A Mixed Method Study of the Impact and Outcomes of Graduates of the CSU Northern California Consortium Doctor of Nursing Practice Program Class of 2014

In 2010, in response to a demand for advanced practice nurses to meet the burgeoning needs of the state\u27s population, the California legislature passed AB 867 which called for a pilot project to institute the Doctor of Nursing Practice program in the California State University campus system (Nava & Arambula, 2010). Two programs, one based in Southern California and the other in Northern California, opened in fall of 2012. In Northern California, Fresno State was chosen as the base campus with San Jose State University as the partner campus for the CSU Northern California Consortium of the Doctor of Nursing Practice Program. The goal of this DNP program is to produce leaders and advanced practice nurses to serve in the increasingly complex California health care system as well as produce faculty capable of teaching nursing in colleges and universities. This report describes the results of a research study undertaken by the Co-Director of the CSU Northern California Consortium of the Doctor of Nursing Practice Program (CSUNCCDNP) program from February 2015 to May 2015 that sought to understand the impact and the outcomes of the program on recent graduates from the Class of May 2014. This report will present both qualitative information and quantitative data on the impact and outcomes of the class of 2014 of the (CSUNCCDNP) program. Because the program is new in the California State University system, evaluation of the DNP program is critical to curricular and program development, and measuring program success. The California state legislature is requesting specific information that can be collected in survey form regarding where DNP graduates are working, what kinds of positions they are holding, and if their employment has changed since their graduation (Nava & Arambula, 2010)

Creating an Interactive DNP Project Repository:A Model for Change

The creation of systems that can provide bridges to information technology requires rethinking old ways of doing business. In the past, individual universities and colleges would accommodate theses and dissertations on their library sites. Some of these sites are public and can be accessed by everyone, while some require university-specific affiliation. This project aims to apply knowledge and skills related to information systems and technology. With the growth of the DNP clinical doctorate programs, and final outcome projects there is a need for specialized DNP database for a new method of data entry and retrieval for DNP’s. The creation of a resource specific to DNP students and faculty can provide easier access to evidence-based projects. Specialization of this database to help track trends and projects of DNP students from different DNP programs and can later be a source for research into the quality and outcomes of DNP final projects across the country. The purpose of this project is to develop consensus as to the valuable aspects related to the creation of a centralized electronically accessible databank for DNP final student projects. The goal is to provide a shortened pathway to get DNP final projects’ evidence-based outcomes easily accessible for people within and outside the DNP program. DNP students in programs across the country could easily access what other students have submitted as final projects, from which they could build on ideas or adapt project criteria to meet the needs of their individual settings

Hermeneutic approach to understanding the DNP degree: renewing the charisma of nursing as “caring practice”

This systems change project (SCP) began in ―real-time‖ nursing faculty consultation work in the community setting. It was in the midst of what in academic language is considered service scholarship (or the scholarship of engagement) that I began to reconsider what is meant by a ―practice-focused‖ doctorate degree in nursing. How do doctor of nursing practice (DNP) prepared nursing faculty participate in a socially just manner in health care systems changes? More importantly, what moral tenets and knowledge practices shape participation in societal and community life for DNPs? These questions are essential to the development of the DNP role in academic nursing settings, both in the educational curricular preparation of DNP students and in the actuation of the DNP role by nursing graduates who chose academic life. Questions such as these are being voiced by nursing academics across university settings. The answers to these questions surpass educational preparation. On one hand, the answers to these questions lie between the societal and professional impetus for the development of a non-research doctorate. On the other hand, answers to these sorts of questions originate in nursing‘s rich historical ancestry of women‘s caring practices and ways of knowing and being that unify caring practice and community service (i.e., activist, social reformers, healers, teachers). Ultimately, the present and past weave together to create an emerging understanding of DNP caring practice. This project takes a hermeneutic approach to change. My goal was to open up a space to ask philosophical questions about the scholarly nature of doctoral nursing practice. This SCP revealed that DNP studies unfold as a process of self-actualization as DNP students question their assumptions, values, and beliefs, and gain new understandings of nursing theory and philosophy, political, economic, and social discourses. A framework for DNP self-actualization was revealed and a potential model for DNP charism was shaped

Doctor of Nursing Practice Roles in Academia

Over 15,000 master’s and doctoral degree students in the United States were denied admission to nursing schools in 2014 because of insufficient nursing faculty. In 2016, over 64,000 undergraduate and graduate students were unable to gain admission to nursing school due to the effects of faculty shortages. This project explored the role of the Doctor of Nursing Practice (DNP)-prepared nurse in academic settings using a systematic review of the literature to determine the role of DNP-prepared nurses in academia. Souza’s systematic review model and Melnyk’s levels of evidence were used to guide the search, review, and the selection of scholarly articles published between 2005 to 2019. A chart of preferred reporting items for systematic reviews and meta-analyses chart was used to organize and select 14 articles meeting the review criteria and included in the analysis. Four themes emerged from the analysis of literature: role in academia from the dean’s and director’s perspective, DNP role as a teacher, preparation for faculty role, and leaving the faculty role. Confusion over the role of the DNP in academia was also identified as a factor affecting DNPs in academic practice settings; however, DNPprepared nurses have the clinical experience, knowledge, and skills to provide evidence-based teaching and fill the gap in practice needed in academic settings. This project may promote positive social change by raising awareness of the role of the DNP in academia to reduce the faculty shortage

Advocating for Nurse Practitioner Independent Practice

This project was an anonymous qualitative/quantitative survey of nurse practitioners in California to determine if passage of AB 890, which provides a pathway to independent practice, will result in more NPs choosing to practice independently after clinical hour requirements are met. Access to primary health care in California is projected to worsen over the next 10-15 years, particularly in rural areas, and an average of 44% of residents may be without enough access to care. Some areas in the state will be harder hit than others with Alpine, Calaveras, Glenn, and San Benito counties likely to be hardest hit by the shortage. Nurse practitioners are uniquely positioned to help alleviate these shortages, provide competent primary care and will now be able to practice independent (after requirements are met) of their physician colleagues. It is unknown how many nurse practitioners are planning to practice independently, however. This project sheds light on this question and explores current nurse practitioner’s thoughts on whether their doctorly prepared nurse practitioner colleagues should be required to complete fewer hours than masters prepared nurse practitioners prior to attaining independent status. An anonymous opt-in survey was emailed to the membership of the California Association for Nurse Practitioners (CANP). Responses were confidential with no identifying information collected. Out of 22 respondents, 86% indicated they are interested in pursuing independent practice. Reasons for not pursuing independent practice include being satisfied with current practice authority. 74% of respondents believed DNP prepared NPs should have the same number of hours required for independent practice, 26% believed DNP prepared NPs should have fewer required hours for independent practice. This study demonstrated that most NPs are interested in pursuing independent practice which could help reduce the number of patients who lack primary care providers and revealed that many NPs would like to practice in areas where the need is greatest. Lastly, results showed most NPs believe the same number of clinical hours should be required for independent status, regardless of educational preparation

Exploring the Attitudes Toward Interprofessional Practice: Eastern North Carolina Perspectives

Interprofessional health care delivery has the potential to greatly impact the experience, costs, and outcomes of health care. Primary care providers have the capacity to be the tipping point of this change. Primary care providers’ attitudes toward interprofessional care may bolster or impede implementation of the concept. The purpose of this study was to ascertain the attitudes toward interprofessional practice as self-reported by primary care providers in eastern North Carolina (NC). The Attitudes Toward Health Care Teams Scale (ATHCTS), a validated 21-item scale, was used to explore providers’ attitudes toward intentional team-based collaborative practice within a large health system in eastern NC. Providers included physicians, physicians’ assistants and nurse practitioners. Cronbach’s alpha for the 21-item scale was calculated at .877. A Kruskal-Wallis test was used to examine a between groups analysis of the mean scores, finding no significant difference between the mean scores of the three professional groups. The findings of the nonparametric, cross-observational, quantitative study are discussed in this report. Further exploration of the attitudes of larger numbers of primary care providers is indicated.D.N.P

Does Use of a Mobile App and Telephone Support Promote Improved Self-Care of Heart Failure?

Background Heart failure is a complex disease and a growing global epidemic. Symptoms and multiple comorbidities contribute to the overwhelming burden of heart failure, and support people make an important contribution to self-care. Effective self-care maintenance behaviors along with confidence and support can help people living with heart failure to effectively self-manage the disease. Purpose This project aimed to determine if use of a mobile app with telephone support calls was an effective intervention to promote improved self-care of heart failure and caregiver contribution to self-care of heart failure compared to the standard of care where the intervention was not used. Methods This project used a quantitative quasi-experimental pretest-posttest design with a non-equivalent control group. Participants included people with heart failure and support people. The pretest and posttest were conducted to measure the effectiveness of a 90-day intervention compared to the standard of care. The evidence-based 90-day intervention, used a mobile app to track daily weight and heart failure symptoms with structured telephone support calls, aimed to improve self-care of and caregiver contribution to self-care of heart failure. This project was guided by the situation-specific theory of heart failure self-care. Results Thirty-five people completed the 90-day project period. While the small sample size and non-normally distributed variables likely contributed to a lack of significant results comparing the intervention to the standard of care, results within groups were interesting. Control group participants (n = 17) made no significant improvements from pretest to posttest in self-care maintenance, management, or confidence. However, intervention group participants (n = 18) made significant improvements from pretest to posttest in self-care management, t(10) = -2.031, p = 0.035, and confidence, t(17) = -3.766, p = 0.001. Examining the level of use of the app in intervention group households, participants in low-level use households (n = 10) made significant improvement from pretest to posttest in self-care confidence, z = -2.214, p = 0.018, while participants in high-level use households (n = 8) made significant improvements from pretest to posttest in self-care management, z = -1.826, p = 0.034, and confidence, z = -2.214, p = 0.014. Conclusions The intervention resulted in significantly improved self-care management and confidence for intervention group participants and improvement above adequate (70%) in self-care maintenance, management, and confidence for high-level users of the app. The results of this project validated the theory and the literature on evidence-based interventions to promote heart failure self-care. This intervention could be applied in practice as part of an individualized care plan to promote self-care of heart failure and caregiver contribution to self-care of heart failure

Improving EMR Competency in First Year Nursing Students

Abstract Purpose: Competency in the nursing profession is a term many nurses are familiar with as it correlates to the ability to perform a task successfully. Nursing skills such as mixing insulin, giving an intramuscular injection, or taking manual blood pressure are all examples of skills evaluated during nursing school to determine the nursing students’ competency level. In addition to these nursing skills, informatics competency using an electronic medical record (EMR) should be assessed as well. The goal of the project is to gain significant insight for informatics curriculum development across and within undergraduate programs at a university in Southwest Georgia (SWGAU). Background: Currently, a new academic electronic medical record (AEMR) called Docucare has been initiated at SWGAU. Informatics competency skills checkoff on the new AEMR are not being assessed with first-year nursing students. Methods: Conceptual and theoretical frameworks were appraised to bring theory to practice implementing the proposed project. Patricia Benner’s Novice to Expert Theory and the Implementation Research Logic Model were analyzed and correlated to AEMR competency with first-year nursing students. The Plan Do Study Act method, along with the Tiger-based Assessment of Nursing Informatics Competencies (TANIC) tool were utilized to implement the simulation event. Results: The results of the project demonstrate the importance of informatics in nursing school and indicated a significant improvement after AEMR education in a simulation activity in first-year nursing students, especially related to the clinical data management area of focus. Conclusion: As technology changes in healthcare, it is vital academic settings should focus on improving informatics knowledge and competencies to guide nursing curriculum development

The Eleventh Hour: Navigating Posttraumatic Stress Disorder Within a Veterans’ Community

War-torn veterans have had limited support when combating symptoms of Post-Traumatic Stress Disorder (PTSD). Historically, PTSD was viewed as a weakness. Only recently has it gained attention as a health priority for veterans. This scholarly project provides an algorithmic resource to help providers discern and assess whether a veteran is suffering from PTSD. This paper will go on to define what PTSD symptoms are, and what care options there are for veterans suffering from PTSD. One specific option explored is animal therapy as a way for a veteran suffering from PTSD to better manage his or her symptoms

A Psychometric Validation of the Provider Responses, Treatment, and Care for Trafficked People Instrument

Background Human trafficking (HT) is often referred to as modern-day slavery, where force, fraud, or coercion is used to lure an individual into a life of labor or sexual exploitation. Although trafficked persons commonly interface with the healthcare setting, they are often unidentified and returned to the trafficked population. Previous studies have shown that while in captivity, trafficked persons have accessed medical care on various occasions, seeking treatments ranging from minor ailments to more severe ones at emergency departments, primary care clinics, and specialized clinics for sexual and reproductive health (Chisolm-Straker et al., 2016; Lederer &Wetzel, 2014). The inability to identify HT victims by healthcare providers can lead to a missed opportunity to empower a victim. Purpose This study evaluates the knowledge, confidence, and barriers regarding HT identification among nurses with a Doctor of Nursing Practice (DNP) degree. The researcher investigated the relationship between perceived knowledge (PK), actual knowledge (AK), and confidence to respond (CR) to HT in the DNP population. The research aims to develop practice recommendations regarding the identification of trafficked persons. Methods A non-experimental, cross-sectional study design evaluated the psychometric properties of a version of the Provider Responses, Treatment, and Care for Trafficked People (PROTECT) survey (Ross et al., 2015) among nurses with a DNP degree. The PROTECT instrument has been tested with other healthcare provider populations but has yet to be tested in this population. Results This study found a seven-factor solution explaining 62.19% of the total variance. In addition, exploratory factor analyses performed on the survey’s subscale were found to be a reliable and valid representation of the underlying structure of the variable. SANE/SAFE–certified nurses had a mean of 3.19 (SD = 1.2) for PK and 3.4 (SD = 1.172) for Confidence in Responding (CR). Pearson’s correlation showed significant relationships between SANE/SAFE certification and PK (r = .265, p \u3c .05) and AK (r = –.382, p \u3c .05). Respondents reported a mean of 11.6 hours of HT. The data showed a positive correlation between total hours of HT training and PK and CR to HT. Nurse practitioners had the highest percentage of correctly answered items on the AK subscale (14%), followed by nurse educators (14.8%). The study’s high Cronbach’s alpha (α = .955) and reliability coefficient (α = .772) for the PK and CR subscales indicated their reliability in assessing healthcare providers’ PK and CR to human-trafficking cases. The survey instrument used in this study was psychometrically valid. The results highlighted the need for targeted training and education for healthcare providers to improve their ability to identify and respond to human-trafficking cases