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    In the first attachment# I gave the writer a sample of what the paper should look like. Attachment #2 is everything I wanted incorporated in the paper. I wanted the writer to use theses examples of what I learned throughout NR 709. Nothing was mention. Attachment #3 is the basis of the you decide reflections. My DNP project. Attachment #4 is the instructions for the paper

    attachment # is the DNP essentials which should be incorporated in the paper



    1. The You Decide Reflection is worth 100 points and will be graded on quality of self-assessment, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
    2. Create your essay using Microsoft Word (a part of Microsoft Office), which is the required format for all Chamberlain College of Nursing documents. You can tell that the document is saved as a MS Word document because it will end in “.docx”
    3. Follow the directions and grading criteria closely. Any questions about your essay may be posted under the Q & A forum.
    4. The length of the reflection is to be within three to six pages excluding title page and reference pages.
    5. APA format is required with both a title page and reference page. Use the required components of the review as Level 1 headers (upper and lower case, centered):

    Note: Introduction – Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63).

    1. You Decide Reflection
    2. Conclusion


    Preparing Your Reflection

    The DNP Essentials (AACN, 2006) outline a number of advanced nursing practice competencies for the DNP-prepared nurse from evaluation perspectives. Reflect on the NR709 course readings, discussion threads, and applications you have completed across this course and write a reflective essay regarding the extent to which you feel you are now prepared to:

    1. “Conduct a comprehensive and systematic assessment of health and illness parameters in complex situations, incorporating diverse and culturally sensitive approaches.
    2. Design, implement, and evaluate therapeutic interventions based on nursing science and other sciences.
    3. Develop and sustain therapeutic relationships and partnerships with patients (individual, family or group) and other professionals to facilitate optimal care and patient outcomes.
    4. Demonstrate advanced levels of clinical judgment, systems thinking, and accountability in designing, delivering, and evaluating evidence-based care to improve patient outcomes.
    5. Guide, mentor, and support other nurses to achieve excellence in nursing practice.
    6. Educate and guide individuals and groups through complex health and situational transitions.
    7. Use conceptual and analytical skills in evaluating the links among practice, organizational, population, fiscal, and policy issues” (pp. 16-17).



    American Association of Colleges of Nursing [AACN]. (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author.


Subject Nursing Pages 9 Style APA


Reflection on DNP Essentials and Competencies

            Advanced nursing practice is defined according to core competencies and skills. Healthcare practitioners pursuing advanced nursing education such as masters and doctoral are required to demonstrate professionalism in performing research which incorporates a number of activities such as data collection, analysis, and disseminating the findings (Andrew, Denise, Freda, Linda, & Debbie, 2014). In the lifelong learning process, reflection is a critical aspect which entails examining the key aspects learned. The American Association of Colleges of Nursing (AACN) continues to play a significant role in research, excellence, and innovation in academic nursing (AACN, 2006). AACN essentials describe the critical content in the learning curriculum and the outcomes expected for students across various levels including masters, baccalaureate, and nursing practice programs. Considering the doctoral programs, they are categorized into two which include practice focused and research focused. This reflection entails the skills, knowledge, and integrative abilities that suffice the DNP essentials and sub-competencies. Notably, the reflection is based on essentials III and VIII.

Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice

            Essential III recognizes that research and scholarship are the foundation of doctoral education. According to AACN (2006), a broader scholarship perspective has been established which transcend the discovery of new information. In these alternative paradigms, they recognize that the integration and discovery are reflections of investigating and synthesizing academic life traditions, and scholars provide meaning to facts that are isolated and make connections between disciplines through integration. In addition, the new paradigms acknowledge the ability of the scholars in applying scientific knowledge to solve a challenge through scholarship and application. Essentially, DNP nurses use their practice to generate evidence that guides enhancement in care outcomes and practice. Reflecting on this essential, my DNP, which involved changing anaesthetic practice using Apfel risk scoring system for postoperative nausea and vomiting (PONV) made references to the vast literature present related to the topic of study and applied this information to conclude according to the research aims and objectives.

Essential VIII: Advanced Nursing Practice

            Enhanced healthcare knowledge and sophistication have resulted in specialization growth in nursing which is aimed at ensuring competence in complex areas of practice. According to AACN (2006), the preparation of a DNP graduate is to practice in the specialization area within the broad nursing domain. Under this essential, the practice competencies are specified which cut across the nursing specialists. The healthcare providers are required to demonstrate professionalism in applying the biophysical, psychosocial, behavioural, economic, cultural, and nursing science according to their specialization. Notably, the DNP programs are centred on diverse patient care settings including home, community, and long-term care. DNP students are required to demonstrate experience across the different settings (Esden & Nichols, 2016). These experiences should aid in effective decision making.

            The application of essentials III and VIII can extensively be demonstrated in my week seven which mainly entailed transformation. Throughout DNP learning, I have understood the importance of quality leadership skills and responsibilities which are mainly applicable in translating research findings into actual practice. In addition, AACN (2006) essentials have enhanced my understanding of utilizing evidence-based approach and its application in promoting quality outcome. In effective leadership, I have learned the application of various competencies and skills which aid in executing the set roles and responsibilities (Trautman, Idzik, Hammersla, & Rosseter, 2018). For instance, the implementation of my DNP project required teamwork and collaboration with healthcare providers and patients. In teamwork, I have also established that healthcare professionals should respect diversity affiliations of the different stakeholders involved in collaboration. This is essential in ensuring a cohesive group and one that achieves the set goals and objectives.

            Drawing from these essentials, healthcare leaders should demonstrate an understanding of different models and theoretical underpinnings such as transformational which is mainly described by motivation and empowerment (Fischer, 2016). Moreover, effective leaders are required to portray understanding of both time and resource management which ensures that the project is completed in time and uses the set resources. This is critical in preventing the use of more resources and delays. For instance, my project was conducted over eight weeks during which the Apfel scoring system was incorporated into the assessment system. In applying these essentials, a key aspect that I have learned is the importance of technical skills in performing research, collecting data, and its analysis. Also, one is expected to make references to the obtained and analyzed data for informed decisions. From week one to six, the importance of these skills was reflected through data gathering using the AGREE II questionnaire, analysis using a t-test, and their discussion and presentation through posters and PPT. This DNP has, therefore, enlightened me on how technology has improved and can be applied across various settings both in the present and future.

Comprehensive and Systematic Assessment

One of the main sub-competencies under essential VIII entails conducting a comprehensive and systematic assessment of health and illness parameters, especially in critical situations. Further, this sub competence involves incorporating the culturally and diverse sensitive approaches. Based on the AACN understanding, I can assess the issues related to health and illnesses in diverse situations which are also challenging. For instance, in my DNP, I used literature and experience to establish that postoperative nausea and vomiting is a critical issue among the surgical patients that are receiving the general anaesthesia. I have learned that such assessments cannot be done without referring to both experience and using literature for an explanation. For instance, using the Apfel risk scoring system to understand PONV which is a complex issue among surgical patients was based on information obtained from previous studies. The DNP required research and analytical tools to define the data obtained and relate the findings to the objectives.

Designing, Implementation, and Evaluation of Therapeutic Interventions

            In advanced nursing practice and education, therapeutic interventions are essential in addressing the health and illness issue facing the particular population. The designing, implementation, and evaluation of these interventions should consider nursing science among other sciences (Nilsen, 2015). A major skill that I learned in doing the DNP project is that the development of the therapeutic interventions is dependent on the data management. During week one which mainly involved data management, I discussed how the use of primary data to examine whether the use of Apfel risk scoring system by the anaesthesia providers would enhance the assessment of PONV. The data management involved using the independent t-test to establish the system’s effectiveness in altering the anaesthesia practice to incorporate using multimodal antiemetic. The compared data was obtained from the pre and post intervention groups. Nurses undertaking DNP project should demonstrate competence in the development and implementation of the therapeutic intervention in response to the particular illness or health issue. I also showed professionalism in distinguishing the data from the two stages in the implementation which is a fundamental aspect of scholarship and research.

Development and Sustaining Therapeutic Relationships and Partnerships

            The implementation of therapeutic interventions for a particular population is founded on various aspects including the relationship between the stakeholders. Notably, a profound and sustainable interaction among the selected population is centred on acceptance and collaborative relationship between the different groups (May, Johnson, & Finch, 2016). In my DNP project, for instance, working with adult patients who have undergone surgery as well as their concerned nurses required effective relationship and partnership. The study population in my DNP were anaesthesia providers who included Anesthesiologists, Certified Registered Nurse Anesthetics (CRNA), Nurse practitioners, and Physician Assistants. Throughout the data collection and implementation of the intervention program, I established that effective interpersonal and communication skills were critical in promoting the relationship with the population (Cheruvelil et al., 2014). For instance, the communication involved a memo requesting the participation of these individuals. Other approaches to maintain the relationship included providing consent to the population which demonstrated respect to their will for participating in the study. This relationship was essential in ensuring the implementation of the Apfel scoring system which was aimed at enhancing the quality of care.

Clinical Judgement, Systems Thinking, and Accountability

            The development and implementation of evidence-based care recognize the importance of one’s critical thinking and decision-making skills. In addition, one should show accountability in their actions and developed strategies. In systems thinking, it entails understanding that the healthcare sector functions as a combination of various subsystems with unique roles to achieve the overall objective of enhanced quality and safety in care (Carayon et al., 2014). During the implementation of the intervention, clinical judgment was based on literature and pre and post-intervention data. I acknowledge the importance of accountability in healthcare which is a critical aspect among professionals. Accountability according to AACN (2006) entails one being responsible for his or her actions and accepting the consequences therein. During week two, accountability and systems thinking were reflected in the clinicians following the recommendations such as antiemetic through its administration to the patient with moderate to severe PONV risk. My clinical judgement, on the other hand, was informed by data from AGREE II questionnaire which was aimed at determining whether the consensus guideline for managing PONV was profound in changing the anaesthesia practice using inferential statistic and descriptive statistic. I also understood the importance of using statistics to inform one’s decision which ensures better strategies to promote patient care.

Guiding, Mentoring, and Supporting other Nurses to Achieve Excellence

            In evidence-based care, it entails the use of researched and ascertained nursing practices in promoting the patient’s welfare. Advanced nursing education in masters and doctoral levels mainly involve research and scholarship to solve health and illnesses issues in complex situations. Throughout this course, I understood that it is the responsibility of every nursing practitioner to support others achieve excellence in their learning and responsibilities. This can occur in various ways including guidance and mentoring (Eller, Lev, & Feurer, 2014). Week four, for instance, involved dissemination of my project findings and results in week three. The discussion entailed analyzing and contextualizing the findings according to the research objectives. In addition, I discussed the implications of the DNP to nursing practice such as the effectiveness of the Apfel scoring system for PONV patients. I further disseminated the information through the PPT presentation. For instance, I established that the Apfel risk scoring system and consensus guidelines for PONV management assists anaesthesia providers to assess and make clinical decisions regarding prophylactic antiemetics. Throughout my DNP, I acquired effective information dissemination skills including making conference paper presentations and the publication process. Notably, this knowledge mainly requires computer skills.

Education and Guiding Individuals through Complex Health and Situational Transitions

            Implementing evidence-based practices and research should further involve educating and guiding others to transition from one healthcare approach to the other which is better and effective in enhancing the quality of care (Ljunggvist, 2014). For instance, the PONV challenge is identified as a critical healthcare issue which is under-evaluated in the current healthcare practice. My DNP, in this regard, entailed educating and guiding healthcare providers on the use of the Apfel risk scoring system which is credited for being time effective and having no harm to the patients. The transitions are mainly reflected in the perioperative care where the Apfel system can be adopted to promote the quality of patient care. The DNP course has played a major role in the development and implementation of the change which is aimed at improving nursing care.

Conceptual and Analytical Skills

            The AACN essentials demonstrate how DNP prepared nurses can use additional practice experiences rather than those acquired during the baccalaureate nursing program to enhance quality outcome (AACN, 2006). Through experimental opportunities, the healthcare providers can use them to inform their decision making and understand the consequences of their decisions. In addition, one should demonstrate professionalism in examining various links in the organizational, practice, fiscal, and policy issues. Throughout this course and the DNP project, I was able to relate the PONV challenge to patients who have undergone surgery as well as use literature to describe the relationship between various variables such as the causes, impacts, and mitigation of the health challenge. This demonstrates the ability to perform comprehensive research regarding a topic and establishing the possible links which further inform the intervention strategies.

            In summary, the application of the DNP essentials in healthcare practice and education is reflected in the skills, knowledge, and integrative abilities. I related the AACN essentials such as III and VIII with my project where I demonstrated various competencies such as leadership, research, and education. As demonstrated in the above reflection, healthcare providers pursuing advanced nursing education should possess diverse research and practice skills which are mainly aimed at enhancing the quality of patient outcome.



AACN (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. Retrieved from https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online Journal of Issues in Nursing19(2), 1.

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied ergonomics45(1), 14-25.

Cheruvelil, K. S., Soranno, P. A., Weathers, K. C., Hanson, P. C., Goring, S. J., Filstrup, C. T., & Read, E. K. (2014). Creating and maintaining high‐performing collaborative research teams: the importance of diversity and interpersonal skills. Frontiers in Ecology and the Environment12(1), 31-38.

Eller, L. S., Lev, E. L., & Feurer, A. (2014). Key components of an effective mentoring relationship: A qualitative study. Nurse education today34(5), 815-820.

Esden, J. L., & Nichols, M. R. (2016). Transforming Post-Masters DNP Education: Student Perspectives About Their Educational Experiences.

Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of advanced nursing72(11), 2644-2653.

Ljungqvist, O. (2014). ERAS—enhanced recovery after surgery: moving evidence‐based perioperative care to practice. Journal of Parenteral and Enteral Nutrition38(5), 559-566.

May, C. R., Johnson, M., & Finch, T. (2016). Implementation, context and complexity. Implementation Science11(1), 141.

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science10(1), 53.

Trautman, D. E., Idzik, S., Hammersla, M., & Rosseter, R. (2018). Advancing Scholarship through Translational Research: The Role of PhD and DNP Prepared Nurses. Online Journal of Issues in Nursing23(2).














Appendix A:

Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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