DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

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DNP 820 Week Two Assignment Instructions 

Please read the instructions thoroughly there are strict requirements

I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject.

Tutor MUST have a good command of the English language

The Rubric must be followed, and all the requirements met DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

This is a thorough professor, and she has strict requirements

I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments

The following needs to be addressed:

Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample:

· How will you determine the sample size?

· What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify!

· Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.

· Data analysis-What test will you use to answer your research question?

Clinical/PICOT Questions:  

“In adult patients with CVC at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?” DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

P: Patients with Central Venous Catheters

I: Staff re-education related to Hygiene of the hub

C: Other hospitals

O: Reduce probability of CLABSIs

T: Two months

“In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene

C: Other area hospitals

O: Reduce probability of CLABSIs

“In adult patients, with define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments

1. I used central Missouri as an example, replace with a description of your site.

2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help

4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments?

5. One month is the longest time you can use for a prospective project

Please note the following regarding the instructors grading

IMPORTANT INFORMATION ABOUT MY GRADING STYLE

As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always

1. Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.

2. Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.

3. You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts.

One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.

Details:

In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • Locate      the “The 10 Strategic Points for the      Prospectus, Proposal, and Direct Practice Improvement Project” that      you completed in DNP-815.
  • Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is located in the      Student Success Center. An abstract is not required.
  • This      assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the      expectations for successful completion.
  • You      are required to submit this assignment to Turnitin. Please refer to the      directions in the Student Success Center.

Directions:

Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

You worked on this last in DNP 815. Pick up from where you left off (if you transferred in and did not complete this, you will have to begin fresh). Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.

Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document, I suggest 5-10 at this point. You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic.

For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology.

Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation.

Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.

Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection.

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Apply Rubrics

  1
Unsatisfactory
0.00%
2
Does Not Meet Expectations
74.00%
3
Approaching Meeting Expectations
87.00%
4
Meets Expectations
100.00%
100.0 %Content  
10.0 %Topic: Provides a broad project topic area/title. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
15.0 %Literature Review: Lists primary points for four sections in the Literature Review: (a) Background of the problem/gap and the need for the project based on citations from the literature; (b) Theoretical foundations (models and theories to be foundation for study); (c) Review of literature topics with key concept (??) for each one; (d) Summary. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Problem Statement: Describes the problem to address through the project based on defined gaps or needs from the literature. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Sample and Location: Identifies sample, needed sample size, and location. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the problem statement. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
5.0 %Variables Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Methodology and Design: Describes the selected methodology and specific research design to address problem statement and clinical/PICOT questions. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Purpose Statement: Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
10.0 %Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.

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The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Introduction

In the Prospectus, Proposal, and Direct Practice Improvement Project there are 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

The ten strategic points are developed in table format.

The 10 Strategic Points

The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document includes the following 10 key or strategic points that define the project focus and approach:

  1. Topic (10%) – Provides a broad project topic area/title.
  2. Literature Review (15%) – Lists primary points for four sections in the Literature Review:
    1. Background of the problem/gap and the need for the project based on citations from the literature.
    2. Theoretical foundations (models and theories to be foundation for project).
    3. Review of literature topics with key theme for each one.
    4. Summary.
  1. Problem Statement (10%) – Describes the problem to address through the project based on defined needs or gaps in practice from the literature.
  2. Sample and Location (10%) – Identifies sample, needed sample size, and location.
  3. Clinical/PICOT Questions (10%) – Provides clinical/PICOT questions to collect data to address the problem statement.
  4. Variables (5%) – Identifies and describes independent and dependent variables.
  5. Methodology and Design (10%) – Describes the selected methodology and specific project design to address problem statement and clinical questions
  6. Purpose Statement (10%) – Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.
  7. Data Collection (10%) – Describes primary instruments to answer clinical questions.
  8. Data Analysis (10%) – Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

The Process for Defining the 10 Strategic Points

The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement.

Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and is not recommended unless learners have a significant amount of extra time and resources to complete it.

For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 strategic points so they are simpleclear, and correct in order to ensure that anyone who reviews them will easily understand them. It is important to align all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

Value of the 10 Strategic Points Document

The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project.

Examples of the 10 Strategic Points Document

It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

Template: 10 Strategic Points Document for a Quantitative Project

The 10 Strategic Points Comments or Feedback
Broad Topic Area 1.      Broad Topic Area: 

Hint: What would I title my project?

Literature Review 2.      Literature Review: 

List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

a.      Background of the Problem/Gap:

·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

b.      Theoretical Foundations (models and theories to be foundation for study):

·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success.

·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

c.       Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Rural Telehealth Services:

·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

Population Specific Telehealth Services:

·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

Settings:

·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).

·         Home-based (Demiris et al., 2103).

·         Community center (Demiris et al., 2103).

·         Library (Demiris et al., 2103).

·         Smart phone, computer-based (Forchuk et al., 2016).

Certifications:

·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

Network Systems:

·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

d.      Summary

·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

Problem Statement 3.      Problem Statement: 

Describe the variables/groups to study, in one sentence.

 

A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower, and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

Other examples are:

·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

·         It is not known how or to what extent ________________.

While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Clinical/
PICOT Questions
4.      Clinical/PICOT Questions:Provide PICOT question to guide the implementation and data collection of findings of the project:

(P) Among adult patients in a rural care setting, (I) how does implementation of a telehealth program (C) compare to traditional commute-for-care (O) impact rate of follow-up with the primary care provider (T) over a period of four weeks.

Sample 5.      Sample (and Location):Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

a.       Location: Arizona

b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

c.       Sample: 40 participants include a power analysis if appropriate. DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Define Variables 6.      Define Variables:a.       Independent Variable: Telehealth program.

b.      Dependent Variable: Follow-up rate with primary care provider.

Methodology  and Design 7.      Methodology and Design:Name the selected methodology and specific design to address the problem statement and clinical questions:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement 8.      Purpose Statement:Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The                                    (dependent variable) will be defined/measured as/by ______ (provide a general definition).

 

 

Data Collection Approach 9.      Data Collection Approach:Describe primary instruments that will be used to answer clinical question.
Data Analysis Approach 10.  Data Analysis Approach:Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

10 Strategic Points Comments/Feedback
Broad Topic Area
Literature Review DNP 820 – 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project
Problem Statement
Clinical/PICO Questions
Sample
Define Variables
Methodology  and Design
Purpose Statement  

 

Data Collection Approach
Data Analysis Approach

10 Strategic Points completed example

The 10 Strategic Points
Broad Topic Area 1. Broad Topic Area/Title of Project:

Improving Medication Adherence among Type II Diabetic Home Healthcare Patients

Literature Review 2. Literature Review:

a. Background of the Problem/Gap:

· Medication adherence is defined as how well patients in home-based care adhere to their medication regimen in the absence of health practitioners.

· Medication adherence incorporates total adherence and compliance with the medical instructions that patients are given.

· Proper medication adherence can significantly improve patient-related healthcare outcomes.

· In the United States, alone, the number of patients who have been diagnosed with type II diabetes cannot be accommodated by hospital settings (Brown & Bussell, 2018). Therefore, to prevent overflowing hospitals, home healthcare programs have been created.

b. Theoretical Foundations (models and theories to be the foundation for the project):

a. Attachment theory: In accordance with Hunter and Maunder (2016), there are two key reasons why the attachment theory is considered effective for the following DPI. First, the theory acts as a solid foundation for the enhanced comprehension regarding the identified development of ineffective coping techniques, as well as the underlying dynamics associated with the emotional difficulties of the person. Clinicians can help people who have attachment anxiety and fail to comprehend past experiences. Through the involvement of caregivers and/or significant others, individuals can help to reshape their coping patterns.

b. Social cognitive theory: The social cognitive theory (SCT) is a critical theory that will be utilized during this DPI project. The SCT is utilized to explain the manner in which human behavior is associated with dynamic, reciprocal, and progressive types of interactions that exist between the person and his/her given surrounding (Bosworth, 2015). Therefore, the SCT is famous because it often proposes that identified behavior aspects are an outcome of the cognitive processes that individuals usually develop. Cognitive processes are developed through social knowledge acquisition.

c. Review of Literature with Key Organizing Themes and sub-themes (Identify at least two themes, with three sub-themes per theme)

a. Theme 1: Medication Adherence – To handle the issue of medication adherence among the diabetic patients who have had an issue with the adherence to medication needs, various strategic should be utilized. The primary focus of this review of literature is to ensure that drug adherence, though understanding why lacking adherence occurs, is improved upon.

i. Drug Adherence: This is the art of sticking to the drug prescription as being presented by the doctors. There are many reasons why home care patients might fail to take drugs as prescribed. For instance, when there is no person to remind them of what is supposed to be taken and at what time (Brown & Bussell, 2018). Some patients go ahead of suffering conditions that make it difficult for them to progress in life.

b. Theme 2: Enhancing Adherence through Understanding

i. Patient-Centered Communication Approach: This approach will incorporate the interests and preferences of the patients. It will also serve to determine the possible barriers that patients might be facing related to their medication adherence (Voortman et al., 2017). To address components associated with the patient-centered approach, the following MAP resources will be used: Questions to Ask Poster and an Adherence Assessment Pad.

ii. Chronic Care Models: It is important to understand that patients need care when they are dealing with a chronic illness. Therefore, to ensure that proper care resources are provided, the My Medications List will be used.

c. Summary

i. Prior studies: Prior studies have revealed that medical adherence among home healthcare-based patients is lacking and has been a smooth process. In fact, up to 14% of diabetic patients (nationally) do not adhere to their prescribed medication regimen; however, other sources note that this lacking adherence is much higher than 14%, thereby contributing an issue that must be addressed.

ii. Quantitative application: The WHO reports numerical data about medication adherence among home healthcare patients. Furthermore, researchers have cited that medication adherence is often impacted by lacking literacy, poor understanding/knowledge about the importance of one’s medication, etc., thereby resulting in inflated adherence rates.

iii. Significance: Using the MAP resources and providing patient-specific care, medical adherence among type II diabetes patients will likely improve, thereby resulting in enhanced health-related outcomes.

Problem Statement 3. Problem Statement:

It is not known if or to what degree the implementation of the Medication Adherence Project (MAP) resources, which include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List, will impact medication adherence among type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas over a period of four weeks.

Clinical/ PICOT Questions 4. Clinical/PICOT Questions:

To what degree does the implementation of Medication Adherence Project resources, which include the Questions to Ask Pad, the Questions to Ask Poster, an Adherence Assessment Pad, and the My Medications List impact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas over a period of four weeks? The following clinical question will guide this quantitative project:

Q1: Does using the MAP resources improve medication adherence among home health diabetic patients?

Sample 5. Sample (and Location):

a. Location: The location of this project is in urban Texas. The project site provides a larger percentage of patients with healthcare services who reside in the urban area as compared to the rural area.

b. At the selected project site, approximately 30 patients have been diagnosed with type II diabetes, though this census changes each month. Patients between the ages of 35 to 64, with no cognitive limitation, who speak English, will be invited to participate in this project.

c. Inclusion Criteria

i. 35 to 64 years of age

ii. Type II diabetes diagnosis

iii. English speakers

iv. Cognitively abled

d. Exclusion Criteria

· Younger than 35 and older than 64 years of age

· Not diagnosed with type II diabetes

· Non-English speakers

· Cognitively disabled/delayed

Define Variables 6. Define Variables and Level of Measurement:

a. Intervention: Use of the MAP resources, by nursing staff members, which will be implemented upon the completion of an educational training session. Starr and Sacks’s (2010) MAP Toolkit and Training Guide resources, include: (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List.

b. Outcome: Enhanced medication adherence.

c. Variables: Medication adherence, which is the dependent variable explored in this project, will be measured using data attained through the project site’s EHR. The MAP resources, which serve as the independent variables explored in this project, include (1) the Questions to Ask Poster, (2) an Adherence Assessment Pad, and (3) the My Medications List.

Methodology and Design Methodology and Design:

A quantitative methodology, which employs a quasi-experimental design, will be used to examine medication adherence rates pre-project implementation and post-project implementation. Statistical analyses will be used to compare pre-and post-project data. Demographic data will be collected because the prevalence of non-adherence is often high among certain groups (e.g., impacted by socioeconomic status, gender, age, etc.).

Purpose Statement Purpose Statement:

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of the MAP resources, which will be delivered by home healthcare nursing staff members, will impact medication adherence when compared to current practice among type II diabetic patients, ages 35 to 64, of a home healthcare setting in urban Texas.

Data Collection Approach

Data Collection Approach:

Each week, nursing staff members will record medication adherence information in the patient’s EHR. If the patient expresses that he/she has not adhered to the medication regiment, during the previous week, lacking adherence information will be recorded in the system. Upon the completion of the four-week project, all information, input by nursing staff members into the EHR, will be assessed. The PI will compare pre-project implementation medication adherence rates to post-project implementation medication adherence rates. In addition to exploring medication adherence rates after the implementation of this project, pre-project implementation adherence rates will be explored over four weeks from April 1, 2021 to April 30, 2021.

Once pre-project implementation data and post-project implementation data are obtained, the results will be statistically analyzed. The PI will work with a statistician, who will assist in the data analysis process. Data will be compared analyze using various statistical techniques.

Data Analysis Approach Data Analysis Approach:

The data will be collected using the project site’s EHR and will be presented to the PI by the secretary in a Microsoft Excel document. Data will be input into SPSS version 28 and analyzed using a t-test with a p-value of 0.05.

References

 

Bosworth, H. B. (2015). Enhancing medication adherence: The public health dilemma. Philadelphia, PA: Springer Healthcare.

Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO Cares? Mayo Clinic Proceedings86(4), 304-314. Retrieved from https://doi.org/10.4065/mcp.2010.0575

Hunter, J., & Maunder, R. (2016). Improving patient treatment with attachment theory: A guide for primary care practitioners and specialists. Switzerland: Springer International Publishing.

Starr, B., & Sacks, R. (2010). Improving outcomes for patients with chronic diseases: The Medication Adherence Project (MAP). NYC Health. Retrieved from https://www.hfproviders.org/documents/root/pdf_9a3a46fa03.pdf

Voortman, T., Kiefte-de Jong, J., Ikram, M. A., Stricker, B. H., van Rooij, F. J. A., Lahousse, L., … Schoufour, J. D. (2017). Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. European Journal of Epidemiology32(11), 993-1005. https://doi.org/10.1007/s10654-017-0295-2

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