If you are considering pursuing a BSN to Doctor of Nursing Practice or MSN to Doctor of Nursing Practice program from Regis College, you will be asked to submit a DNP project proposal as part of the admissions requirement. But what does this entail?
Dr. Karen Crowley, DNP, APRN-BC, WHNP, ANP, CNE; associate dean of online nursing programs at Regis College, took the time to answer some questions about the DNP project proposal. Here are excerpts from the interview.
Tell us a little about yourself.
KC: I’m the associate dean of online nursing programs at Regis College. I have been at Regis for about 19 years as a faculty and administrator of the graduate nursing programs. I’m also a women’s health and adult nurse practitioner and work one day per week in practice.
The DNP project proposal forms a key part of the admission criteria. Tell us how students should approach it.
KC: Our scholarly practice project course is a series of four courses that you’ll take throughout your program at Regis College. You have other courses that are going to help feed into those courses, with respect to providing access to resources and literature and in developing your project.
To apply to Regis, you need to write an essay related to what you see as a practice problem and what you think you can do to alleviate that problem. Setting up a PICO question approach can help you submit your DNP project proposal.
Can you provide more details about PICO?
KC: ‘P’ stands for patient or problems. So, you could look at this from a patient perspective or a problem perspective. A patient perspective could address issues related to a set population, such as veterans or children, while a problem issue could be repeat admissions into the hospital or a lack of dietary education for hypertensive or diabetic patients. You may want to identify a problem you see in your current role or an issue that involves patient safety, patient access, patient quality of care, or equality of care.
Most likely, you’ll be taking these courses while you’re still working, and so we always try to have the students focus on something they have direct access to, and your patient population as a nurse is a great way to start.
Can you elaborate with an example?
KC: Think about what your unit is actually doing, talk with your nurse manager to find out what initiatives — safety or quality — might be at the forefront of your specific unit. You may be able to lead one aspect of that initiative in your unit. As an example, a previous student who graduated from Regis College worked at a facility that was having difficulty in the OR with timeouts as well as critical incidents of right surgery, right side. She implemented an intervention, educating the staff — anesthesia, nurses, and doctors — on the proper protocol for timeouts and acknowledgement of quality health indicators to help reduce errors within the OR.
As you look at your unit, talking to your nurse manager or quality improvement teams in the hospital might be the best place to start. What we want you to do is find a problem that you’re passionate about and have access to, so you can develop a solution to the problem and evaluate this solution. Obviously in your workplace, you’re going to have better access to those patients.
P: PATIENT or PROBLEM | I: INTERVENTION| C: COMPARE| O: OUTCOME
Can you talk a little about the ‘I’ in PICO?
KC: ‘I’ is for intervention. So, what are you going to do to improve the problem? Are you going to do a chart review? Maybe you’re doing a retrospective analysis of something in the hospital, say age or diagnosis for individuals who fall, and develop an intervention and assessment of that intervention to help reduce falls. One of our DNP students created an intervention where they started a ‘no visitor rule’ from 2 to 4 PM every day so the patients could have downtime, and then also no interruptions during the nighttime on a maternity ward where most of the moms are healthy. The student evaluated physiologic indicators (B/P, pulse etc.), sleep and recovery measures related to the implementation of ‘down time’.
How about the ‘C’ in PICO?
KC: The ‘C’ is comparison or control. You might compare two sets of individuals or populations. You may have one receiving an intervention (experimental group) and the other receiving an intervention (control group). One the other hand, you may implement an intervention going forward with your patients, and compare pre-and-post intervention assessment or match these with patients retrospectively.
Can you give us an example?
KC: An example from one of our DNP students to help illustrate the pre-and-post test comparison within a group, is the assessment of anxiety level prior to the initiative of a meditation intervention and comparing the anxiety level after 6 weeks of active meditation. To take this example one step further related to a comparison between two groups, the student assessed the anxiety level pre-intervention, randomized participants into a control group, who received typical care, and experimental group, who received the meditation intervention, and compared pre and post- anxiety levels between both groups.
“Comparison is always good to see how well your intervention might better the situation of the patient or fix the problem you might have.”
Finally, let’s talk about the ‘O’ in PICO.
KC: ‘O’ is outcome. What is your outcome? What do you hope to see? Is it decrease in wrong side surgeries, increase in timeouts in surgery, increase in dietary adherence in the hypertensive patient, or increase in dietary enhancement of the diabetic patient. There are plenty of health indicators that can be part of your outcomes to help demonstrate the effectiveness of your intervention.
How can a student narrow down the area they should be focusing on?
KC: Every student’s project is going to be focused on a different area. Because of this, you will hear a variety of projects that are underway by your classmates, which will add to your knowledge of concepts you haven’t thought about yet or that are not directly related to your doctoral project but may help with a different issue.
Some student’s project will have an educational focus, while others may focus on quality, safety, equality, access to care, practice issues or leadership focused. One of our alums, who is a nurse leader in a major Boston hospital focused her project on a ‘rapid cycle’ intervention within an organization to cut down on the ‘red tape’ in order to initiate change. Once she implemented this cycle on her unit, it was eventually adopted by the hospital system.
We also had another nurse administrator who implemented project boards on a unit, so staff could indicate what issues they were facing. Each week they would prioritize those problems and set up an intervention plan for each issue. They would educate the staff and monitor that problem throughout the next month or six weeks to eight weeks until it was resolved. Once resolved they would move onto the next priority issue. This was adopted throughout the whole hospital system to help the nursing units and nurses address their own practice issues or gaps.
“The best thing you can do is to sit and think about what you see on your floor daily or what you see in patient care. It can even be a family member or your personal experience with your own health care or your community’s or health care in a rural area. You don’t need to have all the answers for your project proposal. What we want you to do is to be able to articulate your practice problem – why the problem exists and how you think this problem can be solved or improved. By doing so, you will set yourself up to have a clear focus when you begin your classwork.”
What criteria do you look at when reviewing project proposals submitted by students?
KC: Your proposal is going to speak to your practice problem. You’re going to tell us about why you think it’s a problem and the negative outcomes that you see with it. We will be looking at your writing style. You may have some ideas about what you think causes the problem and what you might want to do to fix the problem. You may include in your essay, research information, anecdotal information, data from your unit to make this argument. Your DNP project proposal should present one or a few options on how you plan to resolve this problem. Are you going to compare a person or group of people, before or after an intervention and then what you think your outcome will be.
“You are the expert on the problem (P), our goal in the program is to help you with the rest of the PICO questions. The I-C-O comes from you taking classes at Regis and looking at your problem through a different lens.”
Here’s an example:
One of the courses you take is NU 716 – Cultural Perspectives in Healthcare. If you’re doing something on access to care or equality of care, and you’re in a rural area or working with disadvantaged patients — medically underserved patients — then the cultural perspective class is going to assist you in your literature search, specifically to build focus of your project. It’ll help to build your knowledge base on the problem, the negative outcomes of the problem, potential solutions and measurements of outcomes. As you continue reading and synthesizing literature you will begin to identify similarities to your project that will provide you with the foundation you need to develop your project.
This building blocks continue as you progress through each class, so that when you’re in the research classes NU726 and NU727 you would have had the time to synthesize your own literature to begin to create your project. As you read your research articles you start to see all methodologies used and the outcomes. Each article typically will provide you with what ‘additional research’ is needed and that will tell you where the person who did this study left off. That is to say, “All right, we answered our question and we helped a little bit here, but we found that there are other needs related to this problem and that wasn’t a goal of our project.” This is where you might want to pick up.
Your faculty will help in development. As you read your literature through different courses in the program, you might come across different scenarios that may be applied to your project. The faculty will assist you in determining what is the best option to choose for your project. For example, you may see the same educational intervention implemented in two different studies, one that was 15 minutes and the other that was 30 minutes. Your faculty will help to determine how you select the appropriate time frame for your educational intervention.
If students are looking for some help, will you recommend any resources?
KC: Proquest and Proquest Academic resources is a site where you can find any college’s or researcher’s dissertation. The students at Regis College upload their final manuscripts to Proquest upon completion. If you’re in Massachusetts or local to New England, you can access all doctoral dissertations maintained in hard copy format in our library on campus. As a nurse, typically you will have resources at your health care institution that you can use. You should have a library database or UpToDate that you can use. Sigma Theta Tau is another good resource and is open to any member nurse.
If you are a student of Regis College, you’ll have access to our electronic library and research guides as well. We have resources to help you develop your writing skills and use Turnitin to make sure you follow proper citations and don’t accidentally plagiarize or use someone else’s content.
Thank you, Dr. Crowley. Would you like to share any last thoughts?
KC: Don’t be afraid — you can do this! Every educational step is nerve wracking. Remember when you went to nursing school? Many of you might have started with a diploma or associate and then went back to do your bachelor’s. You would have been surrounded by thoughts such as, Can I do this? Can I fit it in? Will I be a good student? You will! Trust yourself. As soon as you get back into the classes, your inquisitive nature that all nurses have is going to take over. All you need to do is apply and just let us take you on the ride. Good luck.