DNP that is leading the Nurse Practice Council that will conduct translational projects in your healthcare organization

Full Answer Section

• Interdisciplinary, but Physician-Centric: While we may have nurses, PAs, and office staff, the physician often leads the clinical decision-making. My role as a DNP will be to elevate nursing's contribution to EBP and patient outcomes.
• Emphasis on Medication Management & Procedures: A significant portion of our practice involves prescribing medications (historically including opioids) and performing interventional procedures.
• High Opioid Prescribing History: Like many pain clinics, we have historically managed pain with opioids, which presents a significant challenge in shifting practice due to patient expectations, provider habits, and the ongoing opioid crisis.
• Patient Education Needs: A critical component of successful pain management, especially with non-opioid strategies, is comprehensive patient education and shared decision-making.
• Data Availability: We utilize an Electronic Health Record (EHR) system, which captures patient demographics, diagnoses, medication lists, pain scores, and visit notes, providing a rich source of data for QI.
• Resistance to Change (Potential): Both providers and long-term patients might have established routines and beliefs about pain management, potentially leading to resistance to new protocols, especially those moving away from familiar opioid regimens.

Considerations When Choosing an EBP Model/Framework

When selecting an EBP model for our Nurse Practice Council, I must consider the unique context of our pain management clinic, the nature of our patient population, the challenges of changing established practices, and the translational focus of our projects.

My key considerations include:

1. Simplicity and User-Friendliness: The chosen model should be easy for nurses and other team members to understand and implement, even those new to formal EBP projects. Complex models can deter engagement.
2. Action-Oriented and Practical: Given that we are a busy clinical office, the model needs to emphasize practical steps and guide actionable changes that can be integrated into daily workflow without undue burden.
3. Emphasis on Translation and Implementation: Our Nurse Practice Council will be conducting "translational projects." This means the model must explicitly guide the movement of evidence into practice, addressing barriers to implementation and focusing on sustainability.
4. Inclusion of Stakeholder Engagement: Any successful change in a clinical setting requires buy-in from all stakeholders – physicians, nurses, office staff, and most importantly, patients. The model should have clear steps for engaging these groups.
5. Focus on Outcomes and Evaluation: The model must provide a clear framework for measuring the impact of our interventions on patient outcomes, particularly for my DNP project on antineuropathics vs. opioids (e.g., pain scores, functional improvement, opioid reduction, patient satisfaction).
6. Addressing Barriers to Change: The model should offer strategies for overcoming common barriers to EBP implementation, such as resistance to new protocols, lack of knowledge, or time constraints.
7. Adaptability to Outpatient Setting: While many EBP models were developed for inpatient hospital settings, our outpatient clinic has different dynamics regarding patient visits, follow-up, and resource availability. The model should be flexible enough to apply effectively here.
8. Alignment with Safety and Quality Imperatives: The chosen model should inherently support efforts to improve patient safety and overall quality of care, linking directly to the DNP's role in this area.
9. Interprofessional Collaboration: Since pain management is inherently interdisciplinary, the model should encourage collaboration between nurses, physicians, and other allied health professionals.

Proposed EBP Model/Framework: The Iowa Model of Evidence-Based Practice to Promote Quality Care

Considering the above factors, the Iowa Model of Evidence-Based Practice to Promote Quality Care (Iowa Model) would be an excellent fit for our Nurse Practice Council at the pain management doctor's office.

Rationale for Selection:

• Action-Oriented and Practical: The Iowa Model is highly practical and action-oriented, featuring clear decision points and feedback loops that guide users through a logical, step-by-step process of EBP implementation. This aligns perfectly with the need for a user-friendly and actionable framework in our busy outpatient setting.
• Emphasis on Problem-Focused Triggers: It starts with either a "problem-focused" or "knowledge-focused" trigger. For my DNP project, the opioid crisis and the associated risks (overdose, addiction) represent a significant problem-focused trigger (high incidence of opioid use, adverse events). This direct link to a clinical problem makes the model highly relevant and motivating for staff.
• Systematic Evidence Appraisal: The model includes robust steps for synthesizing and appraising evidence, ensuring that our recommendations for antineuropathics are based on the strongest available research.
• Pilot and Implementation Focus: Crucially, the Iowa Model emphasizes piloting the change in a clinical setting before widespread implementation. This is perfect for my DNP project, as we can pilot the antineuropathic protocol with a subset of patients, evaluate its effectiveness and feasibility, and then refine it before broader adoption. This also addresses potential resistance by demonstrating success on a smaller scale.
• Feedback Loops and Sustainability: The model incorporates feedback loops that allow for continuous evaluation and adjustment, promoting sustained change and integration of new practices into daily workflow. It encourages ongoing monitoring of outcomes.
• Considers Organizational Context: It explicitly includes steps for assessing the "fit of the evidence to the local context," which is vital for our pain clinic. This allows us to adapt general EBP recommendations to our specific patient population, resources, and existing workflows.
• Encourages Interdisciplinary Collaboration: While a Nurse Practice Council leads the project, the model implicitly encourages collaboration at various stages, from problem identification to implementation and evaluation, fostering teamwork among all clinic staff.

How the Iowa Model will guide my DNP project and other Nurse Practice Council projects:

1. Problem-Focused Trigger: The Nurse Practice Council identifies the excessive reliance on opioids and the associated risks as a key clinical problem in our pain management office. (This is the starting point for my DNP project).
2. Forming a Team: A core team, including myself as the DNP, nurses, a physician champion, and potentially a pharmacist, would be formed.
3. Is This a Priority? The team would assess if reducing opioid reliance and increasing antineuropathic use is a priority for the organization (which it clearly is, given the current healthcare landscape).
4. Synthesize Evidence: The team would conduct a comprehensive literature search to identify the best evidence on the efficacy and safety of gabapentin and pregabalin (and other non-opioid options) for various pain types, as well as strategies for opioid tapering/reduction.
5. Pilot the Change:
   • Develop a Protocol: Based on the evidence, develop a new clinical protocol for initiating and titrating antineuropathics for specific pain conditions, alongside patient education materials.
   • Select Pilot Group: Implement the new protocol with a defined group of patients (e.g., new neuropathic pain patients, or existing patients eligible for opioid tapering).
   • Data Collection: Systematically collect data on pain scores, functional improvement, opioid dosage reduction, patient satisfaction, and any adverse effects. (This directly addresses the data collection for my DNP project).
6. Evaluate Outcome Data: Analyze the collected data to determine the effectiveness and safety of the new protocol.
7. Revise Practice as Needed: Based on the pilot results, the protocol would be refined. If successful, the Nurse Practice Council would then work on broader implementation across the clinic.
8. Integrate and Sustain: Develop strategies for integrating the new protocol into standard practice, including EHR order sets, ongoing staff education, and continuous monitoring of outcomes to ensure sustainability.

By adopting the Iowa Model, our Nurse Practice Council will have a robust, practical, and evidence-driven roadmap for tackling critical clinical problems, translating research into improved patient care, and ultimately enhancing the quality and safety of pain management services in our office.

Sample Answer

As the DNP leading the Nurse Practice Council at a pain management doctor's office, the selection of an appropriate Evidence-Based Practice (EBP) model/framework is crucial for guiding our translational projects. My DNP project, specifically focusing on the use of antineuropathics like gabapentin and pregabalin for pain management instead of opioids, will serve as a pilot and a testament to the chosen model's effectiveness.

Setting of My Organization: A Pain Management Doctor's Office

My organization is a specialized outpatient pain management clinic. We primarily manage chronic pain conditions, including neuropathic pain, musculoskeletal pain, and pain associated with various chronic diseases. Our patient population is diverse, ranging from individuals with post-surgical pain to those with long-standing complex regional pain syndrome or diabetic neuropathy.

Key characteristics of our setting include:

• Outpatient Focus: Patients visit for appointments, procedures (e.g., injections), and follow-up care. This means patient adherence to home-based strategies and medication regimens is critical.