Each area needs to be expanded on. I need more resources. 10 per section. I have a draft. Editing and additional writing requested.

NUR901 Paper #3

 

Write a 7-10 page paper, which includes the noted information. Note this is a narrative paper and NOT to be written as a question and answer assignment. The title page and references are not included as part of page count. Use of headings required. Must use APA format.

 

The faculty will look to determine if elements from the previous assignment have been revised.

 

GROUP ASSIGNMENT

Paper #3 must be narrative

1. Burning Clinical Question/Issue
2. Introduction/Background
3. PICOT elements and research question for provider population
4. PICOT elements and research question for patient population
5. Review of literature (ROL)
6. Foundational Theory
7. Logic Model
8. Methodology and Evaluation Plan
9. Needs Assessment with Change Theory

 

 

Sections	Number of Points Possible
Burning Clinical Question/Issue Introduction/Background	28/30
PICOT elements and research question for provider population PICOT elements and research question for patient population	28/30
Review of literature (ROL)	20/30
Foundational Theory	0/50
Logic Model	0/50
Methodology and Evaluation Plan	48/50
Needs Assessment with Change Theory	50/50
Conclusion and closing remarks	10/10
Total	286/300

There is no foundational theory or logic model in this paper.

 

 

 

 

Anxiety and Depression Treatment in the Primary Care Setting

Shannon Pacheco BSN, RN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction

Mental illness has become a huge topic recently due to media portrayal of gun violence and school shootings. Suicide is also one of the top ten leading causes of death in the United States (Ivey-Stephenson, et. al, 2017). Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States ages 18 and older, or 18.1% of the population every year (Anxiety and Depression Association of America, 2018). Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment (Anxiety and Depression Association of America, 2018). Depression is one of the most common conditions seen in primary care (Heise and Servellen, 2014). People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. Often patients have poor knowledge about their anxiety and depression, as well as treatment options (John, Singh; Nagarajaiah, & Andrade, 2014). Training in depression care can positively affect the quality of patient care (Liekens, et. al, 2014).  When antidepressant medication adherence is low, patients are a risk for treatment failure and decreased quality of life (Al-Harbi, 2012). According to the Center for Disease Control (CDC) 8% of the U.S. population age 12 years or older report current depressive symptoms, while approximately 8 million ambulatory care visits result in the diagnosis of major depressive disorder per year (Centers for Disease Control, 2011; Centers for Disease Control, 2012). As a society, the burden of depression is experienced through the cost of someone’s life, decreased work productivity, and increased cost of medical care (U.S. Preventive Services Task Force, 2009).

Burning Clinical Question/Issue

Would implementation of a screening intervention for anxiety and depression in a rural primary care setting increase the number of patients treated for anxiety and depression and improve patient outcomes with the treatment of depression and anxiety in adults? Provider PICOT

P: Two primary care providers, a nurse practitioner and a physician along with their medical assistants treating patients ages 18 to 40 years in a primary care setting

I:   10 minute standardized educational evidence-based lecture including handouts about the National Institute for Health and Care Excellence quality standard of care for clinical assessment and management of depression and anxiety in adults (ages 18 and older) with the use of PHQ-9 and GAD-7 that will be lead by the student researcher

C:  Current practice of only screening patients that have stated they have depression and/ or anxiety

O: The providers compliance with performing the anxiety and depression screening on all patients that present for care as noted by a chart review

T: Three months

 

Two primary care providers, a nurse practitioner and a physician along with their medical assistants treating patients ages 18 to 40 years in a primary care setting (P) how does a  a 10 minute standardized educational evidence-based lecture including handouts about the National Institute for Health and Care Excellence quality standard of care for clinical assessment and management of depression and anxiety in adults (ages 18 and older) that will be lead by the student researcher (I) compared to the providers’ current practice of only screening patients who state they have anxiety and/or depression (C) affect the providers compliance with performing the screen all patients that present for care as noted by chart review (O) over 3 months (T)?

Patient PICOT

In a rural family health care practice with two primary care providers enforcing that

P: all patients ages 18 and over who present for care including those already diagnosed with anxiety and depression

I:  be screened for depression and anxiety using the PHQ-9 (depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day) and GAD-7 (a 7-item anxiety scale) Will all patients get both instruments? Is a particular screen done and if positive, result in the patient taking the next? If both are to be done by all patients, does this result in patient answer fatigue?

C: compared to present treatment of only patients stating they have anxiety and or depression receiving screening

O: increase the number of patient that meet the criteria to receive prescription for medication or a referral to psychiatry as noted in the assessment and treatment plan in the chart

T: Three months

In a rural family health care practice with two providers will implementing (P) all patients ages 18 and over who present for care including those already diagnosed with anxiety and depression be (I) screened for anxiety and depression using the PHQ-9 and GAD-7 C) compared to present practice of only patients that state they have anxiety and/or depression get screening (O) increase the number of patients that meet the criteria to receive medication or a referral to psychiatry as noted in the assessment and treatment plan in the chart. (T) over a three month time period?

 

Literature Review

A search of the literature was conducted using CINAHL, Cochrane Library, and PubMed. The following terms were used while performing the search: depression, anxiety, screening, program, project, primary care, implementation, nurse practitioner, and family physician. Screening for depression in primary care has been supported by the World Health Organization, the U.S. Preventive Services Task Force, and the American Academy of Family Physicians (AAFP). The AAFP and U.S. Preventive Services Task Force both recommend clinics with the capability to treat depression should screen adults 18 years and older at every visit. The 9 Question-Patient Health Questionnaire (PHQ-9) has been determined as a highly reliable, reproducible, and valid screening tool (Mitchell, Yadegarfer, Gill, & Stubbs, 2016). The PHQ-9 can also be used to measure severity of depression. In a general population, the normal cut-off score is equal to or greater than ten. At ten, the sensitivity is (.93) and the specificity is (.52) and has been established as adequate. Using a cut-off score of equal to or greater than 13 demonstrated sensitivity of (.83) and specificity of (.72). The PHQ-9 tool assesses two categories of symptoms, cognitive-affective symptoms and somatic symptoms. The Institute for Clinical Systems Improvement developed a guideline titled Adult Depression in Primary Care (Mitchell et al., 2013) to assist providers in the assessment, diagnosis, and treatment of depression.

Specific tests that providers can give to patients have assisted in the diagnosis and treatment of mental health issues. The PHQ-9 is a validated, 9-question tool to assess for the degree of depression present in an individual; the last question is not scored, but is useful functionally to help the clinician assess the impact of the patient’s symptoms on his or her life (Kroenke, Spitzer, & Williams, 2001). The seven-item Generalized Anxiety Disorder scale (GAD-7) is a validated diagnostic tool designed for use in the primary care setting (Ebell, 2008). The National Institute for Health and Care Excellence has developed a quality standard of care for clinical assessment and management of depression and anxiety in adults (ages 18 and above). Why do both? Is the reliability and validity increased?

Depression is more prevalent in vulnerable populations such as persons who live in poverty and persons who have one or more physical health problems. The likelihood of having poor mental health was higher for women than for men and for individuals whose household income levels were below $20,000 (Michigan Behavioral Risk, 2018). Suicide rates by sex, race/ethnicity, age group, and mechanism of death for the general population are higher in rural communities than in urban areas (Ivey-Stephenson, et. al, 2017). As prevention practitioners, we need to explore methods to decrease suicide rates and increase treatment and screening of anxiety and depression in the rural community. Before implementing a screening program, it is imperative to review the literature for other programs that have been both successful and found areas for growth. Machado and Tomlison (date) attempted to find programs that addressed and attempted to overcome common barriers to depression screening. Previous research has shown barriers to depression screening to include the following: lack of knowledge regarding current guidelines, lack of providers’ confidence in screening and treating depression, lack of resources to diagnosis, treat, and manage depression, and the providers’ limited time with a patient (Machado & Tomlinson, 2011),

Despite these statistics and guidelines, many providers struggle to implement depression screening. The purpose of this project was to evaluate potential changes in provider’s documentation of depression screening after implementing a provider education session and the use of a depression and anxiety screening tool. It has been shown depression screening does increase the duration of office visits by an average of six minutes if a depression screening tool was administered by a nurse and scored by a physician (Schmitt, Miller, Harrison, & Touchet, 2010).

Evidence from the literature examines on how often do providers currently screen for depression. With a goal to meet current recommendations regarding screening and to be more time efficient, Farrell et al. (2009b) looked for a means to decrease the amount of time necessary for depression screening. The authors used touch screen computer-based technology to perform screening. The authors performed initial depression screening in a rural, primary care setting using the PHQ-9 questionnaire. The authors attempted to implement the screening program with a small convenience sample of 20 participants with the average age of 44. Of these participants, 20% were found to have depression needing treatment, while 25% needed further evaluation. The authors also reported the average time required for a patient to complete the electronic depression screening to have been less than three minutes. Schmitt et al. (2010) recommended the use of the PHQ-9 screening tool due to its specificity and sensitivity.

What about reading levels? Do patients prefer paper or electronic for use?

How do providers learn best? The Cochrane Review on this must be reported in the ROL.  Every element of the PICOTs (both) must be searched in the literature.

Theoretical Integration

Foundational Theory???????

Change Theory

Deming’s Plan-Do-Study-Act (PDSA) change theory is an effective change management model for performance improvement The Model for Improvement is an application of PDSA and is an ideal cycle for continuous improvement (Langley et al., 2009). This model was chosen to integrate findings of this project into clinical practice of a primary care office. The “plan” was to improve identification of depression in a primary care setting. The “do” is implementing a screening method to all patients. “Study” will occur by chart review of patients screened for depression and anxiety.  Finally, “act” is the action of changing clinical practice to address the initial problem. How does this affect your study plan?

Methods

The method is a quasi-experimental translational research design. The first part of the planned practice change was to evaluate the current depression screening rates at a rural health clinic, which is done by performing an initial retrospective chart review. The next step includes a provider educational session regarding current depression screening rates and the planned initiation of depression screening within the clinic. The final component consists of the actual implementation of the PHQ-9 and GAD-7 screening questionnaires within the clinic.

The primary care providers will offer the questionnaires to consenting patients in their practice that fit the age requirements. Since the test will be offered to all patients, there is no bias in the selection in participants. The screening intervention will be implemented as an evidence-based project in a small primary care practice in a rural setting. Consenting adults between the years of 18 and 40 will be screened with the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder Scale. A post-screening chart audit will be conducted to collect data and analyze the outcome of screening related to treatment. Research students will do chart review of the patients that consented to screening. Using more than one person to collect the data increase its reliability. The charts will be assessed for quantity of patients diagnosed with anxiety and depression and those that are treated medically for these mental health disorders. The patients that consented to the screening will also be given a post-test of the same Patient Health Questionnaire-9 and General Anxiety Disorder to evaluate improvement or worsening in scores. The sample size is unknown at this time due to the fact it is unknown how many patients will consent to the screening and post-tests during the three month interval. Also, the study includes a final chart review, attempting to evaluate potential changes in provider’s frequency of diagnosing and documentation of depression and anxiety. The sample size must be determined prior to implementation of the study by a power analysis. Meet with Jenny LaChance to determine the sample size, variables needed to be collected as outcome data and statistical tests to be done to determine a change in the dependent variable.

Evaluation of charts to compare how many patients are usually diagnosed with depression and anxiety would also need to be completed in order to compare current practice with the new implementation of the screening procedure. Quantitative data of the number of patients diagnosed and treated will be assess along with interpretations of the data with the change in scores after medical intervention is provided to patients. Interviews with the primary care physicians and consenting patients can provide qualitative data. Interpretation of data will be done be with statistical analysis programs of Microsoft Excel and ATLAS.TI. Mixed methods include complex approaches that combine to capitalize on strengths and reduce weaknesses that stem from using a single research design. Using this approach to gather and evaluate data may assist to increase the validity and reliability of the research. Variables collected are number of patients screened before the implementation of the study, number of patients screened after the study, and satisfactory scores from patients with their recommended treatment. Both chart reviews gather data including the date of visit, gender, age, current diagnosis of depression or anxiety, current treatment for depression or anxiety, if depression or anxiety screening is documented, the depression and anxiety screening score, and if treatment or an intervention is provided. When evaluating the potential effect of implementing the PHQ-9 and GAD-7 screening tool, the chi-square test will be use to show associations.

The study aims to increase the number of individuals living in rural areas ages 18-40 that are screened in the primary care setting for depression and anxiety. The study aims to increase treatment in those who are diagnosed with depression and anxiety in the rural community that is being evaluated and also aims to improve patient scores on the depression and anxiety screening, i.e. decrease symptoms of depression and anxiety.

All participants would be protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which, among other guarantees, protects the privacy of patients’ health information (Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, 2013). Good.  Additionally, research student and practice personnel who carefully conducted this project followed the Standards of Care for practice in a primary care office.  All information collected, as part of evaluating the impact of this project will be gathered data from the project participants and will not include any potential patient identifiers.

Work Plan

The study will take place in a rural area of Michigan at Family Health Clinic. Education will be given to the primary care providers in the rural health clinic about the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale. The student researcher will provide the exact same education to the primary care providers from The National Institute for Health Care Excellence Guidelines on both anxiety and depression treatment.  See appendix A. The author assessed the need for change based on the Behavioral Health Barometer Michigan, Volume 4. In Michigan, an annual average of about 314,000 adults aged 18 or older (4.1% of all adults) in 2014–2015 had serious thoughts of suicide in the past year. In Michigan, an annual average of about 656,000 adults aged 18 or older with any mental health illness  (45.9% of all adults) actually receive mental health services.

Conclusion

Depression and anxiety are very common amongst Americans, especially those who live in rural areas. Findings from this study could justify the need to identify protective factors as part of comprehensive suicide prevention efforts, particularly in rural areas. Additional information on suicide, depression, and anxiety rates in rural areas might be used to evaluate current mental health screening efforts and determine which rural communities to prioritize when allocating public health and mental health resources. To implement a depression/anxiety screening program, clinics must be able to have a system in place to appropriately evaluate and treat a diagnosis of depression and anxiety. The depression/anxiety screening program described above discussed one potential program that may be utilized by clinics for successful screening.

 

 

 

 

Appendix A

 

Task/Month	1	2	3	4	5	6	7
Recruitment of eligible participants	X	x
Intervention; Evaluation;			X	X	X
Post-test and Analysis of outcomes				X	X	X	X
Results presented to local providers							X

Timeline

 

 

 

 

 

 

Appendix B

Logic Model

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Anxiety and Depression Association of America (2018, September 13). Retrieved from https://adaa.org/understanding-anxiety/depression

Cashman, S., Hale, J., Candib, L., Nimiroski, T. A., & Brookings, D. (2004). Applying service-learning through a community-academic partnership: depression screening at a federally funded community health center. Education Health (Abingdon), 17(3), 313-322. Doi: 10.1080/13576280400002486

Centers for Disease Control (2011). Ambulatory Medical Care Utilization Estimates for 2007. Retrieved from http://www.cdc.gov/nchs/dataS/series/sr_13/sr13_169.pdf.

Centers for Disease Control (2012). QuickStats: prevalence of current depression among

persons 12 years, by age group and sex – United States, national health and nutrition examination survey, 2007. In Morbidity and Mortality Weekly Report. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6051a7.htm?s _cid=mm6 051a7_w

Ebell, M. H. (2008). Diagnosis of anxiety disorders in primary care. American Family Physician, 78(4), 501-502.

Farrell, S. P., Mahone, I. H., Zerull, L. M., Guerlain, S., Akan, D., Hauenstein, E., & Schorling, J. (2009b). Electronic screening for mental health in rural primary care: implementation. Issues Mental Health Nursing, 30(3), 165-173. doi: 10.1080/01612840802694411

Heise, B. A., & Servellen, G. v. (2014). The nurse’s role in primary care antidepressant medication adherence. Journal of Psychosocial Nursing & Mental Health Services, 52(4), 48-57. doi:10.3928/02793695-20131126-08

Ivey-Stephenson AZ, Crosby AE, Jack SP, Haileyesus T, Kresnow-Sedacca M. Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death — United States, 2001–2015. MMWR Surveill Summ 2017;66(No. SS-18):1–16. DOI: http://dx.doi.org/10.15585/mmwr.ss6618a1

John, A. P., Singh, N. M., Nagarajaiah, & Andrade, C. (2016). Impact of an educational module in antidepressant-naive patients prescribed antidepressants for depression: Pilot, proof-of-concept, randomized controlled trial. Indian Journal of Psychiatry, 58(4), 425-431. doi:10.4103/0019-5545.196710

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16(9), 606–613. http://doi.org/10.1046/j.1525-1497.2001.016009606.x

Langley, G., Moen, R., Nolan, K., Nolan, T., Norman, C., & Provost, L. (2009). The improvement guide: A practical approach to enhancing organizational performance. San Francisco, CA: Jossey-Bass.

 

Liekens, S., Vandael, E., Roter, D., Larson, S., Smits, T., Laekeman, G., & Foulon, V. (2014). Impact of training on pharmacists’ counseling of patients starting antidepressant therapy. Patient Education & Counseling, 94(1), 110-115. doi:10.1016/j.pec.2013.09.023

Machado, R.J., & Tomlinson, V. (2011). Bridging the gab between primary care and mental health. Journal of Psychosocial Nursing, 49(11), 25-29.

Michigan Behavioral Risk Factor Surveillance System. MDCH Chronic Disease Epidemiology Section (2018, October 15, 2018) Retrieved from https://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_5279_39424—,00.htmlm

Mitchell, A., Yadegarfer, M., Gill, J., & Stubbs, B. (2016). Case finding and screening clinical utility of the Patient health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: A diagnostic meta-analysis of 40 studies. BJPsych Open, 2, 127-138. doi: 10.1192/bjpo.bp.115.001685.

Mitchell J, Trangle M, Degnan B, Gabert T, Haight B, Kessler D, Vincent S. (2013)Adult Depression in Primary Care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI). Retrieved from: https://www.icsi.org/guideli nes__more t/catalog_guidelines_and_more/catalog_guidelines/catalog_behavioral _health_guidelines/depression/

Schmitt, M. R., Miller, M. J., Harrison, D. L., & Touchet, B. K. (2010). Relationship of depression screening and physician office visit duration in a national sample. Psychiatric Services, 61(11), 1126-1131. doi: 10.1176/appi.ps.61.11.1126

U.S. Preventive Services Task Force (2009). Screening for depression in adults: U.S. preventive services task force recommendation statement. Annals of Internal Medicine, 151(11), 784-792.

 

 

 

 

 

The DNP Scholarly Project is a culmination of the knowledge gained in the DNP courses.  The project is an opportunity to demonstrate an analytical approach to programmatic, administrative, policy, or practice issues in a format that supports the synthesis, transfer, and utilization of knowledge.  This project will demonstrate identification and a plan to address a practice problem/issue through the scholarship of application or integration, rather than the scholarship of discovery associated with a PhD program of study (Boyer, 1997).  The experience is designed to put to use the knowledge and skills gained within the doctoral program in a specific practice area.  The project is chosen to make a contribution – in the workplace, the community, or in the academic arena.  As such, the DNP Scholarly Project is characterized by intensive interactions between and among faculty, students, and the community in which the DNP Scholarly Project is enacted.

 

A DNP Scholarly Project is not intended to test new models, develop new theory, or test hypotheses.

 

Type of DNP Scholarly Research Project

 

Design and evaluate an evidence-based practice improvement project in a clinical setting

 

Documentation of Student Progress

 

The student(s) and Doctoral Committee Chair and Co-chair share responsibility for all documentation of the student’s progress toward completion of the DNP Scholarly Research Project.

All DNP Scholarly Research Project Chairs will be chosen by the DNP Scholarly Research Committee within the School of Nursing, University of Michigan-Flint.

 

Student will file in the DNP Organization Blackboard shell under DNP Scholarly Research Project:

 

1. DNP Scholarly Research Project Proposal Defense Evaluation Form with committee signatures
2. DNP Scholarly Research Project Final Evaluation Form with committee signatures
3. Certificate of PEERRS Training
4. Institutional Review Board (IRB) Application and IRB Notification(s)
5. DNP Scholarly Research Project Authorship Agreement with signatures, if needed.
6. DNP Scholarly Research Project Journal of Clinical Research Hours with all hours.
7. Completed DNP Scholarly Research Project Executive Summary approved by the committee
8. Approved DNP Scholarly Research Project professional presentation (podium or poster) as approved by the committee Chair and Co-chair
9. Completion form of DNP Scholarly Research Requirements signed by student(s) and committee chair

 

DNP Scholarly Research Project Steps

 

1. Completion of NUR700 and NUR701/703.
2. Review the DNP Scholarly Research Project
3. Complete Protection of Human Subjects (PEERRS) training.
4. Work with Research faculty to hone DNP Scholarly Research Project and Working Title.
5. Work with research faculty to determine readiness for committee Chair of your DNP Scholarly Research Project C Committee chair MATCH will occur during NUR901
6. Work with Chair to determine and select co-chair of the committee.
7. Select the site and mentor of the DNP Scholarly Research Project Committee in collaboration with your Chair. The mentor is the liaison at the site when research is implemented.
8. Consult with School of Nursing statistician for appropriate evaluation of data. You may also work with another statistician.
9. Work with DNP Scholarly Research Project Committee Chair to determine proposal readiness for Approval/Defense Meeting. This will take multiple submissions to your committee chair.
10. Submit draft of DNP Scholarly Research Project Proposal to Doctoral Committee members for review and feedback. Allow three weeks for committee review.  Make recommended revisions (may require several submissions).
11. With DNP Scholarly Research Project Committee approval, determine date/time for DNP Scholarly Research Project Proposal Approval/Defense Meeting. Both the proposal and proposal PowerPoint presentation must be submitted to the DNP Scholarly Project Committee Chair and Co-chair a minimum of 21 calendar days prior to the Proposal Approval/Defense Meeting.  The DNP Scholarly Project Proposal Approval/Defense Meeting may be face-to-face or virtual.

1. Present orally with required PowerPoint presentation present your DNP Scholarly Project Proposal to your Doctoral Committee (Proposal Approval/Defense Meeting).  Once approved, the students will send the form to the committee chair. After all signatures have been obtained, the student(s) will file the Doctoral Committee approval of the DNP Scholarly Project Proposal.  The defense meeting may be face-to-face or virtual.

13. Open an IRB application. This may be done at the institution of implementation or UofM-Flint. However, all research must be reviewed by the IRB at UofM-Flint as UofM-Flint may cede to the organization of implementation. Contact the IRB person in the UM-Flint Office of Research and Sponsored Programs for assistance with filing of IRB application and determination of exempt or non-exempt status. The DNP Scholarly Project student researchers will be listed as the PI for the IRB application at UM-Flint. The student researchers will submit the IRB application to the UM-Flint IRB.  Allow 4-6 weeks for the IRB response.  Incomplete or unsatisfactory proposals may require revisions and resubmission and extended time for approval.  It is at the discretion of the UM-Flint IRB to determine if IRB approval will be ceded to the organization in which the research is implemented.  Project implementation or data collection may not begin until IRB approval is formally obtained.
14. Notify DNP Scholarly Project Committee Chair and Co-chair of the IRB status and file IRB Notification(s) of Approval in the DNP Organization Blackboard shell under the DNP Scholarly Project All members of the research team including graduate students, committee chair and co-chair must be listed on the IRB application.
15. Implement your approved project. You must provide biweekly updates, as needed, to your committee chair.
16. Evaluate and analyze data from your implementation. Confer with your statistician, your DNP Research Project Committee members and other statistical resources during this time.
17. Submit the DNP Scholarly Research Project Summary to all Doctoral Committee members for review and feedback. Must include data analysis, application to clinical practice, sustainability, and transferability. Allow 2-3 weeks for Doctoral Committee review and make recommended revisions for each revision.
18. Submit state/national/international poster or podium presentation to the DNP Scholarly Project Doctoral Committee members. Presentation may not be done until approved by DNP Scholarly Project Doctoral Committee.  After approval of the committee, submit all approved documents in the noted area of the DNP Organization shell on Blackboard.
19. Per discussion with your DNP scholarly project committee chair and co-chair, determine if the study will be written as a manuscript and submitted to a journal. All manuscripts must be approved by the chair and co-chair prior to submission. The authorship agreement must be completed and filed prior to submission of the manuscript. The committee chair reserves the right to be corresponding author for all journal submissions.
20. Complete DNP Scholarly Project Journal of Clinical Research Hours. This journal must be in the required format.  Note that this journal must be cumulative during the DNP program and must contain the required number of direct and indirect hours of research.  Submit all approved documents in the noted area.

 

DNP Scholarly Research Project Committee

 

The structure of the committee for the DNP Scholarly Project will include three individuals.  The DNP Scholarly Research MATCH Committee will assign the Chair of the committee.

The DNP Scholarly Project will be under the direction of a doctorally-prepared UM-Flint School of Nursing faculty member (Chair).  The committee structure should take into account the strengths and limitations of both the DNP student and his/her faculty Chair.

The committee structure should meet a threefold goal:  First, this is to align the DNP student with the appropriate research and/or content experts in the area of the proposed DNP Scholarly Project; second, the committee structure will support the completion of the project in a timely manner so as to support the impact of the DNP Scholarly Project on the intended clinical site/population and graduation of the student on time; and third, at least one member of the committee must be an Advanced Practice Registered Nurse (APRN) for students in the NP concentrations.

Chair:  The Chair of the DNP Scholarly Project Committee must be doctorally prepared and must be faculty in the UM-Flint School of Nursing. The graduate faculty will assign this person.

 

Co-chair:  The Co-chair of the DNP Scholarly Project Committee must be faculty within the UM-Flint School of Nursing. The Chair of the committee with graduate faculty input will determine the co-chair of the committee.

 

Mentor:  The Mentor will be a liaison within the organizational structure where the DNP Scholarly Project will be implemented.  If the project does not take place within an organization, the mentor will be someone who is a content expert on the topic of the DNP Scholarly Project.

 

All publication rights must be negotiated prior to submission of the publication rights form.

 

 

Executive Summary, Public Presentation of Project, and Manuscript for Journal

 

After completion of the implementation, the student must work closely with the Chair, Co-chair, and statistician to analyze data.

 

Upon completion of the DNP Scholarly Project implementation at the site, each student must write an executive summary for the institution.  The committee members will then provide guidance for the student to meet DNP Scholarly Project graduation requirements.

 

To meet graduation requirements, the candidate for the DNP must show mastery of translational research having completed:

• Podium or poster presentation of the DNP Scholarly Project at a state, national or international professional conference. The abstract must be approved by the committee chair prior to submission for presentation. The poster or podium abstract and presentation must be approved by both the Chair and Co-chair prior to presentation of the DNP Scholarly Project.
• Manuscript submission of results. All manuscripts must be approved by the Chair and Co-chair prior to submission. The authorship agreement must be completed and filed prior to submission of the manuscript. The committee Chair reserves the right to be corresponding author for all journal submissions.
• Submission of completed DNP Scholarly Project Journal of Clinical Research Hours which documents a minimum of 400 hours (a minimum of 50% of the clinical research hours must be direct).
• Submission of approved DNP Scholarly Project Executive Summary.

 

All required documents must be approved by the DNP Scholarly Project Doctoral Committee and placed in the DNP Organization shell on Blackboard.

 

 

 

 

 

 

Guidelines for the DNP Scholarly Research Project Proposal Approval/Defense Meeting

 

• Meeting may be face-to-face or virtual.
• The proposal must be completed and submitted to the DNP Scholarly Research Committee Chair and Co-chair at least 21 working days prior to the Defense Meeting.
• The DNP Scholarly Project Proposal Approval/Defense Meeting is a presentation of the DNP Scholarly Project proposal.  The presentation should include all elements of the Filter Model for Implementation Research as noted in this document.  PowerPoint slides must be used.
• The DNP Scholarly Project Doctoral Committee Chair will conduct the meeting.  The student, Doctoral Committee Chair, and Doctoral Committee Co-chair must attend the presentation.  The Mentor must be invited to attend.
• The defense meeting shall be scheduled at a time and place that is convenient and agreed upon by the Doctoral Committee Chair, the Doctoral Committee Co-chair, and the defending student(s).  The student(s) is/are responsible for determining a date and time with committee members.
• The Doctoral Committee Chair will advise the student when he/she/they is/are ready to set a date for the proposal meeting.
• Following the defense meeting, the Doctoral Committee Chair and Co-chair will jointly decide if the student has completed the requirements for the proposal.  The Doctoral Committee Chair will notify the student of the decision, including any necessary changes to be made in the proposal, immediately following the committee’s deliberations.  In the event that changes are to be made to the proposal, these shall be done under the direction of the Doctoral Committee Chair.
• The completed proposal and PowerPoint presentation must be submitted to the Doctoral Committee a minimum of 21 days prior to the Approval/Defense Meeting.  Failure to follow this will result in the meeting cancellation/delay. It is the responsibility to send the defense form to the committee chair.

 

Please note that no data collection or interventions related to the project can be started prior to approval by the DNP Scholarly Project Committee and designated IRB.

 

TIMELINES FOR DNP SCHOLARLY RESEARCH PROJECT COMPLETION

 

Doctoral Committee Guidelines

 

A DNP Scholarly Project is done with the advice and guidance of a committee.  The DNP Scholarly Project Committee will consist of at least one UM-Flint doctorally prepared nursing faculty who will function as Doctoral Committee Chair and at least one other UM-Flint nursing faculty who will function as a committee Co-chair.  One of the committee members must be an APRN.

Role of Doctoral Committee Chair:

 

• Mentor student throughout the preparation of the DNP Scholarly Project proposal, the project development, implementation, and evaluation process, assure IRB compliance, and the final written DNP Scholarly Project Requirements;

 

• Collaborate with student(s) to schedule Doctoral Committee meetings for Proposal

Defense Meeting;

 

• Lead the Doctoral Committee review and approval of the DNP Scholarly Project and final DNP Scholarly Project Requirements;

 

• Communicate with committee members;

 

• Provide feedback to student(s) on written drafts in a timely manner (approximately 14-21 working days);

 

• Document student(s) progress toward completion of DNP Scholarly Project requirements.

 

• Mentor School of Nursing faculty with interest in participating in DNP student’s DNP Scholarly Project.

 

Role of Doctoral Committee Co-chair:

 

• Critique drafts of the developing DNP Scholarly Project proposal;

 

• Participate in committee review and approval of the DNP Scholarly Project Proposal and Final Project Requirements

 

• Provide feedback to student(s) on written drafts in a timely manner (approximately 14-21 working days

 

• Communicate concerns to student and Doctoral Committee Chair in a timely manner;

 

 

Role of Student:

 

• Maintain consistent and effective communication with committee Chair and Co-chair; respect the Chair and Co-chair

 

• Collaborate with Doctoral Committee Chair to schedule committee meetings for proposal meeting and final DNP Scholarly Project Requirements

 

• Generate and submit all forms as required
• Submit work to the Doctoral Committee that demonstrates a high level of scholarship
• Collaborate with the Doctoral Committee Chair to refine and narrow the project topic and identify potential committee members.

 

 

DNP Scholarly Research Project Timeline/Framework

 

COMPONENTS/COURSE	OUTLINE/FRAMEWORK OF INFORMATION DATES OF WORK
What is the burning clinical question? What is the potential/actual clinical site? NUR701/703 NUR901
Note how this is a concern for this clinic/population. What guidelines must be applied? NUR701/703 NUR901
MUST HAVE TWO RESEARCH QUESTIONS: one with the providers as the population with the educational presentation as the implementation and resulting outcome noted in chart review AND one with the patient population with the implementation of the guidelines and outcomes for the patients as noted in a chart review.   Identify PICOT elements. What is/are your research question(s)? NUR701/703 NUR901
State themes associated with your review of literature. Identify research terms.  Look at all PICOT elements for both questions. MUST include at least 25 references to the literature. NUR701/703 NUR901
State foundational theory for your research. NUR701/703 NUR901
The DNP Scholarly Research MATCH Committee will MATCH the committee chair with the student research group. The chair will choose the co-chair in consultation with student(s) and faculty. NUR901
Assess the organization’s readiness for change. Include the change theory to be applied for this change of behavior. NUR701/703 NUR901
What statistical tests must be done to analyze data? What methods must be implemented to get the outcomes needed to analyze? How much will this cost? The budget must be detailed. NUR701/703 NUR901
State elements of your logic model for your research. Complete the noted logic model template. NUR701/703 NUR901
MUST BE COMPLETED AND APPROVED PRIOR TO IMPLEMENTATION OF RESEARCH NUR901 NUR902
Initiate and complete IRB application at site and UofM-Flint. UofM-Flint may cede to the institution of implementation. MUST BE COMPLETED AND APPROVED PRIOR TO IMPLEMENTATION OF RESEARCH NUR901 NUR902
State the clinical implementations for the site. NUR902
What results are noted from the statistical analysis? What statistics were used? Why? What are the outcomes? What implications can be inferred from this information? NUR902 NUR903 NUR911/913NUR912
What are the clinical implications? NUR902 NUR903 NUR911/913NUR912
How will this change continue at the clinical site? Is it financial sustainable? Will the providers continue to implement this change? Explain. Will the proposed model for the project be transferable to other clinical sites? NUR902 NUR903 NUR911/913NUR912
Write a 3-5 page summary for the organization and present to key stakeholders NUR902 NUR903 NUR911/913NUR912
What are the plans for podium or poster presentation? Include the presentation. NUR902 NUR903 NUR911/913NUR912
What journal? Manuscript completed in journal format and approved by chair and co-chair. As negotiated with committee chair and co-chair.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DNP Scholarly Research Project Proposal and Defense

 

PROCEDURE:  DNP Scholarly Research Project Proposal Defense

 

1. At the doctoral level, you are honing your skills for analysis, synthesis, and evaluation (Bloom’s Taxonomy). All research papers are more than reports.  They are a professional paper in which you are convincing the reader that your research is important using evidence from the literature.  This is evidence-based research.

 

2. Your research must have two research questions: one with practitioners as the population of interest and one with patients as the population of interest.  In translational research, the comparison is present practice.  The time is relatively short – often 2-4 months for implementation.

 

3. The literature review is a review of research, which confirms the importance of your research. The narrative should be presented in themes rather than reporting a list of research studies/articles.  Each review of literature must contain a minimum of 25 articles.

 

4. Foundational theory: the student needs to associate selected key assumptions/constructs of the theory with the research.  It is not enough to report the theory.  Associate the theory with the research to convince the reader it is a good fit to guide the project.

 

5. The change theory should discuss how the elements of the theory would change the behavior of practitioners to improve care based on evidence and is done with the organizational assessment. It is not enough to report the theory. Associate the theory with the research to convince the reader it is a good fit to guide the project.

 

6. A good introduction and conclusion are the first and last chance the writer has to convince the reader of the importance of the research. Use these wisely.

 

7. Use the elements of the Filter Model for Implementation Science as an outline for your research. You need to make an outline prior to writing a comprehensive, cohesive narrative paper.

 

8. Review drafts of the DNP Scholarly Project

 

9. Submit a written draft of the DNP Scholarly Project Proposal to the Doctoral Committee Chair and Co-chair for review. Amend report as recommended by the committee Chair and Co-chair.

 

10. Collaborate with the Doctoral Committee Chair to schedule the DNP Scholarly Project Proposal Defense Meeting. The student, Doctoral Committee Chair, and Co-chair are required to attend the DNP Scholarly Project Proposal Defense Meeting.  The committee Mentor shall be invited to attend the meeting.  These meetings may not be scheduled during the first two weeks of a semester or the last two weeks of the semester.

 

11. Submit final draft of the DNP Scholarly Project Proposal Paper and PowerPoint to committee members at least 21 calendar days prior to the scheduled approval/defense meeting.

 

12. Be prepared to discuss the entire DNP Scholarly Project As the doctoral student, you are expected to have a high level of knowledge about your topic.

 

13. Doctoral Committee members according to the DNP Scholarly Project Proposal Evaluation will evaluate the proposal defense.

 

14. Following the student presentation, the Doctoral Committee will provide verbal and written feedback and recommendations to the student(s) regarding the defense. At completion of the proposal Defense Meeting, the committee Chair will summarize the major points raised by the committee and solicit recommendations.

 

15. The Doctoral Committee may choose:
16. Approve the proposal.

Doctoral Committee Chair will file approval of the DNP Scholarly Project Proposal on behalf of the Doctoral Committee.

 

1. b. Conditionally approve with minor revisions and no re-review.

The student will file a final/revised project proposal to the Doctoral Committee Chair within one month of the proposal Defense Meeting.

 

1. c. Require minor or major revisions and re-review.

Revisions required:  The student must develop a significantly revised proposal.  The Doctoral Committee Chair will work with the student on the revisions.  The committee will review the new proposal and all prior steps will be repeated.

 

1. Reject the proposal.

The student must develop a new proposal.  The Doctoral Committee Chair will work with the candidate on the revisions.  The Doctoral Committee will review the new proposal and all prior steps will be repeated.

 

Protection of Human Subjects

 

It is the responsibility of the student to seek guidance from the Doctoral Committee Chair regarding the IRB procedures for the DNP Scholarly Project.  The IRB application is submitted to the IRB ONLY AFTER the successful defense of the proposal. The DNP student(s) must be listed as PI(s). The Chair and Co-chair must be listed as members of the research team.  All research team members who participate in the implementation phase must be PEERRS certified by the University of Michigan Office of Research and Sponsored Programs. The University of Michigan initiated a new policy 7/18 to determine if study is exempt. This form must be completed.

 

 

 

PROCEDURE:  IRB Approval

 

• Contact representative in the Office of Research and Sponsored Programs at UM-Flint for assistance with filing of IRB application. If the organization at which implementation occurs has an IRB, the students must consult and follow all guidelines of the institution. UofM-Flint requires all students and faculty to file an IRB application and discuss with UofM-Flint research representative.

 

• Submit IRB application to the UM-Flint IRB and allow four weeks for the IRB response. Incomplete or unsatisfactory proposals may require revisions and resubmission and extended time for approval.  Project implementation or data collection may not begin until IRB approval is formally obtained.

 

• Allow four weeks for a response from the IRB regarding DNP Scholarly Project proposals submitted for review.

 

• Notify Doctoral Committee Chair of the IRB application approval and submit IRB Notification(s) of Approval in the DNP Organization shell on Blackboard.

 

 

 

 

 

 

 

 

 

 

 

 

 

Filter Model for Implementation Science

 

Appendix G

OUTLINE FOR DNP SCHOLARLY RESEARCH PROJECT

 

TABLE OF CONTENTS

Page No.

 

 

Abstract …………………………………………………………………………………………………………………..

 

PART 1

Background and Introduction to Burning Clinical Question …………………………………………..

 

PART 2

 

PICOT elements……………………………………………………………………………..

 

Research Question for Provider……………………………………………………………………………………

 

PICOT elements……………………………………………………………………………..

 

Research Question for Patient Population ………………………………………………….

 

Review of Literature…………………………………………………………………………………………………..

 

Foundational Theory…………………………………………………………………………………………………..

 

Logic Model…………………………………………………………………………………

 

PART 3

 

Study Preparation and Implementation……………………………………………………….

 

Methodology and Evaluation Plan……………………………………………………………

 

Needs Assessment with change theory………………………………………………………

 

Ethics and Human Subjects Protection……………………………………………………….

 

PART 4

 

Implementation……………………………………………………………………………….

 

Timeline/Work Plan….……………………………………………………………………….

 

PART 5

 

Actions and Results ………………………………………………………………………….

 

Data Analysis……………………………………………………………………………….

 

Application to Clinical Practice……………………………………………………………….

Transferability

Sustainability

 

PART 6

 

Dissemination

 

Executive Summary………………………………………………………………………….

 

PowerPoint for Podium Presentation……………………………………………………….

 

Poster for Public Presentation……………………………………………………………….

 

Manuscript………………………………………………………………………………….

 

Conclusion………………………………………………………………………………….

 

 

 

 

References (Must have a minimum of 25 references from the literature) ………………………….

 

Appendices

 

Logic Model

 

Budget

 

Timeline/Work Plan

 

All instruments used for this study

 

Educational presentation for providers

 

Education presentation for patients

 

Proposal PowerPoint

 

Final Public presentation PowerPoint

 

Final Public presentation Poster

 

Manuscript

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX H

Revised Standards for Quality Improvement Reporting Excellence 

SQUIRE 2.0

Notes to Authors
·         The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare. ·         The SQUIRE guidelines are intended for reports that describe system level work to improve the quality, safety, and value of healthcare, and used methods to establish that observed outcomes were due to the intervention(s). ·         A range of approaches exists for improving healthcare.  SQUIRE may be adapted for reporting any of these. ·         Authors should consider every SQUIRE item, but it may be inappropriate or unnecessary to include every SQUIRE element in a particular manuscript. ·         The SQUIRE Glossary contains definitions of many of the key words in SQUIRE. ·         The Explanation and Elaboration document provides specific examples of well-written SQUIRE items, and an in-depth explanation of each item. ·         Please cite SQUIRE when it is used to write a manuscript.
Title and Abstract
1.  Title	Indicate that the manuscript concerns an initiative to improve healthcare (broadly defined to include the quality, safety, effectiveness, patient-centeredness, timeliness, cost, efficiency, and equity of healthcare)
2.  Abstract	a.  Provide adequate information to aid in searching and indexing b.  Summarize all key information from various sections of the text using the abstract format of the intended publication or a structured summary such as: background, local problem, methods, interventions, results, conclusions
Introduction	Why did you start?
3. Problem Description	Nature and significance of the local problem
4. Available Knowledge	Summary of what is currently known about the problem, including relevant previous studies
5. Rationale	Informal or formal frameworks, models, concepts, and/or theories used to explain the problem, any reasons or assumptions that were used to develop the intervention(s), and reasons why the intervention(s) was expected to work
6. Specific Aims	Purpose of the project and of this report
Methods	What did you do?
7. Context	Contextual elements considered important at the outset of introducing the intervention(s)
8. Intervention(s)	a.  Description of the intervention(s) in sufficient detail that others could reproduce it b.  Specifics of the team involved in the work
9. Study of the Intervention(s)	a.  Approach chosen for assessing the impact of the intervention(s) b.  Approach used to establish whether the observed outcomes were due to the intervention(s)
10. Measures	a.  Measures chosen for studying processes and outcomes of the intervention(s), including rationale for choosing them, their operational definitions, and their validity and reliability b.  Description of the approach to the ongoing assessment of contextual elements that contributed to the success, failure, efficiency, and cost c.  Methods employed for assessing completeness and accuracy of data
11. Analysis	a.  Qualitative and quantitative methods used to draw inferences from the data b.  Methods for understanding variation within the data, including the effects of time as a variable
12. Ethical Considerations	Ethical aspects of implementing and studying the intervention(s) and how they were addressed, including, but not limited to, formal ethics review and potential conflict(s) of interest
Results	What did you find?
13. Results	a.  Initial steps of the intervention(s) and their evolution over time (e.g., time-line diagram, flow chart, or table), including modifications made to the intervention during the project b.  Details of the process measures and outcome c.  Contextual elements that interacted with the intervention(s) d.  Observed associations between outcomes, interventions, and relevant contextual elements e.  Unintended consequences such as unexpected benefits, problems, failures, or costs associated with the intervention(s). f.  Details about missing data
Discussion	What does it mean?
14. Summary	a.  Key findings, including relevance to the rationale and specific aims b.  Particular strengths of the project
15. Interpretation	a.  Nature of the association between the intervention(s) and the outcomes b.  Comparison of results with findings from other publications c.  Impact of the project on people and systems d.  Reasons for any differences between observed and anticipated outcomes, including the influence of context e.  Costs and strategic trade-offs, including opportunity costs
16. Limitations	a.  Limits to the generalizability of the work b.  Factors that might have limited internal validity such as confounding, bias, or imprecision in the design, methods, measurement, or analysis c.  Efforts made to minimize and adjust for limitations
17. Conclusions	a.  Usefulness of the work b.  Sustainability c.  Potential for spread to other contexts d.  Implications for practice and for further study in the field e.  Suggested next steps
Other Information
18. Funding	Sources of funding that supported this work. Role, if any, of the funding organization in the design, implementation, interpretation, and reporting

 

http://www.squire-statement.org/index.cfm?fuseaction=Page.ViewPage&pageId=471, 2018