Psychopharmacology And Inclusive Recreation Services

APA format

1) Minimum 12 pages  (No word count per page)-   Follow the 3 x 3 rule: minimum of three paragraphs per page

You must strictly comply with the number of paragraphs requested per page.

The number of words in each paragraph should be similar

         Part 1: minimum 3 pages

         Part 2: minimum 3 pages

         Part 3: minimum 3 pages

         Part 4: minimum 3 pages

Submit 1 document per part

2)¨******APA norms

        The number of words in each paragraph should be similar

        Must be written in the third person

All paragraphs must be narrative and cited in the text- each paragraph

The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information.

         Bulleted responses are not accepted

         Don’t write in the first person 

         Do not use subtitles or titles      

Don’t copy and paste the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)

Parts 1 and 2:  Minimum 6 references (APA format) per part not older than 5 years  (Journals, books) (No websites)

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc

ORDER  A PLAGIARISM FREE PAPER  NOW

__________________________________________________________________________________

The number of words in each paragraph should be similar

Part 1:   Psychopharmacology

Topic:  Amitriptyline

1. Describe uses for treatment FDA approved (one paragraph)

2. Explain Off label uses (one paragraph)

3. Contraindications (one paragraph)

4. Mechanism of action (one paragraph)

5. Potential side effects(one paragraph)

6. Lab monitoring/ follow up (one paragraph)

7. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of prescribing the medication (one paragraph) Psychopharmacology And Inclusive Recreation Services

8. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of managing the medication (one paragraph)

9. Conclusion (one paragraph)

The number of words in each paragraph should be similar

Part 2:   Psychopharmacology

Topic:   Agomelatine

1. Describe uses for treatment FDA approved (one paragraph)

2. Explain Off label uses (one paragraph)

3. Contraindications (one paragraph)

4. Mechanism of action (one paragraph)

5. Potential side effects(one paragraph)

6. Lab monitoring/ follow up (one paragraph)

7. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of prescribing the medication (one paragraph)

8. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of managing the medication (one paragraph)

9. Conclusion (one paragraph)

 

Parts 3 and 4  have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

Part 3: Inclusive Recreation Services

Topic: Ethical Assumptions and Leisure

Read the eight statements presented below:

a. Assumption #1 (Humans): All People Deserve Our Respect

b. Assumption #2 (Humans): Everyone Has the Right to Self-Determination

c. Assumption #3 (Humans): No One Can Be Reduced to One Characteristic

d. Assumption #4 (Ideals): Inclusion Is Good

e. Assumption #5 (Ideals): Diversity Enriches Our World

f. Assumption #6 (Service Providers): With Great Power Comes Great Responsibility

g. Assumption #7 (Service Providers): We Ought to Consider Perspectives Different From Our Own

h. Assumption #8 (Service Providers): Critical and Constructive Thinking Contribute to a More Just Society

1. Describe why you think each of these assumptions are listed at the beginning of the Textbook “Inclusive Leisure Services”(4TH Ed). (Three paragraphs)

a.

b.

c.

d.

e.

f.

g.

h.

2. Which of these assumptions do you think are the most important? (One paragraph)

a. Explain reasons why you selected these particular assumptions.

3. Which of the assumptions have you spent limited time thinking about? (One paragraph)

a. Explain

4. Select one of the assumptions.  (One paragraph)

a. What is the relationship between that assumption and providing inclusive leisure services?

Part 4: Inclusive Recreation Services

Topic: Ethical Assumptions and Leisure

Read the eight statements presented below:

a. Assumption #1 (Humans): All People Deserve Our Respect

b. Assumption #2 (Humans): Everyone Has the Right to Self-Determination

c. Assumption #3 (Humans): No One Can Be Reduced to One Characteristic

d. Assumption #4 (Ideals): Inclusion Is Good

e. Assumption #5 (Ideals): Diversity Enriches Our World

f. Assumption #6 (Service Providers): With Great Power Comes Great Responsibility

g. Assumption #7 (Service Providers): We Ought to Consider Perspectives Different From Our Own

h. Assumption #8 (Service Providers): Critical and Constructive Thinking Contribute to a More Just Society

1. Describe why you think each of these assumptions are listed at the beginning of the Textbook “Inclusive Leisure Services”(4TH Ed). (Three paragraphs) Psychopharmacology And Inclusive Recreation Services

a.

b.

c.

d.

e.

f.

g.

h.

2. Which of these assumptions do you think are the most important? (One paragraph)

a. Explain reasons why you selected these particular assumptions.

3. Which of the assumptions have you spent limited time thinking about? (One paragraph)

a. Explain

4. Select one of the assumptions.  (One paragraph)

a. What is the relationship between that assumption and providing inclusive leisure services? Psychopharmacology And Inclusive Recreation Services

Fundamentals Of Professional Nursing

QUESTION

Please read the following case study and complete the questions below.

Daniel is a 16 year old boy who is an identical twin. He and his brother Jeff are very close and do most things together. While Daniel excels at sports he believe his brother is much better at most everything. Daniel, his brother, and their two sisters live with their parents in the Midwest. Recently Daniel has been feeling more tired than usual. He thought it was because of his schedule and school work, which he is fairly good at. He gets mostly Bs, but his grades have been slipping of late. One day he fainted while getting ready for a game. His coach called his parents to let them know Daniel was taken to the Emergency Room. While there the doctor decided to admit Daniel to the hospital for observation. At the time he was running a slight fever, his breathing was shallow, and he was sweating. He was also very sleepy and his blood pressure was high. He did have some abnormal laboratory work, but his doctor was not too concerned at present. Daniel also stated that he felt achy.

 

You are assigned to take care of Daniel today and when you walk into his room, his mother and brother Jeff are there. Daniel appears to be sleeping. In your written assignment, respond to the following questions applying the nursing process:

ORDER  A PLAGIARISM FREE PAPER  NOW

Assessment: What type of objective and subjective data can you collect with what you know? How will you collect these data? What further evidence do you need? Fundamentals Of Professional Nursing

 

Analysis and Identification of the Problem: What do you believe Daniel’s problem(s) are? What might be the nursing diagnoses? Use the following for identification.

 

Planning: Identify two goals and one nursing intervention for each, based on your nursing diagnoses.

While you will not be able to implement or evaluate, how well do you think your nursing interventions might help with Daniel’s care. Fundamentals Of Professional Nursing

 

Additional Resource

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales

 

Applying Measurement Tools

One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario. Applying Measurement Tools

ORDER  A PLAGIARISM FREE PAPER  NOW

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes. 

 

Take on the role of the staff nurse in the scenario and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all components of HEDIS comprehensive diabetes care.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence Links to an external site.from the readings and include in-text citations Links to an external site.. Utilize essay-level Links to an external site.writing practice and skills, including the use of transitional material Links to an external site.and organizational frames Links to an external site.. Avoid quotes; paraphrase Links to an external site.to incorporate evidence into your own writing. A reference list Links to an external site.is required. Use the most current evidence Links to an external site.(usually ≤ 5 years old). Applying Measurement Tools

 

Topic #1

1. What are some examples that you saw used to drive an increase in Covid-19 vaccination rate? (social media, news outlets, company policy etc) Why were some more successful than others?
2. Do you have any new ideas or variations on existing ideas that you think could have driven increases in US Covid-19 vaccination rates? Nursing homework help

 

Student Initial post #1

To drive an increase in Covid-19 vaccination rates, I saw various implementation tactics. On social media, many “influencers,” politicians, and healthcare professionals were encouraging their followers and the general population to get Covid-19 vaccinations, especially when they first became widely available to the public. I would often see commercials in between sporting events or popular television shows promoting Covid-19 vaccinations, like Pfizer for example. I was working at a Federally Qualified Health Center at the time the vaccinations became available, and it became mandatory that all workers received the vaccination. We were told this was company policy and made mandatory by the State of California. Workers that chose not to be vaccinated at that time had a window to which they could receive their first dose, and if they chose not to be, they were at risk for termination. This did make me feel safer coming to work, especially in an environment that was already high-risk, working in close contact with patients daily.

ORDER  A PLAGIARISM FREE PAPER  NOW

I believe there are many things that could influence people to get vaccinated, however, I don’t believe these ideas are necessarily ethical. For example, if there were incentives to be vaccinated, such as a gift card to grocery stores or extra relief funding. Companies could also advertise other possible health benefits if they could be side effects of the vaccine, for example, weight loss or stronger immunity to the flu (for combined vaccinations). Finally, there could be a task force directed towards “anti-vaxxers” that work toward answering people’s questions about the vaccine if they are skeptical, or debunking the myths around the vaccines and sharing videos on social media. Nursing homework help

 

Student Intial post #2

 

In efforts to increase the the vaccination rate many different tactics were used to influence different groups of people in our society to get vaccinated. Public media campaigns focus on interpersonal relationships, getting vaccinated so you can visit loved ones and keep them “safe”. The community efforts that encourage families to get vaccinated together for sometime of reward like gift cards, sporting event tickets. There was even lotteries where if one was vaccinated in a certain time frame they could win $1,000,000 dollars or a scholarship to a state university if under 18 years of age. I believe for many adults like myself the requirement for work was the catalyst to agreeing to vaccination. I believe the thought of being without a job “voluntarily” was enough for many to get vaccinated, when so may others were losing their jobs or already without employment due to the quarantine and resulting business closures. For those who wanted to socialize and go back to “normal’ the requirement and proof of vaccination to travel, attend concerts, live shows and sporting events persuaded many.

I think that a lack of research and resulting data is a reason many continue to chose not be vaccinated for Covid-19. There are article and news stories published every few days that that highlight side effects of the vaccination that people are not comfortable with. As the vaccines still only have emergency use approval, it will take sometime to for the public to trust the vaccination where they do not need any mass campaigns efforts to drive vaccination rates up especially since you can now go back to most regular activities without providing vaccination status.

Topic #2

 

It shows that the graph of the use of leaded gasoline between 1937 and 1986 is similarly shaped to a graph of violent crime between the years of 1960 and 2009. The authors of the article argue that this shape similarity could imply a causal relationship. Do you agree or disagree? What other factors might play a role in this relationship? Please remember to comment on at least one other student’s post. Nursing homework help

 

Student Initial post #1

As we have heard so often throughout our program: “correlation does not equal causation.” In this week’s materials, we simply used the word “association” instead of “correlation.” While association is defined as an “identifiable relationship between an exposure and disease,” a cause only occurs when something actually makes the difference (Kim, 2023). As such, in order to determine if a situation involves a cause or is just an association, epidemiologists often ask: “Did the exposure cause the outcome?” (Kim, 2023).

The graph above shows that the use of leaded gasoline between 1937-1986 had a similar trajectory to the rate of violent crime between the years 1960 and 2009. While the authors of the article argue that this similarity could imply a causal relationship, it is more likely that the relationship is just an association. There are a variety of factors that could influence the similarity in the relationship. For example, the car industry began to really take off throughout the twentieth century, which could explain the increase in gasoline use. Additionally, given that Great Depression lasted until 1939, the graph shows a time in which many Americans may have been influenced to purchase a vehicle given that the economy was gradually improving. As for violent crimes, BBC remarks that “many violent crimes [during this period] emerged due to the rapid technological, social, and economic changes” (BBC, 2023). Additionally, increased rates of crime may have been simply a result of increased reporting. As such, given the variety of factors, it is unlikely that the use of leaded gasoline and violent crime in the twentieth century was a causal relationship.

Works Cited

BBC. (2023). The Growth of Crime in the 20th and 21st Centuries. https://www.bbc.co.uk/bitesize/guides/z2cqrwx/revision/8Links to an external site.

N.C. Government and Heritage Library. (2020, May 26). The Automobile: Social Game Changer. NCPedia. https://www.ncpedia.org/automobile-social-game-changer-k-8#:~:text=During%20the%20first%20decades%20of,things%20in%20their%20leisure%20time Links to an external site..

Edited by Maureen Murphy on Jan 17 at 1:06pm

 

 

 

 

 

 

 

 

DNP Role Assignment Paper Part I

WEEK 3

ASSUGNMENT QUESTIONS

TOPIC: DNP Role Assignment Paper Part I

 

Title of my Paper: The Role of a DNP Prepared Nurse Committed to Evidence-Based Practice Acting as a DON in a Clinic

 

The purpose of this assignment is evaluate a current or new role relative to a DNP prepared nurse.  The emphasis will be on the skills that a DNP prepared nurse brings to the role. What are the differences coming from a DNP perspective? What skills will a DNP prepared nurse have that a MSN prepared  RN would not.

The Role Paper will be completed in 2 parts.  Part I  will focus on a description of the role and what the DNP/MSN nurse will bring to the role. A SWOT analysis will also be done for Part I.  Part 2 will consist of a PEST analysis and the next steps in moving the role to a DNP level.  References will be completed for both parts of the paper.   The final paper will include both part 1 and part 2. 

Below is an outline of the items for which you will be responsible throughout the module.

1. Read chapter 8 and 9  from Zaccagnini, M.,  &  Pechacek, J.  (2021). The doctor of nursing practice essentials. (4th Ed.). Burlington, MA: Jones & Bartlett Learning.
2. National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982 Links to an external site.. Chapter 4- The role of nurses in improving health care access and quality, p. 99-126, Links to an external site.
3. Chapter 5- The role of Nurses in Improving Health Equity Links to an external site. pp 127-146
4. Review the module lecture materials.
5. Submit Assignment  DNP Roles.- SWOT Analysis
6. No discussion this week

 

sample DNP 802 Role Development DNP Role SWOT Analysis part 1-1.doc   (ATTACHED)

 

Student Sample (with permission) Parts 1 and 2: DNP_SWOT_Analysis_Part 1 and 2 Student Sample Spring 2019.docxDownload DNP_SWOT_Analysis_Part 1 and 2 Student Sample Spring 2019.docx

See the following reference for an example of a DNP Role SWOT Analysis,   Table 10-6, pp. 362-363 in 4th Edition of Zaccagnini and Pecheck

 2013 DNP DNP project. A feasibility and cost analysis on a nurse practitioner managed endoscopy service.pdfDownload  2013 DNP DNP project. A feasibility and cost analysis on a nurse practitioner managed endoscopy service.pdf

Areas to address in Part 1: In 10-12 pages, not including the references.

• Clear description of the specific DNP role of interest, why chosen
• Identifies if there is a gap in this role currently, why it is needed
• Differentiates b/w MSN and DNP in the role- what are the differences from a DNP perspective
• Conducts a SWOT analysis, with references for findings. DNP Role Assignment Paper Part I

 

PLEASE NOTE : 

1. You must use Turnitin- and review your similarity score. No plagiarism.
2. About 10-12 References within the last 5 years
3. Must use and the following references:
   1. Read chapter 8 and 9  from Zaccagnini, M.,  &  Pechacek, J.  (2021). The doctor of nursing practice essentials. (4th Ed.). Burlington, MA: Jones & Bartlett Learning.
   2. National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982 Links to an external site.. Chapter 4- The role of nurses in improving health care access and quality, p. 99-126, Links to an external site.
   3. Chapter 5- The role of Nurses in Improving Health Equity Links to an external site. pp 127-146
4. Please provide in-text citations for all references

 

ORDER  A PLAGIARISM FREE PAPER  NOW

 

 

 

 

DNP Role SWOT Analysis

xxxx MSN, RN

Northern Kentucky University

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DNP Role SWOT Analysis

Define innovation? The Merriam-Webster dictionary (2018) defines innovation as: the introduction of something new, a new idea, method or device. The emergence and continued dedication to employ the Doctorate of Nursing Practice (DNP) has been fueled by the ever-changing health care reform agenda, the aging and multiplying population health of the United States, and its economic welfare. The Affordable Health Care Act, and visions of increasing the affinity of access to high quality, safe, effective, and cost effective health care, has intensified the calls for advanced practice healthcare providers of all respects. Mcsherry and Douglas (2011) summarize the definition of innovation specific to practice: as the utilization of a professional’s knowledge and skill to artistically create and develop new means of working, utilizing technologies, systems, models and theories with stakeholder input and collaboration to evaluate current practice and catapult it to the next level with means of evaluation and measurement based on evidenced based practice (EBP). Melynk and Fineout-Overholt (2011) define EBP as a lifelong commitment to clinical decision making using the best available evidence, coupled with an individual’s own clinical expertise, and patient centered values and preferences, to ultimately improve outcomes for patients, groups, communities, and systems.

At the heart of innovation to practice in the clinical setting are those that we care for: our patients, their families, our neighbors, and our loved ones. EBP inspires innovation and is essential as we work to attain improved patient outcomes and quality of care. Confusion and argument still exist as to whether or not the DNP is a role versus a credential, however, one can conclude that with the gained knowledge and skills upon obtainment of the DNP academia, DNP prepared individuals become excellent innovators. DNP prepared individuals serve in a wide variety of roles and positions, making relevant contribution to all healthcare lead initiatives (Terharr, Taylor, & Sylvia, 2016). This paper will emphasize the role of a DNP prepared nurse committed to EBP serving as the Director of Evidenced Based Practice in the acute care arena.

DNP Role of Interest: Director of Evidenced Based Practice DNP Leader

in the Acute Care Arena

The Director of EBP DNP leader is responsible for inspiring, cultivating, and sustaining organizational culture rich in EBP, within the acute care arena he or she serves. The vision and inspiration for this role is to improve the means of care delivery, knowledge attainment and utilization to improve practice and patient outcomes, increase collaboration and integration of disciplinary health professionals, and ultimately improve the image of nursing within the organization served and its community. Seated adjacent to and working in collaboration with the Chief Nursing Officer this position and its rank signifies the need for collaboration and commitment to providing evidenced based care, affecting both organizational and nursing strategic goals. This role demonstrates the importance of having a DNP leader committed to EBP in quantifying and signifying the impact and joint venture of what happens within administrative walls to that of how care is provided at the bedside.

In the acute care arena, the Director of EBP DNP leader collaborates, cultivates, and inspires evidenced based nursing interventions to influence health care outcomes within all avenues: direct patient care, education, management, administration, development and implementation of policy, outcome measure and evaluation. The Director of EBP DNP leader, serving in the acute care arena, has the affinity to transform health care across disciplines, inspire innovation, improve the context for which care is provided, and ultimately impact the trifecta of care: cost, quality, and safety. Melynk and Fineout-Overholt (2011) consistently report the influential value of bringing EBP to the forefront of care; leading to the highest quality of care, improved patient outcomes, reduction of costs associated with care delivery, expanding access, empowering providers and their roles, and reducing burnout and turnover in the profession.

The 2004 American Association of Colleges of Nursing (AACN) (AACN Position Statement on the Practice Doctorate in Nursing, 2004) position statement on the Practice Doctorate highlights the critical need to provide professional nurses whom serve in a multitude of leadership roles advancement in professional education. These leaders require enhanced knowledge and skill for clinical and administrative leadership in response to our nation’s current and forecasted health care dilemmas. The AACN (2004) also introduced several benefits to the practice-focused doctoral prepared nurse. Here are a few specific to leadership: enhanced skills to strengthen practice and health care delivery, enhanced knowledge improving practice and patient outcomes, collaboration and integration with other health professions, and ultimately improved image of nursing, affirming the professions high regard by the public.

To illustrate further the impact of DNP prepared nurses, Udlis and Mancuso (2015), conducted a qualitative study exploring 340 professional nurses, all with various experiences and academia, assessing their perceptions surrounding the role of the DNP prepared nurse. They reported that to some degree the perception by all survey participants concluded that the DNP prepared nurse is better adapted to assume enhanced complex leadership roles and responsibilities and 84% of the DNP prepared survey participants agreed that their academic accomplishments further prepared them for academic leadership roles.

Background and Significance

The Institute of Medicine has evolved from its means of identifying quality and safety of patient care to further acknowledge the need for 21^st century reform. Reform brings a shifting platform of focus from review and analysis of negative outcomes to a focus on conceptual qualities of care. Demanding quality care that is safe, effective, patient centered, timely, efficient, and equitable (Mitchell, 2008). Professional nurses play a fundamental and critical role in providing quality care to those they serve, with the use of consistent evidenced based research and practice implementation. Inconsistencies, lack of standardization, and failure to utilize EBP at the bedside have been identified within all clinical settings. Bernazzani (2017) reported events associated with preventable harm or adverse events accountable for nearly 1,000 deaths per day. These events such as hospital acquired infections (HAI), surgical errors, medication errors, hospital acquired pressure injuries, and falls increase mortality, decrease patient outcomes, and increase length of hospital stay. Coincidently, cost per incident of preventable harm is nearing $59,000 per occasion (Bernazzani, 2017).

The Director of EBP DNP leader, in an acute health care arena, fosters EBP through philanthropy, development, implementation, and sustainability of an organizational culture engrained and committed to safe, quality, and cost effective care. EBP, coined as the gold standard of care, (Melynk and Fineout-Overholt, 2011) now calls for organizations to prioritize resources to affect care both at the bedside and in collaboration with those whom serve in administrative offices. DNP Role Assignment Paper Part I

Literature Review and Synthesis of Sources

In order to further understand the impact of the role of the Director of EBP DNP leader one must discuss the similarities and differences found in literature regarding the nurse leader, EBP, and nursing excellence. Through accessing Northern Kentucky University’s library and choice of all worldwide libraries, search limiters were utilized to limit the study date to a minimum date of 2008. These search terms: nurse leader, nursing excellence, evidenced based practice quickly resulted in the 4 articles to be presented.  All four articles address the importance of a nurse leader’s role in creating a culture of patient safety committed to use of EBP and in turn cultivating nursing excellence (Grindel, 2016; Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008).  Melynk (2016, p. 3) stated, “Without a culture and environment that supports EBP, evidenced-based care by clinicians is not likely to be consistently implemented and sustained.” This statement made by Melynk (2016) emphasizes the importance of the nurse leader’s ability to promote professional competency in assuring safe quality care, and the need for nurse leaders to take ownership in a culture centrally focused on patient safety (Grindel, 2016; Sammer & James, 2011). Two articles specifically discussed the importance of nurse leaders in influencing the implementation of EBP along with collaboration of direct bedside providers through the design and implementation of policies, protocols, and pathways, standardizing practice and ultimately influencing change in practice and outcomes (Grindel 2016; Sammer & James, 2011). Xiaoshi (2008) was the only article that directly discussed the correlation of EBP and nurse leader responsibilities impacting that of organizational strategic goals and objectives.

All four articles acknowledged the nurse leaders’ skill and competency in influencing a framework and platform to drive initiatives in employing patient safety measures through the use of EBP (Grindel, 2016; Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008). Sammer and James (2011) mentioned that measurement of improvement processes may serve as the “tipping” point to nursing excellence and superior patient care. Melynk (2016) and Xiaoshi (2008) both presented a barrier to the use of EBP, directly related to the resistance of use by nurse leaders and managers, and a lack of leadership, motivation, vision, and strategy to support EBP central to practice. Grindel (2016) introduced leadership competency skills including, but not limited to, clinical expertise, emotional intelligence and the 3 C’s: communication, collaboration, and coordination. These skills were also mentioned in a manner of means in the other three articles but not quite as deliberate as this author (Melnyk, 2016; Sammer & James, 2011; Xiaoshi, 2008).  Sammer and James (2016) introduced the application of theory to practice in means of guiding leaders to become strong foundations and change agents in promoting EBP and improving patient outcomes.

How does the Director of EBP DNP leader commit to EBP? A great example of the application of a DNP leader committed to EBP is that of an organization that has achieved Magnet Recognition. Nurse Leader Insider (2017) presents the nature of organizations that have achieved the American Nurses Credentialing Center (ANCC) Magnet Recognition as an organization with EBP nurses directly impacting patient care and outcomes. Hallmark to Magnet Recognized organizations is the culture surrounding EBP as a “need to have” culture (Nurse Leader Insider, 2017). In order for any organization to achieve Magnet Recognition, multiple quality indicators, nursing practice, and outcomes are appraised for distinction. The Director of EBP DNP leader is committed to guiding EBP through advocating, supporting, and creating a professional environment that embraces practice excellence.  The value in a DNP leader guiding the journey to attainment of Magnet Recognition and its sustained recognition is a prime example of how the DNP degree is more than a degree.

SWOT Analysis

The SWOT analysis below presents an effective means of identifying the strengths, weaknesses, opportunities and threats that a Director of EBP DNP leader should consider in order to commit to identifying opportunities for impact and growth and overcoming potential barriers and challenges.

Strengths EBP practice knowledge and skill central to point of care providers, leaders and organizations committed to safe, effective, quality care Increased culture focused on Patient Safety, Quality Outcomes, and Cost Containment Disciplined educated, knowledgeable, and skilled leader in guiding culture and sustainability Increase teamwork and collaboration Increase communication and transparency Influence ownership and accountability (Xiaoshi, 2008) Empower patient care provider’s confidence (Xiaoshi, 2008) Commitment to lean processes reducing waste in the workplace (Grindel, 2016) Position organization as hallmark to excellence ensuring effective care attractive to communities served (Grindel, 2016)

Opportunities Standardization Nurse driven care protocols, pathways, and practices central to evidenced based practice driven and guided by the DNP prepared Nurse Leader (Grindel, 2016) Decreased health care costs and costs associated to adverse events/preventable harm, suffering, and disability (Sammer & James, 2011) Promote continued learning and academia Recognition of Gold Standard commitment to care central to EBP (Melynk & Fineout-Overholt, 2011) Decrease burnout and turnover amongst providers (Melnyk & Fineout-Overholt, 2011)

Weaknesses Lack of understanding EBP as a direct pathway to improving quality and outcomes (Xiaoshi, 2008) Negative attitude towards research (Melnyk, 2016) Nurse leader and manager resistance to EBP Lack of resources and access to EBP and mentors (Xiaoshi, 2008) Lack of tools and appropriate resources used in research findings and practice (Melnyk & Fineout-Overholt, 2011)

Threats Perception of adopting EBP care (Melnyk, 2016) Outcomes in trials do not reproduce same results in real world clinical settings (Melnyk, 2016) Lack of standardized tools for assessment of organizational culture, readiness, and framework supporting culture (Xiaoshi, 2008) Overwhelming volume and variability of information  (Xiaoshi, 2008) Nurses tendency to rely on experienced based care rather than evidenced based care (Xiaoshi, 2008)

 

PEST Analysis

A PEST analysis has been completed to predict how the role of the Director of EBP DNP leader will resound within the organization and its constituents. A PEST analysis addresses factors that are external and out of direct control by this leader, it inquires consideration of political, economic, social, and technological factors that are common to affecting overall performance (Post, 2017).

Political Evaluation of current political agenda shaping cost, quality, access through efforts to promote EBP Changes and regulation of care based on EBP and care through federal, state, local, and private health insurance companies Increased demand for monitoring of data, outcome research, reporting, and reform due to shift in EBP

Economical EBP influence financing policy through reimbursement, authorization, and payment Elevate medical necessity for care and treatment Cost versus Quality Decrease mortality, decrease length of stay, decrease institutionalization and disability after care, decrease patient harm events Focus on cost minimization, cost utility, cost consequence, and cost effectiveness

Social Shift for education, knowledge, skill attainment based on EBP at the bedside Shift in increased autonomy and accountability of nursing providers Shift in trust of patients and communities in respect to trusted profession focus on a culture of patient safety and quality outcomes Increased collaboration and communication amongst providers, patients, and family/significant others Clarification of roles and responsibilities of all providers

Technological Use in technology to monitor and evaluate data and further imply improvement quality measures Validation of practice through use of modern technology, ability to gather and analyze data Ability to impact media and integrity of the nursing profession central to nursing excellence Increased knowledge and skill sharing and philanthropy of EBP through use of communication devices and resource access

 

Implementation Strategies

Focused facilitation of implementing the Director of EBP DNP prepared nurse leader is essential in confronting the need to expand the roles and responsibilities demanded by trends in health care delivery. The Director of EBP DNP prepared nurse leader utilizes, EBP, as the yellow brick road, to improve quality and outcomes and decrease health care costs. Through guided inquiry, innovation, and the partnership of all providers, nursing accountability and autonomy can impress the importance of EBP to practice (Melynk, 2016). In further demonstration of the value of the Director of EBP DNP leader guiding EBP, please allow the discussion of influencing and changing an acute care arena’s organizational culture.

The first step would be to align with all stakeholders in defining a vision and goals. The conduction of a needs assessment, careful planning of education and development of programs to assist the goals and vision of the Director of EBP DNP prepared nurse leader, in conjunction with the organizational strategic plan are imperative (Xiaoshi, 2008). Motivating stakeholders further compels desired change that results in excellence of practice, sparking transformation and innovation. The Director of EBP understands that the key to transforming behaviors is in the ownership of the change (Melnyk & Fineout-Overholt, 2011). Collaboration with key change agents: mentors, experts, clinicians, direct patient providers and the administrative team is essential in the early stages of transformation and the Director of EBP becomes the main facilitator. The Director of EBP than steers engagement within the organization through forums such as; town halls, unit based councils, patient advisory boards, and leadership conferences to communally assist in the identification of barriers and challenges and strategies to overcome obstacles. DNP Role Assignment Paper Part I

The Director of EBP further assists in the prioritization of clinical issues and serves as the lead resource to all organizational staff in research guidance, appraisal, and development of practice recommendations and the development and implementation of changes with appropriate valid and reliable evaluation measurement. Culture transformation requires time, resources, and facilities in order to ensure all are receptive to the change. Culture transformation is hallmark to EBP as the gold standard of care (Melynk & Fineout-Overholt, 2011; Xiaoshi, 2008).

Stakeholder Support

Support from all stakeholders is essential in encouraging open communication and collaborative decision making to support staff in the culture shift and promote the value and impact of the DNP nurse leader (Melynk, 2016). Implementation of this role must consider factors that influence performance of all whom are internal stakeholders. In identification of key stakeholders internal to the use of the Director of EBP DNP leader, one must consider all who serve in the organization. Sammer and James (2011) stressed the importance of a culture rich in patient safety emphasizing contributing factors specific to leadership, EBP, teamwork, collaboration, communication, learning, and patient centered care. From the top down, every individual serving in that organization must be committed to the mission, vision, and strategic plan, including but not limited to, the chief executive officer, chief nursing officer, providers and nurses, ancillary staff, educators, housekeepers, and volunteers. External stakeholders are those that the organization reports to such as the Joint Commission and local, state, and federal accrediting bodies along with consumer reporting agencies like Press Ganey to measure patient satisfaction and quality of care (Grindel, 2016). External stakeholders also include patients, families, and communities, who seek effective, safe and cost effective care, so that funds, whether private and/or public, such as Medicare and Blue Cross Blue Shield, are being utilized effectively (Xiaoshi, 2008). It is key to consider all internal and external stakeholders influence and interest in implementing the Director of EBP DNP leader to facilitate and ensure success.

Financial Implications

A cost-benefit analysis can be utilized as a tool to validate the importance and utilization of the Director of EBP DNP leader committed to nursing excellence. Zaccagnini and White (2017) attribute the benefit to this analysis through means of justifying commitment to solving the problem well worth the cost. While some benefits are difficult to quantify, such as the worth of an organizations culture, it is useful to illustrate the tangible benefits. Assisting in illustrating the tangible benefits of this role is four approaches: cost minimization, cost utility, cost consequence, and cost effectiveness (White & Zaccagnini, 2017). DNP EBP leaders have an affinity and basic understanding of operating expenses and revenues; they have the ability to help identify where care is driving cost. For example, practicing cost minimization through the evaluation of ineffective work processes, that in turn, increase a patient’s length of stay and increase nurse productivity related to incidental overtime, is an example of cost utility (Grindel, 2016).

DNP EBP leaders have the ability to prevent, predict, and evaluate, an example of cost consequence, through the use of EBP to prevent adverse events by identifying, acting, and eliminating threats to safety, such as lack of nursing knowledge and skill that could precipitate a medication error (Grindel, 2016). Another example of how DNP EBP leaders impact cost effectiveness is through the use of ensuring a culture free from toxic environments and unprofessional behaviors, promoting positive attitudes and improved patient care, and support of a healthy work environment, all factors that directly affect turn over and employee satisfaction and consequently patient care (Grindel, 2016). The financial implications of committing a dedicated and passionate DNP leader focused on EBP far outweigh the negative implications and potential cost effects of nurses not committed to EBP.

Evaluation and Measurement

Essential to determining the impact of the Director of EBP DNP leader is the ability to measure outcomes and provide evidence supporting successful improvements and changes. Finding valid and reliable tools provide credibility and compliance promoting continued action and stakeholder support. Evaluation should suit the design of the role and its projected outcomes. One method of evaluation and measure of the role of the Director of EBP DNP leader is to measure the culture of an organization and its readiness for EBP. Melynk and Fineout-Overholt (2011, p. 559) present an example instrument that utilizes 18 questions focused on EBP to assess an organizations present culture and readiness for a system wide integration and culture shift of focusing on EBP. Other tools of measure and validation are also introduced and exampled by Melynk and Fineout-Overholt (2011, p. 560-561), such as EBP Belief Scales and Implementation Scale. Another method of evaluation and measure is to track data specifically related to nurse sensitive indicators correlated with patient harm, such as hospital acquired pressure injuries and patient falls through use of databases such as the National Database of Nursing Quality Indicators (NDNQI) (Nursing Quality, n.d.). Accurate data can be a critical tool in the reporting, action planning, and intervention, central to the process of quality improvement and pursuit of performance of nursing care at the highest level. These are only a few means of measuring the impact of having a skilled, knowledgeable, committed DNP leader who lives and breathes EBP and a commitment to make changes directly impacting patient care and outcomes and the professional future of nursing.

Summary

DNP nurses serving in leadership roles, both formal and informal, have the ability to govern and lead health care organizations and its stewards to stop, think, act, and review our current “status quo” experienced based care. Care that is safe, effective, patient-centered, timely, efficient, and equitable demands that health care is delivered by all disciplines in collaboration with EBP (Mitchell, 2008). DNP nurse leaders are catalysts for driving change, both at the bedside and within executive board rooms, through transformation of both their operational and clinical foregrounds. DNP nurse leaders create a vision, inspire inquiry and innovation, and continually engage all to seek measures that improve nursing quality and in turn patient outcomes. DNP nurse leaders have been called into action to master quality, improve safety, model professional nursing and credibility through the cross stitching of evidenced based knowledge and information into every day practice. DNP nurse leaders will someday be called the champions of transformation knowledge to practice with tangible proof of the lives saved, improved patient outcomes, and healthcare reform.

 

 

 

 

 

 

 

 

 

 

 

 

 

References- include references for both parts of paper

AACN Position Statement on the Practice Doctorate in Nursing. (n.d.). Retrieved from

http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Practice-Doctorate

Bernazzani, S. (2017, October 5). Tallying the high cost of preventable harm. Retrieved from

Grindel, C, G. (2016). Clinical Leadership: A call to action. MEDSURG Nursing, 25(1), 9-16.

Innovation. (2018). Retrieved July 11, 2018, from

https://www.merriamwebster.com/dictionary/innovation

Mcsherry, R., & Douglas, M. (2011). Innovation in nursing practice: A means to tackling the

global challenges facing nurses, midwives and nurse leaders and managers in the future. Journal of Nursing Management,19(2), 165-169. doi:10.1111/j.1365-2834.2011.01241.x

Melnyk, B. M. (2016). An urgent call to action for nurse leaders to establish sustainable

evidence-based practice cultures and implement evidence-based interventions to improve healthcare quality. Worldviews on Evidence-Based Nursing,13(1), 3-5. doi:10.1111/wvn.12150

Melnyk, B, M., & Fineout-Overholt, E. (2011). Evidenced-based practice in nursing &

healthcare: a guide to best practice (2^nd ed. ). Philadelphia, PA: Wolters Kluwer

Mitchell, P, H. (2008) Defining Patient Safety and Quality Care. In: Hughes RG, editor. Patient

Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality (US): Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2681/

Nurse Leader Insider. (2017). Relationship of nursing excellence to evidence based-practice.

Retrieved from http://www.hcpro.com/NRS-330046-868/Relationship-of-Nursing-Excellence-to-Evidence-BasedPractice.html. DNP Role Assignment Paper Part I

Nursing Quality (NDNQI). (n.d.). Retrieved July 10^, 2018, from

http://www.pressganey.com/solutions/clinical-quality/nursing-quality

Post, J. (2017). What Is a PEST Analysis? Retrieved July 10, 2018 from

https://www.businessnewsdaily.com/5512-pest-analysis-definition-examples-templates.html

Sammer, C. E., & James, B. R. (2011). Patient safety culture: The nursing unit leader’s

role. Online Journal of Issues In Nursing, 16(3), 1.doi:10.3912/OJIN.Vol16No03Man03

Terhaar, M. F., Taylor, L. A., & Sylvia, M. L. (2016). The Doctor of Nursing Practice: From

start-up to impact. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27164770

Udlis, K. A., & Mancuso, J. M. (2015). Perceptions of the role of the Doctor of Nursing Practice-

Prepared nurse: Clarity or confusion. Journal of Professional Nursing,31(4), 274-283. doi:10.1016/j.profnurs.2015.01.004

Xiaoshi, L. (2008). Evidence-based practice in nursing: What is it and what is the impact of

leadership and management practices on implementation? Nursing Journal,12, 6-12.

Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new

model for advanced practice nursing (3^rd. ed.). Burlington, MA: Jones and Bartlett Learning.