Integrating implementation science in Doctoral Nursing Practice Degrees

The Doctor of Nursing Practice (DNP) curriculum focuses on clinical populations, healthcare leadership, and how to improve the quality of healthcare for patients. To optimise healthcare delivery and improve patient outcomes, the DNP student must become proficient with the quality improvement (QI) concept and its application within the clinical environment.

As a DNP student at the University of Mississippi School of Nursing, QI is introduced in the JBI Evidence Implementation Training Program (EITP), accomplished through a series of workshops. QI is further developed and realised after completing an evidence implementation project, submitting a report to the JBI Evidence Implementation journal, and presenting a project abstract and poster at the School of Nursing Research and Scholarship Day. This process is completed over four to five semesters, depending on the student’s plan of study. Guidance, direction and feedback are maintained by a faculty advisor throughout the learning process. This informative process equips the DNP student with the knowledge, understanding and application of QI to elicit change in future clinical environments.

Personal project: from topic selection to sustained interventions

When selecting a topic for an evidence implementation project, DNP students are encouraged to seek opportunities for improvement within their varied healthcare environments and structure an evidence implementation project (EIP) to address a need in one of those areas. Combining knowledge gained through the EITP and applying this selection process, a plan for an EIP arose to address the needs of patients and families in an inpatient stroke care unit. Challenging situations revealed the need for conversations within the acute setting, where palliative care services are introduced to prioritise a patient’s quality of life and personal care goals. Upon discharge, patients and their families expressed frustration with delays in communication and a lack of priority accorded to quality of life. These patients and families also voiced a desire for greater participation in personal healthcare decisions. These concerns highlighted the need to improve palliative care communication through an EIP. The main objective of the EIP was to enhance evidence-based practices regarding palliative care communication among healthcare professionals and stroke patients.

The most significant impact identified by the project team was enhanced comfort in conducting difficult conversations with patients and families. Furthermore, enhanced communication skills positively affected all conversations with stroke patients and their families. The results of this EIP supported the plan to execute annual palliative care communication and enhance palliative care communication through a multidisciplinary approach to improve compliance with best practices.

Familiarity with the JBI Evidence Implementation Framework, JBI PACES and GRiP

Gaining competence in QI through the completion of the EITP and an EIP familiarises the DNP student with resources that can be used to further implement QI in the clinical setting, including the JBI Evidence Implementation Framework, JBI PACES  and GRiP. While completing the DNP program at the School of Nursing, JBI resources are available in the student’s electronic learning management system, making JBI PACES and GRiP accessible throughout all coursework. Combining academic knowledge, practical application and access to resources provided by JBI leaves a positive professional impact on the DNP student’s ability to elicit change and experience the benefits realised through successful QI endeavours. This learning process is supported by the completion of the DNP program at the University of Mississippi School of Nursing, and it furthers the mission of JBI by improving healthcare through evidence-based practice.

Access the full-text manuscript in JBI Evidence Implementation entitled Palliative care communication with stroke patients: A best practice implementation project

Ashley Brook Schaefer, MSN, FNP-BC
Vascular Neurology Nurse Practitioner
Department of Neurology
University of Mississippi Medical Center
Jackson, MI, USA