It is important to note that learners need to be able to demonstrate their achievement of core and specialty Doctor of Nursing Practice (DNP) competencies. The overall integration and synthesis of the acquired knowledge will be presented through the academic and practical readiness to complete the DPI project. The outcome and reflection will be closely related to the DPI topic’s research question. The research question is as follows: For adult patients with hypertension seeking care at an outpatient clinic in New York State, will the implementation of the United States Department of Health’s “Physical Activity Guidelines for Americans. 2nd Edition. Chapter 4: Active Adults” used in conjunction with current practice impact the systolic and diastolic blood pressures over eight weeks (U.S. Department of Health and Human Services, 2018)?
Outcome 1: Application of Appropriate Nursing and Science-based Theories (Competencies 1.2 and 1.3)
The learner demonstrated the competencies of 1.2 and 1.3 by applying appropriate nursing and science-based theories. Competency 1.2 was shown by determining the nature and significance of health and health care delivery phenomena. The acquisition of key knowledge was conducted during the DNP-815A, where the learner reflected on information gained from themes for the class. The relevant concepts and theories included language and theories of informatics, health care technologies such as electronic health records (EHR), computer provider order entry (CPOE), systems, and clinical decision support systems (CDSS) (Title III-D Highest Tier EBPs, 2020).
Other concepts included database design, data mining, telehealth, and current trends in informatics (Committee on Quality of Health Care in America, & Institute of Medicine, 2001). The DNP-805 allowed the learner to analyze ‘health’ from the patient’s perspective, including technology and health literacy (Health People, 2020). For example, the learner identified a specific focus of patient practice (home health care patients) (Center for Medicare & Medicaid Services, 2020). She selected a disease process (hypertension) with a full description of a technology element (telehealth technology) that could be utilized in providing care to a patient with the selected disease process.
Moreover, during the DNP-820A, the learner participated in a multidisciplinary team that planned medical missions executed in five different underserved rural communities in Imo State, Nigeria, by the David Omenukor Foundation (Rural Health Information Hub, 2020; David Omenukor Foundation, 2018). Participating in such endeavors helps strengthen the DNP-prepared nurse’s knowledge and expertise in interprofessional collaboration. In order to properly apply critical nursing and science-based theories, the learner provided an 18-page synthesis of related current literature and evidence required to conceptualize the DPI project. For instance, the application was most evident and conclusive during DNP-815A, where the learner wrote a paper on telehealth technology that can be used in the learner’s current practice. The paper included a precis and mind map, critiquing existing implementation strategies and identified technologies (Curley, 2020). The acquired knowledge of telemedicine was shown during a PowerPoint presentation for administrators and nurses providing direct patient care. The novice to expert theory and the Empowerment Informatics Framework were utilized as frameworks for intervention, which will be applied in the DPI Project (Butts & Rich, 2018). The learner identified diabetes as the clinical problem, and telemedicine and telehealth technology was identified as the technology to improve health outcomes.
It should be noted that competency 1.3 was demonstrated by the learner’s ability to employ science-based theories and concepts to describe the actions and advanced strategies to enhance, alleviate, and facilitate health and health care delivery phenomena as appropriate. In order to be able to use science-based theories and concepts for action properly, the learner acquired the knowledge under the DNP-815A. The learner utilized the reflective journal to focus on the worldview and foundations of nursing science, nursing theory-guided practice, middle-range theories, ethical theories, biophysical and psychosocial theories, organization and system theories, and science-based theories. The case report was created to highlight the relationship-based care (RBC) model’s use as a framework to facilitate effective care coordination in home health patients. The knowledge was turned into the actions and advanced strategies of the case report and DNP-820A. For the latter, ten strategic points were drafted for the learner’s intended DPI project, where feedback was incorporated as well.
Outcome 2: Development and Implementation of Healthcare and Organizational Policy (Competencies 2.1, 2.2, 2.3, 2.4)
The competencies 2.1, 2.2, 2.3, and 2.4 demonstrated the learner’s ability to develop and implement a healthcare and organizational policy. Competency 2.1 was demonstrated by employing principles of business, finance, economics, and health policy to develop and implement effective plans for practice-level or system-wide practice initiatives that will improve the quality of health care delivery. Under the DNP-810A, the learner utilized the family health history (FHH) tool to evaluate the risks of genetic disorders in my family (Center for Disease Control and Prevention, 2018). The learner presented this through the current role as an advanced registered nurse practitioner with a practice or a nurse executive overseeing nursing practice in an organization. In the case of DNP-820A, the learned created a case report on one of the biggest challenges that face the healthcare industry, such as medical errors, in older adult patients’ in-home health care.
Furthermore, competency 2.2 allowed the learner to demonstrate leadership, influence, and advocacy in developing and implementing institutional, local, state, federal, or international health policy. Under the DNP-825A, the learner reflected on the concepts such as equity, ethics in health care, application of public health concepts in practice, and building of culturally diverse health care systems (Curley, 2020). The learner successfully explained how the DNP-prepared nurse, as a leader, can make a positive impact through policy or advocacy and how the leader can create a new community-based health program. With the help of DNP-820A, The AGREE II instrument was identified, and the “Pressure Ulcer Practice Guideline” was chosen for this assignment (Curley, 2020). The learner applied evidence-based practice and research findings to improve practice guidelines and healthcare outcomes using a systematically validated appraisal tool.
Subsequently, competency 2.3 was demonstrated by the learner’s ability to employ consultative and leadership skills to lead interprofessional and interprofessional teams in analyzing and resolving complex practice and organizational issues. The objective was to create change in health care and complex healthcare delivery systems. The DNP-815A allowed the learner to select and critically appraise 15 empirical articles published within the last five years that relate to the PICOT question described above. In addition, the learner provided an 18-page synthesis of related current literature and evidence required to conceptualize the learner’s DPI project under the DNP-820A. Thus, the learner used leadership skills to lead intraprofessional and interprofessional teams to analyze and resolve complex issues.
Competency 2.4 was shown by the learner’s provision of leadership in evaluating and resolving policy, ethical, and legal issues within health care systems. The learner set the focus of the reflective journal on advanced nursing practice and interprofessional care delivery models that center on contemporary nursing science and are feasible within current organizational, political, cultural, and economic viewpoints. The expectations of the DNP learner as future leaders were additionally reflected on through the DNP-840A. The evaluative element was evident when examining key concepts behind database design and the use of standardized languages (Butts & Rich, 2018). The learner described clinical scenarios where re-purposing data is useful in increasing patient safety and quality outcomes, which will be used in the DPI Project.
Outcome 3: Utilization of Information Systems Analyze and Apply Data (Competencies 3.1, 3.2, 3.3, and 3.4)
The competencies 3.1, 3.2, 3.3, and 3.4 were demonstrated through the learner’s ability to utilize information systems for analysis and data application. The utilization and analysis were highlighted through the DNP-805A. The learner identified a clinical problem involving a specific medication (insulin) and designed a Clinical Decision Support Systems (CDSS). The learn additionally utilized a Computer Provider Order Entry (CPOE) system embedded in an Electronic Health Records (EHR) that can help address the identified clinical problem. The key concept behind database design and the use of standardized languages were examined to describe clinical scenarios where re-purposing data can be useful in increasing patient safety and quality outcomes. The data application, as evidenced by the learner’s competence in identifying a specific focus of patient practice (home health care patients), selected a particular disease process (hypertension). The learner described a technology element (telehealth technology) that could be utilized in providing care to a patient with the selected disease process. The concept of health was assessed from the patient’s perspective, including technology and health literacy.
Competency 3.2 was strongly shown by the learner’s ability to evaluate current consumer health information sources for accuracy, timeliness, and appropriateness. Under the DNP-820A, the learner applied the AGREE II instrument to improve practice guidelines and healthcare outcomes (Butts & Rich, 2018). The DNP-810A allowed the learner to demonstrate, evaluate, and assess elements of the user-technology interface and the impact of those elements on workflow. The discussion focused on selecting a specific patient population and selecting one application or technology that could effectively increase patient engagement and patient outcomes. The electronic health record or EHR was selected for the student’s future practice area or work focus. The learner assessed the impact of the aging population and client demand on expenditures and resources (National Council on Aging, n.d.a). The proposed methods will be utilized in the DPI Project in order to ensure the use of evidence-based data sources on innovative approaches to care for the aging.
The learner’s competency 3.3 can be seen through the conducted analysis and communication of critical elements necessary to the selection, use, and evaluation of health information systems and patient care technology. For the DNP-810A, the learner created a case report on a genetic disorder she has encountered in practice, experience, or personal/family experience (Genetic Alliance, n.d.; Center for Disease Control and Prevention, n.d.). It was done by highlighting any guidelines and reasons behind the U. S. Food and Drug Administration (FDA) regulations for introducing new pharmaceutical agents for the disease, and thus Acute Lymphoblastic Leukemia (ALL) was identified. Subsequently, a description of whether the chromosomal analysis is indicated in ALL was provided (National Academy of Sciences, 2019). ALL was detailed in terms of its origin regarding whether this disorder is a single gene inheritance or a multifactorial inheritance disorder and considerations for practice and patient education.
For competency 3.4, the learner designed, selected, used, and evaluated programs that monitor care outcomes, care systems, and quality improvement, including consumer use of health care information systems. The learned assessed the impact of the aging population and client demand for new services, technologies, and drugs as it contributes to increased health care expenditures and wasted resources (Center for Disease Control and Prevention, 2017). She identified and addressed a health issue that faces older individuals, including health inequity and ethical policies, which will be addressed in the DPI Project as well.
Outcome 4: Advocate for the Ethical and Equitable Deployment of Care Delivery Models (Competencies 4.1 and 4.4)
The learner demonstrated the competencies of 4.1 and 4.4 by advocating for the ethical and equitable deployment of care delivery models. For competency 4.1, the learner analyzed epidemiological, bio-statistical, environmental, and other appropriate scientific data related to individual, aggregate, and population health. Under the DNP-825A, the learner explained the concept of descriptive epidemiology using a theoretical knowledge of a particular condition to find patterns in the distribution of data and data collection concerning disease populations. She provided a contemporary illustration of how descriptive epidemiology is applied in public health nursing. She described health disparity, how it occurs, and the factors contributing to it in an at-risk population. The latter was followed by identifying an at-risk population based on data analysis to emphasize how nursing science can impact the health risk of this population.
The interest group comprised adults 65 and older with at least one chronic condition. The learner selected a theory (the Health Belief Model [HBM]) for implementing and assessing prevention and health promotion programs for the identified at-risk population. The Chronic Disease Self-Management Program (CDSMP) was chosen as an evidence-based program that can be used to reduce health risks amongst the identified at-risk population (Center for Disease Control and Prevention, n.d.). The learner will utilize these theoretical concepts and models to enable evidence-based practices in the DPI Project.
For competency 4.4, the learner demonstrated the ability to advocate for social justice, equity, and ethical policies within all health care arenas. With the DNP-810A, the learner wrote a paper constructing a reflective analysis incorporating a personal nursing philosophy with discussions focusing on the learner’s central belief about the individual. The emphasis was put on how the learner’s worldview impacts her approach to patients and patient care and how she thinks nurse leaders might serve others in ways that promote human flourishing. In addition, under the framework of DNP-825A, the learner completed an assignment that was designed to increase the learner’s familiarity with the IRB submission process (Curley, 2020). This assignment presented a practice opportunity for the learner to create a mock GCU Quality Improvement (QI) IRB submission (Butts & Rich, 2018). It was done to ensure that the learner is aware of the QI-IRB submission process at her clinical site and to familiarize the learner with the required documents.
Moreover, the competency was further illustrated by the learner’s capability to apply quality and safety measures specific to contemporary nursing science. She identified how staffing, patient acuity, nurses’ skill mix, training and education, organizational culture, and work environment all play a role in patient safety (Curley, 2020). The learner additionally identified quality components to evaluate a healthcare program’s outcomes. Subsequently, the learner investigated a healthcare entity’s quality outcomes and patient safety measures (the learner identified home health agencies). The home health quality reporting program (HH QRP) by the CMS and the Community Aging in Place: Advancing Better Living for Elders (CAPABLE) program were identified (National Council on Aging, n.d.b). It should be noted that they are safety and quality measures/programs designed to enhance better patient health outcomes.
Outcome 5: Evaluation of Practice Outcomes and Participation in QI Initiatives (Competencies 5.2 and 5.3)
A DNP was able to provide substantive evaluations of key practice outcomes through the DNP-835A and DNP-820A. The competencies 5.2 and 5.3 allowed the learner to evaluate key practice outcomes and participation in QI initiatives. The learner demonstrated the competency of 5.2 by designing and implementing processes/strategies that evaluate practice outcomes, practice patterns, and care systems for individuals, aggregate, and populations against national benchmarks. Under the DNP-835A, the learner reflected on the strategies to ensure safety and quality health care, innovative approaches to health care, change theories, and sustainable change (Butts & Rich, 2018). The focus was on how the DNP learner could help create a culture of excellence and employ consultative skills, patient-centered care models and health care literacy, and evaluation of health care outcomes (Health People, 2020). This was the main way major quality improvement initiatives were designed.
The DNP-820A enabled the learner to select a topic from the AHRQ’s website related to the learner’s DPI project (Agency for Healthcare Research and Quality, 2017). As a result, she critically appraised any identified gaps between research findings and implemented those findings into practice. It should be noted that medication management was the selected topic (AgingInPlace, 2020). It allowed the learner to discuss how available resources found on the AHRQ website on this topic can inform the shift from research into practice.
The competency of 5.3 was shown through the learner’s capacity to design, direct, and evaluate quality improvement methodologies to promote safe, timely, effective, efficient, equitable, and patient-centered care. For the DNP-835A, the learner reviewed the Agency for Healthcare Research and Quality (AHRQ) and the IOM reports, ‘To Err Is Human’ and ‘Crossing the quality chasm’ (Institute for Healthcare Improvement, 2020). She subsequently applied quality and safety concepts to describe the knowledge of the problem or situation of focus. The health promotion model (HPM) by Nola Pender was identified to align with this intervention most closely (Butts & Rich, 2018). The learner further identified the role of health literacy in promoting quality and patient safety as the situation of focus. The learner will apply the learned knowledge in the DPI Project by systematically integrating the health promotion model with a consideration of essential elements from AHRQ and IOM reports (National Council on Aging, n.d.a). Such an approach will greatly enable the realization of competencies 5.2 and 5.3, emphasizing the criticality of utilizing relevant findings, national benchmarks, and research in evidence-based practice.
Moreover, the learner could effectively evaluate useful strategies through the demonstrated examples of activities. The latter was important to direct and design essential quality improvement methodological frameworks to ensure that the outcomes are centered around patients and that they are equitable, efficient, effective, timely, and safe. The use of a wide range of data and sources of information formed a storing basis of evidence on which the proposed measures are made. These concepts are directly translatable to the DPI Project due to their high degree of relevance and substantiality. Evaluating the existing strategies and developing and designing new and more effective ones provides a clear demonstration of the learner’s capability to adhere to the competencies.
Based on the evaluation of the overall learning to date, it can be stated that the learner is fully ready to undertake the DPI Project due to the complete mastery of all critical competencies and outcomes. The adherence to these principles was shown across a multitude of activities, exercises, reports, reflections, assessments, and analyses. The DPI Project’s approaches were primarily informed by identifying, evaluating, and implementing key theoretical concepts, such as the health promotion model. The concepts and theories selected are all relevant to the DPI Project’s research question shown above. However, some revisions might be required to the 10 Strategic Points document to ensure a successful implementation of the model within the specific setting addressed in the project. Some changes might be targeted at the practical elements of the focus under the health promotion model.
In addition, it might be useful to consult the United States Department of Health’s strategic objectives since the proposed plan relies heavily on the government’s overall effort to improve the outlined condition. The learner should consider adding more evidence supporting the strategy and the model to identify their complementary overlapping points to enhance the efficiency and effectiveness of the implementation in a clinical setting. The learner’s progress to this point was substantial due to the acquisition of a significant body of knowledge, skills, and understanding of core concepts demonstrated through a multitude of complex tasks reflected in the competencies.
The specific steps of the DPI Project will include a more detailed and in-depth evaluation of the target population under the existing frameworks in the outpatient clinic of interest. The latter needs to be followed with a more focused literature review on the unique set of issues present in the healthcare organization affecting the patients. It needs to be followed by a comprehensive, evidence-based practice development and design with the use of research, benchmarks, guidelines, and other forms of relevant information. However, it is important to note that these measures and efforts will require the learner to operate under the theoretical framework of the health promotion model. After the proposed approach has been created and refined, it will be critical to revisit the competencies and activities to ensure adherence to the desired metrics and outcomes.
The last step will be the practical implementation with the guidance of the instructors and experienced professionals. The problem of formation and preservation of cardiovascular health can be effectively solved only on the basis of an interdisciplinary approach. This requires analysis and synthesis of existing knowledge and experience in the field of medicine. In order to ensure patients’ health, it is important to use a number of standard interventions that focus on screening for health status and managing the risk of chronic non-communicable diseases. When it comes to the process itself, it will be necessary to consider methods for eliminating bad habits, observing the principles of healthy eating, creating motivation to increase physical activity, and creating appropriate conditions. The focus should be on ensuring health and well-being and optimizing prerequisites.
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