The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing

553 Pages·2010·2.01 MB·English

by  Mary Zaccagnini

73465_FMxx_FINAL.QXD 3/22/10 1:41 PM Page i
The
Doctor
of
Nursing Practice
Essentials
A New Model for Advanced
Practice Nursing
Edited by
Mary E. Zaccagnini, DNP, RN, ACNS-BC, AOCN
Clinical Assistant Professor
University of Minnesota, School of Nursing
Minneapolis, Minnesota
Kathryn Waud White, DNP, RN, CRNA
Chief Nurse Anesthetist
Minneapolis Veterans Affairs Medical Center
Minneapolis, Minnesota
73465_FMxx_FINAL.QXD 3/22/10 1:41 PM Page ii
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Library of Congress Cataloging-in-Publication Data
The doctor of nursing practice essentials : a new model for advanced practice nursing / [edited by] Mary E.
Zaccagnini, Kathryn Waud White.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-7637-7346-5
1. Nursing—Study and teaching (Graduate)--United States. 2. Doctor of philosophy degree—United States. I.
Zaccagnini, Mary E. II. White, Kathryn Waud.
[DNLM: 1. Education, Nursing, Graduate. 2. Nurse Clinicians—education. 3. Nurse Practitioners--education.
WY 18.5 D6367 2011]
RT75.D56 2011
610.73071'1—dc22
2009054073
6048
Printed in the United States of America
14 13 12 11 10 10 9 8 7 6 5 4 3 2 1
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This book is dedicated to all of our current and future DNP colleagues, espe-
cially those who so graciously gave of their time and volunteered to author
this book.
—Kathy & Mary
This book is also dedicated to my sister Karen, who passed away suddenly
while I was writing this book.
—Mary
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73465_FMxx_FINAL.QXD 3/22/10 1:41 PM Page v
CONTENTS
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Reviewers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Imagining the DNP Role. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Sandra R. Edwardson
Practice Doctorates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
The AACN’s Role in Creating the DNP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx
Factors Propelling the Practice Doctorate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvi
PART I ESSENTIALS FOR PRACTICE 1
Chapter 1 Nursing Science and Theory: Scientific Underpinnings
for Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Carole R. Eldridge
Nursing Science. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Scientific Foundations of Nursing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Nursing Theory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Chapter 2 Systems Thinking, Healthcare Organizations,
and the Advanced Practice Nurse Leader. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Sandra Petersen
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Vision and Perspective: Keys to the Future of Advanced Practice. . . . . . . . . . . . . . . 39
Systems Thinking, Advanced Practice, and the Learning Organization. . . . . . . . . 45
The Downside to Systems Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
A Challenge to Advanced Practice Leaders: Operationalizing
Systems Thinking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Summary: The DNP Systems Thinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
v
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vi ■ CONTENTS
Chapter 3 Clinical Scholarship and Evidence-Based Practice . . . . . . . . . . . 61
Catherine Tymkow
What Is Clinical Scholarship? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Evidence-Based Practice and Clinical Scholarship: Are They the Same?. . . . . . . . . 64
What Is the Role of the Doctor of Nursing Practice in Clinical Scholarship?. . . . 67
Translating Research in Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Quality Improvement and Patient-Centered Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Evaluation of Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
The Use of Information Technology and Research Methods . . . . . . . . . . . . . . . . . 100
Participation in Collaborative Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Disseminating Findings from Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . 119
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Chapter 4 Information Systems/Technology and Patient Care
Technology for the Improvement and Transformation of Health Care . . . 137
Susan F. Burkart-Jayez
Information Systems/Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Basic Computer Competencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Information Literacy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Information Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Clinical Information Management Competencies . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Patient Care Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Transformation of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Appendix 4-1 Research Protocol: Research Collaborative:
Examining the Connection Between Patient Care, Nursing Sensitive
Adverse Events, and Environment of Care Intensity. . . . . . . . . . . . . . . . . . . . 172
Susan F. Burkart-Jayez and Deborah Spath
Significance of Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Data Collection Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
List of Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Definitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Appendix 4-2 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
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Contents ■ vii
Chapter 5 Healthcare Policy for Advocacy in Health Care. . . . . . . . . . . . . 195
Angela Mund
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Influencing the Health Policy Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Long-Standing Policy Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Integration of Policy with Ethics, Research, and Education. . . . . . . . . . . . . . . . . . 220
Phases of Policy Involvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Appendix 5-1 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Chapter 6 Interprofessional Collaboration for Improving Patient
and Population Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Laurel Ash and Catherine J. Miller
Improving Health Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Interprofessional Collaboration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Barriers to and Drivers of Effective Collaboration in Interprofessional
Healthcare Teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Necessities for Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Models for Implementation: From Project to Practice. . . . . . . . . . . . . . . . . . . . . . . 261
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Chapter 7 Clinical Prevention and Population Health for Improving
the Nation’s Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Diane Marie Schadewald
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Analysis of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Psychosocial Dimensions and Cultural Diversity in Clinical Prevention
and Population Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Evaluate Care Delivery Models. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Chapter 8 Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Kathryn Waud White, Mary E. Zaccagnini, Katherine H. Casey, and Marcia K. Britain
Overview of Ethical Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Framework for Developing Ethical Competency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Ethical Codes of Nursing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Ethical Issues and Current Debates Relevant to the DNP. . . . . . . . . . . . . . . . . . . . 331
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Appendix 8-1 Application of the Elements of the ICN Code of
Ethics for Nurses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
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viii ■ CONTENTS
PART II DOCTOR OF NURSING PRACTICE ROLES 347
Chapter 9 Traditional Advanced Practice Roles for the DNP . . . . . . . . . . 349
Clinical Nurse Specialist, Mary E. Zaccagnini and Germaine M. Edinger
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Educational Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
Certification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
Core Competencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
The Role and Scope of Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
The Future of CNS Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Nurse Practitioner, Gwendolyn Short. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Birth of a Movement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Educational Requirements and Specialty Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Certification, Licensure, and Credentialing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
Accreditation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Scope of Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Role of the DNP Nurse Practitioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Certified Registered Nurse Anesthetist, Garrett J. Peterson. . . . . . . . . . . . . . . . . . . . . . . . . 364
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
American Association of Nurse Anesthetists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Nurse Anesthesia Education Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Certification and Recertification of Nurse Anesthetists . . . . . . . . . . . . . . . . . . . . . 374
Scope and Standards of Practice for Nurse Anesthetists . . . . . . . . . . . . . . . . . . . . . 376
CRNA Scholarship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Nurse Midwife, Deborah Ringdahl. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Midwifery Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Professional Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Education and Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Scope of Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
The DNP-Prepared Midwife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Chapter 10 Emerging Roles for the DNP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Nurse Educator, Michelle Riley
DNP Nurse Educator Roles and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Role Expansion Strategies for DNPs from a Nurse Educator Perspective. . . . . . 404
Conclusions and Future Directions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Nurse Administrator/Executive, Don R. Hirschman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
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Contents ■ ix
Parity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Credibility and Personal Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
Increased Complexity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Nurse Entrepreneur, Deonne J. Brown Benedict. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Biosketches of Successful Nurse Entrepreneurs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Public and Community Health Practitioner, Kathleen Sgro. . . . . . . . . . . . . . . . . . . . . . . . 420
Historical Development of Community and Public Health Nursing. . . . . . . . . . 420
Measuring Progress in Population Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Organizational Aspects of Public and Community Health. . . . . . . . . . . . . . . . . . . 423
Community Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
Community Healthcare Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Evidence-Based Practice and Community Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Wellness Programs in the Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
Government-Sponsored Community Health Programs. . . . . . . . . . . . . . . . . . . . . . 430
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Integrative Practitioner, Joy Elwell and Kathryn Waud White . . . . . . . . . . . . . . . . . . . . . . 433
Nurses as Integrative Practitioners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Types of Integrative Healing Modalities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
The DNP as Integrative Practitioner: Unique Aspects of DNP Preparation . . . . 441
PART III THE DOCTOR OF NURSING PRACTICE
SCHOLARLY PROJECT 449
Chapter 11 A Template for the DNP Scholarly Project. . . . . . . . . . . . . . . . 451
Kathryn Waud White and Mary E. Zaccagnini
Nature of the Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
Structure of the Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
The Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
Appendix 11-1 Change Theorists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Appendix 11-2 Process Model for the DNP Project . . . . . . . . . . . . . . . . . . . 497
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499