Reflection

At this phase of the semester, I believe most of us are wrapping up our projects.  However, the piece from my reflection paper that I feel was the most beneficial for me was the collaborative efforts of my team to help for problem solving and overcoming the obstacles that we experienced early in the implementation phase.  My faculty content specialist had much experience in this particular population and gave excellent feedback during our project kickoff meeting.  His suggestions were implemented and positively impacted the success of the project’s communication with the participants.  The barriers this project experienced were few and simple and easily overcome.  All in all, I felt as though this project was successful and I look forward to getting the results of the data analysis.

Module 8: Reflection of the semester

My inital challenge was educating all of the providers at my inital session. This was a very important meeting as I felt this would allow them to know that I had the knowledge base to provide them with additional education than what they already knew, to explain to them what I was wanting to do with my project, and to allow them to ask questions. As a perso that gets nervous when speaking this in itself was a challenge.

THe last four months allowed me to see the implmentation of something that I am very passionate about. I hope that educating these providers, that will inturn provide more information to their patients will improve rates, or at least allow patient to make a more informed decision.

Excerpt from my paper:

Research has allowed me to see the importance of evidence-based practice and why it is important to obtain and utilize research so that you are treating patient with the best care and guidance out there. It allows the patient to receive the best care currently available according to the guidelines.

Evidence based practice is the key to our care for patients. This project has allowed me to see the importance the research has and the role it plays in day to day practice.

DNP Project II Reflection

Here are a few excerpts from my paper:

Reflecting upon the past four months and starting into the fifth, I realize this project is not just about what I have accomplished.  Projects are a team effort that comes from a person or persons’ plan.  In the end, it is a team effort that leads to a successful and meaningful conclusion.

The DNP competencies have provided me with the understanding of the scientific underpinnings of practice and the profession which are essential to applying the knowledge.  I have never thought too much about different theories and how they pertain to practice.  This project, however, has provided me with the expertise to bridge the theory-practice gap.  Not only has this aided me in this project, it has proven successful in my professional projects.

I feel I have had personal growth as a leader, not only with medical staff and providers, but with other members of the health team that are not visible on the floor.  The relationship I am referring to is the one with other departments such as information technology.  I soon found out that the IT person was going to be my go-to person in order to extract data.  This project has opened my eyes to other departments that are vital to an organizations success.  The IT department was vital for the success of my project

As for how the DNP Essentials were applicable to my project, they have an implication for nursing as a profession, science, and discipline.  Understanding the scientific foundations of both practice and the profession are essential to applying knowledge in patient care and linking the gap between theory and practice.

The DNP program overall has equipped me with more knowledge base and research wisdom in which I had no experience with.  Actually, at the start of this journey, and even at the start of this project proposal this past summer, I was unsure of how to truly research a topic, gather the necessary information, analyze the information, and put it together in order to begin to develop a project.  Implementing my project was terrifying for myself as I was having to educate medical doctors as to why the pneumococcal vaccination is important and why their clinic should implement this project.  But with the information that I researched and the tools I acquired from various websites, I was armed with the knowledge to answer any and all questions, even when challenged.

I would like to continue to grow in my leadership abilities and possibly take that leadership skills outside of my community to other sectors that could have a direct influence on my community as well as other small communities.

I hope this makes sense to you.  Good luck to each of you with your project and the conclusion of our journey.  We are almost at the end!!

Have a very Merry Christmas and a Happy New Year!!  Enjoy your loved ones.

Starry Night Santa by Dona GelsingerImage result for christmas pictures

Reflection for DNP II

This semester for me has been intense in the beginning to now knowing which direction I am heading in.  It is hard to believe that we are already getting close to the presentation of our project for graduation! It has gone very quickly from the time I began this program.

Before applying to the DNP program, I must have called or emailed Dr. Manry, a dozen times (maybe not that many); I was not sure at my age (over 59, LOL!) if I should be in a doctorate program. However, working with students that were DNP or those that were MSN bridged to DNP; they were so pleased with the knowledge they received and what it added to their practice.  I decided “why not, I just want to complete the program before retirement and hopefully before passing!”  The truth, I have no regrets. I am very happy that I am able to offer an organization or facility the wisdom I have collected through the years and perhaps help those coming up in this profession.  And I will have a doctorate! Dang! At my age!

I was devastated at the beginning of this semester with the dismissal of my IRB to UNM.  It was also unbelievable to me that the head of the IRB would not give an answer for 7 weeks, even though he knew he was not going to sign the proposal. Where are ethics? But, with the assistance of Dr. Manry and Dr. Keenan, we switched to a survey method of data collection.  And it proved to be excellent. They both were so supportive and helpful.  And I was determined to not let that rejection slow me down!   The information which I have researched this semester is so very important to the Nurse Practitioner.  How we can practice safely and provide safety for our patients.  Guidelines are so easy to follow, they are road maps to our practice. Designed to be evidence-based. It still amazes me that others in our profession do not utilize them.  More to come on that at “Scholars Day.”

In summary, I would like to share a piece of my “Reflection Paper” with you:  “With the addition of the title of “DNP”, it will bring recognition and with that some entitlement in practice.  With years of experience as an FNP and CNM (no longer an active CNM), I have the background to be valuable to most areas of practice.  And for that, I am thankful.  Education is something we will never have taken away from us.  Being an RN(Age 22), BSN(36), MSN/FNP (Age 41), CNM(age 42), and now DNP (Age 61), on the horizon has built the woman I am today.  We are never too old to learn and be the best at the care we give to our patients and to each other.”

It has been wonderful interacting with all of you this semester.  I am looking forward to next semester completing this program and our projects with you!  Happy Thanksgiving and Merry Christmas and a very Happy New Year to you all!

Kay

 

Preliminary Data

Preliminary data – what you are learning?

As I stated in the last blog, my project was completed on November 6th.  In glancing over the data on the participants’ self-assessments, it was obvious that they learned from the blogs and activities and increased their knowledge bases.  They didn’t all increase their levels of physical activity or report that they they actively apply their new knowledge to nutrition.  I have a meeting this next week with the statistician to help with data analysis as the data I gathered was created from a Likert scale.

I have learned so much about the process of the DNP project and wish that I could be a peer guide to one of the upcoming students.  I have learned much of what to do and what not to do with this specific project.  I wish that I could build from what I’ve done so far and continue the research to a greater capacity but I’m proud of what this project has demonstrated so far and am excited to see it finish.

Preliminary Data: What Am I Learning?

I will be talking with Dr. Pahls by phone on the 19th next week.  I will have more of an idea of how to proceed with the analysis of the data.

I have been working on the revisions within my project paper. As I am sure, the rest of you have as well — several changes. I have added to the literature review. It is looking at things that relate to the survey, which I did, looking at barriers to adhering to guidelines.  It was interesting (one thing new,, I guess).  Clinical inertia ” is the failure of a healthcare provider to initiate or intensify treatment when indicated ” (Cowart, 2018).  This can be seen in people with diabetes; for example, a provider knows there is perhaps a guideline for changing a medication or what is recommended, yet chooses not to follow it.
Because of a lack of knowledge or bias, or disagreement, do not follow guidelines.  This happens with chronic pain management with opioids.  Providers know that there is a CDC Guideline for chronic pain management with opioids; yet, they choose not to follow for reasons mentioned.  I should rephrase, some are not familiar with the guideline, some do not care about the guideline.  The review which I read discussed the need for further research into clinical inertia as it relates to lack of adherence to prescribing opioids for chronic pain, and why there was lack of use of the CDC guideline.  It was very interesting and was the first time that I had seen this term used.  The authors were concerned with “knowledge synthesis” that was related to a lack of adherence for safe prescription of opioid management of chronic pain.  This, of course, their review does not include patients that have chronic pain related to cancer (Rash, et al., 2018).  My survey does go into what might be barriers.  Listed were 1) Lack of knowledge; 2)Not enough time with the patient; and 3) Lack of support from the organization.

I will give a low-down after I have a structured analysis of the data.

References

Cowart, K. (2018). Overcoming clinical inertia in diabetes management: Pharmacist opportunities. U.S. Pharmacist. Retrieved from https://www.uspharmacist.com

Rash, J.A., Buckley, N., Busse, J.W., Campbell, T.S., Corace, K., Cooper, L., Flusk, D., Iorio, A., Lavoie, K.L., and Skidmore, B., (2018).  Healthcare provider knowledge, attitudes, beliefs, and practices were surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Systematic Reviews, pp. 1-7.  doi: 10.1186/s13643-018-0858-7

UPDATE: 11/23/19

I wanted to let you all know that I did have an appointment with Dr. Pahls last week.  At first, he felt that I would not need statistical analysis, as it was a survey.  I was a little disappointed at first; then I asked him about “comparison” data.  To compare, for example, “those in practice for 1-5 years as compared to those in practice for 10-20 years, etc.” there were differences.  Then he mentions the “Chi-Square” analysis.  Which this would work well for what I wanted to do. This quantitative analysis would also add validity to my project. When looking into “Chi-Square” formulas. I was like, “holy cow, that is not going to be easy.”  But, I am up for that challenge.

Kay

Preliminary data – what you are learning?

My project seems to be flowing nicely, according to my champion.  It is hard to believe that there is only 1 ½ months left before my project concludes.

What I am learning is there are issues that can arise, no matter how trivial they may seem.  After my telephone discussion with Dr. Pahls, I was informed I needed additional data for my sample size.  When I expressed this request to the clinical manager, she hesitated and said that she is unsure of how to do that other than look up every patient during the requested time.  After some discussion about how to remedy this situation, she suggested having the IT department pull the data as they would know how to run a report for the specific data needed.  I did try to contact the IT department on Friday, November 8th, but as of today, November 11th, I have not heard from them.  I will keep trying to get in touch with them.

So, long story short is to expect issues to pop up.  When they do, do not panic but to think around the obstacle as there is always a way to remedy things.  At least I hope so.

I have not received any preliminary data as I am waiting to discuss things with the IT department.  I will finish my clinical rotation this week.  I am hoping to get in touch with the IT department on Friday.

Leadership Challenges, strategies, and hiccups

My weekly blogs finished last week.  This week was the final measurements and post-participation surveys.  I only had approximately 20 of the 27 participants finalize the surveys but I feel like that was decent number.  My biggest leadership challenge has been the fact that the project site is almost two hours from my clinic site.   There were no issues throughout the duration of the 8 week blog publishings other than some verbiage tweaking and a minor alteration in schedule but I definitely had to depend on the administrative assistant on campus to ensure that the blogs published on time and I was thankful to have my faculty content specialist available if necessary.

Strategies:  The activities were very specific to the location and were created to fit well into the participants’ work day.  There were many participants that came to the lunch and learns.  It was a very positive atmosphere and all who participated seemed to really enjoy the topics.  There were also classes held by wellness center which ran congruently with the 8 weekly blogs which helped keep the participants motivated.  (That wasn’t organized by me but instead spotlighted in support of this project.)

Hiccups:  The only hiccups were the schedule conflict with homecoming week but I feel like we adapted to it well and really didn’t see any negative side effects of that.  I wish there were more participants but I loved the project and even though the numbers weren’t very high, all who did participate all unanimously stated that it was a positive experience and some even offered that they were disappointed to see it end.  (I’d call that a success!)

Leadership, Challenges, Strategies & Hiccups

Overall my project is on-time. Now, I will revise and get the proposal and the Survey to Dr. Pahls (statistician) at Hays, and get a time set up to speak with him concerning the statistical analysis.

Things are running smoothly at this time.  Data has been collected, it went reasonably well (240) responses to the survey (I thought it was 235). It was interesting that the largest group to respond were NPs that were in practice for 1-5 years.  I do feel that NP education now is more focused on EBP, guidelines are critical.  Compared to 22 years ago, when I first began practice as an NP, there are more states which are lifting the restriction to NP practice. This does make a difference.

I was asked recently to take a survey from a doctorate student that was an NP working on her Ph.D. with the University of Nebraska; she was reviewing states NPs who have full practice authority; did demographics make a difference? It was an excellent survey. I am confident she was going to get great information.  She was surveying 4 states that had full independent practice, New Mexico was one of them.

Kay

Leadership Challenges, Strategies, and Hiccups.

For the most part, my project seems to be going well.  I really do not want to say that because I do not want to jinx myself.  The biggest challenge I have had is lack of time and availability in case the clinic would need something.  I have been trying to finish my clinical rotation as soon as I can because my preceptor in quitting the clinic and going to work at another FQHC in Wichita.  Her last day is November 15th and she worked only one day this week.  I should be finished by next week and can devote more time to my project.

I did visit with the statistician on Monday and we worked out a game plan.  The statistical test I had planned on using was not the right one.  Thank goodness I was able to get in touch with him.

The only hiccup right now, other than lack of time, is needing the clinic manager to pull more data for me.  The statistician explained what data I need from last year and for this year.  I thought having her pull my data would be easier because the issue of HIPAA.  We figured this way would be easier, but I am beginning to think that maybe I should be pulling the data.  I feel like I am bothering her all the time.  I have completed their HIPAA training so maybe I can visit with her and see what we can figure out.  Otherwise, the project is going well.  I am keeping my fingers crossed.

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