Initial Challenges and Adjustments

Initial challenges were the announcements weren’t posted as scheduled and considered to need to be more frequent.  As I mentioned in a previous posting, we adjusted the announcements to run daily and then approved flyers through the IRB.  The flyers were successful.  We had a good turnout for the first lunch and learn.  I know hind-sight, I wish there had been more time to have more interventions and possibly incorporate specific activities outside of learning.  My main goals are for the participants to feel as though they learned something they didn’t know about improving overall health.  I feel like the participants are already excited about participating and have a good grasp of the program.  The participants that keep coming to the on campus activities are a lot of fun and truly enjoy participating.  I have to be comfortable in the fact that the number of participants is fewer than expected but that at least those participating are learning tips to benefit overall health and achieve lifetime goals.  There’s not much I could adjust at this point of the project.  I definitely know the changes I would make to possibly help a future student with a similar project.  I would encourage them not to start at the beginning of the school year and begin during the spring semester instead.  I feel like participation would be greater during that timeframe.  Also I would encourage daily announcements instead of weekly blogs.

Implementation and checkpoints

I initiated my project on August 27 after IRB approval with coordination with my Clinical Champion. I did my retrospective chart review in 2 weeks, which was quicker than I had expected, and then I will begin sending emails weekly to the clinical champion so that she can send it out to the staff on October 7. My timeline was approved by the IRB so have continued with the same timeline, except I completed my retrospective chart review in the first 2 weeks of September, so I didn’t need the fours weeks set out in my timeline. My implementation to this point has gone smoothly.

 

Implementation Check Points-DNP II

The update on my project since the last blog; I found out just a few weeks ago that UNM IRB would not sign my project proposal. This went on from July 31st to the first part of September.  I had to escalate to a higher power the need to get this signed or not so that I could move on.  The Director of the IRB for the UNM College of Nursing was helping me with this; she was dismissed multiple times no reason given for the “one” signature that I needed. This individual did not sign citing I was not an employee of UNM any longer, and I was not a student with UNM.  However, if we would have known this week’s earlier, we could have submitted an agreement with FHSU and UNM, which may have been accepted. I had to switch to a survey which will be going out to NPs in the state of New Mexico. The study developed was done with Survey Monkey (which I just got done); will need to redo the FHSU IRB BEFORE October 7th and submitted by that date to be able to send the Survey later in October.  I received assistance from Dr. Keenan and Dr. Manry on how to manage this situation and the new direction we needed to take.  It will by no means be as strong of a study. However, it will still yield valuable information on the attitudes, beliefs, and barriers to practice with guidelines from nurse practitioners.

My new proposal:  “Assessment of attitudes, beliefs & barriers of New Mexico nurse practitioners on the utilization of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.”

I created a simple time-line (check points) for the new and current proposal.  The yellow arrow represents the very start and “yield”.  The “green” is a go; the “red” is stop and evaluate.  This will be tweeked as I continue over the next few weeks and will most likely change.

 

 

Project Implementation Check Points

My project, increasing pneumococcal vaccinations in adults 65 and over in a rural health clinic, will implement October 1, 2019.  Education for staff was to be completed on September 6, 2019 but due to an illness by the clinic manager, the meeting was cancelled.  Due to that reason, education was provided on September 10, 2019 to each nurses’ station.  There are four different nurses’ stations, so education was provided four times.  Posters and reading material were provided.  The staff said they would hang the posters and place the reading material out the last few days of September.

Data for the previous year had been pulled from the clinic’s data base.  The clinic manager pulled the information for me, eliminating any issues complying with HIPAA and confidentiality.

I will go to the office on Monday, September 30th and make sure things are in place.  The project will conclude on December 31, 2019.   During the project period time, I will check to make sure things are going well, answer any questions, and provide more material if needed.

During the month of January 2020, I will ask the clinic manager to pull the data for the three months.  I will also compile all the information and try to have Dr. Pahls help me with the statistical portion of my paper.  My goal is to have the information completed and disseminate the findings the latter part of March or the beginning of April.

I tried to paste a copy of my timeline into this blog but the computer is smarter than me.  Please click on the “timeline” link to view my timeline.  It is a rough timeline.  As the project unfolds, the timeline will be filled in.

Timeline

Project Implementation Check points

My project already launched.  I have attached here my approved scheduled along with some notes for myself to refer to to stay on task with communication.  After IRB approved everything, my project was pretty much complete for the planning and implementation phase.  The schedule of blogs was already written this summer and scheduled in collaboration with on campus events.  I’m pretty excited about this project and even though it hasn’t been the smoothest start, I feel like it’s going to benefit many people.  As far as checkpoints, I feel like my timeline is already set and appropriate.  I know that I am in constant communication with the administrative assistant and I touch base with the speakers in order to ensure that we all have open communication.  With the participants de-identified, I do not stay in touch with them but I hope to see them at the lunch and learn activities.  It’s been an exciting process.

August 28-September 16 Announcement/invitation to participate through
Tiger Daily
September 9 Sign up and measurement day on campus
September 11 Blog posted about Body measurements and Posting of Wellness Center Hours
September 16 Sign up and measurement day 2 on campus
September 16 Ensure all data is entered for pre-participation
September 17 Blog posted about physical activity and invitation for campus walk
September 17th Communication with Lunch and Learn Speaker & ensure flyers are posted to invite all participants to lunch and learn
September 25 Nutrition Blog
September 26 Lunch and Learn with Dr. McNeil
September 26 Communication with Lunch and Learn Speaker & post flyers
October 2 Blog about “get up and go”
October 3 Lunch and Learn- Drew Gannon
October 9 Blog about Steps
October 9 Communication with Lunch and Learn Speaker & post flyers
October 16 Cardiovascular Health Blog
October 17 Lunch and Learn- Cardiovascular-Mary Jo
October 23 Blog and invitation for preventative screening on campus
October 30 Blog about water intake benefits
November 6 End of blogs/measurement day
November 6 Data Comparison-Ensure all data is entered.

Initial Approach and Concerns

My DNP project involves an initial invitation sent via newsletter to all staff and faculty of FHSU.  The announcement has run for two weeks with little feedback for participation. The Tiger Daily newsletter has been inundated with information for the university being the first few weeks of school.  Many announcements for back to school activities have been printed in the same newsletter and the team believes that the lack of interest in my project thus far is due to the overwhelming of information to all staff and faculty concerning all back to school events.  My concern is that the participation rate will be too low to achieve accurate results for my project.

I conducted a project kick off meeting with many members of the team including the faculty content specialist and it was suggested that we increase the announcement frequency to daily and that we place flyers in key locations to coincide with announcing the activities throughout the wellness project.  After learning the IRB revision process (which took me a couple of days to get correct), the revisions were approved and the team notified of the approved schedule and flyers.

Another obstacle in these first few weeks was the fact that I had undergraduate students signed up to participate in measurement day 1 and all students were scheduled to be off campus at a facility tour for clinicals.  There were a handful of volunteers but not all time slots were committed.

One last obstacle for the project was that the day of measurements, it downpoured rain.  So the project was set up to encourage increasing physical activity and the participants had to try to decide if they were going to walk in the rain to weigh in or if they were going to struggle to find parking in the university parking lot.

It’s definitely been obstacles I hadn’t considered.  I have grown in my ability to follow up and to communicate with my team and I’m learning a lot about IRB.  It’s been a great learning experience so far.

Initial Approach and Concerns

Starting this project is beginning to be a challenge.  Initially, I had a conversation with the clinic manager about the idea of my project in fall 2018.  She thought my project of increasing pneumococcal vaccination rates among adults 65 and over was a great idea.  Things seem to be starting off smoothly.

Fast forward to summer 2019.  The clinic manager I was working with and was going to be my champion turned in her resignation.  The new manager was willing to work with me, but seems to lack the enthusiasm the previous manager possessed.  From the conversations I have had with both of them, this transition caused hard feelings.  Neither the out-going manager nor the incoming manager talk to each other.  However, I did secure the commitment from the current manager regarding my project and she is now my champion.  We sat up a meeting time for me to talk to the staff at the clinic this week.  In addition, I have secured a nurse who will also help lead the efforts to make this project successful.

Now for another set-back.  The meeting scheduled for this week has been postponed.  Nobody knows when it or if it will be rescheduled.  The clinic manager is out with an illness and the staff as no idea when she will return.  In addition to my clinic manager being ill, I found out the at the same time the nurse who was going to be my leader in the office is resigning and going to work for a different facility.  Her last day will be next week.

On a positive note however, the nurses said I could come and still talk to them and give them the information I had planned on providing during the meeting.  So basically, I will be giving the same speech four different times at eat nurses station.  I also have another nurse who may agree to be a leader for me within the clinic.

My concerns about starting my project is the staff will not have the motivation to implement the project since two of my primary contacts have or are leaving.  To alleviate this concern somewhat, I will also speak to the IT department and make sure the pop up reminder is ready to be implemented.  But wow, I found all this out yesterday.  I still can make this work though.  It is just a few setbacks.

Initial Approach and Concerns and Project Concerns:

My project focuses on increasing immunization rates within a given populace at a local clinic. In order to implement this my first step is to educate the providers and staff at the clinic of  on the available research information and project methodology that I plan to implement at the clinic with a goal of improving immunization rates. This inital implementation phase went well, with discussion and questions from the staff and providers.

Since this is my first clinical research project I am naturally hesitant as to whether my approach and methodology are appropriate. It is my hope that my passion for the project coupled with humility and open communication will allow me to move past any obstacles. I also hope to leverage the experience of the faculty, providers and staff when possible to overcome any challenges presented.

Initial DNP Blog–Kay Gonzales

My proposal: ” Does the use of an evidence-based guideline for opioid therapy improve adherence of chronic pain managment to current standards of care?”

The purpose of this review is to  improve provider knowledge and safe practice in prescribing an opioid for chronic pain in a primary care clinic by adherence to the use of the 2016 CDC Guideline for chronic pain management.  This guideline helps improve safety by the prescriber and prevention of un-intended overdose.  Many providers are not aware of the CDC guideline to provide safe care.

Concerns about this project:  At this time it is still awaiting “one” signature so that it may proceed through the University of New Mexico’s IRB process.  This has been most frustrating for me; it has been setting in an inbox for one persons signature since 7/31/19. It is being escalated to academics to see if we can get this individual to sign so that it may go through the process. The clinics Medical Director is  on board with the project.  I anticipate no problems with the clinic. This is a chart review.  I will be assigned a research assistant who will actually be the one to collect all the data for this project.  By doing this the sample (providers of the clinic) will be de-identified when I receive the harvested data.

Timeline: Definitely a concern.  As this may put me one to two months behind.  I am assured that as soon as the process is concluded, they are swift with getting data to the researcher.  After approval from UNM, the proposal still has to go through the FHSU IRB process before the implementation begins.  I do hope to have some sort of resolution by the end of next week.