nurse leader dnp capstone projects evaluation an action framework

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Nurse Leader DNP Capstone Projects Evaluation: An Action Framework.

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Watson CA 1
Joseph ML 2

Journal of Doctoral Nursing Practice , 01 Oct 2018 , 11(2): 100-106 https://doi.org/10.1891/2380-9418.11.2.100 PMID: 32745015

Abstract

Conclusions, implications for nursing, full text links .

Read article at publisher's site: https://doi.org/10.1891/2380-9418.11.2.100

An examination of the rigor and value of final scholarly projects completed by DNP nursing students.

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Understanding the Basics of a DNP Project
How to Develop a DNP Project Using an Evidence-Based Approach
Stages and Components of a DNP Project
DNP Project Ideas

A 10-year evaluation of projects in a doctor of nursing practice programme

AUTHOR CONTRIBUTION

Associated Data

Aims and objectives:.

The role of professional doctorates is receiving increased attention internationally. As part of building the rigour and scholarship of these programmes, we assessed projects undertaken as part of a doctor of nursing practice (DNP) programme at Johns Hopkins University. Recommendations for programme development in professional doctorates are provided.

Background:

Past research has described the methodologic limitations and dissemination of DNP projects. However, few studies have provided recommendations for strengthening these projects and alternative strategies for achieving scale in larger student cohorts.

A descriptive study reported in accordance with STROBE guidelines.

From 2009–2018, 191 final DNP project reports were obtained from the DNP programme administrator. Essential project characteristics from the papers were extracted, including use of theoretical framework, design, setting, sample and dissemination through publication. To determine whether the results of the projects had been published, the title and student’s name were searched in Google Scholar and Google.

Of the 191 projects, 83% focused on adults and 61% were conducted in the hospital setting. Sample sizes ranged from 7 to 24,702. Eighty per cent of the projects employed a pretest/post-test design, including both single and independent groups. The projects spanned six overarching themes, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment. Twenty-one per cent of the project findings were published in scholarly journals.

Conclusions:

Conducting a critical review of DNP projects has been useful in refining a strategy shifting from incremental to transformative changes in advanced practice.

1 |. INTRODUCTION

As nursing is a practice discipline, there is a strong movement to recognise this significance at the level of the terminal degree ( Fulton, Kuit, Sanders, & Smith, 2012 ). As long ago as the late 1970s, there have been widespread calls worldwide to bring doctoral education closer to practice ( Yam, 2005 ). The professional doctorate has emerged internationally to satisfy university requirements for a doctoral degree and meet the needs of various professional groups by preparing students to work within a professional context ( Yam, 2005 ). The professional doctorate is widespread and increasingly adopted by varied professions, often making it challenging to clearly delineate this credential between disciplines. However, the 2005 task force by the Council for Higher Education Accreditation and Council of Graduate Schools identified a number of core characteristics, recommending that the professional doctorate should (a) address an area of professional practice where other degrees are not currently meeting employer needs, (b) emphasise applied or clinical research or advanced practice and (c) include leaders of the profession who will drive the creative and knowledge-based development of its practices and the development of standards for others ( CGS in the USA, 2007 ; DEST, 1997 ). Professional doctorates have also grown more prevalent internationally ( CGS, 2006 ; CGS in the USA, 2007 ; DEST, 1997 ; Mellors-Bourne, Robinson, & Metcalfe, 2016 ) with the doctor of nursing practice (DNP) being one such professional doctorate that has been developed in recent years ( CGS in the USA, 2007 ).

The professional doctorate typically requires students to complete a dissertation or project to fulfil the requirements of a doctoral degree ( CGS in the USA, 2007 ). In 2015, the American Association of Colleges of Nursing (AACN) issued a report from the Task Force on the implementation of the DNP with a section addressing DNP projects. This document explained that DNP programmes prepare nurses in advanced nursing practice to influence health care outcomes at the individual or population level. It also provided six key elements that should be present in all DNP projects: (a) focus on a change impacting healthcare outcomes, (b) systems or population approach, (c) demonstration of implementation in the appropriate arena of practice, (d) plan for sustainability, (e) evaluation of a process and/or outcomes and (f) provide for future practice scholarship ( AACN, 2015 ). In 2018, a report from AACN provided more information on the scholarship of practice and gave several examples of projects in this category. While the report mentions the translation of research, quality improvement initiatives and the use of big data and system-wide data in the scholarship of practice, it avoids being overly prescriptive about methods to use in the scholarship of practice ( AACN, 2018 ). There have been several papers in the literature describing limitations in the design and reporting of DNP projects both within and across DNP programmes. The Johns Hopkins University School of Nursing is in its 130th year as a school and 10th year as a DNP programme. The authors take this occasion to describe and critique the DNP projects conducted by students in our DNP programme since its outset and provide recommendations to strengthen our programme that we hope may be useful to faculty in other schools with DNP programmes.

2 |. BACKGROUND

There have been several papers in the nursing literature between 2013–2019 that have described curricular and educational approaches to guiding students in the development of DNP projects ( Brown & Crabtree, 2013 ; Kirkpatrick & Weaver, 2013 ; Waldrop, Caruso, Fuchs, & Hypes, 2014 ), DNP project topics ( Howard & Williams, 2017 ; Minnick, Kleinpell, & Allison, 2019 ) and the quality of measurement and analyses used in DNP project reports across schools in the USA ( Dols, Hernandez, & Miles, 2017 ; Roush & Tesoro, 2018 ). Roush and Tesoro (2018) examined 65 DNP project reports stored in the electronic dissertation and thesis database, ProQuest®. The authors reported substantial methodological limitations in the project reports including inadequate description of the methods used for sample selection, intervention implementation and data analyses. The authors had several recommendations including greater attention to teaching these methods and publication of the DNP projects to allow for ongoing evaluation across schools.

Earlier reports of DNP projects at Johns Hopkins University School of Nursing included a report by Terhaar and Sylvia in 2015 examining 80 DNP project reports from the first five years of the DNP programme. The most common method of analysis of project findings was descriptive–comparative and more than half of the students used a pretest/post-test design. The authors noted that the scope and complexity of the projects increased from the first cohort to the fifth cohort and that students in the earlier cohorts were more likely to examine changes in knowledge than students in the later cohorts. In another paper describing publication outcomes of DNP students at Johns Hopkins University School of Nursing, Becker, Johnson, Rucker, and Finnell (2018) described the 156 students enrolled in between 2009–2016 and any publications that they had during their studies and after graduation. Fifty-eight (37%) students published their DNP Project papers and 20 (13%) published integrative reviews of the literature.

2.1 |. Description of the Johns Hopkins University School of Nursing DNP Executive Program

Johns Hopkins University School of Nursing launched a Post-Master’s DNP Executive Program in 2008 that was accredited by the Maryland Higher Education Commission and the Commission on Collegiate Nursing Education. The six-semester programme includes coursework in quality improvement for evidence-based practice, graduate-level biostatistics, finance, informatics, health policy and leadership. At least one full-time faculty member and an organisational mentor guide the student in completing a DNP Project that is relevant to the student’s practice. DNP project proposals are reviewed by the Johns Hopkins University Medicine Institutional Review Board (IRB). Most have been classified as performance improvement projects. A few have undergone an IRB review for human subjects research. Due to the large increases in number of students and subsequently DNP projects, the Johns Hopkins University School of Nursing has established its own internal IRB, in collaboration with the Johns Hopkins University Medicine IRB, to review future DNP projects starting in 2020. The School of Nursing internal IRB will decide whether projects are performance improvement, if projects are thought to be human subjects research, they will still be submitted to the Medicine IRB for review.

Johns Hopkins University School of Nursing saw its first DNP cohort graduate in 2009. The authors take this occasion on the 10th year of the DNP programme and the 130th year of Johns Hopkins University Nursing to describe the DNP projects completed by students in this programme up to 2018. In this descriptive study, we follow 10 cohorts of students and aim to (a) evaluate the publication of project outcomes over time; (b) describe the components of the DNP projects, including the topics addressed in the projects, theoretical underpinnings, designs, samples and methods of analysis; and (c) recommendations for the future direction of DNP projects and education. We offer recommendations for strengthening the DNP projects at our own school including a template to guide construction and reporting of the projects and a summary of common methods of analysis employed in these projects that may be useful to faculty and students in other schools with DNP programmes.

3 |. METHODS

Using the method of a descriptive study design, assessment of 191 projects submitted from cohorts graduating between 2009–2018, as part of course work requirements were assessed. Final versions of the DNP project reports were submitted to the DNP programme administrator to be retained on file as part of the collection of scholarly products of the DNP programme. The authors extracted essential project characteristics from the papers including use of theoretical framework, design, setting, sample and dissemination through publication. Three of the authors performed the initial extraction to an Excel spreadsheet. One co-author extracted information from all 191 projects on the DNP project theme, theoretical framework, sample and setting. The projects were then split evenly between the two co-first authors for verifying the previously extracted information and to extract additional information on project design, analysis and publication. All authors discussed any discrepancies and reached consensus to validate the project characteristics and outcomes. To determine whether the results of the projects had been published at any point since the student graduated from the programme, the two co-first authors searched the title and student’s name, from the list of programme graduates obtained from the DNP programme administrator, in Google Scholar and Google. In some cases when no publications were discovered in Google Scholar and Google, the authors also searched PubMed and CINAHL. The study was carried out according to the STROBE guidelines (see Appendix S1 ). This study was deemed exempt research by the Johns Hopkins University School of Medicine Institutional Review Board (IRB00248926).

4 |. RESULTS

The authors analysed all 191 DNP Executive project reports and Table 1 provides a summary of the key elements of the DNP projects. Eighty per cent of the projects employed a pretest/post-test design which included both single and independent groups. Sample sizes ranged from 7 to 24,702. Eighty-three per cent of the projects focused on adults and 61% were conducted in the hospital setting. Sixty-seven per cent of the projects did not specify a conceptual framework used.

DNP project characteristics

4.1 |. Project themes

The main themes that were the focus of the DNP projects and one or two examples by theme are included in Table 2 . Six overarching themes were identified, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment. Many of the projects spanned multiple of the identified themes.

DNP project themes

4.1.1 |. Process improvement

Process improvement projects sought to increase efficiency of health care delivery related to human factors and systems integration. The processes examined included screening for disease conditions and health risks, documentation of care processes, adherence to guidelines, time to healthcare delivery, time to discharge and reduction of readmission rates. One project involved establishing a command centre for a nearly 1,000 bed hospital and examined admissions and interhospital transfers resulting in increased efficiency in these processes throughout the hospital ( Newton & Fralic, 2015 ).

4.1.2 |. Clinician development

Clinician development refers to improving clinician skills, knowledge and abilities. Projects focused on leadership, mentorship, educational approaches and interprofessional training. Multiple dimensions of communication were examined including the content and timing of communication and the confidence of the clinician communicating. Many of these projects measured knowledge before and after an educational intervention. One of these projects involved examining the effectiveness of short, frequent training sessions on nurses’ retention of initial cardiopulmonary resuscitation priorities and the most efficient training interval ( Sullivan et al., 2015 ).

4.1.3 |. Patient safety

Patient safety included patient protection from medical errors and other harms, including projects associated with reducing medical errors and improving medication administration, infection control, and the informed consent process. One of these projects involved examining the effectiveness of a mandatory computerised ordering tool that allowed for early interdisciplinary communication and evaluation by a Peripherally Inserted Central Catheter (PICC) team for suspected PICC infections and thromboses, on decreasing premature PICC removal rates and associated complications ( Kim-Saechao, Almario, & Rubin, 2016 ).

4.1.4 |. Patient outcome improvement

Projects focused on patient outcome improvement in the healthcare setting assessed various aspects of health, lifestyle behaviour, self-care, symptom management, knowledge and satisfaction. One of these projects involved examining the effectiveness of an education programme and increased patient support options, as well as increased provider education on continuous positive airway pressure adherence ( Dinapoli, 2015 ).

4.1.5 |. Access to care

Access to care refers to connections to care, such as improving patient attendance at follow-up appointments, and transitions of care, such as from the acute to the primary care and the paediatric to adult setting. One of these projects involved examining the effectiveness of a telemental health programme, in a rural setting, in improving time to consult as compared to face-to-face groups ( Southard, Neufeld, & Laws, 2014 ).

4.1.6 |. Workplace environment

Workplace environment included patient factors such satisfaction but also improvement of the work environment for nurses and other health professionals. One of these projects involved determining whether the implementation of a standardised handoff tool, reorganising interrupting processes and training on effective handoff communication could reduce the number of interruptions per intershift report ( Younan & Fralic, 2013 ).

4.2 |. Settings

Sixty-one per cent of projects took place in hospital settings including emergency rooms, inpatient medical or surgical units, critical care areas and the operating room. Thirty-one per cent of projects took place in schools, outpatient and community settings. An additional 3% of projects bridged both the hospital and outpatient/community settings.

4.3 |. Samples

Samples included patients, family members, community members, clinicians, students and healthcare support staff. Eighty-three per cent of projects included adult samples and 5% of projects included paediatric samples. An additional 10% of projects included both adult and paediatric samples. Some projects examined a single race or ethnic group. The locations for the projects relative to the university were local, national and global representing countries on multiple continents in North and Central America, Africa and the Middle East.

4.4 |. Theoretical framework

Thirty-three per cent of the reports described a theoretical framework that was used to guide the project. The most common were evidence translation models such as The Knowledge to Action Framework ( Graham et al., 2006 ), the Johns Hopkins University Translating Evidence into Practice Model ( Dang & Dearholt, 2017 ) and the Ottawa Model of Research Use Framework ( Logan & Graham, 1998 ). Some were broadly focused such as Rogers’ Diffusion of Innovation ( Rogers, 1962 ) and process improvement theories including The Content and Process Model of Strategic Change ( Pettigrew & Whipp, 1992 ). Others were focused on specific conditions such as chronic illness and addiction disorders. Examples of these included the Chronic Care Model ( Kane, 1999 ) and the National Center for HIV/AIDS, Viral Hepatitis, STDs and TB Prevention Framework ( CDC, 2009 ).

4.5 |. Designs

The various types of designs used for the projects are summarised in Table 1 and represent the breadth of advanced nursing practice. Eighty per cent of the projects used a pretest–post-test design and one of these was a mixed-methods study design. Some used the same sample while others used two different samples before and after the introduction of an intervention. Still others used post-test only with a historical comparison group. The remainder of the projects used a variety of designs including single sample post-test only, randomised controlled trial design, systematic review and proposal of strategies. Five of the DNP projects used a randomised controlled trial design. However, in these designs the control group largely consisted of usual care and blinding was not used. Four of these randomised controlled trials employed the typical two group, intervention and control design and one study employed a multi-group design.

4.6 |. Analyses

The majority of the projects used univariate analysis including independent or paired t test and chi-square. Only a few of the projects used regression analysis. Most students used the statistical package, SPSS to conduct their analyses. Most reports did not include a power analysis.

4.7 |. Sustainability

Eighteen per cent of reports included a plan for sustainability of the project. For example, many projects involved the adoption of the new performance improvement process in the unit practice or a plan was developed to adopt the new practice in the future.

4.8 |. Publications

All projects were presented orally or as posters. Publications were discovered for 21% of the projects reviewed in both nursing and interdisciplinary journals. The impact factor of these journals ranged from 0.1 to 5.9. These included both specialty journals, such as Resuscitation, Progress in Transplantation and Advances in Neonatal Care, and journals focused on performance improvement such as Journal of Nursing Care Quality.

5 |. DISCUSSION

Many of the projects undertaken as part of the DNP degree were designed to describe the implementation of a new evidence-based practice intervention and the patient and provider outcomes that followed within a particular practice setting. The evolution of our DNP programme has occurred in the context of significant development in both implementation science and quality improvement methodology. Implementation science is the study of methods for promoting the adoption and integration of evidence-based practices, interventions and policies into routine practice and has been codified in frameworks such as the Consolidated Framework for Implementation Research ( CFIR, 2019 ). Similarly, the Standards for QUality Improvement Reporting Excellence have increased both the rigour in design and reporting of quality improvement strategies ( Ogrinc et al., 2016 ). A strength of the DNP programme at Johns Hopkins University is the collaboration among faculty with research and advanced practice expertise in teaching and guiding DNP students in their DNP projects. This collaboration results in a range of methodological approaches to these projects. Cygan and Reed (2019) have described an approach to collaborative DNP-PhD scholarship that is consistent with what we have described here.

Within the curriculum, there is an emphasis on dissemination and all students present their work as an oral presentation or poster presentation at a School of Nursing conference to which our practice partner institutions are invited. In addition, 21% of students generated a peer-reviewed publication reporting the DNP project outcomes. As part of knowledge sharing and exchange, we also encourage students to place their project in the Sigma Theta Tau Virginia Henderson Repository ( Sigma Theta Tau, n.d. ).

5.1 |. Limitations of this review

This review of DNP projects has some limitations. First, we report that 21% of the projects generated publications. But it can take two or more years for students to publish a paper from their projects so this publication rate may be artificially low. Second, the DNP projects included in this review are solely from the Post-Master’s DNP Executive Track of the DNP programme at Johns Hopkins University School of Nursing. Thus, the findings may not be generalisable to the Post-Baccalaureate DNP Advanced Practice Track at Johns Hopkins University School of Nursing. However, we believe that our recommendations to improve our DNP Executive Track and the guidelines we provide will be useful for faculty in both Tracks. Finally, since this paper has looked at 191 DNP projects over the past 10 years, we provided a general overview of the findings. Faculty may wish to examine various subgroups by population, setting or type of intervention/practice guideline, to provide further detail. More importantly, these data reflect the maturation of the DNP programme and the implementation of the DNP essentials ( AACN, 2006 ) focusing on advanced nursing practice that is evidence-based, innovative and applies credible research findings. We have some exciting new programmes, including the dual degree programmes DNP-PhD and DNP-MBA which will extend our domain-specific knowledge to advance patient outcomes. As many programmes strive internationally to increase the focus on practice doctorate, this reflective analysis provides some useful signposts for increasing both the rigour and programme relevance.

5.2 |. Strengths of projects

One strength of the projects that reflects the strength of the Johns Hopkins University School of Nursing was the international diversity of the projects from countries in North and Central America, Africa and the Middle East. The projects reflected the diversity of nursing practice across these countries such as the nurses’ role in patient education and in leading process improvement initiatives in the practice setting.

Another strength was the number of publications that were generated. We found that 21% of the projects resulted in publication. This was lower than the 37% in a previous report that included DNP projects from Johns Hopkins University School of Nursing up to 2016 by Becker et al. (2018) . This may be because these authors, in addition to searching the literature using PubMed and Google Scholar also accepted a print version of a publication provided by the graduate. For this paper, we only searched the literature electronically and did not also examine publications that the graduates provided that were not found in the literature search.

The diversity of the settings in which the projects were conducted demonstrated the opportunities for nurses to lead initiatives resulting in improvements in patient outcomes. They also demonstrate the rich learning opportunities for nurses in DNP programmes to learn from colleagues who practise across the spectrum of healthcare delivery.

5.3 |. Opportunities for future development of DNP projects

In this section, we discuss the implications of our findings for future directions and improvement in DNP projects and education.

5.3.1 |. DNP project reports

Most studies were designed to evaluate factors influencing the translation of an evidence-based intervention into practice. However, one limitation identified was that only 33% of the project reports included the translation framework used although translational frameworks are a required part of the development of their project proposal. Moving forward, we have increased our teaching and guidance about how these frameworks guide the development of the project and how to incorporate the framework into the project report. The majority of our students did not report a power analysis when it would have been appropriate given the design. In order to promote accurate interpretation of the findings, this has become a requirement in cases where the significance of differences between pretest and post-test within a single group or between two or more groups is being assessed. Students have the opportunity to learn these methods in the curriculum and also have access to a designated statistician for consultation.

In order to promote coherence between the design used in the project and analysis of findings, we have developed a template to guide faculty and students that may be useful to faculty and students in other DNP programmes ( Appendix S2 ). We have also included a description of common DNP project designs ( Figure 1 ) and analyses ( Table 3 ) to guide faculty and students in project development.

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DNP project designs

Guidelines for analysis by design

5.3.2 |. Scope and depth of DNP projects

Opportunities for advancing the scope and depth of the projects in the future may involve group approaches that would allow two or more students to work on one project. This would allow student groups to focus on several dimensions of the same project. For example, among a student group interested in studying readmission rates among patients with congestive heart failure several dimensions the students could address include the following: lifestyle education, patient and caregiver knowledge, symptom management and follow-up care. This would enable each student to select one dimension and working together, and develop a more comprehensive and effective improvement project. Project design courses would need to incorporate elements on developing cohesive interventions supported by practice guidelines and research findings.

While the AACN supports group projects in which each student is accountable for at least one component of the project and a deliverable ( AACN, 2015 ), we have not yet had a group DNP project at Johns Hopkins University. Moving ahead, we are considering how we might engage students in group projects simultaneously or sequentially at different sites or focusing on different aspects of the same project. We are now finding that when the practice sites offer several potential projects to students and students select from among these, the practice site is more likely to be invested in DNP projects.

5.3.3 |. Sustainability of DNP projects

As noted, only 18% of the project reports included a plan for sustainability. Moving forward, the need for sustainability and ideas on how to achieve sustainability should be included in the curriculum at the beginning of project development. Potential methods for promoting sustainability of DNP projects may be through the pursual of longitudinal DNP projects with more than one DNP student participating. Another aspect in the future that will promote sustainability will be a more formal process for having the practice sites select the projects and having DNP students choose from among projects that are a priority to the clinical partner agency. Some challenges in having partner agencies select the project are that they may want to use a self-designed measure that has not been validated. In the light of this, the programme now seeks to emphasise the need to find validated instruments and guides students to the available resources in order to accomplish this goal.

The process of analysing these projects provided us with insight into some strengths and limitations of our programme and has guided our plans for improving our teaching and learning strategies in this programme. This comprehensive review of DNP projects is a critical process in striving for excellence in academic programming and ensuring fidelity to the DNP essentials in fostering advanced practice. We also consider that the recommendations based on this review have relevance for professional doctorates internationally.

In Table 4 , we provide additional recommendations for DNP programmes while conducting programme evaluation.

Recommendations for DNP programme evaluation

6 |. CONCLUSION

Our review has found that process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment were a key focus of projects underscoring the relevance of the practice-focused degree. Ensuring graduates of clinical doctorates have the knowledge, skills and competencies for practice development is of critical importance. Ensuring that the capstone project demonstrates these attributes is essential for programme rigour.

7 |. RELEVANCE TO CLINICAL PRACTICE

DNP scholarly projects are a critical component of DNP curriculum in order to prepare nurses in advanced nursing practice to influence health care outcomes at the individual or population level. Therefore, evaluation of DNP scholarly projects is essential to improving DNP curriculum and ensuring DNP graduates are prepared to lead change in complex healthcare delivery systems. The findings from this descriptive study will provide insight to faculty at other schools with DNP programmes on ways to improve DNP projects that may lead to greater impact on clinical practice.

What does this paper contribute to the wider global clinical community?

Outlines the importance of programme evaluation in professional doctorate programmes
Profiles the challenges and opportunities for developing and refining a project aligned with delineated competencies
Provides recommendations for achieving methodological rigour and programme efficiencies

Supplementary Material

S1 strobe statement checklist, appendix s2 dnp project template, acknowledgements.

The authors would like to acknowledge Denise Rucker, Academic Administrator for the DNP programme, for providing the DNP project report documents to review for this paper.

This study was supported in part by a grant from the Maryland Higher Education Commission (NSP II-17-107). RT is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under award number T32DK062707 and an award by the American Heart Association. ES is supported by the National Institute of Nursing Research of the National Institutes of Health under award numbers F31DR017328 and T32 NR012704.

Sponsors had no involvement in the study design; collection, analysis and interpretation of the data; in writing of the report; or in the decision to submit the article for publication.

SUPPORTING INFORMATION

Additional supporting information may be found online in the Supporting Information section.

Relevance to clinical practice: Programme evaluation is critical in order to sufficiently prepare nurses in advanced nursing practice to influence healthcare outcomes at the individual or population level.

CONFLICTS OF INTEREST

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nurse leader dnp capstone projects evaluation an action framework

All about the DNP project

Understanding the process helps ensure a successful project..

The final doctor of nursing practice (DNP) project provides students with the opportunity to systematically translate the best current evidence into practice. However, variability in how projects are implemented exists among programs. In response, the American Association of Critical Care Nurses (AACN) commissioned white papers from two internal task forces: the Implementation Task Force (ITF) and the Advanced Practice Registered Nurse Clinical Training Task Force. The ITF’s white paper, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations, describes and clarifies the characteristics of DNP graduate scholarship (including the DNP project), efficient resource use, program length, curriculum considerations, practice experiences, and collaborative partnership guidelines. The Advanced Practice Registered Nurse Clinical Task Force white paper, Re-envisioning the Clinical Education of Advanced Practice Registered Nurses , explores how APRN education can adapt to include more simulation opportunities, academic-practice partnerships, competency-based assessments, and nontraditional APRN clinical education models, such as technology or informatics. However, the AACN doesn’t make specific recommendations with regard to the final DNP project, pointing instead to the DNP Essentials to explain the project’s scope and depth.

This article discusses the issue of project variability, then explores DNP project fundamentals to help eliminate ambiguity and confusion and broaden students’ understanding of the project’s significance. Before initiating a DNP project, several key elements—mentoring, time management, organizational and academic support, potential institutional review board approval, and planning for dissemination—must be in place. (See 8 steps to completion.)

8 steps to completion

Students should take these eight steps to complete their doctor of nursing practice (DNP) projects.

Identify and obtain approval for the area of interest.
Write a proposal.
Create a project timeline.
Acquire institutional review board approval (if needed).
Implement project.
Write final report.
Present an oral presentation.
Disseminate the project.

Source: Anderson et al. 2015.

DNP project variability

With the increased volume of new programs and growing interest in the DNP degree, the profession must clarify the scope of the final project, including implementation, impact on system and practice outcomes, extent of collaborative efforts, dissemination, and degree of faculty mentorship and oversight. Some universities require students to complete a practice improvement project over the span of a course, whereas others require students to initiate an evidence-based practice (EBP) innovation project when they begin the program and continue it through the final semester.

Despite projects’ various forms, many elements—including planning, implementation, evaluation, and sustainability—must be consistent across programs. Without concrete guidelines, programs have employed several interpretations, including portfolios, case studies, systematic reviews, and writing projects. (See Project dissemination variability. )

Project dissemination variability

Several doctor of nursing practice (DNP) project types are included in the DNP Essentials . The table compares the American Association of Colleges of Nursing’s (AACN’s) white paper recommendations and AACN DNP Tool Kit with regard to dissemination.

Reasons for variability include:

lack of faculty familiarity with quality improvement (QI) and EBP methods
strain on faculty capacity and time commitment for project completion
lack of faculty expertise in DNP education
inability to find clinical sites that allow students to implement projects
lack of DNP faculty resulting in programs led by PhD faculty
lack of graduate-level writing skills
differing student education levels (for example, BSN-DNP, MSN-DNP)
time constraints within the iterative process requiring multiple revisions of written work.

Although some program variability is expected, concern about the lack of adherence to the DNP Essentials exists . In response, the AACN is committed to enhancing program congruency. To ensure consistency, post-master’s and post-baccalaureate DNP students (who begin their doctoral programs with different education and practice backgrounds) should graduate with the same comprehensive skill set as described in the DNP Essentials .

Project fundamentals

The DNP project, previously called the capstone project or the scholarly project, should demonstrate translation of acquired knowledge into clinical practice and exhibit the student’s growth in clinical knowledge, expertise, and use of the DNP Essentials and DNP Tool Kit. (See DNP Essentials and Tool Kit.)

DNP Essentials and Tool Kit

The American Association of Colleges of Nursing’s (AACN’s) eight DNP program essentials prepare nurse leaders for advanced practice.

Scientific underpinnings for practice
Organizational and systems leadership for quality improvement and systems thinking
Clinical scholarship and analytical methods for evidence-based practice
Information systems/technology and patient care technology for the improvement and transformation of healthcare
Healthcare policy for advocacy in healthcare
Interprofessional collaboration for improving patient and population health outcomes
Clinical prevention and population health for improving the nation’s health
Advanced nursing practice

DNP Tool Kit

The DNP Tool Kit, which continues to evolve, provides schools with the resources for formatting a DNP program. It combines information from the DNP Essentials and recommendations from the AACN DNP white paper to provide templates, exemplars, frequently asked questions, and other resources.

Projects can focus on QI, executive outcomes management, or an EBP change initiative aimed at strengthening healthcare. (See DNP project examples.)

Project examples

The following are examples of doctor of nursing practice (DNP) projects completed by the authors when they were DNP students.

Quality improvement projects

After evaluating evidence-based practices for type 2 diabetic foot management, the student developed a new standardized protocol for staff education and patient care practices for foot care assessment and management.
The student reinforced nursing education as a means to overcoming adherence barriers to an evidence-based sedation protocol for improved ICU outcomes.

Evidence-based practice projects

The DNP student used an evidence-based survey tool to measure student anxiety when caring for dying patients. Based on the results, an education module was developed to help students manage their stress.
To decrease nonurgent use of the emergency department and increase fever knowledge, the student created an educational program for caregivers of pediatric patients.

Guideline development and improvement project

After a systematic evidence search, the student developed a neonatal abstinence syndrome treatment guideline to standardize care and reduce treatment duration, symptom severity, length of hospitalization, and costs.

While working on their projects, students learn to build strong, collaborative partnerships with stakeholders and mentors.

DNP programs throughout the United States require students to conduct various types of projects, which contributes to ongoing confusion about DNP preparation and role. However, all projects should reflect the DNP Essentials in a single, cumulative work that evolves as the student progresses through the program. In addition, this scholarly synthesis should serve as a platform for future scholarship after graduation.

According to the AACN DNP Tool Kit, all projects should:

focus on a change that impacts the outcome of healthcare through direct or indirect care
have a systems (micro-, meso-, or macro-level) or population/aggregate focus
demonstrate implementation in the appropriate practice area
include a plan for sustainability (it should take into account financial, systems, or political realities, not only theoretical abstractions)
include an evaluation of processes and outcomes (formative or summative).

Frequently, a project is the outcome of a student’s identified need for improvement in clinical practice or patient outcomes guided by the spirit of inquiry. The project results are a compendium of graduate education immersed in nursing leadership, education, health policy, or clinical practice.

Dissemination

All DNP projects should emphasize positive change that advances quality outcomes, attention to systems thinking, strategies for sustainability with an appraisal of processes and outcomes, and a structure for future practice. The expectation is that DNP-prepared nurses will contribute to the body of knowledge in nursing practice by sharing their work with others so that they can apply it to their practice roles. Platforms for dissemination include social media, peer-reviewed journals, presentations, professional conferences, brochures, posters, policy briefs, organizational team meetings, media interviews, academia, and press releases. Many programs require students to summarize their projects for publication in a peer-reviewed journal.

The final requirement of the DNP project is a student’s presentation before their institution’s doctoral panel. In this venue, students deliver elemental details about their project’s processes and impact, including purpose, evidence synthesis, project design, data analysis, frameworks, and dissemination.

Be a trailblazer

DNP students’ final projects reflect the culmination of their educational journey and prepare them to share their work with others to benefit patients, the healthcare system, and the nursing profession. The result is a body of information that bridges the gap between research theory and clinical practice. As trailblazers, DNP-prepared nurses can empower other professionals to improve patient outcomes and achieve benchmarks for practice change supported by collaborative endeavors.

The following authors are DNP graduates from the University of Texas at Tyler in Tyler: Barbara Chapman is a family NP with the INTUNE Mobile Unit and assistant clinical professor in the school of nursing at The University of Texas at Tyler. Chiquesha Davis is department head of post-licensure programs, graduate programs, and assistant professor at Tarleton State University in Stephenville, Texas. Sonya Grigsby is a critical care NP at CHRISTUS Mother Frances Hospital in Tyler, adjunct nursing faculty at University of Texas at Tyler, and locum NP at OSF St. Francis Medical Center in Peoria, Illinois. Cyndi B. Kelley is a nurse manager in the special care nursery and chair of the doctoral collaboration council at Texas Health Presbyterian Hospital of Dallas and adjunct faculty in the ADN-to-BSN program at Grand Canyon University in Phoenix, Arizona. Rebecca Shipley is a family NP at CHRISTUS Trinity Mother Frances Health System. Christian Garrett is a DNP student at the University of Texas at Tyler, a family NP at CHRISTUS Trinity Mother Frances Hospital, and an adjunct professor in the school of nursing at The University of Texas at Tyler.

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American Association of Colleges of Nursing. The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations. August 2015. aacnnursing.org/Portals/42/DNP/DNP-Implementation.pdf

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DNP Capstone Project (NUR 7200, 7310, 8200, and 8350): Getting Started

Getting Started
Grey Literature
Madonna's DNP Capstone Collection

Planning & Designing a DNP Capstone Project

This guide provides a library research framework for the Capstone Project for the DNP program at Madonna University.

For more information about Madonna's Graduate Nursing program visit the DNP program page.

Assistance is available from our Chat with a Librarian service in the Ask a Librarian pullout box on the right side of the screen.

What is the DNP Capstone Project?

DNP students will develop a theory-driven Scholarly Project that reflects on a phenomenon of interest in nursing and includes development, implementation, evaluation, and dissemination components. The student works collaboratively with faculty and in partnership with health care organizations to implement and evaluate the results.

Through the Scholarly Project, students exhibit their advanced interpersonal and leadership skill development. This reflects the student’s ability to effectively and efficiently influence health care teams and systems for positive improvement to the delivery of patient care.

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Last Updated: Feb 13, 2024 2:25 PM
URL: https://library.madonna.edu/dnpcapstone

IMAGES

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COMMENTS

Nurse Leader DNP Capstone Projects Evaluation: An Action Framework
Objectives: The twofold purpose of this study was to identify the scope of nurse executive leadership practices, as demonstrated in final health systems' DNP Projects and propose a framework to guide evaluating health systems' DNP capstone projects. Methods: This qualitative study used content analysis to evaluate DNP project posters of 10 ...
Nurse Leader DNP Capstone Projects Evaluation: An Action Framework
The scope of nurse executive leadership practices, as demonstrated in final health systems' DNP Projects, is identified and a framework to guide evaluating health system's DNP capstone projects is proposed. Background: Little is known about available guidelines that can be used to evaluate health systems' Doctor of Nursing Practice (DNP) capstone projects.
Nurse Leader DNP Capstone Projects Evaluation: An Action Framework
Methods: This qualitative study used content analysis to evaluate DNP project posters of 10 health systems' DNP students graduating from one Midwestern college of nursing. Students were engaged in ...
Linking Process Improvement with DNP Projects ...
Nurse leader DNP capstone projects evaluation: an action framework. J Dr Nurs Pract. 2018; 11: 100-106. ... Nurse leader DNP capstone projects evaluation: an action framework. J Dr Nurs Pract. 2018; 11: 100-106. View in Article PubMed; Google Scholar; Biography. Ty Williams, DNP, ACNP-BC, FNP-BC, CNE, is Assistant Professor at Vanderbilt ...
Nurse Leader DNP Capstone Projects Evaluation: An Action Framework
This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy.
Advancing the Rigor of DNP Projects for Practice Excellence
Over a decade has passed since the Institute of Medicine1 first called for a restructuring of how health care professionals are educated. Since then significant changes have occurred, including the creation of the Doctor of Nursing Practice (DNP) degree focused on scholarly practice rather than research. In the context of an increasingly complex health care system and declining health outcomes ...
Strategies for successfully completing a DNP final project
Strategies for successful project planning, implementation, and evaluation are outlined, from identifying an evidence-based practice or quality improvement project, advisor, and practice mentor through completion, presentation, and dissemination of your work. Figure. Before a nursing student can graduate with a Doctor of Nursing Practice (DNP ...
DNP Capstone Project Guide
An example of how one DNP student followed this 5-step evidence-based process to develop a quality improvement project with the goal of reducing delays in treatment for patients with hand trauma: Step 1. A quality improvement project was initiated to avoid delays in care for patients with hand trauma. Step 2.
The Doctor of Nursing Practice Capstone Project ...
The DNP project is seen as the synthesis of the DNP education process (Nelson et al., 2013) and represents a minimum standard which has yet to achieve general agreement across many programs. The ...
PDF UNIT I Preparing for Your Capstone Project
Some DNP programs prefer the capstone project to be a practice portfolio that documents the impact of practice initiatives or outcomes resulting from practice. Another frequently used format is that of a practice change initiative. This can consist of a pilot study, a program evaluation, a quality improvement project, an evaluation of
Linking Process Improvement with DNP Projects: Strategies to Advance
Nurse leaders are positioned to play a pivotal role in creating opportunities for Doctor of Nursing Practice (DNP) projects. A formal process was established at one university school of nursing to match more than 50 DNP students with projects identified by several organizational nurse leaders. The initiative has benefited organizations through the improvement of expanded or extended practice ...
A 10-year evaluation of projects in a doctor of nursing practice
Project themes. The main themes that were the focus of the DNP projects and one or two examples by theme are included in Table 2. Six overarching themes were identified, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment.
DNP project fundamentals: steps to successful completion
8 steps to completion. Students should take these eight steps to complete their doctor of nursing practice (DNP) projects. Identify and obtain approval for the area of interest. Write a proposal. Create a project timeline. Acquire institutional review board approval (if needed). Implement project.
DNP Capstone Projects Exemplars of Excellence in Practice
This book focuses on exemplary, completed DNP capstone projects that have provided leadership for change in clinical practice, enhanced interprofessional collaboration, promoted advocacy and policy changes, or contributed to quality improvement in health care systems. Although several books have been written about creating capstone projects, this is the first to focus on exemplary, completed ...
The Doctor of Nursing Practice capstone project: consensus or ...
The focus of the dialogue was to discuss the intent and breadth of the DNP capstone project and how it demonstrates competencies, to consider in what way it differs from the PhD dissertation, and to identify the similarities and differences among multiple forms of the project in terms of scope and expected deliverables, as well as to examine ...
DNP Capstone Projects : Exemplars of Excellence in Practice
The book examines a variety of capstone projects from across the U.S.--quality improvement projects, strategic plans, advocacy, clinical case narratives, and other innovations--that demonstrate efficacy in clinical nursing practice outcomes and positive impact upon the health care environment.
PDF DOCTOR OF NURSING PRACTICE 2020 PROJECTS
The future of nursing is now as our 2020 DNP graduates lead interprofessional teams to create meaningful innovations that influence advanced nursing practice and healthcare. The DNP projects of the 2020 graduates cross geographical and discipline boundaries to bridge gaps in evidence and practice. Self-described change experts, their impact
DNP Final Project
The DNP final project is the student's original work that establishes them as a Hopkins Nursing clinical scholar. Completion of the project demonstrates the student has achieved the program outcomes and provides evidence of: Expertise in a particular practice arena. Critical evaluation of the evidence. Thorough, disciplined approach to ...
Linking Process Improvement with DNP Projects: Strategies to Advance
Developing Partnerships. Initially, outreach to nursing leaders at the academic medical center was done to identify priority projects or ongoing practice improvement initiatives that could benefit from involving a DNP student—either working on an expanded component or assisting with an evaluation element.
The Doctor of Nursing Practice Capstone Project: Consensus or Confusion
Sun G and Cherry B (2018) Using the Logic Model Framework to Standardize Quality and ... Huber D, Joseph M, Farag A and Watson C (2018) Nurse Leader DNP Capstone Projects Evaluation: An Action Framework, Journal of ... (2016) The Doctor of Nursing Practice Essentials in Action: Using the Essentials to Build a University-wide Automatic ...
DNP Capstone Project (NUR 7200, 7310, 8200, and 8350): Getting Started
DNP students will develop a theory-driven Scholarly Project that reflects on a phenomenon of interest in nursing and includes development, implementation, evaluation, and dissemination components. The student works collaboratively with faculty and in partnership with health care organizations to implement and evaluate the results.
Evidence-Based Communication Strategies to Improve ...
Patient satisfaction scores are among the most challenging measures to improve in the acute-care setting because of human factors' influence on behaviors. The aim was to implement an evidence-based communication framework to improve staff communication competence and increase patient satisfaction. All staff working on an in-patient unit at a hospital attended face-to-face educational ...
DNP Projects: Contributing Knowledge to the Field
"This isn't just about a grade. In the end, a student's DNP project should be sustainable for progress in the field of nursing and allow that student to move forward as a qualified health care leader." DNP Projects in Action. Kandace Williams, a graduate of the U of A DNP program, was completing her project during the height of COVID-19.