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Outcomes and Reflection

Outcomes and Reflection

My project is CLABSI prevention

Benchmark Assignment   – Comprehensive Assessment Part Two: Outcomes and Reflection

The DNP comprehensive assessment provides learners the opportunity to demonstrate their achievement of core and specialty DNP competencies. It is also an appraisal of learners’ ability to integrate and synthesize knowledge within the context of their scholarly and practice interests and their readiness to complete the DPI project. The two-part comprehensive assessment includes evaluation of work completed throughout the program and a final synthesis and self-reflection demonstrating achievement of programmatic outcomes. In Part One of the assessment, learners were required to collect and review coursework deliverables and practice immersion hours completed in the program thus far. In Part Two, learners are required to synthesize and reflect on their learning and prioritize work for their DPI project.

General Requirements:

Use the following information to ensure successful completion of the assignment:

· Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.

· This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

· You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Directions:

To complete Part Two of the DNP comprehensive assessment:

Use the information collected in the competency matrix from Comprehensive Assessment Part One to address the following prompts as directed. Each response should be 500-750 words. Your responses should concisely demonstrate synthesis of knowledge gained in the program and the relevant application of knowledge into your practice. You are further required to cite relevant and specific evidence from your coursework to demonstrate your achievement of these programmatic outcomes and corresponding competencies. Review the rubric for this assignment prior to responding to the prompts. Your responses should specifically address the competencies included on the rubric.

Outcome 1:

A DNP must integrate and apply appropriate nursing and science-based theories to evaluate and analyze health and health care phenomena and develop and implement innovative practice approaches.

In what ways have you integrated and applied nursing and science-based theories in your coursework and practice during your DNP course of study? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.

Outcome 2:

A DNP must provide the leadership to develop and implement health care and organizational policy based on regulatory and other external and internal factors and drive effective change within organizations.

In what ways have you demonstrated leadership in the development and implementation of policy or policy change and contributed to quality improvement during your DNP studies? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.

Outcome 3:

A DNP must be able use information systems to mine, analyze, and apply data for the purpose of improving information systems as well as patient and organizational outcomes.

In what ways have you successfully applied data analysis to the improvement of information systems, patient care, and organizational outcomes during your course of study? How will you apply what you have learned to your DPI project?  Cite specific evidence from your coursework and practice immersion hours in your response.

Outcome 4:

A DNP must be able to articulate and implement strategy and to advocate for the ethical and equitable deployment of care delivery models for improvement of individual, aggregate, and population health management. 

In what ways have you articulated, deployed, or advocated for such strategies in your coursework and practice immersion hours? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.

Outcome 5:

A DNP must be able to evaluate practice outcomes and use research, national benchmarks, and other relevant findings from evidence-based practice to design, direct, utilize, and evaluate quality improvement methodologies that lead to improved patient-centered care.

In what ways have you evaluated practice outcomes and participated in quality improvement initiatives in your coursework and practice immersion hours? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.

Self-Reflection:

Based on an evaluation of your learning to date, assess your readiness for undertaking your DPI project. How has what you learned in your coursework and practice immersion hours and application of learning in your practice informed your approach to your project? What do you need to revise in your 10 Strategic Points document and/or your Draft Prospectus to successfully implement your project? Reflect on your progress to this point and outline the steps necessary to successfully complete your DPI Project Proposal for the Institutional Review Board (IRB) in DNP-955.

Running head: COMPREHENSIVE ASSESSMENT PART TWO 1

COMPREHENSIVE ASSESSMENT PART TWO 15

Comprehensive Assessment Part Two: Outcomes and Reflection

Name

Instructor

Course

Date

Comprehensive Assessment Part Two: Outcomes and Reflection

Outcome 1

In this course, I have done extensive research about several nursing and science-based theories and how these theories can be applied in solving a nursing problem. The problem that needed a solution in this course was chronic non-cancer pain. In this course, I was able to demonstrate how nursing theories can be integrated into efforts to solve chronic non-cancer pain, which happens to be an old-age problem in nursing practice. In particular, I demonstrated how the biopsychosocial model of chronic pain is applied to the management of chronic non-cancer pain. The model provided a clear framework for steps that needs to be taken to manage chronic non-cancer effectively.

Of particular importance was the application of the model in determining factors that determine the speed at which one recovers from chronic non-cancer pain. Some of the factors that I described using the model included coping strategies, distress, illness, and physical dysfunction (Kaiser et al., 2013). Given the multiple factors that determine the speed of recovery from chronic non-cancer pain, it is arguable that it is not possible to manage this problem using a single intervention. The biopsychosocial model of chronic pain came in handy in describing the “cycle of pain”, given the fact that an individual develops pain due to interaction of factors such biological, psychological, and social factors (Kaiser et al., 2013). Explaining the interaction of the aforementioned factors helped in deriving sense from the fact that people who develop chronic pain are unable to engage in social and occupational activities. It also became evident that other factors such as depression and isolation contribute immensely to the exacerbation of pain symptoms.

The Biopsychosocial model of chronic pain was also useful in my course because it helped me in researching deeply on treatment of chronic non-cancer pain. By applying the model, it was possible to gain a deeper understanding of the interaction among different factors that contribute to the exacerbation of chronic non-cancer pain symptoms. Fundamentally, the model was quite useful in understanding that pain has a negative impact on emotions of an individual when it persists. Patients start developing negative beliefs about the negative effects of chronic non-cancer pain (Kaiser et al., 2013). Basing on this information, it was possible to choose pain management approaches that only relieve the pain but also change the negative beliefs that patients develop about pain.

I will apply what I have learnt from this course to my DPI project by researching about a pain management approach that takes into account the multiple factors that contribute to chronic non-cancer pain. In particular, the focus of the research will be on physical, psychological, and social factors. Work-related injuries will also form part of my research given the fact that workers tend to experience multiple stressors when they are unable to return to work due to pain. They live a stressful life when they are unable to return to work and provide for their families (Tompkins, Hobelmann, & Compton, 2017). The stress they develop takes their pain issue beyond any treatment approach that healthcare providers may decide to settle for.

Outcome 2

There are multiple ways that a DNP nurse can demonstrate leadership in a bit to influence the health policy agenda and transform the healthcare policy agenda. My journey to demonstrating leadership began at the lowest level by reviewing literature on the impact on health policies on healthcare delivery. The early stage of policy development blends well with understanding issues that plague the healthcare system, hence making it the most critical step in efforts to have influence in the organization and delivery of healthcare (Cain, 2016). As I gained more knowledge about the process of healthcare delivery, I was better placed to contribute to healthcare policy.

As a DNP-prepared nurse, it was clear in my mind that I have a role in demonstrating leadership that will ensure that the healthcare system meets quality standards of patient care. I demonstrated my leadership through development and implementation of policies that focused on promoting health outcomes of patients. I did this through leading the charging in advocating for policies that would ensure that there is a compete overhaul of the healthcare system to ensure quality healthcare delivery becomes a number one priority. Fundamentally, I demonstrated how a nurse leader can play an active role in the political arena to develop policies and regulations that will the healthcare system to achieve quality standards. During my course, I did a research about a controversial law in California and how I would demonstrate my leadership skills to find a common ground for the law.

Another way in which I demonstrated leadership was through coalition building. During this course, I demonstrated how obtaining a legislative approach can help in advancing policy agenda of a healthcare organization or the entire healthcare system. Nursing organizations are becoming increasingly popular due to the formation of coalitions. I explained how I can serve as leader of these coalitions and ensuring that these coalitions stay focused on achieving their primary objectives.

In the same vein, I demonstrated leadership by explaining how to foster collaboration in healthcare organizations in an effort to optimize patient outcomes. This is the most critical skill that I learnt from this course fostering collaboration. Collaboration is of profound importance in quality healthcare delivery because it allows the nursing leadership to work as a team to achieve the desired goals or provide quality care for patients (Arabi, Rafii, Cheraghi, & Ghiyasvandian, 2013). This course has also helped me to overcome challenges that might plague my efforts to foster collaboration in my team. Some of the challenges I have learnt to overcome include resistance to change and work-related boundaries. I have learnt that collaboration not only strengthens the relationship between interdisciplinary teams but also promotes efficiency in healthcare delivery. This plays a vital role in improving staff satisfaction and patient safety.

Policy intervention was also a critical component of this course. Through the advanced knowledge I gained from the course, I was empowered to advocate for healthcare policies that ensure patients receive healthcare in patient-centered, safe, efficient, and timely manner. Through my experience in health policy implementation, I have been better positioned to garner the support of legislators in efforts to advocate for reforms that will improve quality of service delivery.

This course was covered in a period of 45 hours and I am glad I have learnt a lot that will be of help in completing my DPI project. I will apply what I have learnt through advocating for policies that will ensure patients suffering from chronic non-cancer pain have access to quality healthcare. Fundamentally, I will discuss the due process that is required to implement healthcare policies that will be beneficial to persons with chronic non-cancer pain. I will also use the knowledge I have gained in this course to discuss how I can influence the political process in order to find a lasting solution to chronic non-cancer pain.

Outcome 3

During my course of study, I have learnt that successful application of data analysis to the improvement of information systems, patient care, and organizational outcomes is of critical importance in improving patient outcomes. I have come to learn that health care delivery involves handling large volumes of data that emanate from medical records, health surveys, billing records, and administrative enrollment among other sources of data. Thus, I have strived to apply my knowledge in data analysis in a number of areas in order to improve patient outcome. In particular, I have applied my knowledge in collecting and analyzing data for vulnerable populations. The collection of data for such populations in determining what fraction of the American population develops chronic non-cancer pain. I have also gone further to collect data on treatment approaches that are used in treating chronic non-cancer pain.

During the 45 hours of this course, I have also learnt that health information technology (HIT) is of profound importance in collection of reliable data. HIT comes in hand when healthcare providers want collect data on ethnicity, race, and nationality of patients. This data is vitally essential in health care planning given the fact that people have different healthcare issues and thus the one size fits all approach does not apply. Furthermore, my analysis of data captured when covering the course revealed that vulnerability of a population to healthcare challenges varies considerably based on the three aforementioned factors.

I have applied a wide range of data collection methods in this course, with the principal objective of collecting the most reliable data. If the data collection method is not chosen carefully, redundancy in collecting data on ethnicity, race, and nationality will remain the biggest challenge in data collection (Al-Abri, 2017). In particular, it will be practically impossible to collect data that can aid in making comparisons. Thus, I have always paid close attention to the choice of the data collection method for a project aimed at addressing a particular healthcare problem.

Furthermore, I have discovered that there are multiple limitations that come with the culture of data collection and analysis in healthcare. Traditionally, the primary goal of collecting data was not to improve quality of patient care. Rather, the sole purpose of collecting data was to analyze it and ascertain if there was compliance with state policies and regulations (Al-Abri, 2017). Another limitation I have encountered is that collection of hospital data is not quite systematic given the fact that data categories tend to vary from hospital to hospital. Furthermore, every hospital has its own way of obtaining information.

Besides the challenges I have mentioned in the preceding paragraph, I have discovered that hospitals encounter numerous challenges in their quest to collect accurate and less redundant data. Using this data for quality improvement has also proven to be a daunting task for most hospitals. During the course, I did a survey in three hospitals in my community and asked them whether they used ethnicity and race data to assess quality of care of the patient population or levels of satisfaction. The survey revealed that only one in three hospitals used data for the two purposes mentioned above. Furthermore, the survey revealed that none of the hospitals maintained a database for the data collected. Thus, it was impossible for these hospitals to track patients’ vital information over time.

I will apply what I have learned during the course to DPI project by collecting data on different approaches that hospitals use to manage chronic non-cancer pain. I will develop questionnaires to aid in collecting data that will be used in the project. The questionnaires will be designed in a way that will aid in getting views of nurses on effectiveness of data approaches to managing chronic non-cancer pain.

Outcome 4

Throughout this course, I have strived to advocate for the ethical and equitable deployment of care delivery models to ensure quality patient care. Fundamentally, I focused on establishing the relationship between ethics and implementation of change. In this regard, I explained how observing a code of ethics should be a number one priority when implementing change. I did this through discussing ethical considerations when implementing change. The most critical ethical consideration in my course was making attempts to obtain the approval of Institutional Review Board (IRB) prior to the implementation of change. It is extremely important to secure approval by IRB because the board needs to give green light before implementing change or policies that affect healthcare.

The course also covered a lot about the moral compass of nurses by focusing on the American Nurses Association (ANA) Code of Ethics. On this, it was clear that nurses play a critical role in designing life-saving care. Demonstrating ethical leadership goes beyond providing direct patient care considering the fact that it entails designing system-wide models that contribute immensely to optimal patient care. Out of the 45 hours that were allocated for this course, I used about 15 hours researching about strategies that can be employed in advocating for ethical leadership in healthcare delivery. The reason for spending this amount of time on research is because ethical leadership is of profound importance in both direct and indirect healthcare delivery (Storch et al., 2013). Furthermore, I advocated for frequent revision of the code of ethics to ensure nurses stay updated on leadership qualities.

To provide a better understanding of the relationship between ANA Code of Ethics and qualities of ethical leadership, I went further to research extensively about ethical principles of nursing. My focus was on principles such as respect for autonomy, veracity, beneficence, nonmaleficence, and justice (Storch et al., 2013). I emphasized on the aforementioned ethical principles because I believed this would go a long way in promoting ethical leadership in healthcare. Ultimately, this would translate into quality healthcare delivery and thus optimize patient outcome.

Characteristics of ethical leadership in healthcare delivery were one of my crucial takeaways from this course. I will apply these characteristics in my DPI project by demonstrating how nurses are expected to exemplify these characteristic when providing healthcare to patients. The first characteristic that I will apply in my project is courage. My project will focus on discussing on how nurses have the obligation to confront challenges that do not reflect their beliefs and values. They should not fear potential consequences of their actions as long as what they are doing is right (Storch et al., 2013). The project will provide a detailed discussion about the role of nursing leadership in promoting the moral courage to speak up when they see something is wrong somewhere. This will clearly demonstrate how nurses can remain courageous regardless of the situation they are in.

The project will also dwell on discussing the second characteristic, which is competency. Dinndorf-Hogenson (2013) asserts that patients have the right to receive care from competent nurses. This is the most critical quality that nurse leaders are expected to exemplify. My project will discuss importance of committing to lifelong learning in promoting nursing competency. Nurses become more competent when they engage in lifelong learning because they keep abreast with new findings in nursing. My project will dwell on discussing how nurses promote competency at individual level by pursuing current skills and will help them deliver quality care for patients.

Outcome 5

I participated in a quality improvement initiative by evaluating ability of a healthcare entity known as BS Dialysis Center to provide quality patient care. In my evaluation, I described the healthcare entity in details by describing its location and bed capacity. The number of years that the facility was also part of my description given the fact the number of years that a facility has been operational is a key determinant for the quality of services that a facility provides.

I evaluated practice outcomes during my coursework by describing quality outcomes and patient safety measures that BS Dialysis Center has put in place. My evaluation of the facility clearly revealed that quality service delivery is the number one priority BS Dialysis Center. It is for this reason that BS Dialysis Center remains a household name when it comes to quality service delivery. During my coursework, I stated categorically that BS Dialysis Center is one of the few dialysis centers in the whole of the United States that emphasizes on providing life-sustaining. The leadership of the facility believes life-sustaining dialysis vitally essential for patients because it not only helps in transitioning patients into a life that is free from kidney failures but also stabilize the functioning of the kidneys. BS Dialysis Center’s emphasis on quality service delivery has played a vital role in reducing the number of readmissions. The number of patients discharged in stable conditions has also increased considerably over the last couple of years. The stability of patients’ condition at the time of discharge reduces their risk of getting readmitted.

I interacted with one of the senior nurses in the facility and she had a lot of success stories to share with me. She noted that the hospital has been doing pretty well in providing treatment that is suitable for patients with acute kidney injury (AKI) as well as those with end-stage renal disease (ESRD). As part of the hospital’s commitment to provide quality patient, it strives to upgrade its facilities to ensure AKI and ESRD patients receive treatment in separate units. Patients with AKI receive treatment in a unit with equipments that stabilize functioning of the kidney while those with ESRD are placed on a life-sustaining dialysis (Duffy, 2013). During the 45 hour course, I was keen in determining the dedication that the hospital has in monitoring the progress of patients during and after treatment. From my assessment, I discovered that the hospital puts a lot of efforts in ensuring that patients are free from any eminent danger during and after treatment. The staff of the hospital ensures that safety is observed during insertion and removal of catheters. During this course, I have learnt that observing safety when inserting and removing catheters is vitally essential in preventing infections among patients undergoing dialysis.

I have no doubt in my mind that what I have learnt in this course will be quite helpful in completely my DPI project. The concept that will be of profound importance in my project will be approaches to improving patient safety in dialysis centers. My focus will be on describing how nurses can observe utmost care during insertion and removal of indwelling catheters. Doing this will play a vital role in preventing transmission of infections among patients undergoing dialysis.

Self-Reflection

Based on the evaluation I have done for this course, I have no doubt in my mind that I am prepared to complete my DPI project. What I have learnt in this course informed my approach to my DPI project because I have learnt several concepts that will be helpful in completing the project. The most important concept is the application of theoretical model to quality healthcare delivery. I have gained a more complete understanding of how to theoretical models can provide a framework for implementing change. In that sense, I will apply my knowledge in theoretical model to implement changes that will aid in improving quality of service delivery in hospitals. I believe the models will provide crucial steps that are required to complete the DPI project successfully.

I have also learnt about leadership and I believe this knowledge will come in handy when I start completing my DPI project. I will demonstrate top notch leadership by describing what is expected of a leader when implementing change in healthcare settings. Most importantly, I will be in a position to describe the roles that nurse leaders can play in the political arena to advocate for healthcare reforms. The knowledge I have gained in this course will be sufficient to explain how one can garner legislative support when there is need to pass laws and regulations that will contribute to improvement of quality of patient care.

Furthermore, the knowledge I have gained in this course will be quite helpful in data collection and analysis. My understanding of how to use SPSS in statistical analysis will be quite helpful when it comes to analyzing data for my project. I will use this software in calculating scores for different approaches that will be used in managing chronic non-cancer pain. Additionally, I will use the software to analyze speed of recovery for groups of patients subjected to various pain management approaches. Each pain management approach will have a score that will be used to determine efficiency of various pain management approaches. The knowledge I have gained in this course will also help me creating an outline of my project. I have learnt how to create a prospectus outline which I believe will be helpful in outlining everything that I intend to cover in my project. Creating an outline for my project will be quite essential in successful completion of the projection because there will be high chances that I will cover everything that I will intend to cover.

One of the areas that I need to revise in my 10 strategic points is the literature topics. I believe it is important to add at least 2 literature topics to widen the scope of research of my project. Widening the scope of research will help in researching widely about different approaches that are used in the management of chronic non-cancer pain. As I pause and look back, I believe the past three months have been a major milestone in my preparations to complete my DPI project. I believe what is remaining will just be a tip on the iceberg. What is remaining is to secure the approval of key stakeholders and from there I will be ready to proceed with my project.

References

Al-Abri, R. (2017). Managing Change in Healthcare. Oman Medical Journal22(3), 9–10.

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research19(3), 315–322.

Cain, C. L. (2016). Implementing aid in dying in California: experiences from other states indicates the need for strong implementation guidance. Policy Brief UCLA Cent Health Policy Res, 8(1), B2016-4.

Dinndorf-Hogenson, G. A. (2013). Moral courage in practice: implications for patient safety. J Nurs Regulation, 6(2), 10-16.

Duffy, J. R. (2013). Quality caring in nursing and health systems: Implications for clinicians, educators, and leaders. New York: Springer Pub.

Kaiser, U., Arnold, B., Pfingsten, M., Nagel, B., Lutz, J., & Sabatowski, R. (2013). Multidisciplinary pain management programs. Journal of Pain Research, 6(1), 355–358. http://doi.org/10.2147/JPR.S40512

Storch, J., Schick, Makaroff, K., Pauly, B., & Newton, L. (2013). Take me to my leader: the importance of ethical leadership among formal nurse leaders. Nurs Ethics20(2), 150-157.

Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Dependence, 173(1), S11-S21.

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