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

PhD

Research

Doctorate

DNP

Practice Doctorate

Role Overlap

Goal: Improved Patient/Client Outcomes

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

Clinical

Question

Research

Study

Results

Practice Implementation

Evaluation

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)

QI R

Purposes Examine internal processes and guides actions toward improvement

Generates new knowledge Tests hypotheses

Scope Examines internal institution/process-specific issues

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 R

Design Focuses on processes Well-controlled Scientific framework

Subject selection Available patients or subpopulation of patients

Based on research purpose, study design, power analysis, and statistical models

Results Used by the specific institution/organization

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.)

Quality improvement studies

7. PRISMA – 2009 (PLoS Medicine)

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