Currently, the complex hospital setting requires new nurses to possess mote that knowledge about healthcare to care for patients. According to Irwin et al. (2018), confidence in one’s professional skills is essential for new graduate nurses. However, with multiple responsibilities and new processes to learn, it is difficult for a new nurse to transition from a novice to an advanced beginner. As Ulrich et al. (2010) find, the turnover for new nurses can be high, if the hospital does not have a program to support novices. For example, one organization in the study had a “35% new graduate turnover rate” before implementing a mentorship intervention which lowered the rate of turnover to just above 5% (Ulrich et al., 2010, p. 374). These statistics show the role of a mentorship program for new hires and the healthcare industry as a whole.
By acquiring knowledge and applying it in practice, nurses also develop skills for high-quality patient care. The existing nursing research offers a classification of the stages that describe nurses’ scope of professional experience. According to Benner (1982), the levels of experience include novice, advanced beginner, competent, proficient, and expert. To start, novices are those who still attend or have recently finished a nursing school (Benner, 1982). The following stages (advanced beginner and competent) require the professional to learn standardized procedures and rules and acquire skills for independent decision-making and work structuring. A proficient nurse can make decisions based on their knowledge and precept mistakes made by other specialists. Finally, an expert nurse can see complex situations as a whole and manage co-workers to achieve the best result – these professionals guide others and can become preceptors to new specialists (Benner, 1982). As can be observed, these stages allow one to track the quality of the nurses’ grasp of the profession.
The number of nurses who struggle with confidence at the start of their career is great and this lack of self-assuredness can affect patient quality of care. “Unpreparedness of novice nurses during the process of transition to their professional role can has broad consequences for the nurse and health care system and leads to reduction of the quality of patient care” (Hezaveh et al., 2013, p. 2015). According to Hale and Phillips (2018), it is complicated for new nurses to feel equal to their co-workers, and this raises the question of whether experienced nurses’ support can guide new hires on their journey. The process of mentoring includes several stages: seeding, opening, laddering, equalizing and reframing. The first part, seeding, is the discovery of the relationship between the mentor and mentee. During opening, the professionals test their relationship – they share information and observe their changing dynamic. The third stage is laddering, during which the mentor and their protégé build a “ladder” for the latter to overcome challenges common for a new professional. Equalizing begins when the mentee starts viewing themselves as equal to mentors professionally. Finally, during the reframing phase, the mentee reflects on the relationship with the mentor and evaluates its input in to their professional growth.
After passing these stages of mentoring, a new nurse can feel comfortable to start working full-time. According to the literature, mentorship programs contribute to “improved morale, higher career satisfaction, increased self-confidence, increased professional development, increased publication, obtaining more grants, and quicker promotion” (Nowell et al., 2015, p. 3). Thus, studies support the use of mentorship programs to help novice nurses’ transition into their new roles as confident nurses who are better equipped to manage the challenges of a nursing career.
As noted above, mentorship programs are considered a convenient and effective way to combat new nurses’ lack of professional confidence. A mentorship nursing program is a structured personal and professional development plan that helps novice nurses obtain confidence, job satisfaction, and retention with the assistance of an experienced or senior nurse (Regis College, 2019). To a novice nurse, the clinical setting has multiple unknowns and fears.. A proper mentorship program can help minimize uncertainties that can lead to patient endangerment and new nurse dissatisfaction (Hofman & Hermandez-Romieu, 2020). According to Fleming (2017), mentorship programs help nurses gain confidence in their skills and knowledge and improve patient care.
This project aims to implement an evidence-based mentorship program that has been proven to help novice nurses transition into a thriving, competent nurses using a structured mentorship program. The chosen approach is built on the basis of the Academy of Medical-Surgical Nurses (AMSN, 2012) Mentoring Program. The guide provided by the AMSN is designed guide nurses, promote mutuality and cooperation, increase communication skills, and provide information that helps overcome common stressors (AMSN, 2020).
A mentorship program begins with a set of established guidelines through a unique relationship between mentor and novice nurse. The mentor is someone who has had multiple years of experience in the given field of nursing and a nurse who is considered an expert in his/her field. The mentor may have prior experience as a mentor or may have had previous experience as a preceptor. However, a candidate interested in becoming a mentor must complete a two-week course that prepares them to be mentors. The purpose of pairing a novice nurse with a mentor is to cultivate a learning environment guided by an expert. Assigning a new nurse to a mentor is different than just providing a preceptor. The partnership will last for ten weeks and will be evaluated using the tools mentioned above. The success of the program will be measured using the new nurse confidence scale tool that will be reviewed at the end of the ten weeks mentorship.
Problem
This DNP project aims to address new nurses’ job confidence. On an international level, new nurses face the same issues many American nurses face when entering the workforce. One article mentions that the unpreparedness of novice nurses during the process of transition to their professional role can have broad consequences for the nurse and health care system which leads to a reduction of patient care quality (Hezaveh et al., 2013). In the US, studies have shown that low confidence leads to high turnover rates and nurses’ uncertainty in their fit for the profession (Ulrich et al., 2010). Buerhaus et al. (2017) mention that one million RNs will retire by 2030 and that “the departure of such a large cohort of experienced RNs means that patient care settings and other organizations that depend on RNs will face a significant loss of nursing knowledge and expertise that will be felt for years to come” (p. 40) Thus, it is vital for healthcare organizations to build a system that trains new nurses from the first day on the job to eliminate the knowledge gap between novices and experts.
To date, hospitals and nursing homes do not have standardized guidelines that state how to train new nurses to enhance their job confidence, communicate changes, and overcome challenges. A mentorship program could help these new nurses to face various difficulties. All healthcare workers are risking their lives for others, and present and future crises urge the nursing sector to introduce mentorship programs that improve nurses’ job confidence and satisfaction (Catholic Health Initiatives, 2020).
From a global and national perspective, structured mentorship systems implemented during crises such as the coronavirus could help nurses who need initial guidance (Kofman & Hernandez-Romieu, 2020). Structured mentor programs may also increase the quality and safety of patient care (Goodyear & Goodyear, 2018). Nurses’ high job confidence is essential for hospitals because it consequently influences job satisfaction and intent to stay at the organization (Jones, 2017). Several studies support the idea that nursing confidence is tied to the new nurses intention to stay at the hospital and continue working as a nurse (Ulrich et al., 2010; Schroyer, et al., 2020; Horner, 2017). At the University of Miami hospital, the mission is to provide excellent patient care with a focus on compassion and high-quality services (University of Miami Health System, 2020a).
PICOT Question
The following PICOT question will serve as the basis for the proposed DNP project: “For new nurses in the stroke unit at the University of Miami Hospital (P), how does the implementation of the Academy of Medical-Surgical Nurses (AMSN) Mentoring Program (I), compared to current practice (C), affect new nurse job confidence (O) over ten weeks (T)?”
Literature Synthesis (DONE IN NR 705)
Synthesize at least 10 (no more than 5 years old) primary research studies and/or systematic reviews; do not include summary articles. This synthesis should focus on the evidence-based peer-reviewed research articles that support your intervention. This section is all about the scientific evidence rather than someone else’s opinion of the evidence. Do not use secondary sources; read the entire article and make your own decision about the level of evidence, quality of the evidence, and applicability to your question. The evidence cited in this section must relate directly to your intervention. This is a synthesis where you address the similarities, differences, and controversies in the body of evidence to support your intervention.
Purpose
The DNP project aims to increase job confidence among new nurses by implementing a structured mentorship program introduced in the hospital for the first ten weeks after orientation. Specific objectives related to the DNP project are the following: prepare and implement a structured mentorship program for new nurses in the hospital, evaluate the influence of a formal mentorship program on new nurses’ job confidence in comparison to current practice, and demonstrate a positive impact on job confidence of new nurses through quantitative measures.
Evidence-Based Intervention
The DNP project will implement the Academy of Medical-Surgical Nurses (AMSN, 2020) Mentoring Program. Utilizing Benner’s Novice to Expert theoretical framework, a new nurse (mentee) will be paired with an expert nurse or professional in the hospital (mentor). AMSN Mentoring Program includes guidance for the mentor and mentee, as well as instructions for the site coordinator and details on the principles of a mentoring relationship, self-assessment, mentoring program plan, and necessary evaluation tools (AMSN, 2020). The content of the mentoring guide is separated into three major parts: a site coordination guide, a mentee guide, and a mentor guide. The first document describes the role of this program – the site coordinator, the mentor, and the mentee. Next, it provides checklists for the coordinator that allow one to track the timeline of the program. The mentee guide lists directions for the new nurse to follow, includes templates for background information, confidence scale, plans, guidelines, and other measurements tools to achieve set goals. Finally, the mentor guide starts with the directions and a self-assessment test. The document also contains exercises for mentor to implement and the meeting agenda and tools to use.
To use the AMSN’s guide, the site coordinator has to link the mentees with their mentors, using the self-assessment tests and new nurses’ background information. Then, mentors and mentees review their respective guides and complete initial tests that will allow one to compare the initial numbers with the results of the intervention. Most importantly. The mentees complete the Confidence Scale for New Nurses prior to the start of the intervention, but after being paired with their mentor. After this data is collected, the program begins and continues over the course of ten weeks.
As the scale of the intervention is smaller than that suggested by the AMSN which offers a 12-month program, the progress is tracked by the site coordinator in two-week intervals. Mentor and mentee also meet on a set schedule – during their meetings they use tools from the guide, talk about the results of the Confidence Scale for New Nurses and the Ideal Mentor Exercise, consider the specialty of their nursing occupation, and follow the developed agenda. At the end of the two weeks, the mentee completes the confidence scale again, as well as the Job Satisfaction Scale and Intent to Stay in the Job Survey.
Translational Science Model or Theoretical Framework/Change Model
The translational science model selected as the underpinning for this DNP project is the Knowledge-to-Action (KTA) Framework. This framework was developed in Canada by Graham and colleagues in 2004 (Xu et al., 2020). KTA is a concept that systematically explains how to take actions having knowledge. The Knowledge-to-Action (TKA) process has two components: knowledge creation and Action (World Health Organization, n.d.). Researchers report the TKA framework is frequently cited and widely utilized and integral to knowledge translation (Field et al., 2014). The model’s primary tenets include identification of the problems, adaptation of knowledge, assessment of barriers to knowledge use, selection of intervention, monitoring the implementation, evaluating outcomes, and sustaining knowledge use for future utilization (Field et al., 2014).
The TKA model has seven tenets. The first stage is identifying the problem, which is the job confidence among new nurses. Lack of proper training for new graduate nurses can decrease the job confidence of new members of the healthcare team. This issue brings the process to the second stage, which is to adapt the knowledge into the local context. This can be achieved by recognizing there is a need to adopt a mentorship program at the University of Miami Hospital’s stroke unit. The third stage identifies any barriers that may present themselves in the implementation of a mentorship program. Some of the identified obstacles are the current situation with the global pandemic COVID, leadership motivation, and the nurse’s resistance to change. To overcome these barriers, the DNP student will work closely with the identified stakeholders to determine how to establish this given mentorship program. The fourth stage in this project is the implementation stage. During this stage, the DNP student will launch the mentorship program using the AMSN Mentoring Program that focuses on the Knowledge-to-Action (KTA) Framework (Washington University in St. Louis, 2019).
To help the program succeed, the DNP student will launch the fifth stage of the project to monitor and evaluate the mentorship program through surveys and patient feedback. This is vital to understand the strong and weak aspects of the nurses’ activities and work on them appropriately. This stage is pivotal as it helps identify issues that can be modified to help the program reach completion. Evaluation of the outcomes will occur during the sixth stage using the New Nurse Confidence Scale tool to evaluate the success of the mentorship program. Information gathered will be given to staff members and administrators to reveal the project’s success. The final stage in this project is to establish sustainability within the stroke unit. This will be accomplished by raising awareness about the problem, educating key stakeholders, empowering staff, and creating new protocols to continue the mentorship program for years to come.
Organizational Setting
The organizational setting for this DNP project is the stroke unit at the University of Miami Hospital. The typical client is a patient with neurological problems, aged 55 and above, residing in the hospital vicinity. Typical areas of treatment include the brain, spinal cord, cranial, nerves, muscle, and heart. Most of these patients also suffer from high blood pressure, obesity, high cholesterol, and diabetes. The number of patients seen annually is 1500 with strokes and 35,000 in the whole Department of Neurology (University of Miami Health System, 2020b). The unit of the hospital sees many uninsured patients as well as those on Medicaid, Medicare, and private insurances.
Population Description
The anticipated population for this DNP project is 10-15 new registered nurses hired during the first half of 2020. Inclusion criteria for nurses in this study are newly hired registered nurses in the stroke unit, less than one month out of orientation, less than one-year nursing experience, and willing to be mentored. Traveling or agency nurses, non-nurses, nurses who have been out of orientation for a period longer than one month, nurses in orientation, and those who are unwilling/unable to be mentored will be excluded from the study.
Preceptors are not a part of the population, but due to the controlled nature of the project, some inclusion criteria apply to them as well. Mentors need to have at least five years of nursing expertise in the stroke unit, previous experience in preceptorship/mentorship, and willingness to mentor. Exclusion criteria for preceptors are traveling or agency nurses, non-nurses, and those nurses who have less than five years of nursing experience in the stroke unit.
Considerations and Challenges for Implementation
The project requires substantial time from employees as it asks them to make time for additional meetings, discussions, and planning. As such, the lack of time is the first potential challenge for the implementation. According to Havens et al. (2018), nurses experience continuous time constraints, especially in units with a high number of emergency situations or incoming patients. To overcome this problem, nurse mentees will be allowed to allocate some time at the end of the shift to devote to their planning of the mentorship agenda and completing surveys. Moreover, they will be encouraged to discuss appropriate meeting times with mentors that will not significantly affect the workload of the experience nurses and themselves.
As the AMSN Mentoring Program requires a significant number of mentors to participate, the lack of human resources may arise as another obstacle to completion. Nurses have a busy schedule which demotivates them from additional initiatives (Havens, et al. 2018; Ortiz, 2016). Consequently, when the nursing staff has resistance to change, the DNP student will emphasize the value of mentorship with the help of hospital executives. According to Salam and Alghamdi (2016), resistance to change is a problem in many spheres; however, in nursing, it affects not only the professional but also the patient. The DNP student and hospital leadership will work diligently in explaining the benefits of a mentorship program. A lunch and learn session with staff and administrators will present the mentorship program in detail.
A lack of motivation is another issue from which the results of the project can suffer. Intrinsic and external motivation are essential in the learning process, and if the team fails to participate in the process of mentorship with a complete understanding of its benefits, the results may not demonstrate the full potential of the program (Kodama & Fukahori, 2017). The investigator will discuss the programs’ benefits and introduce it in a way that represents value to all members involved will help with the resistance. Lack of motivation is eliminated with this format, and more nurses will be eager to participate (Kodama & Fukahori, 2017). The University of Miami Hospital employees are open to evidence-based practice; therefore, there will not be any significant objections.
Outcomes
The measurable outcome for this proposed project is an increase in new nurses’ confidence after participation in a structured, evidence-based mentorship program. The data collection process will focus on measuring novice nurses’ confidence prior to and after the mentoring program. For this, the New Nurse Confidence Scale (Appendix D) will be administered pre- and post-intervention – all mentees participating in the program will receive the form to complete, and the data will be collected online. This tool is a part of the AMSN mentorship program; the survey contains 26 questions that assess the level of confidence on a 5-point Likert scale, from “not at all confident” to “very confident.” The New Nurse Confidence Scale has been validated by the AMSN (2012) and the study by Grindel and Hagerstrom (2009). The data analysis of the present project will include internal reliability measurement, using Cronbach’s alpha.
Additionally, the mentees will complete the Assessment of the Relationship with the Mentor Form and the Mentoring Program Satisfaction Survey at the end of the project to ensure the high quality of the mentorship program and gain additional insight into the usefulness of the intervention (AMSN, 2012). As such, the surveys will be administered to the novice nurses during week 10 of the project, together with the posttest completion of the New Nurse Confidence Scale. These tools use the same measurement system as the New Nurse Confidence Scale – a 5-point scale, with the Assessment of the Relationship with the Mentor Form having a separate point, “not applicable.” All measurement tools are available through the AMSN mentorship program toolkit (Szalmasagi, 2018). The statistical evidence of these tools is provided by the AMSN as well, and the internal reliability of the surveys (alpha) will be measured prior to presenting results.
Data Management Plan
The present project is quasi-experimental, with a pretest-posttest design. New nurses’ confidence lies at the center of the project’s investigation, and the AMSN Mentoring Program uses the New Nurse Confidence Scale to assess this factor. Thus, the results of this survey are the main sources of data that indicate nurses’ level of confidence before and after the evidence-based intervention program. As the mentees have to be chosen to participate, and the sample has inclusion criteria, this project cannot be considered fully experimental. The New Nurse Confidence Scale used in the program allows one to compare findings pre- and posttest. Hence, the investigation employs a one group pretest-posttest design, since a control group is not separated from the whole sample (Grimshaw, 2000).
The structured mentor program offered by the AMSN serves as the independent variable for this project. In produces nominal data since the main question here is whether the nurses completed the program or not. Here, no measurement is needed as all nurses in the sample will complete the program. The dependent variable is the nurses’ level of confidence. The latter is calculated using the New Nurse Confidence Scale which is a survey consisting of 26 statements (AMSN, 2020). Nurses assess their agreement with the scale’s statements using the 5-point Likert scale, from “not at all confident” to “very confident.” Then, the items are summed to calculate a total score ranging from 26 to 130, which means that the dependent variable produces interval data (Grindel & Hagerstrom, 2009).
The New Nurses Confidence Scale (AMSN, 2012) will be administered electronically with data being exported to a comma-separated value file and transmitted to the statistician for analysis. Due to the observations being measured prior to and after the intervention study identification numbers will be assigned. The number of participants will be reported for each time period (nominal variable: preintervention and postintervention). As a result, the evidence-based intervention created by the AMSN yields two sets of data from the nurses who completed the New Nurse Confidence Scale before and after the program’s completion. The comparison of these two data sets is the statistic that is interpreted in the QI’s results.
Mean (standard deviation) and median (interquartile range) of the New Nurses Confidence Scale (interval data) will be calculated for both periods of time (Academy of Medical-Surgical Nurses, 2012). Dependent variables were tested for normality using normal probability plots and the Anderson-Darling, Shapiro-Francia, and the Shapiro-Wilk normality tests (Anderson & Darling, 1954; Shapiro & Francia, 1972; Shapiro & Wilk, 1965). The Anderson-Darling test is the recommended empirical distribution function test by Stephens compared to other tests of normality giving more weight to the tails of the distribution than the Cramer-von Mises test (Stephens, 1986). The Shapiro-Francia test was chosen because of its known performance and the Shapiro-Wilk test was chosen because it is one of the best-known tests for normality (Shapiro & Wilk, 1965).
To measure the change in nurses’ confidence after the intervention, the investigator will use the dependent-sample t test. As Gerald (2018) explains, the dependent -sample t test is most often selected for investigations with a pretest-posttest design, where two sets of data are connected to each other, since they originate from one group of participants. In this case, the first group of scores is calculated from pretest scores of the New Nurse Confidence Scale, and the second group is taken from the nurses’ posttest scores of the New Nurse Confidence Scale.
Owning to the dependence of the data a one-sided test [paired t test or Wilcoxon Signed Rank test; (Student, 1908; Wilcoxon, 1945)] will be used to identify an increase in confidence (Wilcoxon, 1945). The dependent sample t test detects an increase (or decrease) in means and the Wilcoxon Signed Rank test examines whether there is a shift (increase or decrease) in location due to the intervention (Hollander & Wolfe, 1999). Since there was an interest in scores increasing after the intervention a one-sided test was used instead of a two-sided test. As a result, the tests should demonstrate a change in the level of the new nurses’ confidence.
Project Management Plan and Gantt Chart
The intervention will be the implementation of the Academy of Medical-Surgical Nurses (AMSN) Mentoring Program. Using Benner’s Novice to Expert theoretical framework, a novice mentee will be paired with a proficient or expert mentor.
Week 1: Recruitment of participants (mentors and mentees), signing of informed consent, education on the structured mentorship program, assignment of a mutually agreed upon 8-week schedule will be created, the mentees will complete the New Nurse Confidence Scale. During the first week, blueprints will be distributed among the nurse, and the nurse educator will establish training sessions with employees. The executives will give a presentation to staff members with the value of the necessity of adjustments. Week 2: the implementation of the intervention in the practicum site.
Weeks 2-9: Biweekly check-ins with the DNP student and the mentor/mentee to assure cooperation between the pair and to answer any questions. Weeks 2-9 will also be used to encourage nurses to be held accountable for meetings with mentors and to track them further with regular meetings. It is also essential to evaluate the initial data and feedback to make changes if needed.
Week 10: Mentors will complete the Assessment of the Relationship with the Mentee and Mentoring Program Satisfaction Survey. The mentees will complete the New Nurse Confidence Scale, the Assessment of the Relationship with the Mentor Survey, and the Mentoring Program Satisfaction Survey. Week 10 will also be dedicated to the analysis of data and feedback gathered and the presentation of the intervention’s central results.
Proposed Budget
The project requires significant resources that will be used in the implementation project phase; they will be indicated in the attached budget plan. The financial expenditures are associated with the work of the compliance committee which includes one nurse, quality team member/statistician, project manager, and a nurse educator. Members of the committee will facilitate project plan execution to improve new nurses’ job confidence and evaluate data on the project implementation and a level of successful application. Members of this team will be paid their average salary to help nurses follow the mentorship principles and undergo extensive training and interactions with mentors. Human resources will be needed to encourage medical professionals to be involved in the project. To address this, the time of the management team and executives should be used to educate people; it is expected that they will do it without additional expenditures because they are interested in enhancing job confidence among nurses. To evaluate results gathered during the project implementation, a Statistician will be used. Finally, other materials, such as conference rooms, paper, printers, laptops, and projectors, will be needed to create a presentation and guidelines and show it to the hospital’s employees to communicate changes indicated in the budget.
The sources of finance will be initially found internally through institutional budget support expected to provide the most significant investments. Among other sources, grants can be found to help with the launch of the project in the hospital because foundations may sponsor such studies to research COVID-19 related concerns and job improvement initiatives. The hospital executives can present a project implementation plan to targeted scholarship and funding organizations and get additional support. The project is non-profit, and benefits are not expected to be monetary. Instead, they should indirectly increase the quality of healthcare services and job retention levels among new nurses of the hospital.
Table 1: Budget
Ethical Issues and Considerations
Approval to conduct this DNP project will be sought from the Institutional Review Board (IRB) at Chamberlain University. IRB approval at the practicum site is not required for quality improvement projects.
Participation in the research is strictly voluntary without monetary benefits of involvement, and evaluation forms for mentors and mentees will be anonymous. All volunteers will receive comprehensive information about the future research, objectives; Q&A session will be held to answer questions of volunteers. Mentors and mentees will get specific guidelines to follow to establish the mentorship program and its aims. Volunteers will sign an informed consent to participate in the study and to provide data to project executors and Chamberlain College of Nursing management team. Informed consent and the questionnaires for the study will be stored electronically in a secured database of the college for seven years. The informed consent will be distributed separately to chosen volunteers after the introduction and Q&A session to ensure that they agree to participate freely.
Results
Sample: This portion should describe in detail the setting, the target or accessible population, the number contacted, the percentage participating, and the details of who participated. For inferences, an analysis of the representativeness of your sample characteristics should be done by comparing your sample to your accessible or target population. These data is best presented in tables detailing those demographic details that are important to the study. An analysis of the demographic data is required.
Table 2
Note: [Place all tables for your paper in a tables section, following references (and, if applicable, footnotes). Start a new page for each table, include a table number and table title for each, as shown on this page. All explanatory text appears in a table note that follows the table, such as this one. Use the Table/Figure style, available on the Home tab, in the Styles gallery, to get the spacing between table and note. Tables in APA format can use single or 1.5 line spacing. Include a heading for every row and column, even if the content seems obvious. A default table style has been setup for this template that fits APA guidelines. To insert a table, on the Insert tab, click Table.]
Findings
This portion provides an interpretation of the major findings in the context of the overall purpose of the project. Present the statistical analyses of your primary outcome and process measures. Discuss how your major findings provide new knowledge or support previous findings that you found in the literature. Note how these findings add to the body of knowledge on this topic and support or expand on the theoretical framework you provided in Chapter I. There should be a clear relationship between the theory that drove the project to the findings presented and analyzed.
Figures Title
For more information about all elements of APA formatting, please consult the APA Style Manual, 6th Edition.
Discussion
This is where you can, and should, express your opinions regarding the results, implications, recommendations and the strengths and limitations of your project. Every study has strengths and limitations, so these should be stated.
If your results are similar to those found in previous studies, you may cautiously infer the results beyond your population and setting. However, if your results are completely different and/or contradict previous studies, you should let the reader know that these results cannot be used beyond the study population and setting.
Recommendations
Recommendations based on the findings should be for the nursing profession and society in general, and to specific nursing leaders as mentioned in the significance portion. A summary of the major findings concludes the findings and interpretations portion with a transitional paragraph introducing the recommendations portion. Recommendations should follow the same logical flow as the findings and interpretations. Include a narrative of topics that need closer examination to generate a new round of questions. Be sure to make specific recommendations for leaders in the nursing field and policy makers. Recommendations for future research should be detailed and extensive. This is a key area that students often fail to elaborate.. What could other researchers do with the new information to find out more gaps as indicated by the new results? New doctoral learners often look in this portion for ideas on problems that remain to be solved so elaborating with detail leaves a legacy to new doctoral students to continue.
Conclusions and Implications for Nursing Practice
Conclusions should relate directly to your purpose and project question. They are generalizations that loop back to the existing literature on your topic. For each conclusion you make, cite the sources that support or contradict your findings. The conclusion should represent the contribution your practice project has made to the body of scientific knowledge on this topic and relate this to the significance of the project, which is always, in some way, to improve nursing practice. Conclusions indicate what is now known regarding nursing practice when your results and results from prior literature are considered together. Implications for nursing should report findings in Section I not reported by any other literature. Why should nursing leaders care? Meanings of any gaps or similarities to literature are critically analyzed and discussed for every unusual finding. What do the findings mean to nurse leaders, and would society care about the results?
Plans for Sustainability
Explain what will be done to sustain the project over time. What strategies will you put into place for the practicum site to ensure the project has ongoing evaluation and modification as needed to ensure its success after your implementation phase is complete?
References
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Appendices, Tables, and Figures
Appendix A
- Johns Hopkins Nursing Evidence-Based Practice
- Appendix G: Individual Evidence Summary Tool
- The Johns Hopkins Hospital/ The Johns Hopkins University
- Practice Question:
- Date:
Attach a reference list with full citations of articles reviewed for this Practice question. The Johns Hopkins Hospital/ The Johns Hopkins University
Directions for Use of the Individual Evidence Summary Tool
Purpose
This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence.
Article Number
Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles.
Author and Date
Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date.
Evidence Type
Indicate the type of evidence reviewed (for example: RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review).
Sample, Sample Size, and Setting
Provide a quick view of the population, number of participants, and study location.
Findings That Help Answer the EBP Question
Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question.
Observable Measures
QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study.
Limitations
Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest.
Evidence Level and Quality
Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column.
The Johns Hopkins Hospital/ The Johns Hopkins University.
Appendix B
- Site Letter of Support
- N/A-Virtual Case Study
Appendix C
Project Schedule
Appendix D
The New Nurse Confidence Scale (AMSN Mentoring Mentee Guide, 2012)
Appendix E
This tool is part of the AMSN Mentorship Program, no permission necessary.