Tag Archives: N958 DNP Project II

DNP Project II Reflection

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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

Preliminary data – what you are learning?

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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.

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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.

Data collection issues, challenges, and triumphs

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My project was implemented on October 1, 2019.  I have not collected any data as of today, October 15, 2019 due to the short amount of time.  There really have not been any major challenges with the exception of the clinic’s EHR program.  The program they are using has ICD-9 diagnosis codes instead of ICD-10 codes.  This should be pose an issue with my project however because my data will be collected using the CPT codes.

Even though I have not started data collection, I have talked with the staff and they said they are giving more pneumonia vaccinations.  That is a win in my corner as that is the goal of my project.  I will begin collection data at the end of the month.  I figure it will be easier on the clinic manager if I asked for data once a month, especially right at this moment and the issues with the ICD codes.

Project Progression and Setbacks

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My project of implementing a reminder system into the rural health clinic’s EHR was implemented on October 1st.  My first issue was the fact I was out of town for clinical when it was implemented.  I finally was able to check in with the clinic in person on Friday, October 4th.

I found out the clinic is having issues with the program.  The issue is the program is defaulting to ICD-9 codes instead of ICD-10 codes.  Even though that is an issue for the clinic, I do not think it has any barring to my project.  I attempting to help the clinic manager resolve this issue, but I think it is a program/system issue and she will need to contact the IT department or her sales representative.  The reminder is popping up, however, and the reminder to inquire about pneumonia vaccination status and provide pneumococcal vaccinations is the focus of this project.  When asked about providing pneumococcal vaccinations, the nursing staff reported they have been giving some.  The timing of this project is perfect because it commences during flu vaccination season.

As of right not (knock on wood), I have not had any additional setbacks.  The project is going along perfectly as expected.  I made additional posters to put in the waiting room as they ran out after all the posters were placed in the exam rooms.  Other than that, things are going well.   I am keeping my fingers crossed.

Challenges and Implementation

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I did finally submit my project to the FHSU IRB on September 30th. Whew! It had to be in by the 7th of October. Keeping my fingers crossed that I do not have to change much.  Again, the main challenge to date was waiting on the UNM IRB; and I waited for 7 weeks. That is not necessary to put a student through that. If an organization such as the University IRB in New Mexico felt that they would not sign it because; A: I was no longer an employee with UNM, and B: It was not the right form.  Do you not think they would have told someone! A dysfunctional system. Instead; a very diligent Research Director for the College of Nursing kept putting herself self-out there daily to get this signed. She was always dismissed. There is a learning curve here; 1. Communicate; 2. Be ethical ; 3. Be a role-model to others.  I do feel relief, however; just glad to be moving.

I plan to send the surveys out as soon as I get IRB FHSU approval. I would imagine 2-3 weeks should be enough time to get the reviews back. Survey Monkey, does quantify the information some statistical analysis; however, for in depth-review; it will go to FHSU statistician. I have re-worked the theory (Lewins Change); it has been modified to the survey and the change in the structure of this project. I think it is exciting, I do hope the NPs in New Mexico find it helpful to them, make them feel, and be familiar with the, 2016  guideline from the CDC on Chronic Pain Management with Opioids. Each state seems a little different on how Primary Care manages opioids for their patients.  My focus remains in New Mexico. For the most part, they are very progressive in adhering to the guidelines from the CDC. Thanks to an Attorney General that is on top of this epidemic (Hector Balderas).

The next blog will be more organized as I will actually be putting the project together.

10/3/19  UPDATE:  MY PROJECT IS APPROVED! I received my “Exempt” letter today from FHSU IRB. YAY!!!   Kay

Implementation Check Points-DNP II

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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.

 

 

Initial Approach and Concerns

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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.