Three years ago, we began a tradition of designating the April issue as a special spotlight on the Doctor of Nursing Practice (DNP). The scholarly Capstone Project is a requirement for the DNP in most programs. The project must identify a current problem or need in clinical practice through evidence-based search strategies and critical appraisal of the literature. According to Zaccagnini and White, "...the project focuses on the application of evidence to the problem that was identified."1
The ultimate purpose in completing the project is the same for all students-to contribute to improving the quality of care and health outcomes for patients. A project's success depends on many factors, such as student and faculty commitment, time invested, academic rigor, communication skills, and personal/system supports.
APRNs taking leadership
This month, we feature three Capstone projects in which the primary author is an advanced practice registered nurse (APRN) who recently graduated from a DNP program. Two projects are focused on diabetic populations and one on older women. Esden and Nichols evaluated the efficacy of group diabetes care in an underserved population using a patient-centered approach with interactive diabetes self-management education as a strategy to improve patient outcomes.
Dewing, Belza, Zierler, and LaCroix also implemented an evaluation project looking at the effectiveness of a clinical decision support tool to improve the rates of bone mineral density screening in women (age 65) in a large health system.
Using critical appraisal, Gray, Drayton-Brooks, and Williamson synthesized the research evidence related to the efficacy of telephone support or follow-up calls for patients with uncontrolled diabetes to improve patient outcomes. All three demonstrate how the APRN can take a leadership role in beginning the process of change.
Redesigning U.S. healthcare
Nurses and our professional colleagues continually return to the Institute of Medicine's (IOM) 2010 report: The Future of Nursing: Leading Change, Advancing Health. The third key message in the report is that "Nurses should be full partners, with physicians and other healthcare professionals in redesigning healthcare in the United States."2 The second recommendation from the report encourages us to, "Expand opportunities for nurses to lead and diffuse collaborative improvement efforts."2 Improvements in quality of care, systems of care delivery, and most importantly, patient outcomes as evidenced in many DNP scholarly projects support full implementation of all the IOM recommendations. APRNs and other nurses are able to design, implement, and evaluate new models of care that are innovative, patient-centered, and cost-effective; involve interprofessional teams; make use of technology; and speak to the urgent need to allow nurses to practice to the full level of their education and training.
Nurses improving care
In 2012, when Health and Human Services Secretary Kathleen Sebelius announced the graduate nursing education awards, she stated, "Nurses are also an important part of improving care. Under the Affordable Care Act, we're moving towards a healthcare system that focuses on increased access to primary care, improved care coordination, and an emphasis on prevention and wellness-the way they practice care at leading health systems around the country. Nurses are a key part of that transformation."3
After graduation from a DNP program, the clinician's practice cannot be business as usual. Colleagues and stakeholders must see a difference in how the DNP-prepared APRN approaches patient care. Read this month's features to see how three graduates have made a difference.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief
[email protected]
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