DNP Assessment

DNP Assessment: A Self-Reflective Overview
Q1: Integration and Application
In terms of the direct application of what I have learned over the course of my DNP studies, I feel I have grown in my ability to systematically apply nursing theory to my everyday practice. A good example of this is the concept of self-care. Like many nurses, encouraging patient self-care has been a priority, given there is a limited extent to which patients, even patients with chronic illnesses, can be maintained within a hospital setting. Orem’s self-care deficit theory suggests that nurses should intervene to rectify self-care deficits of patients when and if needed. This may be as minor as reinforcing wellness patterns for the young and healthy, as well as providing direct assistance to individuals who need medical care. Evidence-based research suggests that using Orem’s theory enhances clinical performance due to its clarity and wide applicability and also enhances patient empowerment and satisfaction. (Malekzadeh, Amouzeshi, & Mazlom, 2018). Evidence-based research provides support for why something works, how it works, and enables me as a nursing leader to make a case for using such theories in a meaningful and operational way to administrators. Changes are costly and inevitably cause disruptions in routines and standard operating procedures, and without outside support that changes will generate quality improvements, there will be greater institutional resistance.
Q2: Leadership
Although there is a greater demand for nurses within the healthcare system than ever before, there are also concerns that nurses are being increasingly overburdened with high patient loads and long shifts. When the organization is experiencing a shortage, the temptation is unfortunately to hope that nurses will be so motivated to help patients that they will ignore physical fatigue and even the fairness owned to them as employees. Once again, evidence-based research can serve to protect nurses against potentially abusive and unwise actions by employers. There is strong evidence-based research linking excessive numbers of patients with increased rates of nursing burnout and errors, particularly given the “growing concern over a caregiver shortage occurring, due to population increases, chronic disease growth, and increased life expectancies” in the U.S. (Hall, et al., 2016, p.3). Through the use of systematic reviews and research evidence, nursing leaders such as myself can make a far better case explaining the risks of overwhelming nurses as a risk to patients and institutional reputations.
DNPs can also provide support, again using evidence-based research, for widening the scope of practice of advance-level prepared nurses. Allowing APRNs to practice to the full extent the law allows has not been shown to negatively impact patient care and can generate cost savings for the institution. There is often resistance to allowing APRNs to do so. Once again as a nursing leader I have acted as an advocate for greater liberalization on an institutional level for independent practice (Joseph & Huber, 2015). Nursing leaders must communicate the unique value that nurses can provide, with their individualized, patient-centric perspective.
I have also been an advocate for greater leadership training and continuing education for all nurses on an institutional level, so that education and training meets the needs of the contemporary healthcare system. “The challenge for clinical leadership is how to structure the knowledge, skills, and abilities required so that nurses are positioned to step into roles that are needed, yet, for which there may not yet be formal jobs” (Joseph & Huber, 2015, par.2).
Q3: Information Systems
It is often said that what cannot be measured cannot be improved. Keeping track of benchmarks such as medical errors, “inpatient mortality…utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality,” as well as specific diseases, including hospital-associated bacterial infections is vital to ensure that an institution can measure itself against comparable institutions = (“Inpatient Quality Indicators Overview,” 2018, par.1). Even if an institution such as ours does not fall below accepted quality indicators, it is important to set higher benchmarks.
As a result, keeping track of in-house data while also comparing available data with other online databases, such as the Agency for Healthcare Research and Quality, requires a comprehensive data warehouse system as well as functional, high-speed internet (“Inpatient Quality Indicators Overview,” 2018). Implementing an electronic medical records system which ensures that all patient data is current and easily available increases patient safety by ensuring preexisting conditions, allergies, and medications are available at a moment’s touch of a button. But it is also important that employees are well-trained to utilize such systems in an effective manner. Some healthcare providers are resistant to using technology, particularly administrative technology, and appropriate training is required to overcome change resistance.
Q4. Population Management
Although certain general principles apply to all population groups, population-specific care is needed in many instances. Many common illnesses affect certain population groups more than others. Even widespread chronic illnesses such as obesity, heart disease, and hypertension may exhibit different patterns within population groups. Part of offering equitable healthcare is operating with this awareness, and ensuring that resources are allocated in an appropriate manner. Providers must be aware of the fact that socioeconomic disadvantages can impede access to healthcare, limiting patients’ access to insurance and the ability to lead a lifestyle that supports wellness. Again, keeping adequate data about the population the institution serves is useful. It is also important for providers to keep abreast of the latest evidence-based research on this issue in peer-reviewed literature, as I have striven to do so as a caregiver and also in preparation for researching my own project.
Q5. National Benchmarks
Grappling with the need to improve patient health to resist national trends which tend to reinforce ill-health is one of the greatest challenges of any practitioners. It is necessary to set reasonable goals, but still strive to exceed current trends which still suggest that today’s generation may have poorer health than previous generations, despite improvements in technology. There are also concerns about ensuring there are adequate nurses and primary care providers to meet current needs. These are larger trends over which an institution cannot have full control, but it is important to establish policies to resist negative trends in a positive way, including supporting continued graduate education for nurses to meet the deficit of primary care providers as ARNPs.
Self-Reflection
I feel well-prepared in pursing my DNP to link my project to specific, desired practice outcomes in my workplace, given the extent to which I have grown more comfortable with theoretical research and applying theory to practice. Given that I am likely to focus more on descriptive research than conducting an experiment, I anticipate my research will pass an Institutional Review Board (IRB). I still must better structure my proposal in an experimental format, to ensure I can isolate the variables I am testing. My first area of proposed research is to explore how nursing burnout and stress can contribute to poorer patient outcomes; I then hope to use the descriptive data to suggest positive solutions to reduce these variables, if I can demonstrate a link consistent with previous evidence-based research in my field.



References
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O'Connor, D. B. (2016). Healthcare staff
wellbeing, burnout, and patient safety: A systematic review. PloS One, 11(7), e0159015. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938539/pdf/pone.0159015.pdf
Inpatient quality indicators overview. (2018). Agency for Healthcare Research and Quality.
Retrieved from: https://www.qualityindicators.ahrq.gov/modules/iqi_overview.aspx
Joseph, M. L., & Huber, D. L. (2015). Clinical leadership development and education for nurses:
Prospects and opportunities. Journal of Healthcare Leadership, 7, 55-64. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740995/
Malekzadeh, J., Amouzeshi, Z., & Mazlom, S. R. (2018). A quasi-experimental study of the
effect of teaching Orem's self-care model on nursing students' clinical performance and patient satisfaction. Nursing Open, 5(3), 370-375. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056447/