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Strategies for successfully completing a DNP final project

Reid, Kimone Racquel Yolanda DNP, MSPH, RN, APRN, CCRN, AGACNP-BC, AGCNS-BC; DeGennaro, Regina DNP, RN, CNS, AOCN, CNL

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Nursing Management (Springhouse): May 2022 - Volume 53 - Issue 5 - p 41-46
doi: 10.1097/01.NUMA.0000829272.72857.a1
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In Brief

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Before a nursing student can graduate with a Doctor of Nursing Practice (DNP) degree, they must complete the final DNP project. The project is sometimes referred to as the DNP capstone project, but according to the American Association of Colleges of Nursing (AACN), the final project should be called “DNP project” to avoid confusion with the term “capstone,” which is used in different levels of education.1 The DNP project demonstrates students' scholarship and focuses on a change impacting a system or population that will affect healthcare outcomes.1 Projects include planning, implementation, and evaluation phases.1 However, students may express confusion regarding program requirements such as the final project, angst about limited DNP-prepared faculty and advisors, and a desire for expanded mentoring.2,3 Thus, this article outlines strategies that DNP students may use to successfully complete the required final scholarly project. These strategies may provide guidance for new DNP faculty and advisors.

Finding a project

An evidence-based practice (EBP) or quality improvement (QI) project can arise from unexpected places. Be open to new experiences and flexible regarding available learning opportunities, especially during this time of uncertainty in healthcare due to the COVID-19 pandemic. For example, consider the needs of the organization when selecting a project topic.

A project may focus on improving an existing practice or implementing a practice change. The American Association of Colleges of Nursing's 2015 Taskforce provides examples of potential settings for DNP practice and final projects.1 For project ideas, consider journal articles featuring innovation in practice or new evidence regarding a practice change that optimizes a current standard of care and quality improvement outcomes.

Identify the QI focus of the organization being considered for completing the DNP final project. In clinical learning experiences, pay close attention to organizational needs and practice gaps, patient and employee engagement data, audit reports featuring gaps in quality and safety, and core measure deficiencies. Organizations may be interested in projects highlighting practice that illustrates outcomes and improvements for accreditation and certification agencies. Seek opportunities to meet with and learn from stakeholders and institutional leaders regarding priorities. Consider what data you'll need to access for driving project design and potential data access requirements.

Collaborate with graduating DNP students to learn about components of their projects that may need follow-up for sustainability. Attending DNP final project presentations is an opportunity to observe the process and consider how best to structure and design a question, and develop a project. Learning from PhD students about their original research may help with identifying practice questions and inform the transition to practice setting needs. There may be opportunities for collaboration as PhD students may need practice expert colleagues to implement nursing research in practice settings.

Check with project stakeholders whether the project aim, methods, and proposed intervention align with the organization's goals, mission, and vision. This will guide development of strategy for project support and stakeholder buy-in.

Select a project that seems like it will be enjoyable; remember, many hours will be spent laboring over the project and project fatigue can set in. Be as clear, specific, and narrow as possible about the project aim and time frame after reviewing the literature. Obtain permission letters to conduct the project from practice setting managers, compliance officers, and the school of nursing.

Determine if you'll need institutional review board (IRB) approval or waiver (if the project is designated as nonresearch). Some DNP programs will require an IRB (or another scientific board review) determination prior to beginning the DNP final project. A number of journals will seek this determination from authors, and the DNP student may be encouraged to seek dissemination and publication of this scholarship. Although the DNP final project is ideally an evidence-based practice project, there may be elements of human participant research, such as surveys or focus groups. Students may be encouraged or required to seek the expertise and determination of the organization's IRB prior to project implementation in order to comply with the protection of human participants and respect for ethical principles. The DNP final project isn't planned as a research study seeking new knowledge, but there can be elements of human participant research embedded, and the IRB in the organization is the body that officially provides this determination.

Selecting an advisor

The DNP advising faculty provides guidance throughout the academic program. Conduct research to learn about the DNP advising faculty and their expertise. It's helpful to know if the advisor has been effective with prior students in the guidance of their projects. Seek clarification regarding school and program policies that allow a student to select an advisor who might meet their scholarship needs in the specialty practice setting.

Once assigned an advisor, be intentional regarding scheduling regular meetings. Seek ongoing feedback on project topic, proposal planning, implementation strategies, evaluation methods, and options for disseminating the project. Learn the best ways to obtain helpful feedback, ideas, and writing examples.

Selecting a practice mentor

A DNP final project team must include a practice mentor.1 It's important to select an expert in the area of interest, and one who may be a gatekeeper to developing partnerships that will foster support and stakeholder buy-in for the project. A practice mentor can help “open doors” and identify experts to assist in guiding project development, methodology, implementation, dissemination, and sustainability. These experts and partnerships will help the student navigate institutional culture, power dynamics, and relationships within the organization. For example, a mentor may be a specialty-certified clinician, who's a member of a professional nursing organization and therefore can provide information regarding scholarships and resources for a specialty-related project. The mentor may be involved in the organization's practice council or quality group, and thus may be able to facilitate connections with pertinent stakeholders.

A mentor with research experience can help with critically appraising the evidence from research studies. Verify with the identified mentor that they can commit to a project that may span several months. It's helpful to develop a schedule and explain what you'll need so that they can plan to devote time for all stages of the project. It's key to be flexible and work together to designate time that works for both student and mentor. Schedule key times to meet (prior to the project proposal and the final presentation) because feedback is important to enhance scholarship for the DNP student.

Include both the DNP advisor and practice mentor in all key decisions regarding anticipated implementation of the DNP final project. It can be helpful to request a meeting with both to clarify assumptions and provide clarity regarding roles and guidance on scholarship.

Time management

Time management is important and critical to success because student projects are time-limited with anticipated graduation deadlines looming. Here are some key time management strategies to keep in mind during the course of the project.

  • Plan each day. Being disciplined is crucial because many DNP students continue to work during graduate studies, or have families and other commitments. Eighty-three percent of DNP students worked full-time, and the competing demands of work, family, and school were barriers to successful academic progression.4
  • Schedule and commit to time for writing. Choose locations free of distraction. Find a writing sanctuary (for example, a library or school room). Regulate phone usage; reduce notifications and adjust ringer volume.
  • Create a project timeline that includes due dates for deliverables including the proposal, IRB application, data analysis, project results, and manuscript draft to stay on track.
  • Focus on addressing the project aim.
  • During the final semester, schedule time for submitting abstracts, obtaining funding for dissemination, job searching, and interview preparation (see Table 1).
  • Consider setting key priorities to accomplish annually, such as completing a board exam, the DNP final project, and job searching.
  • Document all DNP practice hours. Align your academic activities with achieving the DNP essentials, so that your time is purposeful.
Table 1: - Funding sources for DNP projects
Funding source Website
American Association of Colleges of Nursing www.aacnnursing.org/Students/Financial-Aid
Doctors of Nursing Practice www.doctorsofnursingpractice.org/resources/grants-and-scholarships
Health Resources and Services Administration www.bhw.hrsa.gov/loans-scholarships
Johnson and Johnson: Nursing School Financial Aid https://nursing.jnj.com/financial-aid
Johnson and Johnson: Nursing Scholarships https://nursing.jnj.com/scholarships
Jonas Scholars www.jonasphilanthropies.org/jonas-scholars
Nursing License Map www.nursinglicensemap.com/resources/nursing-financial-aid
Oncology Nursing Society www.ons.org/develop-your-career/find-grants-and-scholarships
Sigma Theta Tau International www.sigmanursing.org/advance-elevate/scholarships

Assuring quality and rigor

In your proposal, include methods that will ensure project quality and rigor. Review the literature on the topic and consult your librarian and DNP advisor for ideas on maintaining rigor. Contact authors of the articles found during the literature review if applicable; for example, obtaining permission to use their instruments.

Select a model or framework such as the Johns Hopkins Nursing Evidence-Based Practice Model and the Iowa Model for Evidence-Based Practice to Promote Quality Care to guide project planning and implementation. Keep the project as simple as possible; if possible, avoid a complicated statistical analysis.5,6

Tap into specialists at your school, even those who aren't nurses. For example, an expert at an on-campus survey center may be able to review your data and tables. IRB personnel are helpful for providing guidance in differentiating QI and EBP from research during project development, and completing the IRB application.

Record all project-related activities including meetings with your mentor and advisor. Prepare questions prior to meeting to respect the mentor's time and ensure all concerns are addressed. Document responses for reviewing later. Make detailed notes each day to include logging project participant communications. These may provide useful information such as loss to follow-up data and can aid in creating a consort flow diagram from data collected during follow-up calls. Questions may be asked during your final project presentation, and it will be the details of each day that may help answer these questions (for example, documenting the patients' experience of your project).

Follow your project proposal as a map. Keep a copy with you, along with other pertinent project tools like scripts for telephone follow-up and data collection instruments. Checklists will be instrumental to track data collection and for data analysis. It's key to write down project-related information.

Preparing to write

The medical librarian can help to create search terms and find relevant literature. It's especially useful to use Medical Subject Heading (MeSH) terms for future publication purposes. Build an organized repository of articles needed and save electronic/print versions.

A reporting guideline, the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) is helpful for writing the manuscript and for publication requirements.7

Identify journals that accept your topic and QI or EBP manuscripts. The International Academy of Nursing Editors (INANE) keeps a directory of nursing journals, which may help with identifying other possible journals.8 Examine exemplar articles in the chosen journal to evaluate acceptable writing styles and referencing. Follow author guidelines for the journal selected for publication.

Reference as you go along because referencing can be a time-consuming task. Document the date when the articles were accessed for all articles because this may be required for reference style.

Consult with a statistician to help develop and clarify the data analysis section. Data analysis reference books can be helpful. Statisticians may be found in schools of nursing, libraries, and public health schools.

The writing process takes time, so budget time for it and don't rush. Seek expertise from faculty and peers for review and critical feedback. Consider reading the paper out loud as part of your internal editing process. Consult your school's writing center. Seek editing expertise. Articles critiquing student publication can be helpful for avoiding pitfalls. (See Table 2.) Document your coauthor's contributions; this may need to be declared during publishing.

Table 2: - Useful resources for DNP projects
  1. Books

    • American Psychological Association. Publication Manual of the American Psychological Association: The Official Guide to APA Style. 7th ed. American Psychological Association; 2019.

    • Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 4th ed. Philadelphia, PA: Wolters Kluwer; 2019.

    • Pallant J. SPSS Survival Manual: A Step-By-Step Guide to Data Analysis Using IBM SPSS. 6th ed. Maidenhead, Berkshire, England: McGraw Hill; 2013.

    • Sylvia ML, Terhaar MF. Clinical Analytics and Data Management for the DNP. 2nd ed. New York, NY: Springer Publishing Company; 2018.

    • Wood MJ, Kerr JC. Basic Steps in Planning Nursing Research: From Question to Proposal. 7th ed. Sudbury, MA: Jones and Bartlett Publishers; 2011.

  1. Publications

    • Carter-Templeton H. Converting a DNP scholarly project into a manuscript. Nurs Author & Editor. 2015;25(1):1-4.

    • Kennedy MS, Newland JA, Owens JK. Findings from the INANE survey on student papers submitted to nursing journals. J Prof Nurs. 2017;33(3):175-183.

    • Ogrinc G, Davies L, Goodman D, et al. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25:986-992.

    • Resnick R. Publishing a DNP capstone: the where, what and how. Geriatr Nurs. 2013;34(2):95-97.

    • Nicoll LH, ed. Nursing journals directory. Nurs Author & Editor. www.onlinelibrary.wiley.com/page/journal/17504910/homepage/nursing-journals-directory.


Disseminating your work

The final project presentation is a professional presentation that may take one or more of these formats: public oral presentation, video presentation, poster and podium presentation, and publication.1 Virtual final presentations have become common due to the pandemic.

Begin creating the draft for the final presentation as work on the manuscript progresses. Seek feedback from practice experts, faculty, and presentation experts regarding the slideshow that will accompany the presentation. Consult with graduating doctoral students to provide critical feedback on the presentation. Avoid overcrowding slides with too many words, and limit animations.

Rehearse with faculty and peers. It's helpful to rehearse with someone who has previously completed a final project presentation. Practice is necessary even if these persons are unavailable. Plan a practice run in your presentation site. Test the equipment. Consider questions that may be asked and prepare answers especially for limitations you encountered (for example, loss to follow-up). Seek opportunities to prepare with a mentor, DNP program director, a doctoral nursing graduate student, or a graduate of a doctoral nursing program. Send the presentation slides to all coauthors for review and feedback. Prepare intentionally with a strategy to monitor the timing of your presentation. Invite a peer to time you during the presentation.

After the DNP program is completed, consider presenting the final project at a professional conference, such as those held by Sigma Theta Tau International, in front of a general audience. The best targeted audience is specific to your topic; for example, the American Association of Heart Failure Nurses' conference offers a targeted audience for a heart failure project. Many conferences have changed to a virtual format due to the pandemic. Be prepared to be flexible with these new changes and requirements. Plan ahead to meet deadlines for abstract submissions. Follow abstract guidelines carefully in developing your abstract.

Support success

As DNP programs continue to grow, strategies for successful completion are timely and relevant. Fostering the potential of DNP graduates to optimize healthcare outcomes is necessary in a time of extraordinary change and uncertainty in healthcare.

REFERENCES

1. American Association of Colleges of Nursing. The doctor of nursing practice: current issues and clarifying recommendations, report from the Task Force on the Implementation of the DNP. 2015. www.aacnnursing.org/Portals/42/News/White-Papers/DNP-Implementation-TF-Report-8-15.pdf.
2. Volkert D, Johnston H. Unique issues of DNP students: a content analysis. Nurs Educ Perspect. 2018;39(5):280–284.
3. Grossman S, Kazer MW, Moriber N, Calderwood P. Revising a doctor of nursing practice program in response to student focus group feedback. J Doct Nurs Pract. 2016;9(1):51–54.
4. Hlabse ML, Dowling DA, Lindell D, Underwood P, Barsman SG. Supports and barriers to successful progression in a DNP program: students' and graduates' perspectives. Nurse Educ. 2016;41(5):256–261.
5. Dang D, Dearholt S, Bissett K, Ascenzi J, Whalen M. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines. 4th ed. Indianapolis, IN: Sigma Theta Tau International; 2022.
6. Iowa Model Collaborative. Iowa model of evidence-based practice: revisions and validation. Worldviews Evid Based Nurs. 2017;14(3):175–182.
7. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25(12):986–992.
8. International Academy of Nursing Editors. Directory of nursing journals. 2019. www.nursingeditors.com/journals-directory.
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