DNP-DPI Project- Quality Improvement

Template Explanation on the Direct Practice Improvement (DPI) Project

Proposal and the DPI Final Manuscript Template (all-in-one)

This template is used for both the DPI Project Proposal as well as the Final Manuscript.

You are required to refer to yourself as the Primary Investigator throughout the proposal and final manuscript. It is preferred that you write your manuscript in the third person, but when necessary, you must refer to yourself as the Primary Investigator.

In your proposal, you will write in the future tense (present tense, i.e., the purpose of this quantitative quasi-experimental project is to…). In contrast, in the final manuscript , you will write in the past tense (the purpose of this quantitative quasi-experimental project was to… as now you have implemented your project)

In DNP 955, you will be writing chapters 1-3 which also includes your 10-Strategic Points as an appendix. The learner is required to submit to AQR-1 by the due date week 8 (or you will not pass the course) with your manuscript in the present (future tense). In addition, in DNP 955, the appendices are as follows:

· Appendix A is your 10 Strategic Points – REQUIRED

· Appendix B is your instrument/tools -REQUIRED (if your project includes the use of an instrument/Tool)

· Appendix C is your permission to use your instrument/tools -REQUIRED (if your project includes the use of an instrument)

· Appendix D is a detailed process you as the learner will use to prepare staff/health care providers to implement the practice improvement intervention. This should include specific information obtained from the literature and from developers of the evidence-based practice guideline, protocol, toolkit, or screening tool, etc. An agenda may be included as well as an outline of materials to be used, delivery method, handouts, ppts., when, & where. Remember when you submit to AQR-1, you will include your completed cover page, abstract, TOC, chapters 1-3, and your appendices in the current APA edition.

DO NOT DELETE CHAPTERS 4 AND 5 FROM THE PAPER OR YOU WILL LOSE THE FORMATTING. THE REVIEWERS ARE AWARE THEY WILL BE INCLUDED BUT ARE NOT GOING TO BE REVIEWED DURING AQR-1.

In DNP 960, you are required to make all recommended changes listed within your AQR-1 review for chapters 1-3. This is not optional; failure to do so may result in a failing grade for DNP-960. Address all comments in the 10-Strategic Points. All edits from your AQR-1 revisions are to remain in the present (future tense) until you have received the written GCU DNP IRB Outcome Letter (typically between weeks 3-7). After you have begun implementation, you may start to write in the past tense for all 5 chapters. While waiting for the outcome letter, it is expected that all learners will write chapters 4 (including tables and figures) and 5 as a draft in preparation for the data they will be collecting in implementation. DNP-DPI Project- Quality Improvement

In DNP 965, all writing in the manuscript is written in the past tense (as long as you have received the GCU DNP IRB Outcome Letter. Submission to AQR-2 occurs at the end of week 5 in DNP 965 (required to progress to final manuscript review, no AQR- 2= continuation course).

In this AQR-2 submission, you will submit all five chapters with the actual data (not the made update from DNP-960) along with your cover page, copywrite page, title page, abstract (paragraph form), TOC (updateable), the body of the manuscript, and all applicable appendices:

· Appendix A GCU IRB Outcome Letter

· Appendix B is your instrument/tools -REQUIRED (if your project includes the use of an instrument/Tool)

· Appendix C is your permission to use your instrument/tools -REQUIRED (if your project includes the use of an instrument)

· Appendix D is a detailed process you as the learner will use to prepare staff/health care providers to implement the practice improvement intervention. This should include specific information obtained from the literature and from developers of the evidence-based practice guideline, protocol, toolkit, or screening tool, etc. An agenda may be included as well as an outline of materials to be used, delivery method, handouts, ppts., when, & where.

· No other appendices are needed unless you have multiple tools (which is not recommended).

*Please make certain that you have used programs such as Grammarly (check into investing in Grammarly Premium), ThinkingStorm (GCU), an editor, a formatter, statistician, and any additional resources you feel like you need to be successful before you submit to AQR-2 and most importantly, before final manuscript review.

Feel free to contact the AQR Manager for any questions or concerns related specifically to AQR-1 or AQR-2. Meet regularly with your Chair, mentor, and/or content expert to ensure that your manuscript meets all requirements, deadlines, and revisions. Your DNP faculty, Chairs, and Program Lead want you to be successful and are here to support you each step of the way! Please use your University Policy Handbook on your chain of command and any appeal you feel you might need.

Blessed are those who have learned to acclaim you, who walk in the light of your presence, O Lord. – Psalm 89:15

Submitted by

Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Comment by Author: For example: Jane Elizabeth Smith

Equal Spacing Comment by Author: Delete yellow highlighted “Helps” as project develops.

~2.0” –

(7 lines)

A Direct Practice Improvement Project Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Nursing Practice

Equal Spacing

~2.0” –

(7 lines)

Grand Canyon University

Phoenix, Arizona

[Insert Current Date]

© by Your Full Legal Name (No Titles, Degrees, or Academic Credentials), 2020 Comment by Author: NOTE: The copyright page is included in the final practice improvement project. Comment by Author: For example: © by Jane Elizabeth Smith, 2012 This page is centered. This page is counted, not numbered and should not appear in the Table of Contents.

All rights reserved.

GRAND CANYON UNIVERSITY

The Direct Practice Improvement Project Title Appears in Title Case and is Centered Comment by Author: If the title is longer than one line, double-space it. The title should be typed in upper and lowercase letters.

by

Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Comment by Author: For example: Jane Elizabeth Smith

has been approved

September 22, 2020 Comment by Author: Date of Dean’s signature. Until then, use the current date to fill this space. Upon final submission, this date should match the date on the title page.

APPROVED:

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Chairperson

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Mentor

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Content Expert

ACCEPTED AND SIGNED:

________________________________________

Lisa Smith, PhD, RN, CNE

Dean and Professor, College of Nursing and Health Care Professions

_________________________________________

Date

Abstract Comment by Author: On the first line of the page, center the word “Abstract” (boldface font, italics, underlining, or quotation marks). Beginning with the next line, write the abstract. Abstract text is one paragraph with no indentation and is double-spaced. This page is counted, not numbered, and does not appear in the Table of Contents. Abstracts do not include references or citations. The abstract should be one page Comment by Author: Comment by Author: You will notice a difference between the proposal template and final manuscript template. The final template allows the option to remove headers if you need more room.

The first sentence or two outlines the problem; why is this being addressed? Do not make statements that require a citation as there are no citations in an abstract! The second statement is the supporting what is happening at the site. The purpose of this quantitative quasi-experimental project was to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to current practice among ___________(population) in a ________ (setting i.e.: primary care clinic, ER, OR) in ________ (state) over four-weeks. State the nursing model/theory and other frameworks used in ONE SENTENCE! Data analysis and the sample size is next Now you want to state how the results were statistically and clinically significant. How did these results impact patient outcomes impact the practice at the site and recommendations for what should be done in the future based on the project findings Comment by Author: See the DC Network, Templated Abstract in writing resources Comment by Author: Whose intervenstion? Example: Sutter’s Oral Hygeine Tool or the Institute of Medicinxes XYZ tool.

Comment by Author: this is your measurable PATIENT outcome. Comment by Author: Make sure you take this statement and replace it throughout the manuscript to ensure it matches everywhere you discuss the purpose 🙂 From this statement you will need to make certain that the problem statement and clinical questions match (align) with this statement as well. Comment by Author: – DO NOT SAY p> 0.05 or p<0.05 Must say p= VALUE (EXAMPLE: Data on the motivation to quit was measured by TTM and nicotine dependence was measured by the Fagerstrom Test for Nicotine Dependence (FTND) questionnaire in diabetic adult smokers aged 18 years and older, (n=16) were compared at baseline, two weeks, and four weeks post-implementation of the Five A’s model.

A paired t-test showed that there was a statistically significant improvement in patient’s motivation to quit smoking (M=-2.86; SD=1.29; p=0.003), a substantial decrease in nicotine dependence (M= -1.86; SD=1.41; p=0.001), and 100% of the healthcare providers (n=6) were compliant in assessing tobacco use p=0.000). Comment by Author: (Based on the results, the Five A’s model may result in increased patient motivation to quit smoking as well as a decrease in nicotine dependence. Recommendations include the continuation of the program and possible repetition of the project at another clinical site over an extended monitoring period as well as with larger sample sizes.) or maybe if there was no significance (Even though statistical significance was not found STATS, the INTERVENTION provided needed areas for reinforcement measurement and enhanced nursing staff awareness. Therefore, the findings suggest that continuous utilization of INTERVENTION may DO WHAT to IMPROVE WHAT. Replication of the project is needed in larger settings and over a longer period of time.)

Keywords: Abstract, theory, theorists, tools, instruments, assist future investigators, vital information Comment by Author: Make sure to add the keywords at the bottom of the abstract to assist future investigators.

Comment by Author: Make sure to add the keywords at the bottom of the abstract to assist future investigators. Librarians and investigators use the keywords to catalogue and locate vital research material.

Dedication Comment by Author: Title in bold font

An optional dedication may be included here. While a practice improvement project is an objective, scientific document, this is the place to use the first person and to be subjective. The dedication page is numbered with a Roman numeral, but the page number does not appear in the Table of Contents. It is only included in the final practice improvement project and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below. If you cannot see the page break, click on the ¶Show/Hide button (go to the Home tab and then to the Paragraph toolbar). DNP-DPI Project- Quality Improvement

26

Improving Medication Adherence in Diabetic Patients in Home Health Care Settings Comment by Author: Bola, please use the updated DPI template that I shared with you previously. There are specific things within the template that are required. Your cover pages for example needs to follow the template.

Submitted by

Bola Odusola-Stephen

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

January 30, 2021

GRAND CANYON UNIVERSITY

Improving Medication Adherence in Diabetic Patients in Home Health Care Settings

by

Bola Odusola-Stephen

Proposed

January 30, 2021

DPI PROJECT COMMITTEE:

Mary Guhwe, DNP, Manuscript Chair

Bamidele Jokodola, DNP, Committee Member

Abstract

Home healthcare programs have been effective in the current environment as they provide a technique for improving health outcomes for diabetes patients. At the project site, although staff consistently assesses for patient medication adherence, there is no standardized process for addressing medication adherence when it is identified. Medication adherence project (MAP) resources have been utilized to improve medication adherence in chronic disease management. The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of Medication Adherence Project resources that include the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Padimpact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, at a home healthcare organization located in urban Texas. The theoretical frameworks guiding the project include ………….This paper shall assess the program in line with various articles that promote adoption of the technique. The peer reviewed journal articles would ensure the paper has factual information that ensure implementation of the home healthcare program would occur seamlessly. The inclusion of home healthcare providers promotes the validity of the program. Medication adherence rates will be abstracted from the EHR based on documentation from home health personnel and compared with baseline medication adherence rates.The project would use the proposed initiatives to enhance home healthcare provision based on the need to improve health departments. The project shall assess the validity of the proposed home healthcare initiative based on the availability of trained personnel to monitor patient outcomes. The methodology that shall get applied is using quantitate approach by studying various research articles about diabetes and home-based care. The quantitative approach shall get applied to determine how the proposed MAP resources would promote patient outcomes. The population size for the project shall be persons living with Diabetes in Texas. It shall be possible to enhance the project’s outcome based on the metrics mentioned. DNP-DPI Project- Quality Improvement

Keywords: home-based care, MAP resources, quantitative approach, medication adherence, diabetes mellitus type II.

Chapter 1: Introduction to the Project

According to the CDC (2020) diabetes impacts one in 10 Americans. Furthermore, the prevalence of diabetes continues to rise and is projected to increase by 0.3 % per year until 2030 (Lin et al., 2018). There are two types of diabetes that plague a large proportion of Americans. Type I diabetes is dependent on insulin whereby the pancreas produces little amounts of insulin (Bellou, 2018). Type II diabetes is impairment related to the body’s ability to regulated glucose (Bellou, 2018). There are ways to curtail the onset of Type II diabetes; however, once individuals are diagnosed with diabetes, there is no cure (Kvarnström, 2017). DNP-DPI Project- Quality Improvement

Among individuals with Type II diabetes, proper and effective medication adherence is critical (Kvarnström, 2017). According to the World Health Organization (2003), “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvements in specific medication treatment.” Furthermore, Kvarnström (2017) stated that more than half of the population does not adhere to the prescribed medication regiment, thereby resulting in various health-related challenges. Health-related challenges associated with poor medication adherence include limited knowledge of patients, lack of proper technique of providing dosage, lac of patient self-management, and lifestyle constraints (Kvarnström, 2017). For individuals with Type II diabetes, lacking medication adherence can mean the difference between life and death (Rathish, 2019). DNP-DPI Project- Quality Improvement

Various researchers have denoted the critical role that home healthcare providers play in promoting enhanced medication adherence (Bussell et al., 2017). Furthermore, the World Health Organization (WHO), as cited by Brown and Bussell (2011), explained that there are five factors that impact medication adherence, which include: (1) patient-related factors, (2) socioeconomic factors, (3) therapy-related factors, (4) condition-related factors, and (5) the health system/health care team-related factors. For the purpose of this project, the project investigator (PI) will explore focus on the role that health care team members play in addressing patient related factors that affect medication adherence enhancing medication adherence among home health care diabetic patients.

Background of the Project

Home-based healthcare has existed since 1909 (Choi et al., 2019). Since its inception, home-based healthcare has been perceived as a more costly method of patient care as compared to expenses associated with hospitalization (Singletary, 2019). In the early 20th century, home-based healthcare was mainly practiced due to financial disparities, specifically since many individuals were unable to afford hospitalized care. Furthermore, home-based healthcare was also practiced due to medical inaccessibility, which often existed in African-American communities to due to limited access to resources (Choi et al., 2019).

Present day, home-based healthcare is often selected due to an individual’s personal preferences. There are some situations in which individuals prefer the comforts of their own home as compared to that of a hospital or group home. As older generations continue to age, they often prefer to remain in their home for as long as possible. Given the needs of older generations and the impact of advances in healthcare and technology, home-based healthcare has grown exponentially (Wong et al., 2020). While home-based healthcare is not appropriate for all patients, Szanton et al. (2016) noted that this care option is best when an individual’s condition can be managed without admission to a hospital. Patients who have diabetes and/or hypertension are often recipients of home-based healthcare (Wong et al., 2020). DNP-DPI Project- Quality Improvement

Home healthcare providers often visit patients three and engage in assessment of the patient’s blood pressure, cognitive functioning, and adherence to treatment proposals. During patient visits, home healthcare providers are responsible for biological assessment of patients (Wong et al., 2020). One of the paramount functions of home healthcare providers is to ensure that patients are adhering to their medication regiment (Wong et al., 2020). According to Wong et al. (2020), medication adherence is predicated on medication understanding and education, which should be conveyed by home healthcare providers (Wong et al., 2020).

Adhering to diabetes medication regiment requirements can be complex. In fact, in a study by Rauofi et al., (2018), researchers noted that 0.1 % of diabetic patients did not properly monitor their glucose levels nor did they adhere to medication requirements. Dr. Goldbach, who is the Chief Medical Officer for Health Dialogue, stated, “Especially for people with chronic illness that are facing challenges like depression, or transportation, or complexity of medication regimens – that these interpersonal, trusted interactions with a nurse tend to be very effective” (Heath, 2019). Patients with diabetes often express difficulties in adhering to medication regimens, thereby reinforcing the critical role of receiving education from home healthcare providers (Wong et al., 2020).

In a study by Wong et al. (2020), home healthcare patients expressed that they did not have sufficient knowledge about the requirements associated with diabetes treatment. Often times, diabetic home healthcare patients fail to practice medication adherence, thereby resulting in health complications, which is due to unmanaged health conditions. DNP-DPI Project- Quality Improvement.

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score. DNP-DPI Project- Quality Improvement

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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