You Decide Reflection

Answer

You Decide Reflection

The needs and demands of society as well as the complex and interdisciplinary practice climate call for a kind of nursing education that adequately and appropriately prepares individuals, equipping them with the necessary skills and knowledge as would be needed for practicing in complex interdisciplinary systems.  The ultimate goal is, of course, to realize expertise that would ensure patient safety and quality improvement in the context of healthcare delivery (National Research Council of the National Academies (NRCNA), 2005). In this vein, the Doctor of Nursing Practice (DNP) emerges as part of contextual academic infrastructure for promoting research and scholarship meant to enhance practice specifically through improvement of patient outcomes as well as the quality of care in general. Since the DNP does not specify or designate any specific specialties (areas of specialization) for graduates, the American Association of Colleges of Nursing (2006) came up with the DNP Essentials that outline the principal competencies considered core to various roles in advanced nursing practice. While these competencies may vary from one role (being prepared for) to another, they ensure DNP students have deeper knowledge and understanding as well as more specialized content in various areas, hence the expertise needed for improvement of quality healthcare and related patient outcomes. This paper entails a personal reflection on the core competencies acquired through this course thus far, even as they relate to the broader DNP Essentials.

You Decide Reflection

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

True as it were, doctoral education is pegged upon research and scholarship as its pillars. While scholarly activity in this respect has been conceptualized as mainly revolving around basic research, it has been expanded so that now it can be pursued using alternative approaches that go beyond merely discovering new knowledge.  Beyond discovering new knowledge, scholars are concerned with interdisciplinary integration of that which they discover, and finding areas of applying the new knowledge.  Thus, clinical scholarship in the DNP context is in essence a scholarship of not just discovery, but also integration and application.  Indeed, the DNP scholar can practice and learn at the most advanced nursing level, critique evidence and employ knowledge aimed at improving health and practice outcomes. Accordingly, an integral aspect of my clinical scholarship is the active involvement in evidence-based practice in a bid to provide a higher quality of patient care within and beyond my health organization. According to Apold (2008), the DNP program puts greater emphasis on research utilization more so in relation to comprehension and evaluation of various care delivery and practice models.

Importantly, my preparation for practice goes beyond scholarship and research capabilities to include application of new knowledge to complex practice scenarios. There is also the aspect of integrating and analyzing knowledge sourced from diverse disciplines so that it can be optimally applied to solve problems in practice (American Association of Colleges of Nursing (AACN), 2006). Thus far, I am better positioned to analyze, translate, and apply clinical evidence to improve care quality hence healthcare outcomes. Many aspects of the course work have emphasized the significance of evaluating, integrating, translating, and implementing evidence-based practice across various healthcare disciplines. The concepts learned therein go a long way in guiding practice, for instance in relation to the design, implementation and evaluation of therapeutic interventions based on nursing science and other sciences. To this end I feel I am adequately prepared.

Dunbar-Jacob et al. (2013) inform that the DNP program prepares individuals for roles that include the translation and dissemination of knowledge into practice, and these are roles that I feel adequately prepared to play. Through scholarly work (including avenues like Op-Eds, central repository, peer-reviewed journal articles and seminars among others), I will guide, mentor, and support other nurses even as they seek to achieve excellence in nursing. It is also through such avenues as seminars and discussion (even legislative) forums that I will educate and guide groups and individuals through different health and situational transitions.

Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking

In recognition of the significance of systems and organizational leadership in the improvement of healthcare outcomes, the skills and knowledge sought (therefore delivered) by the current doctoral education are consistent with contextual healthcare goals, especially in the manner they seek to get rid of health disparities, thus promoting patient safety as well as overall practice excellence (AACN, 2006). The DNP student, upon completion of the course, is skilled and informed in an array of policy and organizational areas, and comprehends models of care delivery as may be considered feasible depending on the economic, cultural, political, and organizational practice context.

The AACN (2006) emphasizes the need and significance of preparing expert practitioners who must be leaders that can participate and impact interdisciplinary health teams. DNP graduates are expected to comprehend management principles that also include practical and conceptual strategies that would enable them to balance productivity with care quality. As a DNP-prepared nurse leader, I am aware of the significance of playing a leadership role not only within my organization but also in many practice settings. Importantly, I have demonstrated this role in my current position more so as concerns different care initiatives aimed at improving patient outcomes. Currently, I am able to organize care as may be necessary to address current health needs and challenges.

With this DNP preparation, I am sure to meet the expectation highlighted by Broome et al. (2013) to document and public scholarly work, an initiative the authors present as crucial to practice leadership and contextual participation to effect necessary changes in health care delivery. Among the many and varied DNP scholarship expectations is that of impacting organizations and multidisciplinary bodies to realize changes that impact not only individuals and populations but also systems through which services are delivered. The current DNP preparation will also ensure active participation in policy matters at different levels (including local, national, regional, and international) that differently shape health outcomes. The National Organization of Nurse Practitioner Faculties (2005) emphasizes DNP graduates’ leadership roles in shaping health policies whose aim is to improve general healthcare. I am positive I will not be left behind in this regard.

Essential VII: Clinical Prevention and Population Health for Improving the Nation’s Health

In a bid to improve the general population’s health status, implementing population health initiatives and broader clinical prevention is considered a necessary prerequisite. In this vein, DNP graduates are expected to engage in organizational and systems leadership (as per Essential II) so as to help integrate evidence-based practice more specifically in terms of clinical prevention besides the delivery of population health services (AACN, 2006).

By and large, this course has provided me with a foundation for analyzing environmental, occupational, bio-statistical, and epidemiological data, particularly as may be applicable for developing, implementing, and evaluating clinical prevention and contextual population health services. Indeed, I am adequately informed on various health concepts such as health promotion, health determinants, cultural sensitivity, cultural diversity, and occupational health just to mention but a few. The foundation provided by this course’s core competencies, coupled with comprehension of the aforementioned concepts places me in a strategic position and equips me with the ability to conduct a comprehensive and systematic assessment of health and illness parameters in different situations, and as such make optimal decisions that would ultimately help improve healthcare outcomes. The ability to synthesize concepts such as cultural diversity and how they relate to clinical prevention and population health will go a long way in improving healthcare outcomes among populations and individuals. As a DNP graduate, possessing the ability to evaluate the different care models in existence will enhance the delivery of quality healthcare and the improvement of healthcare outcomes by taking into account a wide range of socioeconomic dimensions that in one way or another, impact population and individual health.

Further, concerning clinical prevention and population health, the relevance of DNP scholarship cannot be overstated.  Murphy et al. (2015) elevate this scholarship as a convenient knowledge development mechanism through which the DNP-prepared nurse engages in relevant activities of inquiry, most of which are clearly spelt out in the DNP curriculum.  Importantly, the implied activities of inquiry seek to achieve goals connected to bringing about organizational impacts and changes that ultimately benefit people (populations and individuals) and the systems through which services are delivered.

A specific area of concern is the need to improve anesthetic practices whereby the Apfel risk scoring system is proposed for use in anesthesia assessment. It is believed the changes will deliver a number of benefits including decreasing the incidence of Postoperative nausea vomiting (PONV), morbidity, and prolonged stays in the hospitals. As a DNP prepared nurse, interest can develop in many other health issues just as it has developed in PONV. In this vein, critically appraising existing literature on issues of interest will always be a good starting point.

Essential VIII: Advanced Nursing Practice

In recognition of the high rate with which knowledge is increasing and the healthcare environment becoming sophisticated, it has become necessary to pursue specialization in the field of nursing in a bid to achieve competence. Amid this specialization, a fact that stands out is that no individual is able to master and excel in all roles; in essence an individual who specializes in one area is likely to lack requisite knowledge in other areas. Nevertheless, DNP offers the academic infrastructure that ensures graduates, while specializing in specific areas, possess broader knowledge that is applicable and relevant to the wider nursing domain. The American Association of Colleges of Nursing (2006) describes the implied distinctive specialization as DNP’s hallmark. Imperatively, the current DNP essential defines the core competencies cutting across various areas of specialization and as they are considered to be necessary for DNP practice. In this respect, a DNP student is expected to demonstrate in-depth understanding and as such assessment skills as well as base practice as concerns application of various concepts (could be economic, sociopolitical, behavioral, cultural, and psychosocial) in their areas.

As the DNP program has provided many learning experiences in different care settings, contextual experiential and practical opportunities will appropriately inform decisions in practice, for they have increased understanding on the impact of caregiver decisions on the quality of care. For instance, in relation to the issue of PONV, current literature can be critically analyzed and, based on evidence, used to establish the rationale for considering changes in practice and care management. This would be in line with the goal of AACN (2006) to produce DNP graduates who can disseminate findings from evidence-based practice and research to improve healthcare outcomes.

Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care

According to the AACN (2006), one thing that sets DNP graduates aside is “their abilities to use information systems/technology to support and improve patient care and healthcare system, and to provide leadership within healthcare systems and/or academic settings” (12). The implied abilities include applying relevant knowledge and skills to care management and quality improvement, as well as designing, selecting, and using information systems/technology to assess and evaluate care programs, systems, and outcomes.

The use of technological tools and electronic health records by DNP graduates is specifically elevated in the current conversation. For instance, in reference to week 4 discussion, using technology in practice (more precisely when making professional presentations) can facilitate easy communication and dissemination of knowledge that could then be used by other professional to impact practice, thus ultimately improving healthcare outcomes. Modern technological tools can find great use in scholarly work where research findings and recommendations can easily be shared across the health fraternity and other disciplines. Besides sharing the generated knowledge, information technology can also be used to analyze data in research and practical settings, thus ultimately helping draw accurate inferences.

Conclusion

The DNP as a doctoral education program emerges as an integral part of the academic infrastructure aimed at promoting research and scholarship as are needed to enhance practice through improvement of patient outcomes and quality of care.  This reflection essay has highlighted and demonstrated understanding and application of some of the core competencies learnt in the course and their connection to the broader DNP Essentials as outlined by AACN.  By and large, it has emerged that DNP prepares graduates and equips them with the necessary knowledge and skills for analyzing, translating, and applying clinical evidence to improve care quality hence healthcare outcomes. It also equips graduates with organizational and systems leadership skills which they can apply in various policy and organizational areas in a quest to improve patient safety and healthcare outcomes. Additionally, DNP helps students/caregivers attain the capability of designing, selecting, and using information systems/technology to assess and evaluate care programs, systems, and outcomes. Last yet important, DNP emphasizes scholarship that serves as a convenient knowledge development mechanism through which the DNP-prepared nurse engages in relevant activities of inquiry and ultimately contributes to the evidence-based practice narrative. I am confident this course has adequately prepared me with the highlighted core competencies for the task ahead.