Nursing Graduate project

Proposed DNP Project 1

Practice Setting 1

Diabetes is a common chronic condition that affects many people and thus there is a need to find different ways that the treatment and its management can be streamlined to ensure the best patient outcomes. My proposed project will be to review and update current protocol used by the Case Management and Care Coordination departments in a Managed Care Organization to coordinate care for all diabetic patients being discharged from an institution back to the community. My target participants for the project will be Care Coordinators and Case Managers.

Topic 1

According to CDC (2020), diabetes intervention plan is found to be cost-effective. 

The topic for this proposed DNP project is Transition of care protocol for use by Case Managers and Care Coordinators in ensuring discharged diabetic members are managed by Interdisciplinary healthcare team members to improve quality of patients care/outcome, prevention of readmission, and to reduce utilization cost.

Current Practice

Care Coordinators and case managers do not have an up-to-date protocol to case manage/ assist in coordination of services and follow up for diabetic patients after they are discharged from the hospital, long term care facility or other institutions to the community. 

Significance

Updating the case management and care coordination protocol for management of diabetic patients will increase evidenced based practice, improve quality of patients’ care and outcome, foster collaboration between healthcare professionals involved in patients’ care, reduce rehospitalization and cost of care.  Collaborative nursing is important and should be encouraged in the nursing practice and when attending to patients as it helps the patients to receive customized care according to their needs (Hicks, 2014). The collaboration of different nursing professionals ensures that nurses can work together thus providing more patient-focused care. Patient outcomes will be improved. 

Problems/Concern

My interview with stakeholders as regards to transition of care for diabetic patients shows a high-cost utilization due to readmission. It also reveals that the readmission was as a result of poor coordination of care during Patients’ transition between healthcare settings that could be prevented by implementing appropriate/additional processes in the current transition of care protocol used by their case management and care coordination department.  There is a need to update the current diabetic protocol at the case management and care coordination level to address gaps that exist between interdisciplinary team collaboration, include current evidenced based practice, and implement a way to measure the impact of the program on quality of patients’ care, readmission rate and cost reduction.

Outcomes

The outcomes of the proposed project that will impact the healthcare industry include the reduction of the cost of health care provision to diabetes patients as collaborative nursing practice is expected to have an impact in reducing the cost of care. Reduction in the rates of readmission of diabetes cases is an expected outcome as patients will be able to get care that is customized for them thus better patient outcomes. 

Audience

The target audience for this proposal project will include nursing staff from Case Management and Care Coordinators of the Managed Care Organization. 

Timeline

The implementation of the project will be within the timeframe of this DNP program. The development of the literature review and theory, implementation, evaluation, and analysis stages, and the implementation and evaluation of the outcomes of the project into the nursing practice. The timeline will be as follows-

· In DNP Project I- I will build a foundation of literature review and theory. 

· In DNP Project II- I will plan your implementation, evaluation, and analysis phases- will include survey and other resource development.

· In DNP Project III- I will utilize about 4 weeks to implement and evaluate the outcomes of my DNP Project. It’s highly likely that I will give “preliminary data” with a plan to continue to evaluate outcomes after graduation. 

Proposed DNP Project 2

Practice Setting 2

The healthcare industry has experienced rapid development in technology, and this has impacted the delivery of health care services. The proposed project will be carried out at a Home Health Agency. And the target participants will be home health Nursing Staff. 

Topic 2

The topic for the proposed DNP project is on the impact of the use of Electronic Health Records (EHRs) in the delivery of care in the nursing practice. Technology has led to the establishment of the use of EHRs as a way of storing health records of patients. 

Current Practice

The healthcare industry has implemented the use of technology in the delivery of care and this is evident in various sectors such as the storage of health records. In the past, health care data was stored manually and in paper form and this delayed the delivery of care when looking for the data records of patients (American Association of Colleges of Nursing, 2015). 

The Home Health Agency do not currently use Electronic Medical Records System for documentation. The currently chart on paper.

Significance

Implementation of electronic health records at the home health agency will help in ensuring proper and safe storage of data record. Reduce cost associated with purchasing papers, increase efficiency and promote easy and accessibility of data for authorized Personnel.

Problems/Concern

Health records are important components in the delivery of care as it helps the caregiver to know the history of a patient and thus helps in decision making. According to Apold (2008), the health records when recorded in paper forms are difficult to store as it takes a lot of time and resources to store data. The use of EHRs can be used to eliminate the challenges in health data storage. 

Below are some of the problems/concerns the Agency is currently experiencing.

Delay in accessing member chart which sometimes result in delayed care delivery. 

Billing inaccuracy which leads to less pay for services provided.

Loss of records  

Misplaced documents. 

Outcomes

The expected outcomes of this proposed DNP project include the reduction of cost of storage of health records, increase accessibility of health records and elimination of paper charting by proposing and assisting with implementation of EHR. 

Audience

The target participants for this study will be nurses and nursing leadership at the Home Health Agency. The target audience has an interaction with the data of patients and thus they are best suited to be involved in the proposed project.

Timeline

The implementation of the project will be within the timeframe of this DNP program. The development of the literature review and theory, implementation, evaluation, and analysis stages, and the implementation and evaluation of the outcomes of the project into the nursing practice. The timeline will be as follows-

· In DNP Project I- I will build a foundation of literature review and theory. 

· In DNP Project II- I will plan your implementation, evaluation, and analysis phases- will include survey and other resource development.

In DNP Project III- I will utilize about 4 weeks to implement and evaluate the outcomes of my DNP Project. It is highly likely that I will give “preliminary data” with a plan to continue to evaluate outcomes after graduation. 

Proposed DNP Project 3

Practice Setting 3

The proposed project will involve the nursing staff and leadership in a medical and surgical unit of a Hospital. This is due to the role of the DNP prepared nurses in the leadership positions have a responsibility to ensure that the nursing resources are adequate and well utilized. 

Topic 3

The topic for the proposed DNP project is on the impact of nursing shortage on delivery of care and productivity of the nursing staff. There is a need to investigate the shortage of nurses in the health facilities and the impact this has to the nursing practice and delivery of care at large (Housing and Urban Development, 2016). 

Current Practice

The Proposed hospital currently have a budgeted staffing ratio of one nurse to six to eight patients for their medical and surgical floor. This budgeted ratio is high Compared with the other hospital in the area with a budgeted ratio of one nurse to four patients. 

Currently there is a nursing shortage in the health care facilities, and this is delaying the care provision due to the high workload that is being experienced in the healthcare industry Nurse leaders strive to ensure that there is an equal distribution of workload ensuring that nurses are working for not too many hours to compensate for the shortage of nursing workforce (Diers, & Price, 2007). 

Significance

The proposed DNP project is important in the nursing practice as it will help come up with recommendations that will ensure that the issue of shortage of nurses in the delivery of care is salvaged. This will ensure that the nurses have a manageable workload conducive working environment where they are able to provide the best quality of care aimed at improving the patient outcome. 

Problems/Concern

The high staffing ratio is contributing to delayed delivery of care/quality of patients’ care and increased reported medical errors. Diers and Price (2007) reports that shortage of nurses affect the overall outcome of patients in the health care facility as time for care delivery may be delayed. The project will be aimed at providing recommendations that will improve this area. 

Outcomes

The outcomes that will be measured in this project include the nursing productivity as impacted by the high staff to patient ratios of nurses when delivering care to patients. The other outcome expected from this project is the cost of health care resulting from the shortage of nurses in health care facilities. 

Audience

The target participants for this study will include the nurses and nurse leaders at the medical and surgical department of Hospital. Nurse leaders due to their involvement in the management of the nursing resources in the delivery of care in health care facilities and nursing staff as they are affected by the issue.

Timeline

The implementation of the project will be within the timeframe of this DNP program. The development of the literature review and theory, implementation, evaluation, and analysis stages, and the implementation and evaluation of the outcomes of the project into the nursing practice. The timeline will be as follows-

· In DNP Project I- I will build a foundation of literature review and theory. 

· In DNP Project II- I will plan your implementation, evaluation, and analysis phases- will include survey and other resource development.

In DNP Project III- I will utilize about 4 weeks to implement and evaluate the outcomes of my DNP Project. It is highly likely that I will give “preliminary data” with a plan to continue to evaluate outcomes after graduation.