Determine the effectiveness of the use of antineuropathics such as pregabaline and gabapentin a first line treatment for lumbar radicul
Follow guidelines, read the material uploaded and use it as a guide consider that my DNP project will be: Determine the effectiveness of the use of antineuropathics such as pregabaline and gabapentin a first line treatment for lumbar radiculopathy instead opioids.
1. Following the PICOT format, please write a possible practice problem for your DNP practicum project.
2. Which nursing theory do you feel could support your practice problem change project?
3. How can this theory apply to your topic?
4. Describe your practice problem within the context of nursing’s meta-paradigm and the theoretical insights
Participation Requirements
The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Wednesday, 11:59 p.m. Eastern Time. Two scholarly sources references NO OLDER ThAN 5 years OLD are required unless stated otherwise by your professor. REMEMBER TO ADD DNP ESSENTIAL
Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points.
Here are the categories of the new discussion rubric:
Initial Post relevance to the topic of discussion, applicability, and insight. (20%)
Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)
Inclusion of DNP essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)
Rigor, currency, and relevance of the scholarly references. (Use articles that are below 5 years). (20%)
Peer & Professor Responses. The number of responses, quality of response posts. (20%)
Timeliness of the initial post and the answers to the peers. (10%)
PICOT
PICOT is a mnemonic used to describe the four elements of a good clinical question. It stands for:
P–Patient/Problem I–Intervention C–Comparison O—Outcome
T—Timeframe (for this program the time frame will be 8-weeks)
In _________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?
Many people find that it helps them clarify their question, which in turn makes it easier to find an answer.
Use PICOT to generate terms – these you'll use in your literature search for the current best evidence. Once you have your PICOT terms, you can then use them to re-write your question.
Question Templates for Asking PICOT Questions:
P: Population/disease (e.g., age, gender, ethnicity, with a certain disorder)
I: Intervention or variable of interest (exposure to a disease, risk behavior, prognostic factor)
C: Comparison (compared to current process if there is a process in place, or compared to not having a specific tool, for example educating diabetes patient with xyz tool compared to educating patient without any tool)
O: Outcome: (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)
T: Time: The time it takes to demonstrate an outcome (i.e., the time it takes for the intervention to achieve an outcome or how long participants are observed) (For our program, the timeframe will be 8-weeks).
Example of PICOT format question:
Example:
Population: Healthcare workers in surgical unit
Intervention: education on proper handwashing
Comparison: no handwashing
Outcomes: reduce infection
Timeframe: over a 8-weeks period.
*** Please note that this week’s discussion will be helping you with next week’s assignment***
,
Using the PICO Framework
PICO Framework
· Patient Problem, (or Population)
· Intervention,
· Comparison or Control, and
· Outcome
· Time
|
Framework item: |
Think about: |
Example: |
|
Patient Problem (or Population) |
What are the patient's demographics such as age, gender and ethnicity? Or what is the or problem type? |
Work-related neck muscle pain |
|
Intervention |
What type of intervention is being considered? For example is this a medication of some type, or exercise, or rest? |
Strength training of the painful muscle |
|
Comparison or Control |
Is there a camparison treatment to be considered? The comparison may be with another medication, another form of treatment such as exercise, or no treatment at all. |
Rest |
|
Outcome |
What would be the desired effect you would like to see? What effects are not wanted? Are there any side effects involved with this form of testing or treatment? |
Pain relief |
|
Time |
In the DNP the time frame is eight-weeks |
Eight-Weeks |
When forming your question using PICOT, keep the following points in mind:
· Your Patient is a member of a population as well as a person with (or at risk of) a health problem. So, in addition to age and gender, you may also need to consider ethnicity, socioeconomic status or other demographic variables.
· A Comparison is not always present in a PICO analysis.
· Outcomes should be measurable as the best evidence comes from rigorous studies with statistically significant findings.
· An Outcome ideally measures clinical wellbeing or quality of life, and not alternates such as laboratory test results.
· A Time ideal for DNP practicum is an eight-week period.
·
PICO Elements Change According to Question Type (Domain)
When forming your question using the PICOT framework it is useful to think about what type of question it is you are asking, (therapy, prevention, diagnosis, prognosis, etiology). The table below illustrates ways in which Problems, Interventions, Comparisons and Outcomes vary according to the type (domain) of your question. Time of eight-week period.
|
Question Type |
Patient Problem or Population |
Intervention or Exposure |
Comparison or Control |
Example Outcome Measures |
|
Therapy (Treatment) |
Patient's disease or condition. |
A therapeutic measure, eg., medication, surgical intervention, or life style change. |
Standard care, another intervention, or a placebo. |
Mortality rate, number of days off work, pain, disability. |
|
Prevention |
Patient's risk factors and general health condition. |
A preventive measure, e.g., A lifestyle change or medication. |
Another preventative measure OR maybe not applicable. |
Mortality rate, number of days off work, disease incidence. |
|
Diagnosis |
Specific disease or condition. |
A diagnostic test or procedure. |
Current "reference standard" or "gold standard" test for that disease or condition. |
Measures of the test utility, i.e. sensitivity, specificity, odds ratio. |
|
Prognosis (Forecast) |
Duration and severity of main prognostic factor or clinical problem. |
Usually time or "watchful waiting". |
Usually not applicable. |
Survival rates, mortality rates, rates of disease progression. |
|
Etiology (Causation) |
Patient's risk factors, current health disorders, or general health condition. |
The intervention or exposure of interest. Includes an indication of the strength/dose of the risk factor and the duration of the exposure. |
Usually not applicable. |
Survival rates, mortality rates, rates of disease progression. |
*****Please include time period of eight-weeks.
Writing Your Question Statement
Once you have clearly identified the main elements of your question using the PICO framework, it is easy to write your question statement. The following table provides some examples.
|
Question Type |
Patient Problem or Population |
Intervention or Exposure |
Comparison or Control |
Outcome Measure |
|
Therapy |
In patients with osteoarthritis of the knee |
is hydrotherapy more effective than |
traditional physiotherapy |
in relieving pain? |
|
Prevention |
For obese children |
does the use of community recreation activities |
compared to educational programs on lifestyle changes |
reduce the risk of diabetes mellitus? |
|
Diagnosis |
For deep vein thrombosis |
is D-dimer testing or |
ultrasound |
more accurate for diagnosis? |
|
Prognosis |
In healthy older women that suffer hip fractures |
within the year after injury |
what is the relative risk of death? |
|
|
Etiology |
Do adults |
who binge drink |
compared to those who do not binge drink |
have higher mortality rates? |
,
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The Essentials of Doctoral Education for Advanced Nursing Practice
October 2006
TABLE OF CONTENTS
Page Introduction
Background 3 Comparison Between Research-Focused and Practice-Focused
Doctoral Education 3 AACN Task Force on the Practice Doctorate in Nursing 4 Context of Graduate Education in Nursing 5 Relationships of Master’s, Practice Doctorate, and Research Doctorate Programs 6
DNP Graduates and Academic Roles 7 The Essentials of Doctoral Education for Advanced Nursing Practice 8 I. Scientific Underpinnings for Practice 8 II. Organizational and Systems Leadership for Quality Improvement and Systems Thinking 9 III. Clinical Scholarship and Analytical Methods for Evidence-Based Practice 11 IV. Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care 12 V. Health Care Policy for Advocacy in Health Care 13 VI. Interprofessional Collaboration for Improving Patient and Population Health Outcomes 14 VII. Clinical Prevention and Population Health for Improving the Nation’s Health 15 VIII. Advanced Nursing Practice 16 Incorporation of Specialty-Focused Competencies into DNP Curricula 17 Advanced Practice Nursing Focus 17 Aggregate/Systems/Organizational Focus 18
ADVANCING HIGHER EDUCATION IN NURSING
One Dupont Circle NW, Suite 530 · Washington, DC 20036 · 202-463-6930 tel · 202-785-8320 fax · www.aacn.nche.edu
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Curricular Elements and Structure 18 Program Length 18 Practice Experiences in the Curriculum 19 Final DNP Project 19 DNP Programs in the Academic Environment: Indicators of Quality in Doctor of Nursing Practice Programs 20 Faculty Characteristics 20 The Faculty and Practice 20 Practice Resources and Clinical Environment Resources 21 Academic Infrastructure 21 Appendix A Advanced Health/Physical Assessment 23 Advanced Physiology and Pathophysiology 23 Advanced Pharmacology 24 Appendix B DNP Essentials Task Force 25 References 27
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Introduction
Background Doctoral programs in nursing fall into two principal types: research-focused and practice- focused. Most research-focused programs grant the Doctor of Philosophy degree (PhD), while a small percentage offers the Doctor of Nursing Science degree (DNS, DSN, or DNSc). Designed to prepare nurse scientists and scholars, these programs focus heavily on scientific content and research methodology; and all require an original research project and the completion and defense of a dissertation or linked research papers. Practice-focused doctoral programs are designed to prepare experts in specialized advanced nursing practice. They focus heavily on practice that is innovative and evidence-based, reflecting the application of credible research findings. The two types of doctoral programs differ in their goals and the competencies of their graduates. They represent complementary, alternative approaches to the highest level of educational preparation in nursing. The concept of a practice doctorate in nursing is not new. However, this course of study has evolved considerably over the 20 years since the first practice-focused nursing doctorate, the Doctor of Nursing (ND), was initiated as an entry-level degree. Because research- and practice-focused programs are distinctly different, the current position of the American Association of Colleges of Nursing (AACN, 2004) [detailed in the Position Statement on the Practice Doctorate in Nursing] is that: “The two types of doctorates, research-focused and practice-focused, may coexist within the same education unit” and that the practice-focused degree should be the Doctor of Nursing Practice (DNP). Recognizing the need for consistency in the degrees required for advanced nursing practice, all existing ND programs have transitioned to the DNP. Comparison Between Research-Focused and Practice-Focused Doctoral Education Research- and practice-focused doctoral programs in nursing share rigorous and demanding expectations: a scholarly approach to the discipline, and a commitment to the advancement of the profession. Both are terminal degrees in the discipline, one in practice and one in research. However, there are distinct differences between the two degree programs. For example, practice-focused programs understandably place greater emphasis on practice, and less emphasis on theory, meta-theory, research methodology, and statistics than is apparent in research-focused programs. Whereas all research- focused programs require an extensive research study that is reported in a dissertation or through the development of linked research papers, practice-focused doctoral programs generally include integrative practice experiences and an intense practice immersion experience. Rather than a knowledge-generating research effort, the student in a practice- focused program generally carries out a practice application-oriented “final DNP project,” which is an integral part of the integrative practice experience.
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AACN Task Force on the Practice Doctorate in Nursing The AACN Task Force to Revise Quality Indicators for Doctoral Education found that the Indicators of Quality in Research-Focused Doctoral Programs in Nursing are applicable to doctoral programs leading to a PhD or a DNS degree (AACN, 2001b, p. 1). Therefore, practice-focused doctoral programs will need to be examined separately from research-focused programs. This finding coupled with the growing interest in practice doctorates prompted the establishment of the AACN Task Force on the Practice Doctorate in Nursing in 2002. This task force was convened to examine trends in practice-focused doctoral education and make recommendations about the need for and nature of such programs in nursing. Task force members included representatives from universities that already offered or were planning to offer the practice doctorate, from universities that offered only the research doctorate in nursing, from a specialty professional organization, and from nursing service administration. The task force was charged to describe patterns in existing practice-focused doctoral programs; clarify the purpose of the practice doctorate, particularly as differentiated from the research doctorate; identify preferred goals, titles, and tracks; and identify and make recommendations about key issues. Over a two-year period, this task force adopted an inclusive approach that included: 1) securing information from multiple sources about existing programs, trends and potential benefits of a practice doctorate; 2) providing multiple opportunities for open discussion of related issues at AACN and other professional meetings; and 3) subjecting draft recommendations to discussion and input from multiple stakeholder groups. The final position statement was approved by the AACN Board of Directors in March 2004 and subsequently adopted by the membership. The 2004 DNP position statement calls for a transformational change in the education required for professional nurses who will practice at the most advanced level of nursing. The recommendation that nurses practicing at the highest level should receive doctoral level preparation emerged from multiple factors including the expansion of scientific knowledge required for safe nursing practice and growing concerns regarding the quality of patient care delivery and outcomes. Practice demands associated with an increasingly complex health care system created a mandate for reassessing the education for clinical practice for all health professionals, including nurses. A significant component of the work by the task force that developed the 2004 position statement was the development of a definition that described the scope of advanced nursing practice. Advanced nursing practice is broadly defined by AACN (2004) as:
any form of nursing intervention that influences health care outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy. (p. 2)
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Furthermore, the DNP position statement (AACN, 2004, p. 4) identifies the benefits of practice focused doctoral programs as:
• development of needed advanced competencies for increasingly complex practice, faculty, and leadership roles;
• enhanced knowledge to improve nursing practice and patient outcomes; • enhanced leadership skills to strengthen practice and health care delivery; • better match of program requirements and credits and time with the credential
earned; • provision of an advanced educational credential for those who require advanced
practice knowledge but do not need or want a strong research focus (e.g., practice faculty);
• enhanced ability to attract individuals to nursing from non-nursing backgrounds; and
• increased supply of faculty for practice instruction.
As a result of the membership vote to adopt the recommendation that the nursing profession establish the DNP as its highest practice degree, the AACN Board of Directors, in January 2005, created the Task Force on the Essentials of Nursing Education for the Doctorate of Nursing Practice and charged this task force with development of the curricular expectations that will guide and shape DNP education. The DNP Essentials Task Force is comprised of individuals representing multiple constituencies in advanced nursing practice (see Appendix B). The task force conducted regional hearings from September 2005 to January 2006 to provide opportunities for feedback from a diverse group of stakeholders. These hearings were designed using an iterative process to develop this document. In total, 620 participants representing 231 educational institutions and a wide variety of professional organizations participated in the regional meetings. Additionally, a national stakeholders’ conference was held in October 2005 in which 65 leaders from 45 professional organizations participated. Context of Graduate Education in Nursing Graduate education in nursing occurs within the context of societal demands and needs as well as the interprofessional work environment. The Institute of Medicine (IOM, 2003) and the National Research Council of the National Academies (2005, p. 74) have called for nursing education that prepares individuals for practice with interdisciplinary, information systems, quality improvement, and patient safety expertise. In hallmark reports, the IOM (1999, 2001, 2003) has focused attention on the state of health care delivery, patient safety issues, health professions education, and leadership for nursing practice. These reports highlight the human errors and financial burden caused by fragmentation and system failures in health care. In addition, the IOM calls for dramatic restructuring of all health professionals’ education. Among the recommendations resulting from these reports are that health care organizations and
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groups promote health care that is safe, effective, client-centered, timely, efficient, and equitable; that health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement, and informatics; and, that the best prepared senior level nurses should be in key leadership positions and participating in executive decisions. Since AACN published The Essentials of Master’s Education for Advanced Practice Nursing in 1996 and the first set of indicators for quality doctoral nursing education in 1986, several trends in health professional education and health care delivery have emerged. Over the past two decades, graduate programs in nursing have expanded from 220 institutions offering 39 doctoral programs and 180 master’s programs in 1986 to 518 institutions offering 101 doctoral programs and 417 master’s programs in 2006. Increasing numbers of these programs offer preparation for certification in advanced practice specialty roles such as nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists. Specialization is also a trend in other health professional education. During this same time period, the explosion in information, technology, and new scientific evidence to guide practice has extended the length of educational programs in nursing and the other health professions. In response to these trends, several other health professions such as pharmacy, physical therapy, occupational therapy, and audiology have moved to the professional or practice doctorate for entry into these respective professions. Further, support for doctoral education for nursing practice was found in a review of current master’s level nursing programs (AACN, 2004, p. 4). This review indicated that many programs already have expanded significantly in response to the above concerns, creating curricula that exceed the usual credit load and duration for a typical master’s degree. The expansion of credit requirements in these programs beyond the norm for a master’s degree raises additional concerns that professional nurse graduates are not receiving the appropriate degree for a very complex and demanding academic experience. Many of these progr
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