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Doctor of Nursing Practice (DNP) Tool Kit

Expectations for DNP Faculty

DNP program faculty hold the primary responsibility of meeting the intended program outcomes pursuant to the institutions accreditation standards.  Faculty are responsible for the evaluation of student outcomes that include the faculty, student, clinical preceptor, and practice mentor, as appropriate. Faculty are responsible to evaluate the appropriateness of the experience and setting of the practice immersion.  In addition, program faculty must ensure that the DNP student acquires the content and demonstrates the expected outcomes delineated in the DNP Essentials (2006).  Program faculty will need to clearly communicate to the clinical preceptor and the practice mentor the level, the intended outcome objectives of the practice hours and practice experience as well as expected learner outcomes for the practice immersion of the DNP student.

Furthermore, the responsibility of the faculty includes the oversight of the design, implementation, and evaluation of DNP Project and associated experiences that are aligned to student and program outcomes.  Lastly, program faculty are responsible for evaluation of the practice site and the students’ experiences in addition to communicating objectives and learner outcomes.  Regular communication with the clinical preceptor and the DNP practice mentor is pivotal to ensure the curriculum is being effectively delivered and student outcomes are met. This necessitates rigorous oversight of scholarly DNP Projects by faculty.

Guidelines for DNP Final Project

The content below originates from the following AACN documents: 1) The Essentials of Doctoral Education for Advanced Nursing Practice (2006); 2) The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations (2015); and 3) Defining Scholarship for Academic Nursing Position Statement (2018).

The Final DNP Project provides an opportunity for the student to integrate their new skills into practice and to demonstrate many of the principles of nursing scholarship and the competencies delineated in the DNP Essentials.  The integration of these new or refined skills improves outcomes through organizational/systems leadership, quality improvement processes, and the translation of evidence into practice. 

All DNP Projects should:

  • Focus on a change that impacts healthcare outcomes either through direct or indirect care.
  • Have systems (micro-, meso-, or macro- level) or population/aggregate focus.
  • Demonstrate implementation in the appropriate arena or area of practice.
  • Include a plan for sustainability (e.g. financial, systems or political realities, not only theoretical abstractions).
  • Include an evaluation of processes and/or outcomes (formative or summative). DNP Projects should be designed so that processes and/or outcomes will be evaluated to guide practice and policy. Clinical significance is as important in guiding practice as statistical significance is in evaluating research.
  • Provide a foundation for future practice scholarship

It’s important to note that integrative and systematic reviews alone do not constitute a DNP project. Integrative and systematic reviews form the basis to evaluate the literature, identify gaps and the evidence to guide any proposed practice change. While portfolios are an important tool to document and evaluate the professional development and learning synthesis of students, portfolios are not considered a DNP Project. In addition, group/team projects can be valuable; however, group/team projects present challenges, particularly for the student evaluation and grading.

The DNP Project should be guided by evidence-based practice, quality improvement processes, and/or clinical program evaluation and reviewed by the faculty at regular intervals. Faculty review should include formative and summative reviews affording DNP students with feedback and input to incorporate into the final DNP Project. DNP Projects should be designed so that the processes and/or outcomes will be evaluated to guide practice and/or policy.

The DNP student is responsible to evaluate the effectiveness of the practice change proposed and implemented as part of the DNP Project. Evaluation of the final DNP Project is the responsibility of the faculty. Evaluation includes a review process, which may include academic review, peer review and/or stakeholder review. In addition, review and input from stakeholders outside of academia are important to ensure rigor, applicability, and impact of the work as well as to disseminate outcomes (AACN, 2015).

The impact of systems and/or practice outcomes of the DNP Project are to contribute to a micro, meso, or macro level systems problem that has been examined through the literature and is to guide a change in practice through an evidence-base. The impact will be measured by the proposed practice change and outcomes of the DNP Project as evaluated after the rapid translation of research to practice, thereby minimizing the research to practice gap (AACN, 2018).

When possible, the DNP Project team should consist of a student with a minimum of a doctorally prepared faculty member and a practice mentor who may be from outside the university. In some instances, additional experts/mentors/partners/facilitators can be formal or informal collaborators and may provide intermittent or limited support throughout the project stages as needed.

The following are examples of settings, areas of practice, and final projects that could be considered to provide a broader array of opportunities particularly in geographic areas with limited access to traditional practice sites. A project developed in any of these settings or areas of practice delineated here should include planning, implementation, and evaluation.

Organizational Systems Leadership

Work with the Director of the Red Cross exploring ways to improve disaster preparedness; Work with a director of system IT exploring the preparedness strategies to prevent an IT shutdown and strategies for communication and charting to continue during a shutdown, or focus on the nursing leadership role in leading IT design and implementation issues; Work with the System Safety Office evaluating the disaster plan incorporating national best practices and making recommendations for quality improvement of the system plan.

Population Health

Partner with community organizations that affect the health of high risk populations to address screening or health education processes, financial challenges (including how to raise money and manage money), volunteerism, and interactions/ collaborative opportunities with the healthcare system. Examples of community agencies include: Habitat for Humanity, food pantries, Catholic Charities, homeless shelters, Salvation Army, and Hope Center. Other opportunities might include collaboration with private sector companies to design healthcare facilities, or design and implement wellness/health programs in conjunction with business such as the airline or auto industry.

Policy Projects

Evaluate evidence to develop a policy to reduce major events that trigger an ED visit, e.g. by notifying a provider that a fall has occurred, document evidence of need for the policy change; Evaluate geriatric trauma screening for triage; make a recommendation for policy change to revise criteria.

Long-Term Care Facilities

Evaluate and implement a quality improvement program within a long-term care facility, e.g. Evercare or a Medicare Advantage plan, to improve antibiotic selection for symptomatic UTIs in older adults without indwelling catheters and to decrease the inappropriate use of nitrofurantoin. Implement a policy and care practice for antibiotic selection guided by the Infections Disease Society of America guidelines for treatment of UTIs. 

Urgent Care

Focus on achieving the national benchmark of urgent care visit times lasting less than 60 minutes, identifying and mitigating impediments to efficient patient flow at a Family Medicine Center Walk-in Clinic. Implement a quality improvement project to identify measure and rectify bottlenecks impacting patient flow through the clinic while tracking total visit times. 

Prison Systems

Explore the effectiveness of chronic disease management models and mental health services among the aging population in prison systems. Focus on the institution of mental health screening and care models to be integrated into the prison system of care. 

School Systems

Evaluate Tobacco Free Teens program as a mobile device application, introduce the mobile application in a middle school classroom and evaluate the adolescents’ satisfaction with the tool; other areas of focus may include evaluating immunizations, weight loss, and healthy eating.

Community-based Care Network

Implement a quality improvement project developed to address the gaps in APRN practice and evaluate the impact of a competency-based training program on the translation of evidence in the APRNs’ practice. Specific projects may include:

  • Increase documentation of didactic training and skills validation for transvaginal ultrasounds and endometrial biopsy from 0% to 90%.
  • Increase the number of APRNs who perform transvaginal cervical length measurement in the assessment of symptomatic preterm labor patients from less than 40% to 75%.
  • Decrease the number of fetal fibronectin studies run without a corresponding cervical length measurement by 20%.
  • Decrease the number of inadequate endometrial samples from the current 25% to less than 10% by X date.
  • ncrease the percent of endometrial biopsies being done by APRNs in the region to greater than 50%.
Rural Native American Reservation

Form a working group with health department personnel to discuss and address the issues of health literacy and cultural sensitivity; Develop a case management model for more complex patients that includes the development of a cost sharing plan that proposes utilizing social workers from the senior center to coordinate this service and proposes to the community council the need to add a professional nurse FTE position to the clinic to help coordinate the effort of the social workers in ensuring regular follow up of patients; implement the use of community health workers as a means of further engaging the community and as a means of increasing follow-up visits. 

Public Health Department

Collaborate with state government units to improve access to health care, negotiating tribal governance, gender issues, language, and culture in a population by training lay health promoters e.g. to improve the diet and access to fresh foods or providing zinc supplementation to the under age 5 population in Guatemala.

Non-governmental Organizations and Community Health Organizations

Collaborate with in country NGOs to decrease stigmatization and increase screening for breast cancer in Zambia; or collaborate with the American Heart Association or other organization to improve outcomes in the community. 

Corporations

Focus on decreasing the percentage of employees in a manufacturing plant with a BMI in the obese or overweight category by changing cafeteria food options, educational initiatives and a voluntary employer-based 16 week wellness program.

Dissemination of the DNP Project should include a product that describes the purpose, planning, implementation, and evaluation components of the project, and should be required for each student’s project. Dissemination of the project outcomes is essential and may include a variety of forms depending upon the focus and area of advanced nursing practice and should be targeted to appropriate audiences to ensure impact. It is not appropriate to expect every DNP Project to be published in a peer-review journal. However, every DNP Project should be disseminated to a broad audience.

Dissemination examples include presentations at either a regional, state, national, or international meeting or through one of the identified channels in the Doctor of Nursing Practice: Current Issues and Clarifying Recommendations white paper to share the findings with the larger nursing community.

  • Publishing in a peer reviewed print or on-line journal (individual faculty or a faculty committee/team should carefully evaluate any manuscript for publication probability and select those appropriate for submission).
  • Poster and podium presentations.
  • Presentation of a written or verbal executive summary to stakeholders and/or the practice site/organization leadership.
  • Development of a webinar presentation or video, e.g. for YouTube or other public site.
  • Submission and publication to a non-refereed lay publication.
  • Oral presentation to the public-at-large.
  • Development and presentation of a digital poster, a grand rounds presentation, and/or a PowerPoint presentation. Providing financial and production resources to assist students is recommended.
  • A student’s portfolio is not considered a DNP Project or a form of dissemination but rather a tool to document and evaluate professional development and learning. A minimum of an executive summary or a written report that is disseminated or shared beyond the academic setting is recommended for dissemination of the DNP Project outcomes.

While not intended to be an inclusive list, the following are examples of the scholarship of practice (AACN, 2018):

  • Develops best practices for incorporation of findings generated through translational and implementation science.
  • Publishes to impact practice via peer-reviewed venues.
  • Disseminates policy papers through peer-reviewed media.
  • Disseminates practice-based findings at regional, national, or international meetings.
  • Analyzes system-wide data to evaluate practice patterns and/or uncovering new issues related to practice from such data.
  • Serves as a clinical practice specialist in partnerships that advance research, clinical improvements, policy development and/or implementation.
  • Analyzes big data (such as healthcare systems dashboard measures) or conducts policy analysis at the community, state, national, or international level.
  • Engages with stakeholders including patients, coalitions, corporations, and industries to educate the workforce, develop clinical innovations, and/or translate research for practice transformation.
  • Influences policy through leadership activities at the local, national, and international level and participates on policy think tanks.
  • Translates research and utilizes evidence to improve health and generate practice-based knowledge.
  • Develops unique clinical nursing programs (within healthcare systems) or interventions with documented effectiveness.
  • Disseminates clinical programs or quality improvement initiatives in regional, national, or international arenas.
  • Establishes and evaluates quality improvement initiatives.
  • Leads in the development, review, and evaluation of clinical practice models to transform healthcare delivery.
  • Translates research and utilizes evidence to improve health, impact practice, and effect change in health systems.
  • Develops clinical guidelines, innovations, and new program initiatives.
  • Engages in systematic reviews that synthesize/summarize research findings to recommend solutions to current clinical problems.
  • Evaluates and reports population health, satisfaction, and cost outcomes.
  • Communicates to lay groups to promote translation and implementation of research findings demonstrating evidence-based best practices.
  • Consults within healthcare organizations to build capacity for improving care and implementing evidence-based practice.
  • Uses secondary data from the electronic medical record to evaluate health care processes and patient outcomes to improve quality of care.

Glossary

Impact: The force exerted by a new idea, concept, technology, or ideology.  Having influence or effect, e.g., The Essentials of Doctoral Education for Advanced Nursing Practice has had significant impact on the education of nurses (Dictonary.com, 2017a).

Implementation Science: The study of integrating research findings into healthcare practice and policy by understanding facilitators and barriers to the uptake of evidence (NIH, n.d.). The goal is to determine which factors promote the use of innovations in practice to the fullest extent and in the most effective way possible (National Implementation Research Network, 2015)

Improvement Science: A multidisciplinary applied science that seeks to improve healthcare processes and outcomes through quality improvement strategies such as innovation and rapid cycle testing in real-world environments (National Institutes of Children's Health Quality, 2017).