DNP Programs: Making the most of faculty resources Arlene Sperhac PhD, APRN, CPNP, FAAN Patricia Clinton, PhD, CPNP, FAANP Ann L. O'Sullivan, PhD, CRNP, FAAN Victoria Erickson, PhD, PNP-BC, FAANP
Objectives Describe judicious use of faculty resources and methods for DNP/PhD collaboration. Discuss common DNP program concerns and strategies for addressing them.
Education for the Future Blind spots of knowledge error and illusion Principles of pertinent knowledge Human condition & Earth identity Confronting uncertainties Understanding each other Ethics for the human genre Edgar Morin
Doctoral Education in Health Sciences Judicious use of faculty resources requires critical conversations about: Level of rigor and relevance Research competence or systems/quality improvement project Pedagogy and shift in mental models, health care, academic economics Where science and inquiry need to go
Science Based Practitioners & Nurse Scientists Gibbons Model, Co-Evolution Production of socially robust knowledge Construction of narratives of expertise Contextualization
DNP Project -Research or Not? Is Research Nontraditional applied form, evaluation research Process or implementation analysis Outcome analysis Cost analysis Is Not Research Partnership with clinical/community agency Applies evidence-based research to clinical setting/organization Integrates leadership & advocacy skills in process Evaluated to determine outcomes/effectiveness Limitations on control of variables, design, sample size, etc Linda Lindeke and Mary Chesney
DNP and PhD Commonalities Knowledge, Research and Practice Do not stand alone Contributes to value of all Creates return on investment Creates tangible assets Benefits patients and organizations
Interdependent Unity and Complexity DNP PhD
Doctoral Education in Nursing Goal: Improved Patient/Client Outcomes PhD Research Doctorate DNP Practice Doctorate Role Overlap
Quality Education Meeting the DNP essentials, competencies and standards AACN The Essentials of Doctoral Education for Advanced Nursing Practice, 2006 NONPF - Nurse Practitioner Core Competencies, 2011 NTF - Criteria for Evaluation of Nurse Practitioner Programs, to be released in 2012 Education for highly collaborative team interprofessional practice
Complementary Roles: DNP & PhD Collaboration PhD Admission criteria Career goals Gaining the right skill set DNP Admission criteria Career goals Gaining the right skill set
DNP & PhD course planning Effective and efficient Identification of essential concepts Role socialization Measuring outcomes
Addressing Clinical Issues Evaluation Clinical Question Practice Implementation Research Study Results
Teaching content overlap Research content PhD Research? DNP Research? Theory content PhD Theory? DNP Theory?
The Iowa Model
DNP Projects Quality Improvement vs Research
Quality Improvement Activity or Research Ask these questions: Does the activity involve research (45 CFR 46.102(d); Does research activity involve human subjects (45 CFR 46.102(f); Does the human subjects research qualify for an exemption (45 CFR 46.101(b); and Is the non-exempt human subjects research conducted or supported by HHS or otherwise covered by an applicable FWA approved by CHRP. U.S. Department of Health & Human Services HHS.gov (2011). Quality improvement activities frequently asked question: Retrieved from http://answers.hhs.gov/ohrp/categories/1569
Quality Improvement (QI) vs Research (R) Purposes Scope QI Examine internal processes and guides actions toward improvement Examines internal institution/process-specific issues R Generates new knowledge Tests hypotheses May be generalizable to other patients, situations, and settings Informed Consent Generally not required Must be obtained if human subjects are involved Beyea, S.C., Nicoll, L.H. (1998). Is it research or quality improvement? - Clinical practice problems. AORN Journal, 68(1): 117-9 retrieved from http://answers.hhs.gov/ohrp/categories/1569
Quality Improvement (QI) vs Research (R) QI Design Focuses on processes Well-controlled Scientific framework Subject selection Results Available patients or subpopulation of patients Used by the specific institution/organization R Based on research purpose, study design, power analysis, and statistical models Presented and available to others Beyea, S.C., Nicoll, L.H. (1998). Is it research or quality improvement? - Clinical practice problems. AORN Journal, 68(1): 117-9 retrieved from http://answers.hhs.gov/ohrp/categories/1569
Reporting Resources: Equator Network Enhancing the quality and transparency of health research 1. CONSORT 1996 (many journals) Randomized control trials 2. QUOROM-1999 Quality of Reporting of Meta - analysis 3. MOOSE 2000 (JAMA) Meta analysis of observational studies in epidemiology 4. TREND 2004 (AJPH) Prospective Clinical Studies-Behavioral interventions and public health
Reporting Resources: Equator Network Enhancing the quality and transparency of health research 5. STROBE 2007 Observational studies in epidemiology 6. SQUIRE 2008 (J of Inter Med.) 7. PRISMA 2009 (PLoS Medicine) Quality improvement studies Systematic reviews and meta analysis update of QUOROM
Framework for Quality Improvement Projects Plan Do Study Act Six Sigma Process Other Approaches
DNP Project Completion
1000 hours of what for whom?
Post-BSN students NONPF requires a minimum of 500 clinical hours (as defined by NONPF focusing on direct care to individuals and families in a specific area of NP practice)....more than 500 hours will be needed for students to meet the first NONPF DNP competency of Independent Practice NONPF (2008 b). Clinical Hours for Nurse Practitioner Preparation in Doctor of Nursing Practice Programs. In: Clinical Education Issues in Preparing Nurse Practitioner Students for Independent Practice: An ongoing series of papers. (2010).
MS grad with a new population A minimum of 500 clinical hours in direct care with the new population
MS grad without new population Sally Sample graduated with a MS as a FNP She has worked as a FNP for 10 years, is certified as a FNP and has prescriptive authority She has precepted the students from your university for over 5 years Does she need more clinical hours providing direct pt care? Does she need any clinical hours?
DNP student teams
DNP implementing PhD work Let s create some Positive Deviants
Working with clinical staff I love you, now change
We Are The Link
References Beyea, S.C., Nicoll, L.H. (1998). Is it research or quality improvement? - Clinical practice problems. AORN Journal, 68(1):117-9. Bleich, M. The Future of Nursing: Implications for Doctoral Education. American Association of Colleges of Nursing Doctoral Education Conference, Presentation, January, 18 2012. Davidoff, F., Batalden, P., Stevens, D., Ogrinc, G., Mooney, S., and for the SQUIRE development group, (2008). Publication guidelines for quality improvement in health care: Evolution of the SQUIRE project. Quality and Safety in health Care, 17 ; i3-i9[supplement] Hartnett, T. (2008). Quality improvement: When is it research that requires informed consent? Research Practitioner. 9 (2), 36-42 Krugman, M. (2008). Is it research, evidence-based practice, or a quality improvement project? Journal of Nurses in Staff Development 24 (3), 137-9. Lindeke, L., Chesney, M. Is the DNP Scholarly Project Research? American Association of Colleges of Nursing Doctoral Education Conference, Poster, January, 18 2012. Miller, F.G., Emanuel, E.J. (2008), Quality-Improvement research and informed consent. New England Journal of Medicine 358(8), 765-767
References (cont.) Moher, D., Weeks, L., Ocampo, M., Seely, D., Sampson, M. Altman, D.G., et al (2011). Describing reporting guidelines for health research: A systematic review. Journal Clinical Epidemiology 64(7), 718-42. Morin, E. (1999) Seven Complex Lessons in Education for the Future. Retrieved from http://unesdoc.unesco.org/images/0011/001177/117740eo.pdf Newhouse, R. P. (2007) Diffusing confusion among evidence-based practice, quality improvement, and research. Journal of Nursing Administration 37(10), 434-435. Nowotny, H., Scott, P., Gibbons, M. (2001)Re-thinking science: knowledge and the public in an age of uncertainty. Malden MA: Blackwell. Ogrinc, G., Mooney, S.E., Estrada, C., Foster, T., Goldman, D., Hall, L.W., et al. (2008). The SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Quality and Safety in Health Care 17(Suppl_1), i13-i32. U.S. Department of Health & Human Services HHS.gov (2011). Quality improvement activities frequently asked question: Retrieved from http://answers.hhs.gov/ohrp/categories/1569