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 – 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.

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

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!)

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