October 10, 2022

DNP 820 Discussions and Ten Strategic Points

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GCU DNP 820 Topic 1 DQ 1

Describe a situation in which a new clinical practice was put into place. Was there a DNP-prepared nurse leading the translation of the practice from research to practice? If so, describe the process that individual took for translation and why it made a difference in the translation. If there was not a DNP-prepared nurse, describe the process and what would have been different about the process had there been a DNP-prepared nurse leading the practice translation?DNP 820 Discussions and Ten Strategic Points

DNP 820 Topic 1 DQ 2

Compare the PhD and DNP degrees. Define the differences in roles and education associated with the two degrees. Describe future opportunities for DNP-prepared nurses.

DNP 820 Topic 2 DQ 1

Which research methodology would be the most appropriate for your project and how does it align with your clinical question, data collection, and data analysis? Demonstrate an example of when you might use the opposite methodology in your EBP projects and why.

DNP 820 Topic 2 DQ 2

Within nursing, the patient’s perception is recognized as the patient’s reality. How does this way of knowing in nursing fit within an objective or subjective paradigm of the world? Explain your reasoning.

DNP 820 Topic 3 DQ 1

Which method do you prefer in determining levels of evidence? Describe two advantages to the method and one disadvantage to the method. Explain how you have used this method in your current practice or education. Why are levels of evidence important in selecting empirical articles for your ROL (Chapter 2 of your DPI project)?

DNP 820 Topic 3 DQ 2

Research can take between 10-20 years to be translated into practice. Discuss your thoughts on the reasons why this may occur and describe the barriers within your own practice that prevent you from practicing from a 100% evidence base.

DNP 820 Topic 4 DQ 1

Reliability and validity are often misunderstood and not given much notice in research articles. Using any example, demonstrate how you would correctly describe these two terms to a nurse prepared at a bachelor’s degree level or below. Then describe why the reliability and validity of a study is important for translation.

DNP 820 Topic 4 DQ 2

What are the criteria for selecting qualitative versus quantitative resources in relation to your literature review? Which method(s) of research are you selecting? Why?

DNP 820 Topic 5 DQ 1

What effect does a meta-synthesis or meta-analysis have on research translation? Describe a clinical practice in place that is supported by this level of evidence.

DNP 820 Topic 5 DQ 2

Comparative effective research is important in translating research. Describe one study that used comparative effective research. What were the findings and were they translated into practice?

DNP 820 Topic 6 DQ 1

There is a heavy focus on achieving statistical significance when evaluating outcomes. Often in research or EBP projects, there is no statistical significance, only possible clinical significance. When is it appropriate to deem a project’s outcomes successful only using clinical significance as the only measure of success?

DNP 820 Topic 6 DQ 2

The three components of EBP include clinical expertise, best evidence, and patient preference. Often, patient preference and clinical expertise are at odds with each other. Describe a scenario where you might need to mediate this issue and what is the solution when this occurs. It can be a real-life example as well.

DNP 820 Topic 7 DQ 1

Choose one model for EBP implementation. Describe its components and why you believe this model is most appropriate for assisting in translational activities. Contrast this model with another.

DNP 820 Topic 7 DQ 2

Discuss the role of the DNP-prepared nurse in sustaining an EBP culture. What are two effective methods the DNP can use in sustaining an EBP culture?

DNP 820 Topic 8 DQ 1

Describe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.

DNP 820 Topic 8 DQ 2

Describe how you will assist others to generate their own evidence-based practice questions. Discuss what your professional obligation as a DNP-prepared nurse is related to evidence-based practice, patients, and other nurses?DNP 820 Discussions and Ten Strategic Points

The Ten Strategic Points Sample Paper

	10 Strategic Points	Comments/Feedback
Broad Topic Area	Evaluation of benefits of transradial vs. transfemoral cardiac catheterization for adult patients in a Level I Trauma Center located in Alabama
Literature Review	Background of the Study Cardiac problems, especially the coronary artery diseases, are among the common ailments experienced in various healthcare institutions. Basing the issue on the sensitivity of the heart to cardiac problems, healthcare providers pride the various approaches used to combat diseases for that matter. The transfemoral approach takes place in light of femoral artery at the groin that serves as the main channel for catheterization to the chest (Sanidas, Buysschaert & van Langenhove, 2014) On the other hand, the transradial approach utilizes radial artery whereby the catheter is inserted with a balloon in it to facilitate opening of the blocked artery (Aamir, Mohammed, & Sudhir, 2016). That being said, it is not clear if transradial approach is better than the transfemoral approach hence giving the study a new starting point. Therefore, basing the research on level 1 trauma center in Alabama in relation to determining the benefits of both transradial and transfemoral approach is critical in the attempt to evaluating the best approach to adopt. Theoretical Foundations Organizational change theory The organizational change theory is one of the models that highlight more on organizational capabilities in making either transradial or transfemoral approach a success. The theory considers both approaches as a non-issue and lays blame on the involved healthcare providers bearing in mind that they need to be innovative enough to better the patient care outcomes (Basile et al., 2018). However, the organizational change theory also appreciates Lewin’s theory of change which elaborates that caregivers in the cardiac catheterization laboratory must incorporate and embrace new changes to facilitate the quality of the outcomes. In this case, embarking on transradial approach becomes the center of attention since the approach allows treatment modifications necessary to containing artery problems. Theory of diffusion Recent research conducted by Dibraa (2015) suggests that the theory of diffusion seeks to explain rates, means and reasons at which embracement of new ideas takes place. In a healthcare arena, the diffusion theory outlines that transradial approach is one of the new ideas that healthcare providers need to prioritize as it easily accomplishes treatment objectives. System theory System theory is a clinician-based model that steers caregivers to understanding the operation of a given system. One of the fascinating ideas regarding system theory is that it does not favor transradial catheterization approach more than the transfemoral approach (McEvoy et al., 2014). Instead, it encourages the caregiver to comprehend how each approach works particularly radial and femoral artery. In so doing, any of the two approaches can yield dependable results. Review of Literature According to Seto et al. (2015), transfemoral and transradial cardiac catheterization work best to diagnose various heart conditions. However, the transfemoral approach does not hold insisting on its unwelcome outcomes ranging from prolonged hospital stays to nerve bleeding. On the same note, the transfemoral approach is known for causing bleeding at the puncture site. Major complications associated with femoral catheterization technique include death by major vascular bleeding (Piccolo et al., 2014). It is significant to note that femoral artery is wider than the radial artery, an aspect that subjects the patient to excessive bleeding after treatment. Basile et al. (2018) posit that Transradial approach is the best move toward containing cardiac artery diseases simply because the patients can walk right after treatment. As explained above, the radial artery is small enough to allow pressure pumping in a bid to contain bleeding after the procedure is complete. As such, Transradial approach has recently gained popularity in Asia and Europe due to its decreased impacts on bleeding complications. It is unfortunate that femoral artery does not hold when it comes to applying direct pressure to combat bleeding hence proving to be an ineffective method of treating cardiac problems. However, much transradial catheterization appears to be; it is only limited to patients with sufficient blood flow to their hands. The reason behind the good supply of blood is to assist in tackling issues of artery blockage (Jang et al., 2016). The transradial approach also leads to problems such as nerve damage, blood clot and damage to the blood vessel. Whichever the case, it is always necessary for healthcare providers to understand the required procedures in each case to minimize the risks involved. Summary: Femoral artery has a wider lumen than radial artery making it more accessible by practitioners (Qi et al., 2017). As such, the femoral approach is common than the transradial approach. The dangers of the femoral approach outweigh the benefits of the transradial approach. Transradial procedure minimizes vascular and nerve injuries as well as patient morbidity which have dangerous consequences.
Problem Statement	Heart conditions have been known to increase with age, and in some cases, they lead to the death of the individuals who have not taken a keen interest in checking their vulnerability. Interventions to the heart conditions early enough, therefore, can save the lives of the potentially vulnerable people. The purpose of cardiac catheterization, therefore, is to detect early heart conditions after which the right intervention methods can be applied for timely treatment (Feldkamp et al., 2018). The approaches used to diagnose possible heart conditions have nonetheless been marred with many risks which have often outweighed the approach’s many benefits. Even though the transfemoral interventions that have often been used have been associated with more health problems, it is not known if prioritization of transradial catheterization approach is reliable enough.	1.
Clinical/PICO Questions	P – Adult patients aged 45 and above with heart diseases I – Cardiac catheterization in both groups of patients. C – Transradial Vs. Femoral approaches. O – Reduced complications and problems during cardiac catheterization. T – The study was set to take place for three months during which the patients that have undergone the procedures would offer information regarding the procedure undertaken.
Sample	A sample of 50 adult patients with heart diseases aged 45 years and above will be necessary for the study. It is quite important to highlight that the sample contains both the healthcare providers and the patients in that caregivers would give individual accounts of their knowledge on transradial and transfemoral approach while the patients’ responses to such approaches are recorded as well (Sahlström, 2016). The study will take place in the Level I Trauma Center located in Alabama.
Define Variables	Independent variable: Femoral and Transradial catherization procedures. Dependent variables: The follow-up checks carried out by practitioners. That is, Follow up checks carried out by practitioners(Y) = Femoral(X) or Transradial (Z) catheterization procedures. It is also true to deduce that Reduction in bleeding complications, readmissions, infections, and improved patient comfort (Y) = Femoral(X) or Transradial (Z) catheterization procedures. That means, for patients to pride reduction in bleeding complication, improved patient comfort, and reduced infections and readmissions, it all depends on the choice of catheterization procedures (transradial or transfemoral).
Methodology and Design	The project will use the qualitative methodology and quasi-experimental design. Qualitative methodology rightly fits in most of the studies citing its ability to capture expressive information (Thanh, 2015). Unlike quantitative methodology that relies on feelings, values, and beliefs, the quantitative method serves best to get to the bottom line of the whole issue concerning the suitability of both transfemoral and transradial approaches. It is not possible to leave cardiac ailments at the mercies of feelings and values since the study seeks to identify the best treatment approach by evaluating the data at hand. The quasi-experimental design serves best to facilitate the quality of the study because it combats disruption. One of the facts about quasi-experimental design is that it works on the basis of arbitrary selection of participants (Ceritoglu et al., 2017). It would, therefore, be important for the study to arbitrarily select the first 50 patients according to the order in which they appear in the healthcare register to avoid unnecessary commotion not forgetting research only seeks to highlight the variation in the recovery process to determine the right catheterization approach.
Purpose Statement	The main purpose of this quantitative study is to explore and describe the benefits of using the transradial approach for cardiac catheterization over the classical transfemoral approach of cardiac catheterization in the adult patients in the Level I Trauma Center located in Alabama. This is measured by a reduction in bleeding complications, readmissions, infections, and improved patient comfort over a period of 4 weeks. It, therefore, helps the healthcare practitioners administering care in the facility to reflect under the project in the process of identifying the benefits and the negative impact of the approach outcomes through the nominal scale.
Data Collection Approach	There would be the use of interviews and questionnaires to find out basic information regarding the femoral and transradial approaches from the sample population and the healthcare providers (Vaismoradi, Jordan & Kangasniemi, 2015). In particular, interviews will purposely serve the healthcare providers as it will allow them to express their knowledge of both femoral and transradial approaches. In such a case, the reliability and validity in terms of success rate about reduced bleeding, reduced hospital stays linked to catheterization approaches will be examined. The open-ended questionnaire will rightly fit the sampled patients because it will take care of their privacy and ensure their relationships with the healthcare providers will not be undermined. Now that the study blends both the patients who underwent transfemoral approach of cardiac catheterization and those committed to transradial approach of cardiac catheterization, the open-ended questionnaire will be the best fit in examining patients’ encounters for that matter. For instance, the questionnaire would assess both cases by requiring the patients to record the extents of bleeding at the puncture site, comfort, and readmissions. It is from that point the study will gain momentum particularly in determining the right procedure to apply when treating cardiac ailments. For example, if the questionnaires indicate a high number of readmissions for patients that underwent transradial catheterization, it would mean transfemoral approach is more effective and vice versa.
Data Analysis Approach	Here, the use of the independent T-tests will be critical in determining the best approach to treat the sample population. The t-test surpasses other data analysis approaches in that it enhances statistical significance (Kim, 2015). In other words, in the end, the researcher can fully understand the meaning of the results. One of the facts about t-test is that it gives accounts populations regarding their means while explaining why the means significantly differ. In the case of the research at hand, the participants constitute both transfemoral and transradial approaches. Considering such factors as a reduction in bleeding complications, readmissions, infections, and improved patient comfort it will be possible to achieve dependable outcomes regarding the t-test as it will expose mean differences of the sample population hence contributing the selection of the most appropriate approach to containing heart-related problems. The t-test will also justify the sample size thus yielding multiple benefits to the study.

References

Aamir, S., Mohammed, S., & Sudhir, R. (2016). Transradial approach for coronary procedures in the elderly population. Journal of Geriatric Cardiology: JGC, 13(9), 798.

Basile, A., Rebonato, A., Failla, G., Caltabiano, G., Boncoraglio, A., Gozzo, C., … & Garcia-Medina, J. (2018). Early post-procedural patients compliance and VAS after UAE through transradial versus transfemoral approach: preliminary results. La Radiologia Medica, 1-5.

Ceritoglu, E., Yunculer, H. B. G., Torun, H., & Tumen, S. (2017). The impact of Syrian refugees on natives’ labor market outcomes in Turkey: evidence from a quasi-experimental design. IZA Journal of Labor Policy, 6(1), 5.DNP 820 Discussions and Ten Strategic Points

Dibraa, M. (2015). Rogers theory on diffusion of innovation-the most appropriate theoretical model in the study of factors influencing the integration of sustainability in tourism businesses. Procedia-Social and Behavioral Sciences, 195, 1453-1462.

Feldkamp, T., Luedemann, M., Spehlmann, M. E., Freitag-CreWolf, S., Gaensbacher, J., Schulte, K., … & Frey, N. (2018). Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clinical Research in Cardiology, 107(2), 148-157.

Jang, H. J., Kim, J. Y., Han, J. D., Lee, H. J., Kim, J. S., Park, J. S., … & Kim, T. H. (2016). Numbness after transradial cardiac catheterization: the results from a nerve conduction study of the superficial radial nerve. Korean circulation journal, 46(2), 161-168.

Kim, T. K. (2015). T test as a parametric statistic. Korean Journal of Anesthesiology, 68(6), 540-546.

McEvoy, R., Ballini, L., Maltoni, S., O’Donnell, C. A., Mair, F. S., & MacFarlane, A. (2014). A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Science, 9(1), 2.DNP 820 Discussions and Ten Strategic Points

Piccolo, R., Galasso, G., Capuano, E., De Luca, S., Esposito, G., Trimarco, B., & Piscione, F. (2014). Transradial versus transfemoral approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome. A meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One, 9(5), e96127.

Qi, G., Sun, Q., Xia, Y., & Wei, L. (2017). Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery. Clinics, 72(1), 1-4.

Sahlström, M., Partanen, P., Rathert, C., & Turunen, H. (2016). Patient participation in patient safety still missing: Patient safety experts’ views. International Journal of Nursing Practice, 22, 5, 461-469

Sanidas, E. L. I. A. S., Buysschaert, I., & van Langenhove, G. (2014). Iatrogenic left main coronary artery dissection and intramural hematoma caused by diagnostic transradial cardiac catheterization. Hellenic J Cardiol, 55(1), 65-69.

Seto, A. H., Roberts, J. S., Abu-Fadel, M. S., Czak, S. J., Latif, F., Jain, S. P., … & Kern, M. J. (2015). Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial). JACC: Cardiovascular Interventions, 8(2), 283-291.

Thanh, N. C., & Thanh, T. T. (2015). The interconnection between interpretivist paradigm and qualitative methods in education. American Journal of Educational Science, 1(2), 24-27.

Vaismoradi, M., Jordan, S., & Kangasniemi, M. (2015). Patient participation in patient safety and nursing input – a systematic review. Journal of Clinical Nursing, 24(5/6), 627-639

DNP 815 10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

	10 Strategic Points	Comments/Feedback
Broad Topic Area	Benefits of transradial vs. femoral cardiac catheterization patient downtime.
Literature Review	Background of the study and literature review: Femoral approach is classical approach used to diagnose heart diseases. Transradial approach came up as solution to femoral procedures (Stefanescu Schmidt et al., 2017). The femoral approach can be performed to the same patient, especially those with pulses difficult to pulpate. The minor complications that may occur during transfemoral access include hematomas, fistulae and signs of pseudoaneurysm (Garbade et al., 2016). Major complications associated with femoral catheterization technique include death by major vascular bleeding. Transradial approach has recently gained popularity in Asia and Europe due to its decreased impacts on bleeding complications. It takes 10 to 15 minutes longer than the transfemoral approach (Squire et al., 2014). Bleeding at the radial artery can be controlled easily through compression, this may be difficult in the transfemoral approach Stefanescu Schmidt et al., 2017). The transradial approach offers easy access, fewer complications, timely ambulation, and less total costs of hospitalization when compared to the classical transfemoral access (Garbade et al., 2016). Summary: Femoral artery has a wider lumen than radial artery making it more accessible by practitioners. As such, femoral approach is common than transradial approach. The dangers of the femoral approach outweigh the benefits of transradial approach. Transradial procedure minimizes vascular and nerve injuries as well as patient morbidity which have dangerous consequences.
Problem Statement	Heart conditions have been known to increase with age, and in some cases, they lead to the death of the individuals who have not taken a keen interest in checking their vulnerability. Interventions to the heart conditions early enough, therefore, can save the lives of the potentially vulnerable people. The purpose of cardiac catheterization, therefore, is to detect early heart conditions after which the right intervention methods can be applied for timely treatment. The approaches used to diagnose possible heart conditions have nonetheless been marred with many risks which have often outweighed the approach’s many benefits. Even though, the transfemoral interventions that have often been used have been associated with more health problems which raise interest in how the transradial approach may be relied on as a better approach.
Clinical/PICO Questions	P – Adult patients aged 45 and above with heart diseases I – Cardiac catheterization in both groups of patients. C – Transradial Vs. Femoral approaches. O – Reduced complications and problems during cardiac catheterization. T – The study was set to take place for three months during which the patients that have undergone the procedures would offer information regarding the procedure undertaken.
Sample	Adults 45 years and above. Sample size = 50 Adults
Define Variables	Independent variable: Femoral and Transradial catherization procesdures. Dependent variable: The follow up checks carried out by practitioners.
Methodology and Design	The project will use qualitative methodology and quasi-experimental design.
Purpose Statement	The purpose of this quantitative project is to determine the benefits and negative impacts of diagnosing heart conditions using the transradial and transfemoral cardiac catheterization in adults’ population with suspected heart conditions and how the transradial approach is preferable to the patient when compared to the transfemoral approach through conducting a research among 50 adults aged 45-years from the local community. The benefits and the negative impact of the approach outcomes will be measured through the nominal scale.
Data Collection Approach	There would be the use of interviews to find out basic information regarding the the femoral and transradial approaches from the sample population and the health care providers.
Data Analysis Approach	Here, the use of the independent T-tests to determine the best approach to treat the sample population is applicable.

References

Creswell, J. W. (2003). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: Sage Publications.DNP 820 Discussions and Ten Strategic Points

Garbade, J., Fischer, J., Meyer, A., Lehmann, S., Arya, A., Hindricks, G., & Mohr, F. W. (2016). Catheter ablation for recurrent ventricular tachycardia after implantation of a left ventricular assist device: A interdisciplinary approach. Journal of Cardiac Failure, 22(8), S114.DNP 820 Discussions and Ten Strategic Points

Squire, B. T., Tamayo-Sarver, J. H., Rashi, P., Koenig, W., & Niemann, J. T. (2014). Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation. Prehospital Emergency Care, 18(1), 1-8.DNP 820 Discussions and Ten Strategic Points

Stefanescu Schmidt, A. C., Armstrong, A., Kennedy, K. F., Nykanen, D., Aboulhosn, J., & Bhatt, A. B. (2017). Prediction of adverse events after catheter-based procedures in adolescents and adults with congenital heart disease in the IMPACT registry. European Heart Journal, ehx200.DNP 820 Discussions and Ten Strategic Points

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DNP 820 Discussions and Ten Strategic Points