In today’s rapidly evolving healthcare world, evidence-based research is the cornerstone for achieving clinical excellence. Nursing is a core pillar of the field, which harnesses the power of empirical research findings to shape, guide, and enhance its practice. This commitment not only ensures the highest standards of patient care but also propels the nursing profession forward. As challenges in healthcare become more complex, the role of evidence-based research in nursing becomes even more important. This paper explores the intricacies of the Doctor of Nursing Practice (DNP) project, emphasizing its vital role in translating research insights into meaningful clinical interventions.
A Doctorate of Nursing Project is a final project in which DNP students transform evidence-based research into practical applications to enhance outcomes in a healthcare setting. It is essential not to confuse this with what a Ph.D. dissertation paper is. It should be clear that the DNP project is multifaceted: a required program deliverable, the demonstration of doctoral competencies, and a means to achieve professional goals and the goals of the organization where the project is executed (Moran et al., 2020, p. 52). The DNP project focuses on a topic the student is passionate about and can make impactful contributions to propel their nursing career.
What is the difference between a Ph.D. dissertation and a DNP project? First off, they have different aims regarding discipline and practice development. A Ph.D. program is research-focused, whereas a DNP is focused on preparing future clinical leaders by steering them toward evidence-based nursing practice (Dobrowolska et al., 2021). While the dissertation prioritizes generating fresh insights through the student’s original research, the DNP project, on the other hand, leverages existing research to drive change. While these projects represent pinnacle achievements in advanced nursing education, they serve distinct purposes and methodologies.
The major entities that support the DNP degree include the American Association of Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner Faculties (NONPF). The 2004 AACN Position Statement accurately outlined the need for administrative and advanced practice leaders with stronger preparation system-based practice improvement and translational research (Cronenwett et al., 2011). The AACN is a major drawing force pushing nurses to advance to higher education in nursing. Together with NONPF, the degree is reflective of the rigorous education that nurse practitioners receive to be top-tier clinicians, leaders in collaborative healthcare teams, and contributors in reshaping and enhancing healthcare delivery models (The Doctorate of Nursing Practice NP Preparation: Nonpf Perspective 2015, n.d.). The DNP program will equip the DNP student with skills to make critical decisions and apply knowledge that is evidence-based, patient-centered, and proven to be effective. As well as improve patient outcomes and enhance the overall patient experience.
I am working towards a PMHNP degree, with a keen interest in areas such as depression, anxiety, and schizophrenia. The impact of Transcranial Magnetic Stimulation (TMS) on depression treatment particularly fascinates me. For my DNP project, I decided to reconsider topics since I thought I would encounter roadblocks with my idea. I chose to explore the impact of medication on schizophrenia. It has been estimated that as many as sixty percent of schizophrenics stop antipsychotic medication use after two to three months and eighty percent after two years (Leijala et al., 2021). Schizophrenia is a complex and multifaceted mental disorder. Schizophrenia medications, while crucial for managing symptoms and improving the quality of life for those suffering, present a significant challenge in terms of adherence. Disruption in treatment ranging from one to ten days has been associated with an increased risk of hospitalization, violence, arrests, increased risk of suicide attempts, poor social and occupational functioning, and reduced quality of life (Velligan et al., 2017).
A PICOT is an important piece when initiating a DNP project. It stands for patient population of interest, intervention of interest, comparison of interest, outcome of interest, and time frame (Eriksen & Frandsen, 2018). It directs the questioner to clearly identify the problem, intervention, and outcomes related to specific care provided to a patient (Eriksen & Frandsen, 2018). My PICOT question is: In patients eighteen years and older diagnosed with schizophrenia, what is the effect of the BARS scale on medication adherence compared with adherence rates prior to implementation of the BARS scale when evaluated after three months of implementation?
P- Targeted population eighteen years and up that suffer from schizophrenia
I- BARS scale will be given to patients at three-month follow-up visit
C- Half of the participants in the study will be given the BARS scale, while the remaining half will not
O- Enhance symptom relief for individuals diagnosed with schizophrenia
T- The outcome will be measured after three months
What is a systematic literature review? A systematic literature review is carried out to consolidate existing knowledge and identify gaps of knowledge concerning the topic of interest, but it can also help illuminate the value of the phenomenon of interest and identify the appropriate methods to use to examine the phenomenon (Moran et al., 2020, p. 42). This method involves examining the current body of literature pertaining to a particular topic or research question. It provides a comprehensive overview of a topic but also highlights its importance, guides future research, and can have broader policy and practice decisions.
There are seven established tiers of evidence allocated to studies based on the methodological quality of the design, the credibility of their findings, and their relevance to patient care (Brunt & Morris, 2023). The hierarchy of evidence is like a ladder that ranks the trustworthiness of scientific research. The higher up the ladder a study is, the more we can trust its results. It helps us determine which research findings are the most reliable when making decisions. However, all levels have their place in research and can contribute valuable information depending on the context and specific research question. Listed below is the Appendix which discusses the ladder of study.
When seeking the most credible and authoritative information on a topic, it’s crucial to refer to trusted sources. The Idaho State University library is a valuable resource that provides access to many scholarly databases, ensuring that the information I gather is of the highest quality.
I can source scientifically-backed articles for my topic from databases like CINAHL, PubMed, and UpToDate. Utilizing articles from predatory journals to publish low-quality studies and citing this work undermines the scholarly literature in nursing (Oermann et al., 2020). Predatory journals are publications that claim to be legitimate scholarly journals, yet they distort and mislead with their actual publishing standards. Starting research in databases such as MEDLINE, CINAHL, or Scopus, the results will typically ensure that the findings do not include citations to predatory publications (Oermann et al., 2020). Using specific search terms is imperative. For example, using keywords that are too broad to pinpoint specific, relevant information about children and asthma might yield thousands of results, such as 2,274 entries in the CINAHL database (Moran et al., 2020, p. 124). By narrowing down literature review categories to specific topics, such as hyperlipidemia management, you will get fewer but more relevant articles.
A search strategy is a structured method used to locate information on a particular topic. It is a roadmap for collecting the right data from different sources, mainly when conducting in-depth research. The search process needs to be documented in enough detail throughout the process to ensure that it can be reported correctly in the review, ensuring that the searches across all databases can be replicated (Systematic Reviews for Health: Documenting Search Strategies, n.d.). I will utilize search terms such as schizophrenia and medication adherence, BARS effectiveness, BARS impact on schizophrenia patients, medication adherence in adults with schizophrenia using BARS, and three-month outcomes of BARS in schizophrenia treatment when researching for my project.
I have selected Hildegard Peplau’s Interpersonal Model Theory as the foundational theoretical framework. Peplau’s theory is considered a theory-to-practice-to-theory strategy. Using this approach, a theorist starts by choosing a theory for practical application and then employs practical experiences to further refine and develop the theory (Meleis, 2018, p. 69). Peplau’s theory exemplifies this method by establishing a theoretical base, promoting its implementation in real-world settings, and then iterating upon the theory based on practical insights and experiences.
Peplau has been coined the “Mother of Psychiatric Nursing” and the “Nurse of the Century”(Gonzalo, 2023). In 1952 Peplau published her Theory of Interpersonal Relations (Gonzalo, 2023). Peplau’s interpersonal model pictures nursing as a collaborative process between the nurse and patient, who are working toward mutually agreed-on goals (Zaccagnini & Pechacek, 202, p. 15).
Her model highlights the active collaboration between patient and nurse as opposed to the client passively receiving treatment and the nurse executing the doctor’s orders (Gonzalo, 2023). Schizophrenic patients often experience difficulties in trusting others due to the nature of their symptoms. Peplau’s framework will be instrumental in my endeavors, fostering a collaborative relationship with my patients. By adopting Peplau’s Theory, I am emphasizing the centrality of the nurse-patient relationship in enhancing medication adherence among schizophrenia patients. This approach recognizes the patient as an active participant in their care, fostering a more personalized, effective, and holistic approach to treatment.
The sequential steps taken to reach the goals are (1) orientation, in which the patient’s problems are defined; (2) identification, in which the nurse and patient clarify expectations and figure out how to work together; (3) exploitation, in which the patient uses the services offered by the nurse that the patient finds useful; and (4) resolution, in which the patient’s needs have been met and the patient moves towards independence (Zaccagnini & Pechacek, 202, p. 15).
In the initial phase, when a patient seeks assistance, I will introduce them to the BARS, explaining its role and how it can help improve medication adherence. As we move to the identification phase, patients can visualize where they struggle with medication adherence. In the exploitation phase, the patient and I will collaboratively use the BARS to develop strategies to enhance medication adherence. Finally, the resolution phase is where the patient’s needs have been met. Over time, as the patient becomes more compliant with his medication regimen, their dependence on the healthcare provider will diminish.
The Collaborative Institutional Traning Initiative (CITI) program is currently used by thousands of organizations worldwide to meet federal mandates for training faculty, staff, and students engaged in research involving human subjects (Hadden et al., 2017). The CITI program serves as a cornerstone for organizations globally in ensuring that human subjects research is conducted with the utmost integrity, responsibility, and care. DNP projects involve patient-centered research; understanding and adhering to these standards is paramount. It ensures the projects are conducted with the highest levels of integrity, respect, and care for the patients and communities DNP students will serve.
In conjunction with the CITI program, the Institutional Review Board (IRB) is pivotal in the project’s approval process. Once their project proposals receive faculty approval, students adhere to a set algorithm designed to safeguard the protection of human subjects and maintain patient privacy in their DNP projects (Foote et al., 2015). The first step in any project that involves the collection or use of data from or about human subjects is to identify the IRB of record based on the project setting; the next step is determining whether the project constitutes Human Subjects Research (HSR) (Foote et al., 2015). Should the project be classified as Human Subjects Research (HSR), it necessitates Institutional Review Board (IRB) approval but in cases where the project is not considered HSR but involves accessing Protected Health Information (PHI), the student must secure authorization from an administrator or a privacy officer at the project location (Foote et al., 2015). The IRB’s role is not just to grant approval but to provide guidance, feedback, and oversight throughout the research process. This collaborative approach ensures that DNP projects not only contribute valuable knowledge to the field but also prioritize the well-being and rights of human subjects.
What is the purpose of evaluating a DNP project? The purpose of evaluating a DNP project is essential to determine its effectiveness, impact, and relevance. Many tools can be used to evaluate the DNP project. The DNP Project Critical Appraisal Tool offers sixteen core competencies required of a successful DNP project, a quality improvement tool kit, and the SQUIRE (Standards for Quality Improvement Reporting Excellence) publication guidelines, which students can use to guide their evaluation plans (Wright et al., 2022). The critical appraisal tool provides nurses with a structured framework, including specific questions and/or a checklist, to assess the evidence systematically (Buccheri & Sharifi, 2017). The critical appraisal tool is designed to provide a framework for evaluation by highlighting sixteen core competencies that are deemed essential for a successful DNP project. By going through the competencies, this is what I will use to evaluate my project.
The AACN (2021) recognizes various dissemination methods, such as delivering a written report to stakeholders, creating a poster presentation, submitting a manuscript for journal publication, conducting an educational presentation, or producing a podcast (Ayala et al., 2022). I intend to showcase my research findings to my target audience through a poster presentation. This visual format will allow for an engaging and concise representation of my work, facilitating direct interactions and discussions with those who are interested.
The DNP project is a hallmark of the nursing profession’s dedication to excellence in patient care. This unique positioning ensures that the knowledge and skills honed through the DNP project are not only theoretically sound but also practically applicable in real-world healthcare settings. It goes beyond theoretical knowledge, emphasizing applying evidence-based practices to real-world clinical scenarios. This ensures that the interventions and strategies developed are not only grounded in solid research but are tailored to address the unique challenges and needs of patients in healthcare settings. Through the DNP project, nurses are not just passive recipients of knowledge; they are active creators and implementors of solutions that elevate the standard of care in healthcare settings worldwide.
References
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Ladder of study
Level I – Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence-based clinical practice guidelines based on a systematic review of RCTs or three or more RCTs of decent quality with comparable results.
Level II – Evidence obtained from at least one well-designed RCT
Level III – Evidence obtained from well-designed controlled trials without randomization
Level IV – Evidence from well-designed case-control or cohort studies
Level V -Evidence from a systematic review of descriptive and qualitative studies (meta-syntheses)
Level VI – Evidence from a single or descriptive or qualitative study
Level VII -Evidence from the opinion of authorities and/or reports of expert committees.