This document contains a reflection on outcomes from a nursing course. It discusses applying various theories, such as the biopsychosocial model of chronic pain, to better understand and manage chronic non-cancer pain. It also covers demonstrating leadership in healthcare policy, applying data analysis skills to vulnerable populations, advocating for ethical leadership, and participating in a quality improvement evaluation of a dialysis center. The student reflects on applying the knowledge and skills gained from each outcome area to their DNP project focused on improving care for patients with chronic non-cancer pain.

1. Running head: COMPREHENSIVE ASSESSMENT PART TWO
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COMPREHENSIVE ASSESSMENT PART TWO
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Comprehensive Assessment Part Two: Outcomes and Reflection
Name
Instructor
Course
Date
Comprehensive Assessment Part Two: Outcomes and Reflection
Outcome 1
In this course, I have done extensive research about several
nursing and science-based theories and how these theories can
be applied in solving a nursing problem. The problem that
needed a solution in this course was chronic non-cancer pain. In
this course, I was able to demonstrate how nursing theories can
be integrated into efforts to solve chronic non-cancer pain,
which happens to be an old-age problem in nursing practice. In
particular, I demonstrated how the biopsychosocial model of
chronic pain is applied to the management of chronic non-
cancer pain. The model provided a clear framework for steps
that needs to be taken to manage chronic non-cancer effectively.
Of particular importance was the application of the model in
determining factors that determine the speed at which one
recovers from chronic non-cancer pain. Some of the factors that
I described using the model included coping strategies, distress,
illness, and physical dysfunction (Kaiser et al., 2013). Given

2. the multiple factors that determine the speed of recovery from
chronic non-cancer pain, it is arguable that it is not possible to
manage this problem using a single intervention. The
biopsychosocial model of chronic pain came in handy in
describing the “cycle of pain”, given the fact that an individual
develops pain due to interaction of factors such biological,
psychological, and social factors (Kaiser et al., 2013).
Explaining the interaction of the aforementioned factors helped
in deriving sense from the fact that people who develop chronic
pain are unable to engage in social and occupational activities.
It also became evident that other factors such as depression and
isolation contribute immensely to the exacerbation of pain
symptoms.
The Biopsychosocial model of chronic pain was also useful in
my course because it helped me in researching deeply on
treatment of chronic non-cancer pain. By applying the model, it
was possible to gain a deeper understanding of the interaction
among different factors that contribute to the exacerbation of
chronic non-cancer pain symptoms. Fundamentally, the model
was quite useful in understanding that pain has a negative
impact on emotions of an individual when it persists. Patients
start developing negative beliefs about the negative effects of
chronic non-cancer pain (Kaiser et al., 2013). Basing on this
information, it was possible to choose pain management
approaches that only relieve the pain but also change the
negative beliefs that patients develop about pain.
I will apply what I have learnt from this course to my DPI
project by researching about a pain management approach that
takes into account the multiple factors that contribute to chronic
non-cancer pain. In particular, the focus of the research will be
on physical, psychological, and social factors. Work-related
injuries will also form part of my research given the fact that
workers tend to experience multiple stressors when they are
unable to return to work due to pain. They live a stressful life
when they are unable to return to work and provide for their
families (Tompkins, Hobelmann, & Compton, 2017). The stress

3. they develop takes their pain issue beyond any treatment
approach that healthcare providers may decide to settle for.
Outcome 2
There are multiple ways that a DNP nurse can demonstrate
leadership in a bit to influence the health policy agenda and
transform the healthcare policy agenda. My journey to
demonstrating leadership began at the lowest level by reviewing
literature on the impact on health policies on healthcare
delivery. The early stage of policy development blends well
with understanding issues that plague the healthcare system,
hence making it the most critical step in efforts to have
influence in the organization and delivery of healthcare (Cain,
2016). As I gained more knowledge about the process of
healthcare delivery, I was better placed to contribute to
healthcare policy.
As a DNP-prepared nurse, it was clear in my mind that I have a
role in demonstrating leadership that will ensure that the
healthcare system meets quality standards of patient care. I
demonstrated my leadership through development and
implementation of policies that focused on promoting health
outcomes of patients. I did this through leading the charging in
advocating for policies that would ensure that there is a
compete overhaul of the healthcare system to ensure quality
healthcare delivery becomes a number one priority.
Fundamentally, I demonstrated how a nurse leader can play an
active role in the political arena to develop policies and
regulations that will the healthcare system to achieve quality
standards. During my course, I did a research about a
controversial law in California and how I would demonstrate my
leadership skills to find a common ground for the law.
Another way in which I demonstrated leadership was through
coalition building. During this course, I demonstrated how
obtaining a legislative approach can help in advancing policy
agenda of a healthcare organization or the entire healthcare
system. Nursing organizations are becoming increasingly
popular due to the formation of coalitions. I explained how I

4. can serve as leader of these coalitions and ensuring that these
coalitions stay focused on achieving their primary objectives.
In the same vein, I demonstrated leadership by explaining how
to foster collaboration in healthcare organizations in an effort to
optimize patient outcomes. This is the most critical skill that I
learnt from this course fostering collaboration. Collaboration is
of profound importance in quality healthcare delivery because it
allows the nursing leadership to work as a team to achieve the
desired goals or provide quality care for patients (Arabi, Rafii,
Cheraghi, & Ghiyasvandian, 2013). This course has also helped
me to overcome challenges that might plague my efforts to
foster collaboration in my team. Some of the challenges I have
learnt to overcome include resistance to change and work-
related boundaries. I have learnt that collaboration not only
strengthens the relationship between interdisciplinary teams but
also promotes efficiency in healthcare delivery. This plays a
vital role in improving staff satisfaction and patient safety.
Policy intervention was also a critical component of this course.
Through the advanced knowledge I gained from the course, I
was empowered to advocate for healthcare policies that ensure
patients receive healthcare in patient-centered, safe, efficient,
and timely manner. Through my experience in health policy
implementation, I have been better positioned to garner the
support of legislators in efforts to advocate for reforms that will
improve quality of service delivery.
This course was covered in a period of 45 hours and I am glad I
have learnt a lot that will be of help in completing my DPI
project. I will apply what I have learnt through advocating for
policies that will ensure patients suffering from chronic non-
cancer pain have access to quality healthcare. Fundamentally, I
will discuss the due process that is required to implement
healthcare policies that will be beneficial to persons with
chronic non-cancer pain. I will also use the knowledge I have
gained in this course to discuss how I can influence the political
process in order to find a lasting solution to chronic non-cancer
pain.

5. Outcome 3
During my course of study, I have learnt that successful
application of data analysis to the improvement of information
systems, patient care, and organizational outcomes is of critical
importance in improving patient outcomes. I have come to learn
that health care delivery involves handling large volumes of
data that emanate from medical records, health surveys, billing
records, and administrative enrollment among other sources of
data. Thus, I have strived to apply my knowledge in data
analysis in a number of areas in order to improve patient
outcome. In particular, I have applied my knowledge in
collecting and analyzing data for vulnerable populations. The
collection of data for such populations in determining what
fraction of the American population develops chronic non-
cancer pain. I have also gone further to collect data on
treatment approaches that are used in treating chronic non-
cancer pain.
During the 45 hours of this course, I have also learnt that health
information technology (HIT) is of profound importance in
collection of reliable data. HIT comes in hand when healthcare
providers want collect data on ethnicity, race, and nationality of
patients. This data is vitally essential in health care planning
given the fact that people have different healthcare issues and
thus the one size fits all approach does not apply. Furthermore,
my analysis of data captured when covering the course revealed
that vulnerability of a population to healthcare challenges varies
considerably based on the three aforementioned factors.
I have applied a wide range of data collection methods in this
course, with the principal objective of collecting the most
reliable data. If the data collection method is not chosen
carefully, redundancy in collecting data on ethnicity, race, and
nationality will remain the biggest challenge in data collection
(Al-Abri, 2017). In particular, it will be practically impossible
to collect data that can aid in making comparisons. Thus, I have
always paid close attention to the choice of the data collection

6. method for a project aimed at addressing a particular healthcare
problem.
Furthermore, I have discovered that there are multiple
limitations that come with the culture of data collection and
analysis in healthcare. Traditionally, the primary goal of
collecting data was not to improve quality of patient care.
Rather, the sole purpose of collecting data was to analyze it and
ascertain if there was compliance with state policies and
regulations (Al-Abri, 2017). Another limitation I have
encountered is that collection of hospital data is not quite
systematic given the fact that data categories tend to vary from
hospital to hospital. Furthermore, every hospital has its own
way of obtaining information.
Besides the challenges I have mentioned in the preceding
paragraph, I have discovered that hospitals encounter numerous
challenges in their quest to collect accurate and less redundant
data. Using this data for quality improvement has also proven to
be a daunting task for most hospitals. During the course, I did a
survey in three hospitals in my community and asked them
whether they used ethnicity and race data to assess quality of
care of the patient population or levels of satisfaction. The
survey revealed that only one in three hospitals used data for
the two purposes mentioned above. Furthermore, the survey
revealed that none of the hospitals maintained a database for the
data collected. Thus, it was impossible for these hospitals to
track patients’ vital information over time.
I will apply what I have learned during the course to DPI
project by collecting data on different approaches that hospitals
use to manage chronic non-cancer pain. I will develop
questionnaires to aid in collecting data that will be used in the
project. The questionnaires will be designed in a way that will
aid in getting views of nurses on effectiveness of data
approaches to managing chronic non-cancer pain.
Outcome 4
Throughout this course, I have strived to advocate for the

7. ethical and equitable deployment of care delivery models to
ensure quality patient care. Fundamentally, I focused on
establishing the relationship between ethics and implementation
of change. In this regard, I explained how observing a code of
ethics should be a number one priority when implementing
change. I did this through discussing ethical considerations
when implementing change. The most critical ethical
consideration in my course was making attempts to obtain the
approval of Institutional Review Board (IRB) prior to the
implementation of change. It is extremely important to secure
approval by IRB because the board needs to give green light
before implementing change or policies that affect healthcare.
The course also covered a lot about the moral compass of nurses
by focusing on the American Nurses Association (ANA) Code
of Ethics. On this, it was clear that nurses play a critical role in
designing life-saving care. Demonstrating ethical leadership
goes beyond providing direct patient care considering the fact
that it entails designing system-wide models that contribute
immensely to optimal patient care. Out of the 45 hours that
were allocated for this course, I used about 15 hours researching
about strategies that can be employed in advocating for ethical
leadership in healthcare delivery. The reason for spending this
amount of time on research is because ethical leadership is of
profound importance in both direct and indirect healthcare
delivery (Storch et al., 2013). Furthermore, I advocated for
frequent revision of the code of ethics to ensure nurses stay
updated on leadership qualities.
To provide a better understanding of the relationship between
ANA Code of Ethics and qualities of ethical leadership, I went
further to research extensively about ethical principles of
nursing. My focus was on principles such as respect for
autonomy, veracity, beneficence, nonmaleficence, and justice
(Storch et al., 2013). I emphasized on the aforementioned
ethical principles because I believed this would go a long way
in promoting ethical leadership in healthcare. Ultimately, this
would translate into quality healthcare delivery and thus

8. optimize patient outcome.
Characteristics of ethical leadership in healthcare delivery were
one of my crucial takeaways from this course. I will apply these
characteristics in my DPI project by demonstrating how nurses
are expected to exemplify these characteristic when providing
healthcare to patients. The first characteristic that I will apply
in my project is courage. My project will focus on discussing on
how nurses have the obligation to confront challenges that do
not reflect their beliefs and values. They should not fear
potential consequences of their actions as long as what they are
doing is right (Storch et al., 2013). The project will provide a
detailed discussion about the role of nursing leadership in
promoting the moral courage to speak up when they see
something is wrong somewhere. This will clearly demonstrate
how nurses can remain courageous regardless of the situation
they are in.
The project will also dwell on discussing the second
characteristic, which is competency. Dinndorf-Hogenson (2013)
asserts that patients have the right to receive care from
competent nurses. This is the most critical quality that nurse
leaders are expected to exemplify. My project will discuss
importance of committing to lifelong learning in promoting
nursing competency. Nurses become more competent when they
engage in lifelong learning because they keep abreast with new
findings in nursing. My project will dwell on discussing how
nurses promote competency at individual level by pursuing
current skills and will help them deliver quality care for
patients.
Outcome 5
I participated in a quality improvement initiative by evaluating
ability of a healthcare entity known as BS Dialysis Center to
provide quality patient care. In my evaluation, I described the
healthcare entity in details by describing its location and bed
capacity. The number of years that the facility was also part of
my description given the fact the number of years that a facility

9. has been operational is a key determinant for the quality of
services that a facility provides.
I evaluated practice outcomes during my coursework by
describing quality outcomes and patient safety measures that BS
Dialysis Center has put in place. My evaluation of the facility
clearly revealed that quality service delivery is the number one
priority BS Dialysis Center. It is for this reason that BS
Dialysis Center remains a household name when it comes to
quality service delivery. During my coursework, I stated
categorically that BS Dialysis Center is one of the few dialysis
centers in the whole of the United States that emphasizes on
providing life-sustaining. The leadership of the facility believes
life-sustaining dialysis vitally essential for patients because it
not only helps in transitioning patients into a life that is free
from kidney failures but also stabilize the functioning of the
kidneys. BS Dialysis Center’s emphasis on quality service
delivery has played a vital role in reducing the number of
readmissions. The number of patients discharged in stable
conditions has also increased considerably over the last couple
of years. The stability of patients’ condition at the time of
discharge reduces their risk of getting readmitted.
I interacted with one of the senior nurses in the facility and she
had a lot of success stories to share with me. She noted that the
hospital has been doing pretty well in providing treatment that
is suitable for patients with acute kidney injury (AKI) as well as
those with end-stage renal disease (ESRD). As part of the
hospital’s commitment to provide quality patient, it strives to
upgrade its facilities to ensure AKI and ESRD patients receive
treatment in separate units. Patients with AKI receive treatment
in a unit with equipments that stabilize functioning of the
kidney while those with ESRD are placed on a life-sustaining
dialysis (Duffy, 2013). During the 45 hour course, I was keen in
determining the dedication that the hospital has in monitoring
the progress of patients during and after treatment. From my
assessment, I discovered that the hospital puts a lot of efforts in
ensuring that patients are free from any eminent danger during

10. and after treatment. The staff of the hospital ensures that safety
is observed during insertion and removal of catheters. During
this course, I have learnt that observing safety when inserting
and removing catheters is vitally essential in preventing
infections among patients undergoing dialysis.
I have no doubt in my mind that what I have learnt in this
course will be quite helpful in completely my DPI project. The
concept that will be of profound importance in my project will
be approaches to improving patient safety in dialysis centers.
My focus will be on describing how nurses can observe utmost
care during insertion and removal of indwelling catheters.
Doing this will play a vital role in preventing transmission of
infections among patients undergoing dialysis.
Self-Reflection
Based on the evaluation I have done for this course, I have no
doubt in my mind that I am prepared to complete my DPI
project. What I have learnt in this course informed my approach
to my DPI project because I have learnt several concepts that
will be helpful in completing the project. The most important
concept is the application of theoretical model to quality
healthcare delivery. I have gained a more complete
understanding of how to theoretical models can provide a
framework for implementing change. In that sense, I will apply
my knowledge in theoretical model to implement changes that
will aid in improving quality of service delivery in hospitals. I
believe the models will provide crucial steps that are required to
complete the DPI project successfully.
I have also learnt about leadership and I believe this knowledge
will come in handy when I start completing my DPI project. I
will demonstrate top notch leadership by describing what is
expected of a leader when implementing change in healthcare
settings. Most importantly, I will be in a position to describe
the roles that nurse leaders can play in the political arena to
advocate for healthcare reforms. The knowledge I have gained
in this course will be sufficient to explain how one can garner

11. legislative support when there is need to pass laws and
regulations that will contribute to improvement of quality of
patient care.
Furthermore, the knowledge I have gained in this course will be
quite helpful in data collection and analysis. My understanding
of how to use SPSS in statistical analysis will be quite helpful
when it comes to analyzing data for my project. I will use this
software in calculating scores for different approaches that will
be used in managing chronic non-cancer pain. Additionally, I
will use the software to analyze speed of recovery for groups of
patients subjected to various pain management approaches. Each
pain management approach will have a score that will be used to
determine efficiency of various pain management approaches.
The knowledge I have gained in this course will also help me
creating an outline of my project. I have learnt how to create a
prospectus outline which I believe will be helpful in outlining
everything that I intend to cover in my project. Creating an
outline for my project will be quite essential in successful
completion of the projection because there will be high chances
that I will cover everything that I will intend to cover.
One of the areas that I need to revise in my 10 strategic points
is the literature topics. I believe it is important to add at least 2
literature topics to widen the scope of research of my project.
Widening the scope of research will help in researching widely
about different approaches that are used in the management of
chronic non-cancer pain. As I pause and look back, I believe the
past three months have been a major milestone in my
preparations to complete my DPI project. I believe what is
remaining will just be a tip on the iceberg. What is remaining is
to secure the approval of key stakeholders and from there I will
be ready to proceed with my project.
References

12. Al-Abri, R. (2017). Managing Change in Healthcare. Oman
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Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S.
(2014). Nurses’ policy influence: A concept analysis. Iranian
Journal of Nursing and Midwifery Research, 19(3), 315–322.
Cain, C. L. (2016). Implementing aid in dying in California:
experiences from other states indicates the need for strong
implementation guidance. Policy Brief UCLA Cent Health
Policy Res, 8(1), B2016-4.
Dinndorf-Hogenson, G. A. (2013). Moral courage in practice:
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Duffy, J. R. (2013). Quality caring in nursing and health
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Kaiser, U., Arnold, B., Pfingsten, M., Nagel, B., Lutz, J., &
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(2013). Take me to my leader: the importance of ethical
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