Doctor of nursing practice (DNP) projects are summative evaluations of enactment of the DNP Essentials. However, information about structure, process, and outcomes of DNP projects is scarce. Guided by an enhanced actualized DNP model, this study tested the effect of a PhD-DNP-site mentor model to guide DNP projects. Time-to-complete assignments, defense, and graduation improved; high satisfaction for students, mentors, and faculty were found; and a strengthened academic-practice partnership occurred, leading to additional student placements. Broader testing of the enhanced model in various size and types of academic-practice settings is needed prior to use

Conrad, Dianne

Spoelstra, Sandra

VanderKooi, Marie

English

Scholarworks@GVSU

Grand Valley State UniversityScholarWorks@GVSUFunded Articles Open Access Publishing Support FundFall 2018An Enhanced Actualized DNP Model to ImproveDNP Project Placements, Rigor, and Completion:A Research BriefMarie VanderKooiGrand Valley State University, vandema1@gvsu.eduDianne ConradGrand Valley State University, conraddi@gvsu.eduSandra SpoelstraGrand Valley State University, spoeslta@gvsu.eduFollow this and additional works at: https://scholarworks.gvsu.edu/oapsf_articlesPart of the Nursing CommonsThis Article is brought to you for free and open access by the Open Access Publishing Support Fund at ScholarWorks@GVSU. It has been accepted forinclusion in Funded Articles by an authorized administrator of ScholarWorks@GVSU. For more information, please contact scholarworks@gvsu.edu.ScholarWorks CitationVanderKooi, Marie; Conrad, Dianne; and Spoelstra, Sandra, "An Enhanced Actualized DNP Model to Improve DNP ProjectPlacements, Rigor, and Completion: A Research Brief " (2018). Funded Articles. 114.https://scholarworks.gvsu.edu/oapsf_articles/114Downloadedfromhttps://journals.lww.com/neponlinebyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3dW0s7N5CLiaEjmFx5t+6b5IwoPOvV48pWvQvTXL31RxL1WfuDSOlhQ==on10/25/2018Downloadedfromhttps://journals.lww.com/neponlinebyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3dW0s7N5CLiaEjmFx5t+6b5IwoPOvV48pWvQvTXL31RxL1WfuDSOlhQ==on10/25/2018Research BriefAn Enhanced Actualized DNP Model to Improve DNP ProjectPlacements, Rigor, and CompletionMarie E. VanderKooi, Dianne M. Conrad, and Sandra L. SpoelstraAbstractDoctor of nursing practice (DNP) projects are summative evaluations of enactment of the DNP Essentials. However,information about structure, process, and outcomes of DNP projects is scarce.Guided by an enhanced actualizedDNPmodel,this study tested the effect of a PhD-DNP-sitementormodel to guideDNPprojects. Time-to-complete assignments, defense, andgraduation improved; high satisfaction for students, mentors, and faculty were found; and a strengthened academic-practicepartnership occurred, leading to additional student placements. Broader testing of the enhanced model in various size and typesof academic-practice settings is needed prior to use.KEY WORDS Actualized DNP Model – DNP Project – Enhanced Actualized DNP ModelAreport by the American Association of Colleges of Nursing(2015) provides guidance on the implementation of the doc-tor of nursing practice (DNP). According to the report, DNPprojects should focus on change that can influence health care out-comes through direct or indirect care and/or a system or populationchange. They should be conducted in a setting congruent with theprogram of study (e.g., older adult primary care nurse practitioner[NP] in geriatrician office). They should evaluate a process and/or out-come and include a plan for sustainability. Finally, academics shoulddesign newmodels and processes to enact DNP projects to improveefficiency, effectiveness, and rigor and support student learning.A survey by Dols, Hernandez, and Miles (2017) found varia-tion among academic settings implementing DNP projects, with87 percent of faculty dissatisfied with the process and products.Faculty were not knowledgeable in evidence-based practice orquality improvement. Challenges with DNP project site placementswere a barrier to enacting the DNP project. There was also a lack ofconsensus on what a DNP project entails and no consensus on what“rigor” for a DNP project entails (Waldrop, Caruso, Fuchs, & Hypes,2014). Overall, DNP projects should be recognized as doctoral work(Chism, 2019) that influences a health care system and/or patients(Moran, Burson, & Conrad, 2017; Waldrop et al., 2014).Consistent with the literature, our college of nursing had severalbarriers to DNP project completion. First, locating the number andquality of sites needed for students to conduct DNP projects waschallenging. Second, faculty had to review student papers multipletimes prior to attainment of the expectation. Third, students were re-questing additional time to complete DNP projects. Finally, time tograduation was longer than desired.This article reports on research that applied an enhanced ac-tualized DNPmodel (Burson, Moran, & Conrad, 2016) to guide im-provements in the DNP project process. The model describes thestructure and process that impacts practice doctorate outcomesfor advanced nursing practice knowledge (see SupplementaryDigital Content 1 at http://links.lww.com/NEP/A94 for figure).The enhanced model was tested in six DNP projects at onepractice site and compared to projects of students who werenot exposed to the enhanced model (retrospective publicallyAbout the Authors The authors are faculty at the Grand Valley StateUniversity Kirkhof College of Nursing, Grand Rapids, Michigan. MarieE. VanderKooi, DNP, RN, is an assistant professor. DianneM. Conrad,DNP, RN, FNP-BC, FNAP, is an associate professor. Sandra L. Spoelstra,PhD, RN, FGSA, FAAN, is an associate dean for research and scholar-ship. This grant was funded by the Grand Valley State University PewCenter for Faculty Teaching and Learning; A Teaching Innovation Grantentitled NUR 792/793 Scholarly Inquiry in Nursing Practice: Testing aFaculty Advisor PhD-DNP Team for a Cohort of Students Scholarly Pro-ject (April 2017 to March 2018). The authors thank Dr. Jennifer Kaiser forher guidance in facilitating the practice-academic partnership at the siteand all of the site mentors and other staff who guided students. For moreinformation, contact Dr. VanderKooi at vandema1@gvsu.edu.The authors have declared no conflict of interest.Supplemental digital content is available for this article.DirectURLcitationsappear in the printed text and are provided in the HTML and PDFversions of this article on the journal’s website (www.neponline.net).This is an open-access article distributed under the terms of the CreativeCommons Attribution-No. Commercial-No Derivatives License 4.0(CCBY-NC-ND), where it is permissible to download and share thework provided it is properly cited. The work cannot be changed inany way or used commercially without permission from the journal.Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc.doi: 10.1097/01.NEP.0000000000000384Nursing Education Perspectives VOLUME 39 NUMBER 5 299available data were used). Objectives were threefold: 1) improvetime-to-completion of assignments, defense, and graduation;2) improve satisfaction of students, faculty, and site mentors; and3) enhance an academic-practice partnership. Our intention wasto increase the time to complete the project while reducing timeto graduation, simultaneously improving satisfaction and our academic-practice partnership relationship.METHODAquasiexperimental mixed-method designwith an intervention groupand control group was used to answer three research questions:1) Did use of the enhanced model improve time-to-complete DNPproject assignments, defense, and on-time graduation? 2) Were stu-dents, faculty, and site mentors more satisfied using the enhancedmodel? 3) Was the academic-practice partnership improved?The setting was a college of nursing located in the Midwestwith 120 DNP students in three tracks (adult/older adult NP, child/adolescent NP, health system leader). The site for the interventiongroup was a Magnet health system with 14 acute care hospitalsand 184 primary care offices; the control group used 14 differentsites (primary care, community based, nursing home, hospital).The university institutional review board (IRB) approved the pro-ject. The control group consisted of retrospective publically avail-able data from 17 April 2017 graduates. The intervention groupconsisted of a convenience sample of six students completingDNP projects between January 2017 and April 2018. Studentsin the intervention group were provided a description of the study,consented to participate, and were enrolled.Both groups received a DNP project handbook, the online Black-board platform, which provided information on the project process,and used a textbook containing the model (Moran et al., 2017) incoursework. The intervention group also received a one-hour educa-tion session to review the enhanced model, assignment expectations(literature review, manuscript format), and timelines. The interventiongroup also participated in a two-hour session at the site to design stan-dardized workflow, develop relationships, and identify project ideasand scope.Each student in the control group had an advisor, selected by thestudent, who provided feedback throughout the project and anotherfaculty member who read the final paper. Students in the controlgroup visited the site initially, presented a project focus, and tried toengage the site in the project. The faculty advisor for the control groupvisited the site once each semester, and the project plan defense washeld at the university.The intervention group had a PhD-prepared advisor and DNP-prepared second faculty member, both assigned by the graduate pro-gram director. The PhD-prepared advisor focused on use of theories,models, and frameworks; methodology; analysis; and result reporting;the DNP-prepared teammember focused on clinical expertise and im-plementation strategies. The intervention group faculty simultaneouslyreviewed assignments and provided feedback to the student. The sitementor identified the project foci, and the faculty guided the studentconducting the project. The intervention group PhD-DNP faculty vis-ited the site with the student to meet the mentor, inform the mentorof role and responsibilities, construct the prospectus outline, obtaindata for the assessment, and agree upon a timeline. Update monthlymeetings and the plan defense were conducted at the site (see Sup-plementary Digital Content 2 at http://links.lww.com/NEP/A95 for tablewith intervention and control group components).To examine the effect on enhanced model outcomes, measuresof time-to-complete assignments, defense, and graduation were thenumber of days from start to finish. We defined on-time graduation forthis study as completion of the DNP program in four years of full-timestudy. To examine satisfaction of students, faculty, and site mentors,we designed a survey based on the literature and identified barriers.We measured academic-practice partnership improvement by com-paring of the number of students conducting projects at the site priorto, during, and after this study. Data were collected via course rubricsfrom the registrar and advisor and on surveys. Analysis included de-scriptive statistics, t test/chi-square, and compilation of field notes.RESULTSAll six participants in the intervention group were women, and all werewhite. Fourteen of the 17 participants in the control group were women;16werewhite, and 1wasAfrican American. Both groups had studentsin both NP tracks: adult/older adult (intervention, n = 5; control, n = 13)and child/adolescent (intervention, n = 1; control, n = 4). No statisticaldifferences were found between the groups.The first question examined if time to assignment completion,defense, and on-time graduation improved with the enhancedmodel. As desired, the number of days to complete the project in-creased (p = .03) in the intervention group (343, SD = 69.0, range320 to 366) compared to the control group (228, SD = 109.5,range 201 to 310).The entire intervention group obtained IRB determination threesemesters prior to graduation; the control group obtained IRB deter-mination in the final semester prior to graduation. Prior to meeting fac-ulty expectation, the intervention group submitted 3.3 (SD = 1.21)draft organizational assessments, 3.3 (SD = 1.03) draft literature re-views, and 2.8 (SD = 1.30) draft project plan defenses. No assign-ment data were available on draft papers from the control group.However, faculty who advised the control group faculty anecdotallyreported 8 to 10 draft papers. A higher rate of on-time graduationwas found in the intervention group (n = 5/6, 83.3 percent) than thecontrol group (n = 10/17, 58.8 percent; p = .02).The second question examined if students, faculty, and site men-torswere satisfied using the enhancedmodel. All students in the inter-vention group felt advisors who visited the site frequently facilitatedproject completion and that faculty and site mentors guided the pro-ject. All faculty (n = 2) reported reduced burden to reviewing studentpapers and improved student, faculty, and site mentor communica-tion. The three site mentors who provided feedback stated role andexpectations were clear.The third question examined the academic-practice partnership.The intervention group site provided a standardized workflow for theidentification of project topics, mentors, and IRB processing and allo-cated space on an internal drive for data storage and usage. The in-tervention group site appointed the PhD-DNP-prepared faculty tothe research council as ex officio members to review opportunitiesfor student projects and report project results. The control group sitesdid not provide standard workflow, internal drives, or routine facultyinteraction with other teammembers. The number of student projectsconducted at the site where the study occurred increased from 2 in2016–2017 and 5 in 2017–2018 to 22 planned in 2018–2019.DISCUSSIONThis study found the enhanced actualized DNP model (Burson et al.,2016) operationalized enactment of the DNP project and improvedResearch Brief300 September/October 2018 www.neponline.netthe structure, process, and outcomes of the educational endeavor.Overall, collaboration among the PhD-DNP-prepared faculty, sitementor, and student were enhanced. Students had less difficultyin locating a site to conduct the project when faculty led the process.“Wicked” problems that kept site mentors awake at night informedstudent DNP projects and simultaneously met the health care orga-nization’s strategic plan.The number of drafts of the organizational assessment and lit-erature review decreased, resulting in a reduction in faculty time toreview papers. Students had more time to complete the project,which led to in-depth plans with more potential for sustainability.On-time graduation improved while high satisfaction was foundfor students, faculty, and site mentors. All project team memberswere informed throughout the process, which reduced questionsduring defense. A stronger academic-practice partnership formedthat led to a standardized workflow and increased number of stu-dent placements. A stronger PhD-DNP-prepared faculty partner-ship formed with mutual respect for the education and skills ofeach doctorate, which contributed to students following scientificmethods, having multiple appropriate measures, and demonstrat-ing competency in the DNP Essentials. In summary, the enhancedmodel improved every facet of the DNP project structure, pro-cess, and outcome.Study LimitationsData for this study were from a small group of students in a singleuniversity and site. Satisfaction was only measured in the interven-tion group. Participants were primarily female and Caucasian,thus limiting generalizability. The faculty time for reviewing organi-zational assessments and literature reviews were reported anec-dotally in the control group.Future ImplicationsThere are numerous implications for faculty: collaborate early and of-ten with the project site mentor regarding the purpose of the DNPproject; roles of the faculty, student, and mentor; the problem; anddata availability, collection, and storage. Further analysis is neededin multiple settings with a larger, more diverse group of students toinclude examination of student attrition, distress, and tuition cost sav-ings. The sustainability of projects needs to be evaluated to furthersupport academic-practice partnerships. The AACN (2006)DNP Essentials need further examination to evaluate what skillsare enacted by students using the enhanced model. Finally, thevalue DNP-prepared nurses add to practice settings needs tobe measured.CONCLUSIONContrary to what others have found (Dols et al., 2017), the enhancedactualized DNP model (Burson et al., 2016) DNP project structureand process improved time to completion of assignments, defense,and graduation; increased satisfaction; and supported an academic-practice partnership. Operationalizing the model provided facultywith a deeper understanding of how students can conduct theDNP project. As recommended by the AACN (2015), our team de-signed an enhanced model, operationalizing the structure andprocess, then tested the model. The results of this study advancethe science of doctoral nursing education by improving efficiency,effectiveness, and rigor and support student learning during com-pletion of the DNP project.REFERENCESAmerican Association of Colleges of Nursing. (2006). The essentials for doctoral ed-ucation for advanced nursing practice. Retrieved from www.aacn.nche.edu/publication/position/DNPEssentials.pdfAmerican Association of Colleges of Nursing. (2015). The doctor of nursing practice:Current issues and clarifying recommendations. Retrieved from www.aacn.nche.edu/aacn-publications/white-papers/DNP-Implementation-TF-Report-8-15.pdfBurson, R., Moran, K., & Conrad, D. (2016). Why hire a DNP? The value-added im-pact of the practice doctorate. Journal of Doctoral Nursing Practice, 9(1),152-157. doi:10.1891/2380-9418.9.1.152Chism, L. (2019). The doctor of nursing practice: A guidebook for role developmentand professional issues (4th ed.). Burlington, MA: Jones and Bartlett.Dols, J. D., Hernández, C., &Miles, H. (2017). TheDNPproject: Quandaries for nursingscholars. Nursing Outlook, 65(1), 84-93. doi:10.1016/j.outlook.2016.07.009Moran, K., Burson, R., & Conrad, D. (2017). The doctor of nursing practice scholarlyproject: A framework for success (2nd ed.). Burlington, MA: Jones & Bartlett.Waldrop, J., Caruso, D., Fuchs, M. A., & Hypes, K. (2014). EC as PIE: Five criteria forexecuting a successful DNP final project. Journal of Professional Nursing, 30(4),300-306. doi:10.1016/j.profnurs.2014.01.003Research BriefNursing Education Perspectives VOLUME 39 NUMBER 5 301

An Enhanced Actualized DNP Model to Improve DNP Project Placements, Rigor, and Completion: A Research Brief

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