsevier, SciTech Premium Collection, Wiley Online Library, Sage Journals, and Social Sciences databases were searched to gather relevant publications from the last five years
(2015-2020) with the following search terms: “mentorship programs”, “new nurses”, “mentoring new nurses”, “perioperative services”, “outcomes”, “retention or attrition or turnover”, “self-efficacy”, and “nursing”. The initial search obtained 5,161 articles. The search was reduced to peer-reviewed, full-text only, English-only, nursing-focused articles. By excluding all articles related to experienced nurses, nursing management, and student mentorship, and opinion-based articles and editorials, the search was reduced to 698 abstracts to review. Upon review of the abstracts, 26 articles were selected for full review. Eleven articles were selected relevant to mentorship programs tailored to support new nurses transitioning to practice with varying levels of evidence ranging from four level I systematic reviews, three level III quasi-experimental studies, one level IV case-control study, one level V integrative review of mixed method studies with majority qualitative data, and two level VI cross sectional descriptive surveys.
Despite the number of systematic reviews included in this review of literature (ROL) which provides the highest level of evidence according to Melnyk and Fineout-Overholt (2019), Brook et al. (2019) offers the most comprehensive and compelling compilation of research to demonstrate the effectiveness of mentorship programs on supporting the transitions of new nurses. Multiple studies exist providing quasi-experimental and lower level research studies with small sample sizes boasting similar results on a lesser scale (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016). While mentorship has been shown to provide multiple benefits to include enhanced job satisfaction, enhanced clinical competence, and reduced anxiety, the focus of the DNP project is to impact new nurses’ self-efficacy and reduce employee turnover (Ajorpaz et al., 2016; Jones, 2017; Van Patten & Bartone, 2019; Zhang, et al., 2019). The Ajorpaz et al. (2016) randomized control study is the only perioperative specific to perioperative new hires that is part of the literature review.
Nursing Turnover and Retention
Overwhelmingly, the evidence demonstrates pairing mentors with new nurses positively supports the transition to nursing practice and reduces turnover within the first year of practice (Brook et al., 2019; Edwards et al., 2015; Jones, 2017; Pennington & Driscoll, 2019; Zhang et al., 2016; Zhang et al., 2019). However, the longitudinal study completed by Zhang et al. (2019) with new graduates and the Pennington and Driscoll (2019) mentorship program for new home health nurses both illustrated drops in nurse retention rates in subsequent years. However, both studies maintained retention rates far superior to pre-mentorship retention numbers. Evidence has shown pairing a mentorship and preceptor component improves turnover metrics resulting in an average decrease in turnover by 20% with three studies indicating 15% improved nurse retention (Brook et al., 20).
Self-Efficacy
Experienced nurses who are fully socialized within a unit often possess the resilience and self-efficacy which in turn makes them more committed to the organization and more engaged as employees. According to Innes and Calleja (2018), new graduates often experience lower self-confidence related to the stresses of being a novice nurse particularly in a specialty setting like perioperative services hindering their ability to develop the skills needed to meet the clinical competencies of the department. Self-efficacy is important for nurses as it allows one to face challenges head-on despite the obstacles, have increased levels of resilience, and experience lower levels of stress and anxiety (Wang et al., 2018). Nurse mentorship programs can serve to build new nurses’ confidence, moderate stress levels, enhance unit socialization, increase resilience, and positively impact self-efficacy (Brook et al., 2019; Edwards et al., 2015; Innes & Calleja, 2018; Van Patten & Bartone, 2019: Wang et al., 2018; Zhang et al., 2016).
Characteristics of a Successful Mentorship Program
Factors to influence successful mentorship programs include:
· Thoughtful mentor selection (Zhang et al., 2016)
· Mentor training (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016)
· Mentor/mentee matching (Brook et al., 2019; Tiew et al., 2017; Zhang et al., 2016)
· Mentor and mentee relationship (Lin et al., 2018; Zhang et al., 2016)
· Preceptor/Mentorship paired programs (Brook et al., 2019; Edwards et al., 2015; Van Patten & Bartone, 2019)
Gaps in the Literature
Gaps remain in the literature. Few studies have been conducted exclusively in the United States within the last five years and little research on mentorship programs has been focused in perioperative services, particularly in the operative room. The research studies conducted have been on the lower end of the evidence hierarchy with smaller sample sizes or based on expert opinion limiting the number of studies in the ROL. No clear guideline exists to provide best practice for design of a nurse mentorship program to support the transition of new graduate nurses during the first year of practice.
Implementation Plan
February 2020
· Complete review of the literature and project timeline
· Obtain faculty advisor and project mentor project approval
· Meet with Burkardt Consulting Center regarding statistical support for project and will submit data throughout project based on direction received during meeting
· Complete project proposal
March 2020
· Present project plan to facility Nursing Research Committee. Obtain approval for IRB submission
· Submit IRB application to facility to introduce a 12-month pilot mentorship program for the perioperative nurse interns utilizing a mixed methods approach
· Focus Groups and Pre-and Post-Test Measurement Tool utilizing the General Self-Efficacy Scale (GSE) developed by Schwarzer and Jerusalem (1995).
April 2020
· Develop Mentorship Committee to serve as mentors and help to select mentors for pilot study
· Application process with explanation of commitment
· Assist with mentor matching
· Utilize personality testing to pair mentor/interns
· Shape project with input from staff by conducting Focus Groups (approximately 10 participants per group). Conduct focus groups in March 2020.
· Recent Nurse Interns: < 2 years in department
· Nurse Preceptors: 2-5 years’ experience in department
· Nurse Preceptors: 5+ years’ experience in department
May 2020
· DNP student will conduct mentor training to educate mentors on roles and obtain commitment. Considering training on following:
· Personality type training – considering Myers-Briggs Type Indicator (MBTI) – utilize the free tool on www.truity.com
· Resilience training
· Conflict Management
· Administer the General Self-Efficacy Scale (GSE) Test for the four nurse interns (pre-test) prior to introducing the interns to the mentors. The GSE does not require special permission for utilization, consists of ten questions on using a Likert-scale, and is a highly reliable, valid study with a Cronbach alpha between .76-.90 (Schwarzer & Jerusalem, 1995).
· Introduce mentors to interns. Will need four mentors to connect with four interns for the winter 2020 intern group.
June 2020
· The second group of nurse interns should start in June 2020. Expect 10-12 interns in the June 2020 intern group. Will need to recruit an additional 10-12 new mentors with the help of the mentorship committee via application process.
· Meet with mentorship committee
July 2020
· Conduct mentorship training for the mentors selected by the mentorship committee.
· Administer the GSE pre-test to summer intern class
August 2020
· Meet with mentorship committee. Focus on pairing new mentors with interns.
· Pair mentors with summer interns
· Administer the GSE post-test to the Winter interns (stagger start but half the winter intern group started in Feb. 2020)
· Trace retention of the Winter intern group
October 2020
· Meet with mentorship committee to support mentorship program
December 2020
· Meet with the mentorship committee to support the mentorship program
· Administer the GSE post-test to the Summer interns
· Track retention of the Summer intern group
January 2021
· Submit data to the Bukardt Consulting Center
February 2021 – March 2021
· Data analysis and review project outcomes
· Meet with Burkardt Consulting Center to review data
· Meet with faculty advisor and project mentor to review project findings
· Preparation for DNP project presentation and dissemination of DNP project
April 2021
· Present DNP Project in April 2021 for graduation requirements
Outcomes
· Improved employee retention in the perioperative nurse intern program with implementation of a mentorship program
· Increased self-efficacy of perioperative interns after introduction of mentorship to support transition of new nurses into practice
Evaluation
After six months, the interns will transition from the perioperative internship to independent practice as a new nurse in the operating room. During this transition period and throughout the first year of hire, the novice perioperative nurse is vulnerable and turnover rates are high. The formal mentorship relationship will last for 12 months, but the evaluation period for tracking outcomes related to the pilot study will be completed at six months based on the length of the intern program and general orientation to the operating room when historically turnover has been the highest for the facility.
It is estimated during the pilot study, there will be approximately 15 perioperative nurse interns participate in the pilot study which could impact the ability to obtain statistically significant results based on low volume. However, based on the pre- and post-test design a paired t-test would allow measurement of the impact of the mentorship intervention on self-efficacy. A meeting with the Burkardt Consulting Center will further build out statistical analysis plan to possibly add ANOVA and other data analytics options based on projected numbers in pilot study. Tracking nurse intern retention rates will also be part of the analysis. Further, focus groups will allow for the DNP student to pick up on themes to shape the mentorship program and provide qualitative research for the pilot study (Polit & Beck, 2017). The pilot study could be extended until statistically significant results are obtained demonstrating a possible relationship between mentorship program support and the perioperative nurse interns’ self-efficacy and nurse retention rates.
Project Budget
Program Expenses
Salaries/Wages Monthly Total
·
DNP Student $0 $0
·
Focus Group Staff Time $227.50 $2,730
·
Focus Group Observer $13 $156
·
Mentor Committee Meetings $257.83 $3,094
·
Mentor Training (staff time) $242.66 $2,912
·
Intern Testing (staff time) $61.75 $741
Total Salary Costs
$9,633
Startup Costs Monthly Total
·
Supplies $4.16 $50
Total Startup Costs
$50
Capital Costs $0
Operational Costs $0
Total Project Expenses $9,683
Most of the cost of the mentorship program is related to the expense of paying staff for their time to participate in the committee work, training sessions, and focus groups. No additional capital costs will be incurred as the mentorship will utilize a free tool for mentor and intern matching. If the mentorship program could retain one perioperative intern, the return on investment in the mentorship program would be significant. As the cost of the program is $9,683 for one year, and the cost to recruit and train one perioperative intern exceeds $59,000 (Ball et al., 2015). Retaining only one employee annually nets a return on investment in excess of $49,317.
Dissemination Plan
Based on the perioperative mentorship focus, the Association of periOperative Registered Nurses (AORN) is the ideal audience for dissemination of project findings. AORN is the leader for perioperative nursing professional practice and provides the most up-to-date evidence-based practice information related to clinical, research, education, and management for perioperative nursing professional Either a poster presentation at an AORN conference or pursuing publication in the AORN Journal is the goal for dissemination of the evidence.
Summary
The evidence clearly shows there is a need to support new nurses during the first year of practice and establishing programs to ease entry into practice is important to ensure delivery of safe nursing care while retaining nursing talent according to the Institute of Medicine (Van Patten and Bartone, 2019). Organizations owe it to nurses and the profession to invest in programs to support new nurses. Mentorship is a tool consistently recognized in the literature to be effective at positively building the self-efficacy of new nurses and impacting nurse retention rates, thereby easing the transition into practice (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016).
References
Ajorpaz, N., Tafreshi, M., Mohtashami, J., Zayeri, F., & Rahemi, Z. (2016). The effect of
mentoring on clinical perioperative competence in operating room nursing students.
Journal of Clinical Nursing, 25, 1319-1325. doi: 10.111/jocn.13205
Ball, K., Doyle, D., & Oocumma, N. (2015). Nursing shortages in the OR: Solutions for new
models of education.
Association of periOperative Registered Nurses (AORN) Journal, 101(1), 115-136. doi: 10.1016/j.aorn.2014.03.015
Brook, J., Aitken, L., Webb, R., Maclaren, J., & Salmon, D. (2019). Characteristics of successful
interventions to reduce turnover and increase retention of early career nurses: A systematic review.
International Journal of Nursing Studies, 91, 47-59. doi: 10.1016/j.ijnurstu.2018.11.003
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness
of strategies and interventions to improve the transition from student to newly qualified nurse.
International Journal of Nursing Studies, 52, 1254-1268. doi: 10.1016/j.ijnurstu.2015.03.007
Fitzgerald. B. (2009). Educating novice perioperative nurses.
Perioperative Nursing Clinics,
4(2), 141-155. doi:10.1016/j.cpen.2009.01.006
Innes, T., & Calleja, P. (2018). Transition support for new graduate and novice nurses in critical
care settings: An integrative review of the literature.
Nurse education in Practice, 30, 62-72. doi: 10.1016/j.nepr.2018.03.001
Jones, S.J. (2017). Establishing a nurse mentor program to improve nurse satisfaction and intent
to stay.
Journal for Nurses in Professional Development, 33(2), 76-78. doi: 10.1097.NND.0000000000000335
Lin, J., Chew, Y.R., Toh, Y.P., Krishna, L.K.R. (2018). Mentoring in nursing: An integrative review
of commentaries, editorials and perspective papers.
Nurse Educator, 43(1), E1-E5. doi: 10.1097/NNE.0000000000000389
Melnyk, B.M., & Fineout-Overholt, E. (2019).
Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Pennington, G., & Driscoll, A. (2019). Improving retention of home health nurses: Fostering
sustainability through an innovation orientation and mentorship program.
Home Healthcare Now, 37(5), 256-264. doi: 10.1097/NHH.0000000000000782
Polit, D. F., & Beck, C. T. (2017).
Nursing research: Generating and assessing evidence for
nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Health.
Schwarzer, R. & Jerusalem, M. (1995). Generalized self-efficacy scale. Retrieved from
https://www.drugsandalcohol.ie/26768/1/General_Self-Efficacy_Scale%20(GSE)
Tiew, L.H., Koh, C,S., Creedy, D.K., & Tam, W.S.W. (2017). Graduate nurses’ evaluation of
mentorship: Development of a new tool.
Nurse education today, 54, 77-82. doi: 10.1016/j.nedt.2017.04.016
Van Patten, R., Bartone, A.S. (2019). The impact of mentorship, preceptors, and debriefing on
the quality of program experiences.
Nurse Education in Practice, 35, 63-68. https://doi.org/10.1016.j.nepr.2019.01.007
Wang, L., Tao, H., Bowers, B.J., Brown, R., & Zhang, Y. (2018). Influence of social support and
self-efficacy on resilience of early career registered nurses.
Western Journal of Nursing Research, 40(5), 648-664. doi: 10.1177/0193945916685712
Whelan, T., Shi, X., Yarke, S., Andony, K., & McKenzie, M.L. (2016). Knowledge and skills
enhancement through perioperative nursing simulation lab training.
Operating Room Nurses Association Journal of Canada, 34(2), 13-30. http://ezproxy.uky.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=116541007&site=ehost-live&scope=site
Zhang, Y., Huang, X., Xu, S., Xu, C., Feng, X., & Jing-fen, J. (2019). Can a one-on-one
mentorship program reduce the turnover rate of new graduate nurses in China? A longitudinal study.
Nurse Education in Practice,40. doi:10.1016/j.nepr.2019.08.010
Zhang, Z. Qian, Y., Wu.J., Wen, F., & Zhan, Y. (2016). The effectiveness and implementation of
mentoring program for newly graduate nurses: A systematic review.
Nurse Education Today, 37, 137-144. doi:10.1016/j.nedt.2016.11.027
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Preliminary Budget
From Moran, K., Burson, R., & Conrad, D. (2017). Appendix D:sample budget.
The DNP Scholarly Practice Scholarly Project (2nd Ed). Jones & Bartlett, pp. 219-220.
Be sure to include a narrative to help explain specifics for each category. For example-
Jane Doe
will be doing xxxx for 4 hours a week at
$
25/hour for $400/month. Explain what items are needed for start up as well as any capital costs and operational costs. If an agency is donating this expense, include it as an “in kind” donation. For revenue, consider possible income and/or potential decrease in costs- for example with increased retention, the savings in terms of finding and hiring a new employee or if increased numbers of patients are discharged earlier, how does that impact the patient flow and ability to admit more patients to the unit?
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Project Expenses |
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Salaries/Wages* |
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Individual
Jane Doe Tom Smith Feliz White Juan Rodrigez |
Monthly | $ |
Total $ $ $ $ Total |
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Start Up Costs: |
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(Itemize costs here- copies, charts, display board etc.) Total Start Up Costs |
$ |
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Capital Costs |
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Hardware Equipment Other Total Capital Costs |
$ $ $ $ Total |
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Operational Costs |
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Itemize operational costs in this section (electricity, heat, etc) |
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Total Project Expenses |
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Project Revenue** |
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Revenue Generation |
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Itemize potential revenue in this section Total Project Revenue |
$ Total |
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Program Benefit/Loss |
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Total Revenue |
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Less Expenses |
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Total Program Benefit/Loss |
*Include either actual wages if paid (if available) or median FT salary for the same position in the US. An additional 30% may be added to wages to cover benefits.
**For example, revenue obtained through billable evaluation and management codes, teaching codes, and so on. It may also include decreased costs thus increasing revenue.
Adapted from Moran, K., Burson, R, Critchett, J., & Olla, P., (2011). Exploring the cost and clinical outcomes of integrating the registered nurse certified diabetes educator in the patient centered medical home.
The Diabetes Educator, 37 (6), 780-793.
2
DNP Role Development
FINAL ASSIGNMENT
Please use the attached Timeline & Outline Project Plan with ROL Template to complete this assignment.
Please make sure to use 6-7 Articles within the last 5 years to complete the assignment. Articles must target Home-Based Patients
VERY IMPORTANT: THE NEW PICOT: Please note that the PICOT has changed DO NOT USE the one in the attached paper. Please use the following
NEW PICOT:
·
NEW PICOT Question: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?
PDF of previously used Articles are also attached
*Please note that a draft form of this assignment for faculty feedback prior to final assignment submission is required for this course.*
In week 13, your timeline and outline of your project will be due. At this point, you have been working with your faculty advisor to gather ideas and work through the specifics of your project. The purpose of this assignment is to explain your ideas to ensure you are on the right track before starting on the Timeline and Outline.
INSTRUCTIONS
1. Include your PICO(T) question. State the issue and explain why this issue is of interest. Include background information showing the need for this project.
2. Show at least some of your review of the literature (ROL) so we can get an idea of how you are synthesizing the information. The more you have the better. You should have some information from your matrix assignment in 816 that you can use here.
3. Next, briefly explain what your project is. Include where you plan to conduct your project, who you plan to collaborate with for your project (who the key participants will be to ensure the success of your project), and approximately how long your project will last. Also include sampling information, any intervention that you propose as well as the design you will be using.
4. Last, discuss what tools you plan to use for your project. If you will be using a survey to measure the results, you will need to include the name of the survey and identify the creator. If you plan on using an established teaching tool as your intervention, again you will need to identify the originator of that tool. Any established tools will need permission to use before you initiate your intervention
5. Begin to think about the budget that you will need to carry out this project.
6. These are not all the details- if you want more details- review the rubric for the document and see the template below.
7. The Review of Literature MUST be 2 Pages.
8. State why the model and design were chosen.
9. Explain the Data Analysis Software used.
10. Project requires 6-7 Articles within the last 5 years. Must target Home-Based Patients
MY INFORMATION FOR THIS PROJECT
My PICOT Question
·
PICOT Question
: Among patients requiring health care visits (P) how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)?
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