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10 Strategic Points for the Prospectus, Proposal, and Direct
Practice Improvement Project
Week Two Assignment Instructions DNP 820
Please read the instructions thoroughly
Tutor MUST have a good command of the English language
The Rubric must be followed, and all the requirements met
This is a thorough professor, and she has strict requirements
I have attached the PICOT and the first 10 points (DNP 815)
assignment. This is a continuation of that assignment. Please
read the attachments
The following needs to be addressed:
Please note the followings: The introduction and the literature
review are complete and thorough. The problem statement is
written clearly PICOT is clear and very good Sample:
· How will you determine the sample size?
· What are the inclusion/exclusion criteria of the subjects?
Methodology: Why is the selected methodology is appropriate?
Please justify!
· Data collection approach needs to be clear. How will you
collect your data? What is needed here is to describe the process
of collecting data form signing the informed consent until
completing the measuring.
· Data analysis-What test will you use to answer your research
question?
Clinical/PICOT Questions:
“In adult patients with CVC at a Clear Lake Regional Medical
Center, does interventional staff education about hub hygiene
provided to RN’s who access the CVC impact CLABSI rates
compared to standard care over a one-month period?”
P: Patients with Central Venous Catheters
I: Staff re-education related to Hygiene of the hub
C: Other hospitals
O: Reduce probability of CLABSIs
T: Two months
“In Patients > 65 years of age with central line catheters at a
Clear Lake Regional Medical Center, how does staff training of
key personnel and reinforcement of central line catheter hub
hygiene after its insertion, along with the apt cleansing of the
insertion site, before every approach compared with other area
hospitals, reduce the incidence of CLABSIs (Central Line
Associated Blood-stream Infections) over a one-month period?”
P: Patients > 65 years of age with a Central line
I: Staff training and reinforcement of Central Catheter, Hub
Hygiene
C: Other area hospitals
O: Reduce probability of CLABSIs
“In adult patients, with define CVC (CVC), does
interventional staff education about hub hygiene provided to
RN’s who access the CVC impact CLABSI rates compared to
pre and post-intervention assessments
1. I used central Missouri as an example, replace with a
description of your site.
2. While you might be interested in CLASBI rates as a primary
variable, there are other patient outcomes that would also be
important to consider
3. Ensure you can find validity and reliability measures on
CLASBI rates if you cannot, we need to determine another
question to help
4. How are your two comparison groups different, as they are
currently stated the groups seem very much the same, could you
state, standard care instead of pre and post intervention
assessments?
5. One month is the longest time you can use for a prospective
project
Please note the following regarding the instructors grading
IMPORTANT INFORMATION ABOUT MY GRADING STYLE
As you prepare for written papers and manuscripts I’d like to
give you some details about my grading style. I provide
significant feedback on your papers, this is because I believe
you should be working towards improving your writing so that
at the end of this program you are able to successfully write
your DPI project. In order to write well, you need feedback and
you need to review that feedback and make progress on the next
written work. To that end I always grade accordingly. This
means that if I provide feedback one an item (for example APA
format of your reference page) I expect that this will be
improved on the next written submission. Otherwise I will
deduct additional points. In addition, some other criteria to get
down pat now. References should always
1. Be current, no older than 5 years that means 5 years from
your proposed graduation date (2014-2019). Otherwise you will
have to redo everything in DNP 955.
2. Be primary sources. You can no longer cite Young declared
literary war in 1956 (as cited by Brown 2006). You must cite
Young 1956. That means go find that paper and read it and
make sure that you agree with what Brown said. What if you
don’t agree due to some very valid points? Then the literary war
is not what occurred, but instead you have concerns regarding
point ____, ____, and ____.
3. You may no longer cite textbooks, they are 1) secondary
sources and 2) not current enough, and please use peer reviewed
manuscripts.
One more item that is not a reference. You may not use direct
quotes any longer. There is no need. This may be difficult at
first, but you are moving towards a different type of writing.
This is manuscript writing (scientific writing). Scientific
writing is terse, clear, and concise. No frilly words. In order to
avoid the use of direct quotes you will synthesize the literature.
There is a great resource for synthesizing the literature under
Resources – Add-ons. These are also some other great writing
resources there.
Details:
In the prospectus, proposal, and scholarly project there are 10
strategic points that need to be clear, simple, correct, and
aligned to ensure the research is doable, valuable, and credible.
The 10 strategic points emerge from researching literature on a
topic that is based on or aligned with the learner's personal
passion, future career purpose, and degree area. These 10 points
provide a guiding vision for DPI Project. In this assignment,
you will continue the work begun in DNP-815, working on your
draft of a document addressing the 10 key strategic points that
define your intended research focus and approach.
General Requirements:
Use the following information to ensure successful completion
of the assignment:
· Locate the "The 10 Strategic Points for the Prospectus,
Proposal, and Direct Practice Improvement Project” that you
completed in DNP-815.
· Doctoral learners are required to use APA style for their
writing assignments. The APA Style Guide is located in the
Student Success Center. An abstract is not required.
· This assignment uses a rubric. Please Review the rubric prior
to the beginning to become familiar with the expectations for
successful completion.
· You are required to submit this assignment to Turnitin. Please
refer to the directions in the Student Success Center.
Directions:
Use the "The 10 Strategic Points for the Prospectus, Proposal,
and Direct Practice Improvement Project" resource to draft
statements for each of the 10 points for your intended research
study.
You worked on this last in DNP 815. Pick up from where you
left off (if you transferred in and did not complete this, you will
have to begin fresh). Please include a copy of your last
instructor feedback when you submit this assignment. You can
either copy and paste the instructor feedback into your current
paper (as an appendix and clearly marked); or upload two
separate papers. I expect significant improvement from your last
submission.
Please review the 10 Strategic Points document for additional
instructions and an example. Add references to this document, I
suggest 5-10 at this point. You need to realize that your
literature review chapter will need at least 50+ articles by the
time you get to DNP 955, so work on expanding your literature
search each week, to include more and more to this paper as you
move through each course. If you cannot locate 50+ articles you
can ask your faculty for assistance or chose a different topic.
For the methodology and design sections. Methodology should
cover the broad methods you plan to use (qualitative,
quantitative, or mixed methods). The design portion will then
go into more detail and discuss the design (i.e. correlational,
cross-sectional, pre/posttest, etc.). Describe each and explain
why your chosen methodology and design are appropriate to
your topic and project questions. You may NOT use qualitative,
GCU leadership does not support a qualitative methodology.
Intervention. You must have an intervention that you
implement. Since you cannot evaluate a project that has already
been implemented, please write up a description of your
intervention and what your role will be in implementing this
intervention. This is not a section listed on your 10 Strategic
Points document as of yet, so add it after the methodology and
design sections. Describe step by step what the intervention
consists of, how it is evidence based, how you will implement,
and your role in implementation.
Data collection should go step by step (extremely over-detailed)
on how you will collect the data. Tell me about all instruments,
surveys, and/or questions you will ask of participants. One
MUST be a valid and reliable tool.
Data Analysis. Tell me the specific statistics you will use. Start
with descriptive statistics, which ones will you use, why (cite
current primary sources). Then tell me how you will compare
your data (which statistic), what your p value will be before you
start your data collection.
Apply Rubrics
DPI Project Milestone: 10 Strategic Points for the Prospectus,
Proposal, and Direct Practice Improvement Project
1
Unsatisfactory
0.00%
2
Does Not Meet Expectations
74.00%
3
Approaching Meeting Expectations
87.00%
4
Meets Expectations
100.00%
100.0 %Content
10.0 %Topic: Provides a broad project topic area/title.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
15.0 %Literature Review: Lists primary points for four sections
in the Literature Review: (a) Background of the problem/gap
and the need for the project based on citations from the
literature; (b) Theoretical foundations (models and theories to
be foundation for study); (c) Review of literature topics with
key concept (??) for each one; (d) Summary.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Problem Statement: Describes the problem to address
through the project based on defined gaps or needs from the
literature.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Sample and Location: Identifies sample, needed sample
size, and location.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Clinical/PICOT Questions: Provides clinical/PICOT
questions to all of the collected data needed to address the
problem statement.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
5.0 %Variables
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Methodology and Design: Describes the selected
methodology and specific research design to address problem
statement and clinical/PICOT questions.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Purpose Statement: Provides one sentence statement of
purpose including the problem statement, methodology, design,
population sample, and location.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Data Collection: Describes primary instruments and
sources of data to answer research questions. Reliability and
Validity of the instruments are addressed.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
10.0 %Data Analysis: Describes the specific data analysis
approaches to be used to address clinical/PICOT questions. The
statistical test(s) that will be used must be identified and must
be appropriate for the level of data and the clinical/PICOT
question.
Item is not present.
Not all components are present. Large gaps are present in the
components that leave the reader with significant questions.
Component is present and adequate. Small gaps are present that
leave the reader with questions.
Component is addressed clearly and comprehensively. No gaps
are present that leave the reader with questions.
The 10 Strategic Points for the Prospectus, Proposal, and Direct
Practice Improvement Project
Introduction
In the Prospectus, Proposal, and Direct Practice Improvement
Project there are 10 key or strategic points that need to be clear,
simple, correct, and aligned to ensure the project is doable,
valuable, and credible. These points, which provide a guide or
vision for the project, are present in almost any research. They
are defined within "The 10 Strategic Points for the Prospectus,
Proposal, and Direct Practice Improvement Project" (10
Strategic Points) document.
The ten strategic points are developed in table format.
The 10 Strategic Points
The 10 strategic points emerge from researching literature on a
topic that is based on, or aligned with, the defined need in the
literature as well as the learner’s personal passion, future career
purpose, and degree area. The 10 Strategic Points document
includes the following 10 key or strategic points that define the
project focus and approach:
1. Topic (10%) – Provides a broad project topic area/title.
2. Literature Review (15%) - Lists primary points for four
sections in the Literature Review:
a. Background of the problem/gap and the need for the project
based on citations from the literature.
b. Theoretical foundations (models and theories to be
foundation for project).
c. Review of literature topics with key theme for each one.
d. Summary.
3. Problem Statement (10%) – Describes the problem to address
through the project based on defined needs or gaps in practice
from the literature.
4. Sample and Location (10%) – Identifies sample, needed
sample size, and location.
5. Clinical/PICOT Questions (10%) – Provides clinical/PICOT
questions to collect data to address the problem statement.
6. Variables (5%) – Identifies and describes independent and
dependent variables.
7. Methodology and Design(10%) - Describes the selected
methodology and specific project design to address problem
statement and clinical questions
8. Purpose Statement (10%) – Provides one sentence statement
of purpose including the problem statement, methodology,
design, population sample, and location.
9. Data Collection (10%) – Describes primary instruments to
answer clinical questions.
10. Data Analysis(10%) – Describes the specific data analysis
approaches to be used to address clinical/PICOT questions.
The Process for Defining the 10 Strategic Points
The order of the 10 strategic points listed above reflects the
order in which the learner completes the work product. The first
five strategic points focus primarily on defining the focus for
the project based on a clearly defined need or gap from the
literature as well as the learner’s passion, purpose, and
specialty area focus. First, learners identify a broad topic area
to investigate for their Direct Practice Improvement (DPI)
Project based on a clearly defined need or gap from the
literature or practice problem, and one in which they are
interested based on personal passion, future career purpose, and
degree being pursued. Second, learners complete a review of the
literature to define the need or gap to be addressed, the theories
and models that will provide a foundation for the project,
related topics that are needed to demonstrate the learner's
expertise in the field, and to define the key strategic points
behind the learner's proposed research. Third, the learners
develop a clear, simple, one-sentence problem statement that
defines the problem or gap that will be addressed by the DPI
project. Fourth, learners identify potential population samples
for which they would have access in order to collect the data for
the project, considering the fact the quantitative study sample
sizes need to be much larger than those for qualitative studies.
Fifth, learners develop the clinical/PICOT question(s) that will
define the data needed to address the problem statement.
Based on the first five strategic points above, learners next
define the key aspects of the project methodology through the
last five strategic points. The sixth point describes the
independent and dependent variables. Seventh, learners
determine if the project will be a qualitative, quantitative or
mixed methodology. Due to the nature of the DPI project
requirements, most projects will be utilizing a quantitative
method because learners are not creating new research in a
qualitative study. Qualitative projects often do not facilitate the
intervention needed to demonstrate direct practice improvement.
Please note that if you choose a qualitative project, you are still
responsible for ensuring practice improvement is demonstrated
through your work. Additionally, learners must be able to
perform both qualitative and quantitative data analysis. A
qualitative project with numbers or descriptive statistics does
not mean it is mixed method study. Qualitative data can be
displayed using tables, charts, graphs and descriptive statistics.
Following are samples for a quantitative project and a
qualitative project. A mixed method project, which includes
quantitative and qualitative methods, takes much more time and
many more resources to complete and is not recommended
unless learners have a significant amount of extra time and
resources to complete it.
For the eighth strategic point, learners develop a purpose
statement by integrating the problem statement, methodology,
design, sample, and location. Ninth, learners identify the data
they will need to collect to address the clinical questions or
hypotheses and how they will collect the data (e.g., interviews,
focus groups, observations, tested and validated instruments or
surveys, databases, public media, etc.). Tenth and last, learners
identify the appropriate data analysis, based on their project
design, which will be used to answer the clinical questions and
address the problem statement.
Criteria for Evaluating the 10 Strategic Points: Clear, Simple,
Correct, and Aligned
When developing a project, it is important to define the 10
strategic points so they are simple, clear, and correct in order to
ensure that anyone who reviews them will easily understand
them. It is important to alignall of the 10 strategic points to
ensure it will be possible to conduct and complete the project.
The problem statement must come out of the literature or
practice problem. The clinical questions must collect the data
needed to answer the problem statement. The methodology and
design must be appropriate for the problem statement and
PICOT questions. The data collection and data analysis must
provide the information to answer the PICOT questions.
Developing the 10 Strategic Points document as a two- or three-
page document can help ensure clarity, simplicity, correctness,
and alignment of each of these 10 key or strategic points in the
prospectus, proposal, and Direct Practice Improvement Project.
Developing these 10 strategic points in this format also provides
an easy-to-use use template to ensure the 10 strategic points
will always be worded the same throughout the prospectus,
proposal, and Direct Practice Improvement Project.
Value of the 10 Strategic Points Document
The 10 Strategic Points document can be used for
communicating and aligning key stakeholders for the Direct
Practice Improvement Project. This document can be used to
obtain agreement between the learner and the chair regarding
the initial focus and approach for the project. The document can
be used to review the proposed project with the people or
organizations from whom learners need to gain permission to
conduct their research, a critical step required before learners
can develop their proposal. The document also proves useful for
communicating the Direct Practice Improvement Project focus
when attracting a Content Expert, as well as for reviewing the
proposal with the Direct Practice Improvement Project
committee and the AQR reviewers. Learners may choose to
consult methodologists, statisticians, and editors in the process
of developing the final manuscript.
Examples of the 10 Strategic Points Document
It is important that the 10 strategic points are clear, concise,
doable, and aligned throughout the prospectus, proposal, and
Direct Practice Improvement Project. Provided below is an
example of a completed 10 Strategic Points document for a
quantitative project. A blank 10 Strategic Points Table template
is provided following the example for learners to use when
developing their own 10 Strategic Point documents.
Example: 10 Strategic Points Document for a Quantitative
Project
The 10 Strategic Points
Comments or Feedback
Broad Topic Area
1. Broad Topic Area:
Hint: What would I title my project?
Literature Review
2. Literature Review:
List primary points for four sections in the Literature Review:
Background of the problem/gap; theoretical foundations (models
and theories to be foundation for study); review of literature
topics with key theme for each one; and summary.
a. Background of the Problem/Gap:
· Rural ambulatory clinics have had to reorganize their
management structures to enhance reimbursement.
· Access to appropriate health services for rural Americans
needs to be improved in areas where specialists are not
available (Schoenberg, 2012).
· Telehealth nursing services can be provided through rural
health clinics to support specialty clinics (Schoenberg, 2012).
· Approximately 200 telemedicine networks have been
established nationwide. (American Telemedicine Association,
2017)
b. Theoretical Foundations (models and theories to be
foundation for study):
· The Greenhalgh’s Dissemination of Innovations model
(Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005)
can be used to implement rural telehealth services for rural
Americans.
· The D&M Information System Success model (DeLone
&McLean, 2003) is a framework to conceptualize and
operationalize information system success.
· Path constitution theory combines two contrasting
perspectives on technology, path dependence, and path creation
(Singh, Mathiassen, & Mishra, 2015).
c. Review of Literature Topics With Key Organizing Concepts
or Topics for Each One
Rural Telehealth Services:
· Rural telehealth can improve care in burn patients
(McWilliams, Hendricks, Twigg, Wood, & Giles, 2016);
smoking cessation (Carlson, Lounsberry, Maciejewski, Wright,
Collacutt, & Taenzer, 2011), psychotherapy (Gonzales &
Brossart, 2015); cancer education (Doorenbos et al., 2011);
diabetes (Holloway, Coon, Kersten, & Clemins, 2011).
Population Specific Telehealth Services:
· Community based telehealth: Home-based telehealth can
enhance older adults’ access to care and facilitate patient-
provider collaboration which may in turn improve patient self-
management (Hsieh, Tsai, Chic, & Lin, 2015).
· Chronically ill: Disease management needs of chronically ill
patients include prescription refills, medication and symptom
management, lab results, and patient education (Vinson,
McCallum, Thornlow, & Champagne, 2011).
· Rural Native American telehealth: Telehealth can improve
health disparities in Native American communities (Kruse,
Bouffard, Dougherty, & Parro, 2016).
· Diabetes education and management: Telehealth education
improves glycemic control (Barker, Mallow, Theeke, &
Schwertfeger, 2016).
· Mental health emergencies can be managed effectively through
telehealth services (Saurman et al., 2011).
Settings:
· Rural health clinic/hospital (Carlson et al., 2011); Doorenbos
et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).
· Home-based (Demiris et al., 2103).
· Community center (Demiris et al., 2103).
· Library (Demiris et al., 2103).
· Smart phone, computer-based (Forchuk et al., 2016).
Certifications:
· National Committee for Quality Assurance (n.d). Disease
Management Accreditation. Retrieved from
http://www.ncqa.org/programs/accreditation/disease-
management-dm
· American Association of Critical Care Nurses (n.d.). CCRN-E:
Certification for Tele-ICU Nurses. Retrieved from
https://www.aacn.org/certification?tab=First-
Time%20Certification
· Acute stroke ready designation (Slivinski, Johes, Whitehead,
& Hooper, 2017).
Network Systems:
· American Telemedicine Association: approximately 200
telemedicine networks have been established nationwide
(Frederick, 2013).
· Tablet PC Enabled Body Sensor System: real-time continuous
collection of physiological parameters (Panicker, Kumar, 2016).
d. Summary
· Gap/Problem: There is a need to implement evidence-based
methods of improving health outcomes of rural residents
through the use of telehealth.
· Prior studies: Prior studies show that telehealth improves
patient outcomes in diverse settings, including rural areas.
· Quantitative application: Sources of data exist to collect
numerical data on the rate of follow-up with primary care
provider in rural areas.
· Significance: Improving rate of follow-up with primary care
provider will improve health outcomes of rural residents.
Problem Statement
3. Problem Statement:
Describe the variables/groups to study, in one sentence.
A well-written problem statement begins with the big picture of
the issue (macro) and works to the small, narrower, and more
specific problem (micro). It clearly communicates the
significance, magnitude, and importance of the problem and
transitions into the Purpose of the Project with a declarative
statement such as: “It is not known if and to what
degree/extent...” or “It is not known how/why and….”
Other examples are:
· While the literature indicates ____________, it is not known
in _________ (organization/community) if __________.
· It is not known how or to what extent ________________.
While the literature indicates that telehealth is an important
emerging technology for rural patient access, it is unknown if
the implementation of telehealth impacts the rate of patient
follow up for patients living in a rural area.
Clinical/
PICOT Questions
4. Clinical/PICOT Questions:
Provide PICOT question to guide the implementation and data
collection of findings of the project:
(P) Among adult patients in a rural care setting, (I) how does
implementation of a telehealth program (C) compare to
traditional commute-for-care (O) impact rate of follow-up with
the primary care provider (T) over a period of four weeks.
Sample
5. Sample (and Location):
Identify sample, needed sample size, and location (study
phenomena with small numbers and variables/groups with large
numbers).
a. Location: Arizona
b. Population: Two neighboring rural towns equal distance from
the nearest primary care provider.
c. Sample: 40 participants include a power analysis if
appropriate.
Define Variables
6. Define Variables:
a. Independent Variable: Telehealth program.
b. Dependent Variable: Follow-up rate with primary care
provider.
Methodology and Design
7. Methodology and Design:
Name the selected methodology and specific design to address
the problem statement and clinical questions:
This project will use a quantitative methodology with a quasi-
experimental design.
Purpose Statement
8. Purpose Statement:
Provide one sentence statement of purpose including the
problem statement, sample, methodology, and design:
Creswell (2003) provided some sample templates for developing
purpose statements aligned with the different project methods as
follows:
The purpose of this quantitative ___________ (correlational,
descriptive, etc.) project is to ____________ (compare or see to
what degree a relationship exists) between/among
______________________ (independent variable) to
___________________ (dependent variable) for
________________ (participants) at ___________________
(project site/geographical location). The ________ (independent
variable) will be defined/measured as/by _______ (provide a
general definition). The (dependent variable) will be
defined/measured as/by ______ (provide a general definition).
Data Collection Approach
9. Data Collection Approach:
Describe primary instruments that will be used to answer
clinical question.
Data Analysis Approach
10. Data Analysis Approach:
Descriptive statistics will describe the sample characteristics
and variable results. An independent t-tests will test for
difference between the two groups of 40 participants (telehealth
and commute-for-care) follow-up with primary physician. A
priori analysis will be used to justify the sample size.
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
Literature Review
Problem Statement
Clinical/PICO Questions
Sample
Define Variables
Methodology and Design
Purpose Statement
Data Collection Approach
Data Analysis Approach
© 2017. Grand Canyon University. All Rights Reserved.
10
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 2
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 2
The 10 Strategic Points for the Prospectus, Proposal, and Direct
Practice Improvement Project
Kerry S. Murphy
Grand Canyon University
Scientific Underpinnings
DNP-815-O503
Dr. Usama Saleh
July 18, 2018
Running head: THE 10 STRATEGIC POINTS FOR THE
PROSPECTUS, 2
The 10 Strategic Points for the Prospectus, Proposal, and Direct
Practice Improvement Project
The 10 Strategic Points
Broad Topic Area
1. Broad Topic Area:
The topic taken into consideration is the Central Line-
Associated Bloodstream Infections (CLABSIs) and prevention
Literature Review
2. Literature Review:
1. Primary points basis four sections in the Literature Review:
a. Background of the problem/gap:
· There arises an urgency to intervene and develop effective
measures to curtail the incidence of CLABSIs.
· The use of proper hand hygiene and skin aseptic techniques
over the insertion site is necessary for preventing microbial
infections
· The nurses need to have the significant knowledge associated
with evidence-based practices for the Central line-associated
bloodstream infections (CLABSIs), their attitude towards the
guidelines and the utilization of the hygienic measures for the
Central Venous Catheter (CVC) patients.
b. Theoretical foundations (models and theories to be the
foundation for the project)
· The efficacy of training of nurses over the prevention of
Central line-associated bloodstream infections (CLABSIs) in
neonates and children, through the exploitation of a
questionnaire defining their socio-demographic data and their
practical skills (Elbilgahy, A. A. et al., 2015).
· Knowledge about evidence practice reveals the discrepancies
in the praxis, by the different nursing Pedagogics
(Esposito, M. R. et al., 2017).
· Prophylactic measures to eradicate the incidence of CRIs or
Central line-associated bloodstream infections (CLABSIs),
based on the opinions of the experts as well as the analysis of
the research literature (Hentrich, M. et al., 2014)
c. Review of literature topics with a key theme for each one.
d. Prevention of Central Line Associated Blood Stream
Infection (CLABSI)
· The efficacy of hygiene maintenance in the preponderance of
CLABSIs rates in patients with CVCs, maintenance of patients
with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in
the study entail CLABSIs, ICU patients with CVCs, dressings,
hygiene hub (Esposito, M. R. et al., 2017); The relevance of
various interventions in reducing device-related infections. The
key concepts are related to interventions (Hentrich, M. et al.,
2014)
Setting
· Adult ICU (Elbilgahy, A. A. et al., 2015).
· The incidence of CRIs in cancer patients at the hospital
(Hentrich, M. et al., 2014).
Summary
· Gap/Problem: There is a need to implement evidence-based
methods of improving health outcomes and CLABSIs prevention
including the nursing education
· Quantitative application: the Quantitative project is to
establish a relation between the occurrence of CLABSIs and
staff training, reinforcement, and proper hygiene for Central
Venous Catheters (CVCs) inserted in the hospital setting.
· Significance: The use of proper hand hygiene and skin aseptic
techniques over the insertion site is necessary for preventing
microbial infections. Therefore the necessity to maintain
insertion site hygiene consistently is determined to be the best
practice in preventing infections that can lead to sepsis and
septicemia
Problem Statement
3. Problem Statement:
Thoughthe studies have substantiated the CLABSIs to be a
significant health concern as it impedes the recovery of the
patients, the degree of efficacy of hygiene of hub, before each
access in the prevention of CLABSIs, is not well documented
Clinical/
PICOT Questions
4. Clinical/PICOT Questions:
“In Patients > 65 years of age with central line catheters, how
does staff training of key personnel and reinforcement of
Central line catheter hub hygiene after its insertion, along with
the apt cleansing of the insertion site, before every approach
compared with other area hospitals, reduce the incidence of
CLABSIs (Central Line Associated Blood-stream Infections)?”
P: Patients > 65 years of age with a Central line
I: Staff training and reinforcement of Central Catheter, Hub
Hygiene
C: Other area hospitals
O: Reduce probability of CLABSIs
Sample
5. Sample (and Location):
a. Location: ICU Clear Lake Regional Medical Center, Webster,
Texas
b. Population: The population being sampled in the study is 120
adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses
were intrigued (Esposito, M. R. et al., 2017)
Define Variables
6. Define Variables:
a. Independent Variables: crystalloid fluids, hub hygiene and
line changes
b. Dependent Variables: pedagogy
Methodology and Design
7. Methodology and Design:
The data tools were exploiting the practices of nurses in Adult
ICU, questionnaire responses, and a review of the other related
articles.
**The collection of data will be through an interview
questionnaire which will be derived from previous literature
exploring the related issues. The sources of data will be the
healthcare professionals with allied staff as data will be
gathered from them via interviews.
Purpose Statement
8. Purpose Statement:
The purpose of this quantitative project is to establish a relation
between the occurrence of CLABSIs, and staff re-education of
hub hygiene for Central Venous Catheters (CVCs) inserted
patients at the hospital and to explore the preventive measures
being taken by the healthcare staff at hospitals in Webster,
Texas for the prevention of CLABSIs.
Data Collection Approach
9. Data Collection Approach:
10. The primary instruments were nursing observations being
done. The collection of data will be through an interview
questionnaire which will be derived from previous literature
exploring the related issues. The sources of data will be the
healthcare professionals with allied staff as data will be
gathered from them via interviews.
Data Analysis Approach
11. Data Analysis Approach:
The specific data analysis approach was chi-square and t-test
are exploited for data analysis, and analysis was performed by
using descriptive statistics through SPSS Statistics, Version
16.0. Also, The approach used for analysis of data will be
thematic analysis as the data collected from interviews will be
coded and these codes will further assist in the development of
themes based on similarity in the content of interview data.
Thematic analysis will facilitate in answering the clinical
question developed.
Reference
Elbilgahy, A. A., Davidson, P. M., Sharps Mohamed, P. W., &
Elassmy, M. (2015). Nursing Practice for Prevention of Central
Line Associated Blood Stream Infection (CLABSI) in A
Pediatric Intensive Care Unit. IOSR Journal of Nursing and
Health Science (IOSR-JNHS), 5(6), 150-154. Retrieved from
www.iosrjournals.org
Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017).
Knowledge, attitudes, and practice on the prevention of central
line-associated bloodstream infections among nurses in
oncological care: A cross-sectional study in an area of southern
Italy. PLOS ONE, 12(6), e0180473.
doi:10.1371/journal.pone.0180473
Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I.,
Mousset, S., Buchheidt, D., … Karthaus, M. (2014). Central
venous catheter-related infections in hematology and oncology:
2012 updated guidelines on diagnosis, management, and
prevention of the Infectious Diseases Working Party of the
German Society of Hematology and Medical Oncology. Annals
of Oncology, 25(5), 936-947. doi:10.1093/annonc/mdt545

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10 Strategic Points for the Prospectus, Proposal, and Direct Pract.docx

  • 1. 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project Week Two Assignment Instructions DNP 820 Please read the instructions thoroughly Tutor MUST have a good command of the English language The Rubric must be followed, and all the requirements met This is a thorough professor, and she has strict requirements I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments The following needs to be addressed: Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample: · How will you determine the sample size? · What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! · Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring. · Data analysis-What test will you use to answer your research question? Clinical/PICOT Questions: “In adult patients with CVC at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?” P: Patients with Central Venous Catheters I: Staff re-education related to Hygiene of the hub C: Other hospitals O: Reduce probability of CLABSIs
  • 2. T: Two months “In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?” P: Patients > 65 years of age with a Central line I: Staff training and reinforcement of Central Catheter, Hub Hygiene C: Other area hospitals O: Reduce probability of CLABSIs “In adult patients, with define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments 1. I used central Missouri as an example, replace with a description of your site. 2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider 3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help 4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments? 5. One month is the longest time you can use for a prospective project Please note the following regarding the instructors grading IMPORTANT INFORMATION ABOUT MY GRADING STYLE
  • 3. As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always 1. Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955. 2. Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____. 3. You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts. One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.
  • 4. Details: In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner's personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach. General Requirements: Use the following information to ensure successful completion of the assignment: · Locate the "The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” that you completed in DNP-815. · Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. An abstract is not required. · This assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the expectations for successful completion. · You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Directions: Use the "The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project" resource to draft statements for each of the 10 points for your intended research study. You worked on this last in DNP 815. Pick up from where you left off (if you transferred in and did not complete this, you will have to begin fresh). Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current
  • 5. paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission. Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document, I suggest 5-10 at this point. You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic. For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology. Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation. Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.
  • 6. Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection. Apply Rubrics DPI Project Milestone: 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project 1 Unsatisfactory 0.00% 2 Does Not Meet Expectations 74.00% 3 Approaching Meeting Expectations 87.00% 4 Meets Expectations 100.00% 100.0 %Content 10.0 %Topic: Provides a broad project topic area/title. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 15.0 %Literature Review: Lists primary points for four sections
  • 7. in the Literature Review: (a) Background of the problem/gap and the need for the project based on citations from the literature; (b) Theoretical foundations (models and theories to be foundation for study); (c) Review of literature topics with key concept (??) for each one; (d) Summary. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Problem Statement: Describes the problem to address through the project based on defined gaps or needs from the literature. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Sample and Location: Identifies sample, needed sample size, and location. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Clinical/PICOT Questions: Provides clinical/PICOT questions to all of the collected data needed to address the
  • 8. problem statement. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 5.0 %Variables Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Methodology and Design: Describes the selected methodology and specific research design to address problem statement and clinical/PICOT questions. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Purpose Statement: Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that
  • 9. leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Data Collection: Describes primary instruments and sources of data to answer research questions. Reliability and Validity of the instruments are addressed. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. 10.0 %Data Analysis: Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The statistical test(s) that will be used must be identified and must be appropriate for the level of data and the clinical/PICOT question. Item is not present. Not all components are present. Large gaps are present in the components that leave the reader with significant questions. Component is present and adequate. Small gaps are present that leave the reader with questions. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
  • 10. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project Introduction In the Prospectus, Proposal, and Direct Practice Improvement Project there are 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within "The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project" (10 Strategic Points) document. The ten strategic points are developed in table format. The 10 Strategic Points The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document includes the following 10 key or strategic points that define the project focus and approach: 1. Topic (10%) – Provides a broad project topic area/title. 2. Literature Review (15%) - Lists primary points for four sections in the Literature Review: a. Background of the problem/gap and the need for the project based on citations from the literature. b. Theoretical foundations (models and theories to be foundation for project). c. Review of literature topics with key theme for each one. d. Summary. 3. Problem Statement (10%) – Describes the problem to address through the project based on defined needs or gaps in practice from the literature. 4. Sample and Location (10%) – Identifies sample, needed sample size, and location. 5. Clinical/PICOT Questions (10%) – Provides clinical/PICOT questions to collect data to address the problem statement. 6. Variables (5%) – Identifies and describes independent and
  • 11. dependent variables. 7. Methodology and Design(10%) - Describes the selected methodology and specific project design to address problem statement and clinical questions 8. Purpose Statement (10%) – Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location. 9. Data Collection (10%) – Describes primary instruments to answer clinical questions. 10. Data Analysis(10%) – Describes the specific data analysis approaches to be used to address clinical/PICOT questions. The Process for Defining the 10 Strategic Points The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner's expertise in the field, and to define the key strategic points behind the learner's proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement.
  • 12. Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and is not recommended unless learners have a significant amount of extra time and resources to complete it. For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement. Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned When developing a project, it is important to define the 10
  • 13. strategic points so they are simple, clear, and correct in order to ensure that anyone who reviews them will easily understand them. It is important to alignall of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions. Developing the 10 Strategic Points document as a two- or three- page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. Value of the 10 Strategic Points Document The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript. Examples of the 10 Strategic Points Document It is important that the 10 strategic points are clear, concise,
  • 14. doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents. Example: 10 Strategic Points Document for a Quantitative Project The 10 Strategic Points Comments or Feedback Broad Topic Area 1. Broad Topic Area: Hint: What would I title my project? Literature Review 2. Literature Review: List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary. a. Background of the Problem/Gap: · Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement. · Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012). · Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012). · Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017) b. Theoretical Foundations (models and theories to be foundation for study): · The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural
  • 15. Americans. · The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success. · Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015). c. Review of Literature Topics With Key Organizing Concepts or Topics for Each One Rural Telehealth Services: · Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015); cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011). Population Specific Telehealth Services: · Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient- provider collaboration which may in turn improve patient self- management (Hsieh, Tsai, Chic, & Lin, 2015). · Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011). · Rural Native American telehealth: Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016). · Diabetes education and management: Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016). · Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011). Settings: · Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).
  • 16. · Home-based (Demiris et al., 2103). · Community center (Demiris et al., 2103). · Library (Demiris et al., 2103). · Smart phone, computer-based (Forchuk et al., 2016). Certifications: · National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease- management-dm · American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First- Time%20Certification · Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017). Network Systems: · American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013). · Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016). d. Summary · Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth. · Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas. · Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas. · Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents. Problem Statement 3. Problem Statement: Describe the variables/groups to study, in one sentence.
  • 17. A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower, and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent...” or “It is not known how/why and….” Other examples are: · While the literature indicates ____________, it is not known in _________ (organization/community) if __________. · It is not known how or to what extent ________________. While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area. Clinical/ PICOT Questions 4. Clinical/PICOT Questions: Provide PICOT question to guide the implementation and data collection of findings of the project: (P) Among adult patients in a rural care setting, (I) how does implementation of a telehealth program (C) compare to traditional commute-for-care (O) impact rate of follow-up with the primary care provider (T) over a period of four weeks. Sample 5. Sample (and Location): Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers). a. Location: Arizona b. Population: Two neighboring rural towns equal distance from the nearest primary care provider. c. Sample: 40 participants include a power analysis if
  • 18. appropriate. Define Variables 6. Define Variables: a. Independent Variable: Telehealth program. b. Dependent Variable: Follow-up rate with primary care provider. Methodology and Design 7. Methodology and Design: Name the selected methodology and specific design to address the problem statement and clinical questions: This project will use a quantitative methodology with a quasi- experimental design. Purpose Statement 8. Purpose Statement: Provide one sentence statement of purpose including the problem statement, sample, methodology, and design: Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows: The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The (dependent variable) will be defined/measured as/by ______ (provide a general definition). Data Collection Approach 9. Data Collection Approach:
  • 19. Describe primary instruments that will be used to answer clinical question. Data Analysis Approach 10. Data Analysis Approach: Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size. 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 Literature Review Problem Statement Clinical/PICO Questions Sample Define Variables
  • 20. Methodology and Design Purpose Statement Data Collection Approach Data Analysis Approach © 2017. Grand Canyon University. All Rights Reserved. 10 THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 2 THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 2 The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project Kerry S. Murphy Grand Canyon University Scientific Underpinnings DNP-815-O503 Dr. Usama Saleh July 18, 2018
  • 21. Running head: THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 2 The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project The 10 Strategic Points Broad Topic Area 1. Broad Topic Area: The topic taken into consideration is the Central Line- Associated Bloodstream Infections (CLABSIs) and prevention Literature Review 2. Literature Review: 1. Primary points basis four sections in the Literature Review: a. Background of the problem/gap: · There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs. · The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections · The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients. b. Theoretical foundations (models and theories to be the foundation for the project) · The efficacy of training of nurses over the prevention of Central line-associated bloodstream infections (CLABSIs) in neonates and children, through the exploitation of a questionnaire defining their socio-demographic data and their practical skills (Elbilgahy, A. A. et al., 2015).
  • 22. · Knowledge about evidence practice reveals the discrepancies in the praxis, by the different nursing Pedagogics (Esposito, M. R. et al., 2017). · Prophylactic measures to eradicate the incidence of CRIs or Central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich, M. et al., 2014) c. Review of literature topics with a key theme for each one. d. Prevention of Central Line Associated Blood Stream Infection (CLABSI) · The efficacy of hygiene maintenance in the preponderance of CLABSIs rates in patients with CVCs, maintenance of patients with CVCs (Elbilgahy, A. A. et al., 2015); The key concepts in the study entail CLABSIs, ICU patients with CVCs, dressings, hygiene hub (Esposito, M. R. et al., 2017); The relevance of various interventions in reducing device-related infections. The key concepts are related to interventions (Hentrich, M. et al., 2014) Setting · Adult ICU (Elbilgahy, A. A. et al., 2015). · The incidence of CRIs in cancer patients at the hospital (Hentrich, M. et al., 2014). Summary · Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes and CLABSIs prevention including the nursing education · Quantitative application: the Quantitative project is to establish a relation between the occurrence of CLABSIs and staff training, reinforcement, and proper hygiene for Central Venous Catheters (CVCs) inserted in the hospital setting. · Significance: The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections. Therefore the necessity to maintain insertion site hygiene consistently is determined to be the best practice in preventing infections that can lead to sepsis and septicemia
  • 23. Problem Statement 3. Problem Statement: Thoughthe studies have substantiated the CLABSIs to be a significant health concern as it impedes the recovery of the patients, the degree of efficacy of hygiene of hub, before each access in the prevention of CLABSIs, is not well documented Clinical/ PICOT Questions 4. Clinical/PICOT Questions: “In Patients > 65 years of age with central line catheters, how does staff training of key personnel and reinforcement of Central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections)?” P: Patients > 65 years of age with a Central line I: Staff training and reinforcement of Central Catheter, Hub Hygiene C: Other area hospitals O: Reduce probability of CLABSIs Sample 5. Sample (and Location): a. Location: ICU Clear Lake Regional Medical Center, Webster, Texas b. Population: The population being sampled in the study is 120 adult ICU nurses (Elbilgahy, A. A. et al., 2015); 335 nurses were intrigued (Esposito, M. R. et al., 2017) Define Variables 6. Define Variables: a. Independent Variables: crystalloid fluids, hub hygiene and line changes
  • 24. b. Dependent Variables: pedagogy Methodology and Design 7. Methodology and Design: The data tools were exploiting the practices of nurses in Adult ICU, questionnaire responses, and a review of the other related articles. **The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews. Purpose Statement 8. Purpose Statement: The purpose of this quantitative project is to establish a relation between the occurrence of CLABSIs, and staff re-education of hub hygiene for Central Venous Catheters (CVCs) inserted patients at the hospital and to explore the preventive measures being taken by the healthcare staff at hospitals in Webster, Texas for the prevention of CLABSIs. Data Collection Approach 9. Data Collection Approach: 10. The primary instruments were nursing observations being done. The collection of data will be through an interview questionnaire which will be derived from previous literature exploring the related issues. The sources of data will be the healthcare professionals with allied staff as data will be gathered from them via interviews. Data Analysis Approach 11. Data Analysis Approach: The specific data analysis approach was chi-square and t-test are exploited for data analysis, and analysis was performed by using descriptive statistics through SPSS Statistics, Version
  • 25. 16.0. Also, The approach used for analysis of data will be thematic analysis as the data collected from interviews will be coded and these codes will further assist in the development of themes based on similarity in the content of interview data. Thematic analysis will facilitate in answering the clinical question developed. Reference Elbilgahy, A. A., Davidson, P. M., Sharps Mohamed, P. W., & Elassmy, M. (2015). Nursing Practice for Prevention of Central Line Associated Blood Stream Infection (CLABSI) in A Pediatric Intensive Care Unit. IOSR Journal of Nursing and Health Science (IOSR-JNHS), 5(6), 150-154. Retrieved from
  • 26. www.iosrjournals.org Esposito, M. R., Guillari, A., & Angelillo, I. F. (2017). Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLOS ONE, 12(6), e0180473. doi:10.1371/journal.pone.0180473 Hentrich, M., Schalk, E., Schmidt-Hieber, M., Chaberny, I., Mousset, S., Buchheidt, D., … Karthaus, M. (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management, and prevention of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Annals of Oncology, 25(5), 936-947. doi:10.1093/annonc/mdt545