Journal of Nursing Education

Educational Innovations 

Doctor of Nursing Practice Project Advisement: A Roadmap for Faculty and Student Success

Kerry Milner, DNSc, RN; Mary Zonsius, PhD, RN; Catherine Alexander, DNP, RN; Cindy Zellefrow, DNP, RN, PHNA-BC

Abstract

Background:

Robust enrollment in Doctor of Nursing Practice (DNP) programs has created a need for faculty teaching in other nursing programs to be project advisers. Faculty may lack the knowledge and skills needed to advise projects that are evidence-based practice (EBP) or quality improvement (QI) initiatives. A project roadmap with tools and resources was needed.

Method:

Practice-based evidence from members of the Quality and Safety Education for Nurses (QSEN) DNP Leadership Taskforce was used to inform the process for DNP project advisement. This evidence was integrated with the American Association of Colleges of Nursing Taskforce 2015 recommendations and literature on DNP project criteria to develop a roadmap.

Results:

Twenty-two students and six faculty have piloted the DNP Project Roadmap and provided positive feedback. Eight peer-reviewed presentations and three manuscript submissions with one acceptance have resulted from using the roadmap.

Conclusion:

Data support that the project roadmap phases and associated tools and resources facilitate faculty project advisement and offer students clear project guidelines and a foundation for future practice scholarship. [J Nurs Educ. 2019;58(12):728–732.]

Abstract

Background:

Robust enrollment in Doctor of Nursing Practice (DNP) programs has created a need for faculty teaching in other nursing programs to be project advisers. Faculty may lack the knowledge and skills needed to advise projects that are evidence-based practice (EBP) or quality improvement (QI) initiatives. A project roadmap with tools and resources was needed.

Method:

Practice-based evidence from members of the Quality and Safety Education for Nurses (QSEN) DNP Leadership Taskforce was used to inform the process for DNP project advisement. This evidence was integrated with the American Association of Colleges of Nursing Taskforce 2015 recommendations and literature on DNP project criteria to develop a roadmap.

Results:

Twenty-two students and six faculty have piloted the DNP Project Roadmap and provided positive feedback. Eight peer-reviewed presentations and three manuscript submissions with one acceptance have resulted from using the roadmap.

Conclusion:

Data support that the project roadmap phases and associated tools and resources facilitate faculty project advisement and offer students clear project guidelines and a foundation for future practice scholarship. [J Nurs Educ. 2019;58(12):728–732.]

Enrollment in Doctor of Nursing Practice (DNP) programs is robust; the American Association of Colleges of Nursing reported 32,678 students enrolled in 348 programs in 2018 (AACN, n.d.). Robust enrollment has created a need for faculty teaching in other nursing degree programs to be DNP project advisors at the authors' universities. The authors discovered that most faculty lacked the knowledge and skills needed to advise DNP projects that take the form of an evidence-based practice (EBP) or quality improvement (QI) initiative as many have research doctorates and/or received their terminal degrees before EBP became mainstream in national nursing curricula.

This article describes the DNP project roadmap that was developed to facilitate project advisement in a post-master's and a postbaccalaureate DNP program. The roadmap includes EBP and QI tools and resources that faculty project advisors, especially those new to the DNP project advisement role, can use for their own professional development and to guide and support student projects that involve implementing a new practice (e.g., EBP, purposeful hourly rounding) or improving an existing practice (e.g., QI, standardizing asthma treatment using an integrated care model).

Method

Development of the DNP Project Roadmap

The AACN (2015) DNP scholarly project guidelines, literature on DNP project criteria, and faculty project advisor expertise were used to create the roadmap. The DNP project advisement process was developed from practice-based knowledge from members of the Quality and Safety Education for Nurses DNP Leadership Taskforce that included faculty and practice mentor experiences with DNP project advisement and personal experiences as a DNP student.

Table A (available in the online version of this article) displays the project phases and descriptions aligned with the DNP scholarly project guidelines from the AACN (2015) Taskforce. The Problem Identification & Evidence Review, Project Planning, Implementation, and Evaluation phases follow the AACN project recommendations of evidence synthesis and translation, and implementation of a practice change that improves health outcomes for a system or population. In the Evaluation and Dissemination phases, students evaluate the practice change processes and/or outcomes and share the results locally, regionally, and nationally. The last column contains a place for the student to record the date the component was completed. A foundation for future practice scholarship is built as students successfully complete each roadmap phase.

Doctor of Nursing Practice Project RoadmapDoctor of Nursing Practice Project RoadmapDoctor of Nursing Practice Project Roadmap

Table A:

Doctor of Nursing Practice Project Roadmap

Problem Identification and Evidence Review. In this first phase of the DNP Project Roadmap, faculty project advisors facilitate the process of problem identification by asking students to question their clinical practice (e.g., Is my practice based on best available evidence?) and to look for new or existing standards of care. Tools to facilitate problem identification and practice gaps include visual tools (e.g., Fishbone diagram) for categorizing potential causes of a problem ( https://asq.org/quality-resources/fishbone), diagramming a clinical care process (e.g., process map, flow chart), and identifying unit or organizational strengths, weaknesses, opportunities, and threats through tools such as a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis (Day, 2017; Marriott, 2018). Sources for new or existing standards of care may be practice organizations (e.g., American Nurses Association), government agencies (e.g., Agency for Healthcare Research and Quality), and health care leaders (e.g., Institute for Healthcare Improvement, Quality and Safety Education for Nurses).

Project advisement continues with faculty having students confirm that their project topic is aligned with the practice organizations' priorities. If not, the faculty project advisor may want to guide the student toward a topic that is a priority for the practice organization. Tools for answering “Is this an organization's priority?” can be found in the Iowa Model text (Cullen et al., 2018). Students should also inquire about potential individuals in the practice organization that can be mentors who can give them onsite support and guidance throughout the project phases.

Next steps include crafting a clinical question and searching relevant databases. If students use an established method to craft the question that includes identifying the population, intervention, comparison, and outcome such as PICO (Problem, Intervention, Comparison, Outcome), the search for relevant evidence is easier (Melnyk & Fineout-Overholt, 2019). McMaster University has an EBP guide with templates for building PICO questions ( https://hslmcmaster.libguides.com/c.php?g=306765&p=2044787). To hone their search skills, faculty project advisors should encourage their advisees to meet with the health science librarian in their academic or practice setting. There are also free tutorials for several of the major health care literature databases (e.g., PubMed®, EBSCO) on their websites.

Evidence-based practice or QI initiatives usually include an evidence review that differs from the more commonly known literature review. An evidence review includes critical appraisal, a process where students rate the strength (i.e., level and quality of evidence) and applicability of evidence using critical appraisal tools (Jones, 2010). In contrast, the purpose of a literature review is to identify what is known about a topic, formulate new questions that have not been answered, and make a case to address the gaps using research methods (Baker, 2016). Buccheri and Sharifi (2017) summarized tools and resources that faculty project advisors and students can use to learn and support the skill of appraising external evidence from research studies. Welk (2007) provided an overview of summary statistic terms (e.g., number needed to treat, risk ratio, odds ratio) commonly seen in the evidence-based literature.

In some project evidence reviews, it is equally important to collect and analyze internal evidence (e.g., performance metrics) from the organizational system to define the problem and to use these outcomes in the project evaluation (Alexandrov, Brewer, & Brewer, 2019). Sources of internal evidence may come from quality management, finance, human resources, and clinical systems.

Evidence summary and recommendations refer to the process of synthesizing information from external and internal sources that address the clinical question and making a decision on whether or not to translate the evidence into practice (Dearholt & Dang, 2018). Synthesis tables are a clear, concise way to display the evidence strength (e.g., Level I, II, or III) and direction (i.e., improving selected outcomes) (Melnyk & Fineout-Overholt, 2019, p. 183). Synthesis tables are visual tools that support recommendations to make or not to make a practice change. When synthesis tables reveal a lack of sufficient evidence to support a recommendation, more research needs to be performed. In these situations, faculty project advisors should develop a new plan with the student to meet the AACN DNP scholarly project recommendations. At this point in the DNP Project Roadmap, students that have identified a sufficient body of evidence to recommend a practice change are ready to move to the next phase of project planning.

Project Planning. In the project planning phase of the DNP roadmap, students begin by determining the intended outcomes of the project using established goal setting criteria that facilitate accountable project goals. Defining outcomes using SMART (Specific, Measurable, Achievable, Relevant, and Timely) goals is one commonly used approach. Templates to use for SMART goals are available (Ogbeiwi, 2017).

During project planning, students select a model and/or framework to guide the project implementation (e.g., EBP, QI, change and implementation models). Common models for EBP implementation include The Iowa EBP model (Buckwalter et al., 2017), advancing research and clinical practice through close collaboration model (Melnyk & Fineout-Overholt, 2019), and the Johns Hopkins nursing EBP model (Dearholt & Dang, 2018). Models that merge EBP with QI and include the Plan, Do, Study, Act approach are the evidence-based practice improvement model (Levin et al., 2010), and the Institute for Health-care Improvement model for improvement. Examples of change models are Kotter's 8-steps for change (Appelbaum, Habashy, Malo, & Shafiq, 2012) and Lewin's change theory (Shirey, 2013). Tucker (2019) stressed that using a toolbox of implementation strategies that include leadership, coaching, communication, reinforcement, recognition, measurement, and reporting improve the success of implementing EBP changes. Faculty project advisors can direct students to literature that provides an overview of implementation models and frameworks (Day, 2017; Mitchell, 2013; Picarillo, 2018; Tucker, 2018). Students should consider using implementation strategies as suggested by Tucker (2019) with any of these models and frameworks.

Powell et al. (2015) and the National Implementation Research Network offer additional strategies to ensure a smooth implementation process. Powell et al. (2015) provided a collection of 73 implementation strategies including the importance of stakeholders (e.g., opinion leaders, project champions, patients), use of audit and feedback, cues to action, and training the project team. The National Implementation Research Network is an interactive website that addresses implementation drivers with a compilation of leadership, organizational, and competency factors, and their influence on the implementation process.

Project planning continues with a description of the context (e.g., circumstances or conditions of setting in which the practice change will occur), the evidence-based strategy (e.g., intervention description or new or revised policy), and key stakeholders or champions who can help to facilitate the practice change. Students create an evaluation plan that may include both process and outcome measures, data tracking tools, and methods for data analysis and interpretation. Identifying possible barriers to implementation and sustainability should be identified and strategies for mitigating these barriers complete the planning process. Tools to support these project planning activities are found in the DNP project toolbox (Moran, Burson, & Conrad, 2019) and several articles on QI methods for evaluating improvement projects (Brady, Tchou, Ambroggio, Schondelmeyer, & Shaughnessy, 2018; Picarillo, 2018; Shaughnessy, Shah, Ambroggio, & Statile, 2018).

Students should be advised to create a realistic time line for completion of the project that meets the practice setting's needs and the academic institution's requirements. The Gantt chart is an example of a popular tool used during project planning (Shirey, 2008). Resources needed to conduct the project are described in the project planning phase, and this information will be used in the evaluation phase when students calculate the return on investment (ROI) (Garrison & Beverage, 2018; Opperman, Liebig, Bowling, Johnson, & Harper, 2016).

Typically, DNP projects that are EBP or QI initiatives must be reviewed according to the practice site and academic institution policies before implementation can occur. Review requirements for EBP or QI projects may vary widely by practice site and academic institution and may range from institutional review board review to organization-level feasibility review that vets the proposed practice change before implementation can occur. The faculty project advisor can help students navigate the academic institution review and the practice site mentor can help with the practice site review. Once the review process is complete, students can move on to the implementation phase.

Implementation. During the implementation phase, the DNP student performs the practice change guided by the selected implementation framework and monitors the progress of the change by collecting data and tracking deviations from the original project plan. Students need leadership and communication skills to promote the success of the project implementation (Reavy, 2016). This is an optimal time for faculty project advisors to remind DNP students that as project managers, it is their responsibility to champion the implementation process and take project ownership and seek guidance as needed from the practice site mentor. Students should be advised that communication with stakeholders during key checkpoints of the project is essential to keep all individuals involved and informed of the roll out progress. Key checkpoints with the project team include at the beginning of the project (i.e., setting expectations), several midway check-ins (i.e., to see if the project is going as planned), and at the conclusion of the project (Reavy, 2016).

An important project management role for the DNP student is to provide ongoing oversight, support, and assistance to the project team and monitor the degree of project progress. The project manager can use three questions to guide ongoing process evaluation of the project:

  • Is the project progressing according to the plan and expected time line?
  • Have unexpected barriers delayed the project?
  • How will the implementation strategies need to be modified based on identified barriers?

Given the dynamic nature of project implementation and sustainment, students may need to revise the strategies identified in the project planning phase and try new strategies. Moran et al. (2019) and Zaccagnini and White (2017) offered additional tools and suggestions to support implementation.

Evaluation. In phase four, evaluation of the DNP project roadmap, students display process and outcome data and interpret these data. Reavy (2016) offered an extensive review of qualitative and quantitative data analysis methods for practice change projects. The Institute for Healthcare Improvement has a comprehensive free QI tool kit that provides an overview of 10 commonly used tools for data display and interpretation ( http://www.ihi.org/resources). Similarly, Brady et al. (2018) and Shaughnessy et al. (2018) demonstrated how to display and analyze QI results with attention to common cause (i.e., expected) and special cause (i.e., unexpected, indicating either a process change or an unstable process) variation.

Faculty project advisors may want to discuss with their students the scope of the evaluation and clinical meaningfulness related to EBP or QI projects. Faculty can use the following questions to frame the discussion:

  • Was the plan implemented?
  • Was the practice/policy change effective/did it fix the problem?
  • What was the extent to which the desired outcomes were achieved?
  • What do the findings mean to the stakeholders (e.g., health care services, professionals, staff, patients, families)?

Implementing a practice change that improves a process outcome or patient care outcome may be deemed a success; however, the outlay of resources must be examined for cost effectiveness. Calculating the ROI is one way to determine the financial impact of the practice change (Cullen et al., 2018). The resources (e.g., indirect and direct) that were identified during project planning phase are used to determine the ROI. Opperman et al. (2016) provided the formula for determining the cost analysis and specific steps to calculate the ROI. Once the evaluation phase is complete, students can move on to the final phase of dissemination.

Dissemination. The dissemination phase is the final phase of the roadmap, where DNP students share project findings locally, regionally, nationally, or internationally in traditional and nontraditional forms. The AACN (2018) white paper Defining Scholarship for the Discipline of Nursing broadened the definition of scholarship to specifically include practice scholarship-like DNP projects. The faculty project advisor role is crucial in terms of building writing skills for traditional practice scholarship dissemination (Murphy, Staffileno, Hinch, & Carlson, 2018).

Traditional dissemination forms may include an electronic poster or an executive summary as the deliverable for the project site. The executive summary may be used as the basis of an abstract to submit for a poster or paper presentation at a professional conference. Siedlecki (2017) and Wood and Hollier (2017) provided resources on how to create a poster and present a professional presentation. Additionally, the Navy and Marine Corps published a guide for writing executive summaries (Navy and Marine Corps Public Health Center, n.d.).

Dissemination can take the form of a publication in a peer-reviewed journal (Morton, 2016). One strategy for DNP program faculty to consider is moving the structure of the final project paper to a journal article format. The faculty project advisor can be a key resource to guide the student through the process of writing for publication. Resources exist for journal selection ( http://jane.biosemantics.org), how to write an abstract (Pearce & Ferguson, 2017), and reporting guidelines for EBP and QI projects (Milner, 2016).

Nontraditional forms of practice scholarship dissemination are gaining acceptance and support as expressions of scholarship (AACN, 2018). Nontraditional dissemination includes social media, blogs, and op-eds. Betz, Smith, Melnyk, and Tassa (2019), as well as Dearholt and Dang (2018), offered guides to nontraditional dissemination.

Process for Implementing the DNP Project Roadmap

A university with a hybrid post-master's and a postbaccalaureate DNP program was the setting for piloting the implementation of the roadmap. In these programs, the DNP project was supported by six 1-credit online courses that start in the second semester of the first year. The students and faculty project advisors were given the DNP project roadmap with the descriptions in the first course. Students were exposed to the resources described in the previous section throughout the 1-credit courses and in other DNP courses. Time was devoted to discussing the roadmap and highlighting the resources at the monthly DNP programmatic meetings, where faculty attendance was required. Faculty project advisors teaching in other programs were provided the information via e-mail and were encouraged to ask questions.

Results

The DNP project roadmap with tools and resources was piloted with 22 full-time DNP students and six faculty project advisors. Programmatic evaluation data using a 5-point Likert scale, with 5 = strongly agree, show that the roadmap increased students' understanding of the project phases: “This course improved my understanding of the subject matter” (M = 4.1; SD = .57) and “Class activities, readings, and/or assignments supported my learning” (M = 4.2, SD = .42). Timely execution of the project phases was also observed with 100% (n = 9) of the post-masters' students completing their project and disseminating their results as an executive summary and poster presentation by the program deadline. Similarly, in the postbaccalaureate group 84% (n = 11) presented their project proposals by the program deadline.

Student feedback on the roadmap has been positive (i.e., “I like having the project expectations spelled out in one document”). Informal feedback from faculty project advisors also supports the positive benefits of the roadmap (i.e., “The number of project proposal drafts per student has decreased because the roadmap spells out what to include”). Faculty shared that the specificity of the roadmap and the associated tools has improved the process of project advisement (e.g., “I have the student complete the done column before each advisement meeting so we can focus on what needs to be done…more efficient process,” “The tools seem to help the student give me what I am looking for the first time”) and has resulted in eight peer-reviewed presentations and three manuscript submissions for publication, resulting in one acceptance.

Conclusion

Implementation of the DNP project roadmap has improved processes for faculty and students. Preliminary data support that the project roadmap used, as well as the tools and resources, increased student understanding and resulted in timely execution of the project roadmap phases. Faculty saw improvements in the advisement process and efficiency. Clear project guidelines with tools and resources sets the foundation for future practice scholarship for DNP graduates.

References

  • Alexandrov, A. W., Brewer, T. L. & Brewer, B. B. (2019). The role of outcomes and evidence-based quality improvements in enhancing and evaluating practice changes. In Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Wolters Kluwer Health.
  • American Association of Colleges of Nursing. (2015). The Doctor of Nursing Practice: Current issues and clarifying recommendations report from the Task Force on the Implementation of the DNP. Retrieved from http://www.aacnnursing.org/Portals/42/DNP/DNP-Implementation.pdf?ver=2017-08-01-105830-517
  • American Association of Colleges of Nursing. (2018). Defining scholarship for the discipline of nursing. Retrieved from http://www.aacnnursing.org/Portals/42/DNP/DNP-Implementation.pdf?ver=2017-08-01-105830-517
  • American Association of Colleges of Nursing. (n.d.). DNP fact sheet. Retrieved June 3, 2019, from https://www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet
  • Appelbaum, S. H., Habashy, S., Malo, J. & Shafiq, H. (2012). Back to the future: Revisiting Kotter's 1996 change model. Journal of Management Development, 31(8), 764–782 https://doi.org/10.1108/02621711211253231 doi:10.1108/02621711211253231 [CrossRef]
  • Baker, J. D. (2016). The purpose, process, and methods of writing a literature review. AORN Journal, 103(3), 265–269 https://doi.org/10.1016/j.aorn.2016.01.016 doi:10.1016/j.aorn.2016.01.016 [CrossRef]26924364
  • Betz, C. L., Smith, K. A., Melnyk, B. M. & Tassa, T. (2019). Evidence based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Wolters Kluwer.
  • Brady, P. W., Tchou, M. J., Ambroggio, L., Schondelmeyer, A. C. & Shaughnessy, E. E. (2018). Displaying and analyzing quality improvement data. Journal of the Pediatric Infectious Diseases Society, 7, 100–103 https://doi.org/10.1093/jpids/pix077 doi:10.1093/jpids/pix077 [CrossRef]
  • Buccheri, R. K. & Sharifi, C. (2017). Critical appraisal tools and reporting guidelines for evidence-based practice. Worldviews on Evidence-Based Nursing, 14(6), 463–472 https://doi.org/10.1111/wvn.12258 doi:10.1111/wvn.12258 [CrossRef]28898556
  • Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B. & Tucker, S. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182 https://doi.org/10.1111/wvn.12223 doi:10.1111/wvn.12223 [CrossRef]28632931
  • Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J., Tucker, S. & Kleiber, C. (2018). Evidence-based practice in action comprehensive strategies, tools, and tips from the University of Iowa hospitals and clinics. Indianapolis, IN: Sigma Theta Tau.
  • Day, J. (2017). Inpatient dialysis unit project development: Redesigning acute hemodialysis care. Nephrology Nursing Journal, 44(3), 251–264.29165957
  • Dearholt, S. & Dang, D. (2018). Johns Hopkins nursing evidence-based practice: Models and guidelines (3rd ed.). Indianapolis, IN: Sigma Theta Tau.
  • Garrison, E. & Beverage, J. (2018). Implementing a process to measure return on investment for nursing professional development. Journal for Nurses in Professional Development, 34, 8–11 https://doi.org/10.1097/NND.0000000000000419 doi:10.1097/NND.0000000000000419 [CrossRef]29298222
  • Jones, K. R. (2010). Rating the level, quality, and strength of the research evidence. Journal of Nursing Care Quality, 25(4), 304–312 https://doi.org/10.1097/NCQ.0b013e3181db8a44 doi:10.1097/NCQ.0b013e3181db8a44 [CrossRef]20821835
  • Levin, R. F., Keefer, J. M., Marren, J., Vetter, M., Lauder, B. & Sobolewski, S. (2010). Evidence-based practice improvement: Merging 2 paradigms. Journal of Nursing Care Quality, 25(2), 117–126 https://doi.org/10.1097/NCQ.0b013e3181b5f19f doi:10.1097/NCQ.0b013e3181b5f19f [CrossRef]
  • Marriott, R. D. (2018). Process mapping—The foundation for effective quality improvement. Current Problems in Pediatric and Adolescent Health Care, 48(7), 177–181 https://doi.org/10.1016/j.cppeds.2018.08.010 doi:10.1016/j.cppeds.2018.08.010 [CrossRef]30205944
  • Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
  • Milner, K. A. (2016). Sharing your knowledge: Getting your idea published. Journal of Infusion Nursing, 39, 297–305. doi:10.1097/NAN.0000000000000188 [CrossRef]27598069
  • Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20, 32–37 https://doi.org/10.7748/nm2013.04.20.1.32.e1013 doi:10.7748/nm2013.04.20.1.32.e1013 [CrossRef]23705547
  • Moran, K. J., Burson, R. & Conrad, D. (2019). The Doctor of Nursing Practice scholarly project (3rd ed.). Burlington, MA: Jones & Barlett.
  • Morton, P. (2016). Helping students turn scholarly projects and papers into publishable articles. Journal of Professional Nursing, 32, 75–76 https://doi.org/10.1016/j.profnurs.2016.03.001 doi:10.1016/j.profnurs.2016.03.001 [CrossRef]
  • Murphy, M. P., Staffileno, B. A., Hinch, B. & Carlson, E. (2018). Promoting clinical scholarship in DNP programs. The Journal for Nurse Practitioners, 14(2), e31–e39 https://doi.org/10.1016/j.nurpra.2017.12.003 doi:10.1016/j.nurpra.2017.12.003 [CrossRef]
  • Navy and Marine Corps Public Health Center. (n.d.). A guide to writing an effective executive summary. Retrieved from https://www.med.navy.mil/sites/nmcphc/Documents/environmental-programs/risk-communication/Appendix-E-Guide-to-Writing-Effective-Executive-Summary.pdf
  • Ogbeiwi, O. (2017). Why written objectives need to be really SMART. British Journal of Healthcare Management, 23(7), 324–336 https://doi.org/10.12968/bjhc.2017.23.7.324 doi:10.12968/bjhc.2017.23.7.324 [CrossRef]
  • Opperman, C., Liebig, D., Bowling, J., Johnson, C. S. & Harper, M. (2016). Measuring return on investment for professional development activities: A review of the evidence. Journal for Nurses in Professional Development, 32(3), 122–129 https://doi.org/10.1097/NND.0000000000000262 doi:10.1097/NND.0000000000000262 [CrossRef]27187826
  • Pearce, P. F. & Ferguson, L. A. (2017). How to write abstracts for manuscripts, presentations, and grants: Maximizing information in a 30-s sound bite world. Journal of the American Association of Nurse Practitioners, 29(8), 452–460 https://doi.org/10.1002/2327-6924.12486 doi:10.1002/2327-6924.12486 [CrossRef]
  • Picarillo, A. P. (2018). Introduction to quality improvement tools for the clinician. Journal of Perinatology, 38(7), 929–935 https://doi.org/10.1038/s41372-018-0100-4 doi:10.1038/s41372-018-0100-4 [CrossRef]29795322
  • Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M. & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10, 21 https://doi.org/10.1186/s13012-015-0209-1 doi:10.1186/s13012-015-0209-1 [CrossRef]25889199
  • Reavy, K. (2016). Inquiry and leadership: A resource for the DNP project. Philadelphia, PA: F.A. Davis.
  • Shaughnessy, E. E., Shah, A., Ambroggio, L. & Statile, A. (2018). Introduction to quality improvement. Journal of the Pediatric Infectious Diseases Society, 7, 6–10 https://doi.org/10.1093/jpids/pix061 doi:10.1093/jpids/pix061 [CrossRef]
  • Shirey, M. R. (2008). Project management tools for leaders and entrepreneurs. Clinical Nurse Specialist, 22, 129–131 https://doi.org/10.1097/01.NUR.0000311692.92662.5d doi:10.1097/01.NUR.0000311692.92662.5d [CrossRef]18438161
  • Shirey, M. R. (2013). Lewin's theory of planned change as a strategic resource. The Journal of Nursing Administration, 43, 69–72 https://doi.org/10.1097/NNA.0b013e31827f20a9 doi:10.1097/NNA.0b013e31827f20a9 [CrossRef]23343723
  • Siedlecki, S. L. (2017). Original research: How to create a poster that attracts an audience. The American Journal of Nursing, 117(3), 48–54 https://doi.org/10.1097/01.NAJ.0000513287.29624.7e doi:10.1097/01.NAJ.0000513287.29624.7e [CrossRef]28230691
  • Tucker, S. (2018, December). Development of the EBP implementation strategies self-efficacy scale. Paper presented at the 11th Annual Conference on the Science of Dissemination and Implementation. , Wasington, DC. . Washington, DC: AcademyHealth.
  • Tucker, S. J. (2019). Implementation: The linchpin of evidence-based practice changes. American Nurse Today, 14(3), 8–13.
  • Welk, D. S. (2007). How to read, interpret, and understand evidence-based literature statistics. Nurse Educator, 32, 16–20 https://doi.org/10.1097/00006223-200701000-00006 doi:10.1097/00006223-200701000-00006 [CrossRef]17220762
  • Wood, T. J. & Hollier, A. (2017). Punch up your podium presentations. Journal of the American Association of Nurse Practitioners, 29(8), 470–474 https://doi.org/10.1002/2327-6924.12477 doi:10.1002/2327-6924.12477 [CrossRef]28594108
  • Zaccagnini, M. & White, K. (2017). The Doctor of Nursing Practice essentials (3rd ed.). Burlington, MA: Jones & Bartlett.

Doctor of Nursing Practice Project Roadmap

ComponentDefinitionDateDone
Phase 1: Problem Identification and Evidence Review
Clinical inquiry including background and significance of problemDescribe local problem and its significance. Include data to frame local problem.
Organizational prioritySummarize information that supports topic/problem is an organizational priority.
Searchable QuestionWrite a focused, searchable question using an established method (e.g. PICO).
Evidence searchExternal evidence

□ Summarize search strategy (e.g. databases, keywords, filters/limits, criteria for article selection, tools for critical appraisal). Include practice-based evidence (e.g. evidence-based solutions that experts/other health systems have implemented to address practice problem).

Internal evidence

□ Summarize applicable unit/community/department/hospital/organizational level data or data required for national entities (e.g. CMS, NDNQI, AHRQ).

Perform needs assessment if applicable.
Evidence appraisal, summary, and recommendationsOrganize evidence that answers focused clinical question in a clear concise format (e.g. table or matrix). Appraise literature for quality and applicability of evidence using established method (e.g. Johns Hopkins Nursing EBP Research Evidence Appraisal Tool, Joanna Briggs Institute Critical Appraisal Tools, Fuld Institute for EBP critical appraisal tools etc.).
State recommendations(s) and link to evidence strength and quality and risk/benefits.
Phase 2: Project Planning
Project goalsState intended, realistic outcomes of project using established method (e.g. SMART criteria).
FrameworkSelect framework/model to guide implementation (e.g. EBP model, QI framework, Change model).
ContextDescribe project setting and participants or population, or other elements that are central to where the change will occur.
Key stakeholdersIdentify agencies, departments, units, individuals needed to complete the project and/or affected by project, and strategies to gain buy-in.
Practice change/interventionProvided detailed description of practice change or intervention (e.g. new or revised policy).
EvaluationSummarize plan for evaluating the effectiveness of the practice change. Identify applicable process and outcome data to be collected/tracked and tools to do this. Identify the methods for analyzing/interpreting the data (e.g. control, run or Pareto charts).
Possible barriers to implementationIdentify possible barriers and implementation strategies to mitigate these barriers.
SustainmentIdentify strategies to sustain the change.
Time lineCreate a realistic timeline for project completion.
ResourcesIdentify all resources (e.g. indirect and direct) needed to complete the project.
Ethical meritIdentify and obtain the required review and approval needed for implementation (e.g. institution, community agency, IRB).
Phase 3: Implementation
Implement projectCarry out the project using selected implementation framework/model. Track any deviations/changes from the project plan.
Phase 4: Evaluation
Results/interpretationUsing an established method (e.g. run or control charts) display data and interpret project outcomes. Report evaluation of the effectiveness of the practice change, including extent the practice change was implemented (process outcome) and extent to which the desired outcome(s) were achieved.
Return on investmentIdentify the final resources that were used to implement the project. Calculate and report the return on investment.
Phase 5: Dissemination
TraditionalDisseminate to the project setting in a manner meaningful to them (e.g. executive report, poster, presentation at a meeting, poster with QR code to access details of project, etc.) Disseminate in the format required by the academic institution (e.g. poster, public presentation) and Prepare final project write-up using established reporting guidelines (e.g. EPQA, SQUIRE) and academic institution requirements.
NontraditionalDevelop a website to display project, use personal or program social media (e.g. Twitter, Facebook) to share project information.
Authors

Dr. Milner is Associate Professor, Sacred Heart University, College of Nursing, Fairfield, Connecticut; Dr. Zonsius is Assistant Professor and Adult Health and Gerontological Nursing Program Director, Rush University, College of Nursing, Chicago, Illinois; Dr. Alexander is Consultant Co-Investigator, Multiple Sclerosis Continuous Quality Improvement Collaborative, Department of Community & Family Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire; and Dr. Zellefrow is Director, Academic Core at The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing & Healthcare, and Assistant Professor of Clinical Practice, The Ohio State University College of Nursing, Columbus, Ohio. Each author is a member of the Quality and Safety Education for Nurses (QSEN) Doctor of Nursing Practice (DNP) Leadership Taskforce.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kerry Milner, DNSc, RN, Associate Professor, Sacred Heart University, College of Nursing, N322 5151 Park Ave., Fairfield, CT 06825; e-mail: milnerk@sacredheart.edu.

Received: June 11, 2019
Accepted: August 21, 2019

10.3928/01484834-20191120-09

Sign up to receive

Journal E-contents