NR700 All Discussions Latest 2017 August

| August 31, 2017

Question
NR700 Week 1 Discussion 1 & 2 Latest 2017 August

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Week 1: Why I Chose to Pursue a DNP Degree

1313 unread replies.4343 replies.

How did you decide on pursuing a doctorate? How did you decide that a DNP was right for you and your career goals? What are your short-term and long-term career goals? Include the goal you hope to accomplish as a result of obtaining this degree.

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Week 1: Practice Problem in Two Distinct Statements

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You will be learning about your DNP project and perfecting the ideas you have about this as you go along in the program — ideas will be added and you’ll frame your project question in the PICOt format (more on that later). For now, begin thinking about an organization that may need a practice change or a quality improvement effort. You will build your project idea from that base of awareness and information.

To begin, recognize that you have been gathering assessment data for many years as a nurse. You are observing, listening, analyzing, discussing situations in health care related to quality, leadership, safety, cost and access. You have listened to patients and families, you have read about issues that concern you, you have listened to subordinates and superiors and you know inside your own mind, that there are possibilities that haven’t been tapped yet to improve the health care system and delivery of care.

In this post please describe an idea you have (problem that you have noticed) about an organizational need for practice change to improve health outcomes, cost or access; or an organizational need for quality improvement.

What have you seen that could be addressed by a clinical leader? Don’t worry about having a refined idea yet — just say what you see as a problem, and suggest a set of ideas you may have for solving it.

An example might be that you have witnessed bullying in the work place and you’d like to intervene by providing nurses with tools to interfere with bullying when it happens and an “on the floor” coaching program to facilitate the nurses’ implementation of their anti-bullying tools.

Another example may be that clinic nurses are not addressing smoking with stop smoking interventions and you’d like to intervene by teaching the nurses ways to address smoking and encourage them to commit to addressing every smoking patient with a smoking cessation intervention. You also want to assure that this change takes place after intervention so you will audit the charts and give feedback to the nurses on their progress.

What ideas to solve practice problems do you have? Review the lesson for this week and remember to state the problem in two distinct statements: (a) the problem and (b) the etiology. Finish your post by thinking about and then writing, what kinds of interventions would work to resolve the causes of the problem.

NR700 Week 2 Discussion 1 & 2 Latest 2017 August

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Week 2: Nursing’s Ways of Knowing

No unread replies.4747 replies.From the perspective of your practice change interest (clinical outcomes, safety and quality, leadership or health policy) consider the specific ways of knowing as they have played into your awareness of the need for practice change?

Further, consider how intuitive/personal or ‘unknowing’ knowing dimensions of practice integrate with broader social, cultural and theoretical dimension to create meaning and inform ideas for practice change.

Give two specific examples from your practice. For example, let’s say that your practice change interest is in the way treatment decisions are made in end-of-life care for elderly patients. Which ‘Ways of Knowing’ have played primarily in to your observations and insights about this problem?

Examples of integration with broader social and cultural dimensions in this scenario of treatment decisions in end-of-life care: how does your intuitive/personal knowing integrate with what patients and families say about their experiences? What do you know about the cost of care, access to care or quality of care relative to the issue?

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Week 2: Formatting your Problem Statement into a PICOT Question

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In preparation for this discussion, first prepare interview notes with the following questions:

1. I’d like to validate a problem statement and begin to formulate a PICOT question with the needs of your organization in mind.

2. A problem I’d like to work to improve is _________ and some of the causes of this problem seem to be _______________. Would you agree? Are you asking questions within the organization about this problem? Do you have additional insights to the specific problem statement and the etiology I’ve come up with?

3. What Outcomes would you hope result from addressing this problem?

Next make a phone interview (5-10 minute) appointment with a nursing or other leader in your chosen organization. The purpose of your interview will be to validate with the interviewee (from their point of view), whether your initial problem statement agrees with their needs.

With this interview information validating or changing your problem statement, you can move forward.Keeping the main ideas from the problem statement you drafted in Week 1 wherein you identified the problem and the etiology; now state the problem in the PICOT format.

WhatPopulation you will be working with to improve outcomes?

Whatintervention possibilities are there (these would be aimed at the etiology portion of your statement)?

To what existing practice in health care are youcomparing the outcome of your intervention?

Whatoutcome do you expect to see as a result of your intervention?

NR700 Week 3 Discussion 1 & 2 Latest 2017 August

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Week 3: Nursing’s Theories and Conceptual Models

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Explicate a selected nursing theory or conceptual model from this week’s lesson and assigned readings and explain how you already do or how you would apply the theory/conceptual model to your advanced nursing practice. Identify whether your chosen theory or model falls within the totality or simultaneity paradigm and explain why that view may be preferred in your practice understandings. Finally, explicate in four single statements, how that theory or model has guided and further developed your understanding of each metaparadigm concept. In other words, how does the theory direct your understanding of (a) person, (b) health, (c) environment and (d) nursing?
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Week 3: Use of Nursing Theory to Guide DNP Projects

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Conduct a literature search in one or more of the nursing databases on the potential topic or problem of interest to you for your eventual DNP Project. Select one article or paper and discuss how a particular nursing theory or model was used as a framework for the research study or DNP project. What insights has reading this article provided you in considering and firming up, supporting the problem statements that you have formatted in Weeks 1 and 2?

Hint: If searching the Proquest Dissertations and Theses database, use the search words: DNP (as author) and Nursing Theory (contained in abstract).

NR700 Week 4 Discussion 1 & 2 Latest 2017 August

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Week 4: Nursing Theories and Middle-Range Theories

1717 unread replies.3535 replies.

Considering the nursing theory you discussed last week (or a new one if you desire) describe how you would apply that nursing theory as a basis fornursing actions related to your practice change idea(that you developed in a problem statement and PICOT in weeks 1 and 2.

Specifically relate theoretical concepts to the elements of your problem statement — how does the theory guide your ideas about the problem, etiology, population, intervention and outcomes?

An example would be to explain how Roy’s adaptation model describes the victim of lateral violence in the work place. How does the model recommend assessing a victim’s adaptation range and what modes of assessment (physiologic, self concept, role and interdependence) would the nurse use to determine how positive coping can take place?

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Week 4: Empiric Versus Aesthetic Critical Appraisal

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List the elements of empiric and aesthetic critical appraisal tools. Discuss your chosen theory in light of these two points of view – consider whether or not you believe it is important to appraise a theory from both perspectives and state why you think so. Be sure to integrate your understanding of Carper’s Ways of Knowing into this discussion. What new understandings do you have regarding implications of limited or expanded points of view?

NR700 Week 5 Discussion 1 & 2 Latest 2017 August

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Week 5: Application of Borrowed Theories to Advanced Nursing Practice

2020 unread replies.3939 replies.

Explicate a selected borrowed theory that you already know or one that you read about in this week’s lecture, readings or other materials. Provide an example of how this theoretical perspective has been used to frame nursing knowledge, care or leadership in any health care setting.

List the concepts that constitute the theory and
Describe the relevance of those concepts to your advancing nursing knowledge and practice.

In other words, you would not describe Maslow’s theory as it relates to an entry-level, new graduate nursing assessment, but you could consider how an advanced practice nurse, working on his or her doctoral degree would use that theory to improve patient outcomes, quality and safety, access or cost.
Similarly you could talk about how using Albert Bandura’s Self Efficacy concept facilitates more effective intervention in smoking cessation initiatives.

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Week 5: Scholarship of Evidence-based Practice

2121 unread replies.3838 replies.

Describe at least two examples of how EBP scholarship is demonstrated either by you personally or by someone in your practice environment. Include in your example descriptions, which type of scholarship the example represents.

Recall from your lesson that the types of scholarship include (a) discovery, (b) teaching or (c) application and integration. Which type of scholarship do you think that your DNP project will be? Why do you think so?

Further, projects can be categorized into (a) quality improvements, (b) implementing practice guidelines, (c) evaluating practice processes and policy, or (d) examining patterns of behavior.

Thinking about these categories of scholarship and project type, how would you describe your potential project?

NR700 Week 6 Discussion 1 & 2 Latest 2017 August

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Week 6: Evidence Supporting the Clinical Question and Suggested Interventions

1313 unread replies.3232 replies.

Consider your inquiry and formulation of the clinical question thus far.

Explicate at least two pieces of evidence (current literature less than 5 years old) that support the idea that the problem you’re naming exists and is significant. For example, here is a 2013 American Heart Association article on predicting and preventing early readmission: http://circ.ahajournals.org/content/126/4/501.full

Be sure to also note what the evidence says about the etiology or causative factors (what’s going on that influences this problem)? For example, in the article above, early readmission rates are influenced (caused by) situations such as psycho social and economic factors that limit adherence as well as physiologic factors such as elevated filling pressures.

Finally, point to the evidence that suggests an intervention that works to address the causes of the problem and to improve what we’re now seeing in clinical practice on this topic. The AHA article named above suggests that interventions such as comprehensive discharge planning, including patient and caregiver education, guidance regarding sodium and fluid restriction, collaboration with visiting nurses, and planned follow-up, may reduce early readmission rates by as much as 25%.

In other words, for your problem, grounded in the literature, what is the problem/etiology and what two pieces of current literature provides evidence supporting those? Then what evidence supports the intervention idea to improve this problem situation?

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Week 6: Evidence-based Practice Change and Quality Improvement Models

1212 unread replies.3232 replies.

Identify an evidence-based practice change model and a quality improvement model that you could use for your eventual DNP project.

Explain how each model may be applied to create change through your practicum and project efforts.

Illustrate your ideas with two examples; one example of applying a change model, and one example of applying a quality improvement model.

NR700 Week 7 Discussion 1 & 2 Latest 2017 August

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Week 7: Interprofessional Collaboration for Improving Practice

2323 unread replies.3838 replies.

Discuss the role of the DNP-prepared nurse in leading interprofessional collaboration and partnership for promoting safe clinical practice within healthcare systems.

Consider your reading this week from Chapters 6 and 10 in Zaccagnini, M. E. & White, K.W. (2014); and in light of that reading, discuss ways that you currently work in or have developed interprofessional collaboration.

What more can you do relative to interprofessional collaboration as you move through your DNP education? Give specific examples of your current actions and future plans and tell why those actions are likely to improve outcomes? Be specific.

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Week 7: Emerging Roles for the DNP-Prepared Nurse

2727 unread replies.3838 replies.

What emerging DNP roles do you imagine yourself in upon completion of your degree? What skills and/or competencies do you think will be most beneficial to you as you take on those advanced roles? Consider your readings in Zaccagnini, Chapters 8 and 9 as you formulate your discussion post. Compare your role in performing traditional advanced practice actions to what is possible in emerging roles when you have completed your DNP degree.

NR700 Week 8 Discussion Latest 2017 August

Week 8: Clinical Scholar

3636 unread replies.4747 replies.

After reading the lesson and assignments for this week, describe at least two examples of scholarship as demonstrated either by you personally or by someone in your practice environment. You should describe which type of scholarship the examples represent and why.

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