In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

1. Background
2. Clinical problem statement.
3. Purpose of the change proposal in relation to providing patient care in the changing health care system.
4. PICOT question.
5. Literature search strategy employed.
6. Evaluation of the literature.
7. Applicable change or nursing theory utilized.
8. Proposed implementation plan with outcome measures.
9. Discussion of how evidence-based practice was used in creating the intervention plan.
10. Plan for evaluating the proposed nursing intervention.
11. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
12. Appendix section, if tables, graphs, surveys, educational materials, etc. are created.

Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:     Exemplify professionalism in diverse health care settings.

2.2:     Comprehend nursing concepts and health theories.

3.2:     Implement patient care decisions based on evidence-based practice

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

• Write a report on the application of population health improvement initiative outcomes to patient-centered care, based on information presented in an interactive multimedia scenario.
  In this assessment, you have an opportunity to apply the tenets of evidence-based practice in both patient-centered care and population health improvement contexts. You will be challenged to think critically, evaluate what the evidence suggests is an appropriate approach to personalizing patient care, and determine what aspects of the approach could be applied to similar situations and patients.
  By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
  • Competency 1: Apply evidence-based practice to plan patient-centered care.
    • Evaluate the outcomes of a population health improvement initiative.
    • Develop an approach to personalizing patient care that incorporates lessons learned from a population health improvement initiative.
  • Competency 2: Apply evidence-based practice to design interventions to improve population health.
    • Propose a strategy for improving the outcomes of a population health improvement initiative, or for ensuring that all outcomes are being addressed, based on the best available evidence.
  • Competency 3: Evaluate outcomes of evidence-based interventions.
    • Propose a framework for evaluating the outcomes of an approach to personalizing patient care and determining what aspects of the approach could be applied to similar situations and patients.
  • Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
    • Justify the value and relevance of evidence used to support an approach to personalizing patient care.
  • Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
    • Write clearly and logically, with correct grammar and mechanics.
    • Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.
  • Competency Map
    Use this online tool to track your performance and progress through your course.
• Questions to ConsiderAs you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
  Recall an instance in which you have taken a strategy, finding, or lesson learned from one care context and applied it in another.
  • What challenges did this type of knowledge transfer present?
  • Did applying this knowledge in a different setting lead to improvements in the safety and quality of care? How?
  • Did applying this knowledge in a different setting raise any particular ethical issues affecting the provision of care?
• Assessment Instructions Preparation
  In this assessment, you will base your Patient-Centered Care Report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece should serve as pre-writing for this assessment and inform the final draft of your report. Even though the media piece presented only one type of care setting, you can extrapolate individualized care decisions, based on population health improvement initiative outcomes, to other settings.
  Requirements
  Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.
  Writing, Supporting Evidence, and APA Style
  • Write clearly and logically, using correct grammar and mechanics.
  • Integrate relevant evidence from 3–5 current scholarly or professional sources to support your evaluation, recommendations, and plans.
    • Apply correct APA formatting to all in-text citations and references.
    • Attach a reference list to your report.
  • Report Content
    Address the following points in a 4–6 page report:
  • Evaluate the expected outcomes of the population health improvement initiative that were, and were not, achieved.
    • Describe the outcomes that were achieved, their positive effects on the community’s health, and any variance across demographic groups.
    • Describe the outcomes that were not achieved, the extent to which they fell short of expectations, and any variance across demographic groups.
    • Identify the factors (for example: institutional, community, environmental, resources, communication) that may have contributed to any achievement shortfalls.
  • Propose a strategy for improving the outcomes of the population health improvement initiative, or ensuring that all outcomes are being addressed, based on the best available evidence.
    • Describe the corrective measures you would take to address the factors that may have contributed to achievement shortfalls.
    • Cite the evidence (from similar projects, research, or professional organization resources) that supports the corrective measures you are proposing.
    • Explain how the evidence illustrates the likelihood of improved outcomes if your proposed strategy is enacted
  • Develop an approach to personalizing patient care that incorporates lessons learned from the population health improvement initiative outcomes.
    • Explain how the outcomes and lessons learned informed the decisions you made in your approach for personalizing care for the patient with a health condition related to the population health concern addressed in the improvement initiative.
    • Ensure that your approach to personalizing care for the individual patient addresses the patient’s:
      • Individual health needs.
      • Economic and environmental realities.
      • Culture and family.
    • Incorporate the best available evidence (from both the population health improvement initiative and other relevant sources) to inform your approach and actions you intend to take.
  • Justify the value and relevance of evidence you used to support your approach to personalizing care for your patient.
    • Explain why your evidence is valuable and relevant to your patient’s case.
    • Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
  • Propose a framework for evaluating the outcomes of your approach to personalizing patient care.
    • Ensure that your framework includes measurable criteria that are relevant to your desired outcomes.
    • Explain why the criteria are appropriate and useful measures of success.
    • Identify the specific aspects of your approach that are most likely to be transferable to other individual cases.
  • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.
    Patient-Centered Care Report Scoring Guide

• As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
  Recall an experience you have had working with a population, or as part of a community health improvement initiative, or a time in your care setting that you observed this type of work within your organization or community.
  • How were data and information about the community incorporated into the work?
    • Was the diversity of culture and beliefs in the community taken into account?
    • Were other, secondary, health concerns of the community also taken into account?
    • Were the economic and daily environmental realities of the community taken into account?
  • What, if any, ethical issues were considered in working with specific groups and stakeholders in the community?
  • What suggestions might you offer for doing things differently, if you could revisit that work?
    • Would you set different goals?
  • What evidence would you present to support your recommendations?
• Resources Suggested Resources
  The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6011 – Evidence-Based Practice for Patient-Centered Care and Population Health Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
  Evidence-Based Practice
  • Cabassa, L. J., Stefancic, A., O’Hara, K., El-Bassel, N., Lewis-Fernández, R., Luchsinger, J. A., . . . Palinkas, L. A. (2015). Peer-led healthy lifestyle program in supportive housing: Study protocol for a randomized controlled trial. Trials, 16, 388–401.
  • Dombrowski, J. J., Snelling, A. M., & Kalicki, M. (2014). Health promotion overview: Evidence-based strategies for occupational health nursing practice. Workplace Health & Safety, 62(8), 342–9, 350.
  • Evidence-Based Practice in Nursing & Health Sciences.
  • Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
  • The Joint Commission. (2016). Health care leaders meet, address health care disparity. Retrieved from www.jointcommission.org/health_care_leaders_meet_address_health_care_disparity_/
  • SHOW LESSTriple Aim
  • American Hospital Association. (2015). Zeroing in on the Triple Aim [PDF]. Retrieved from www.aha.org/content/15/brief-3aim.pdf
  • Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759–769.
  • Institute for Healthcare Improvement. (2016). Triple Aim for populations. Retrieved from http://www.ihi.org/Topics/TripleAim/Pages/default.aspx
  • Research Guides
  • Database Guide: Ovid Nursing Full Text PLUS.
  • Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf
  • Nursing Masters (MSN) Research Guide.
• Assessment Instructions: Preparation
  Your organization is undertaking a population health improvement initiative focused on one of the pervasive and chronic health concerns in the local community. Examples of health improvement initiatives include nationwide concerns, such as type 2 diabetes, HIV, obesity, and Zika. However, your organization has asked you to determine which widespread health concern should be addressed in a population health improvement plan for the community in which you practice and has entrusted you with gathering and evaluating the relevant data.
  Requirements
  Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.
  Data Evaluation
  Evaluate community demographic, epidemiological, and environmental data.
  • Identify the relevant data.
  • Describe the major community health concerns suggested by the data.
  • Explain how environmental factors affect the health of community residents.
  • Health Improvement Plan
    Develop an ethical health improvement plan that effectively addresses the population health concern that you identified in your evaluation of the relevant data.
  • Base your plan on the best available evidence from a minimum of 3–5 current scholarly or professional sources.
    • Apply correct APA formatting to all in-text citations and references.
    • Attach a reference list to your plan.
  • Ensure that your plan meets the cultural and environmental needs of your community and will likely lead to some improvement in the community’s health related to this concern.
    • Consider the environmental realities and challenges that exist in the community.
    • Address potential barriers or misunderstandings related to the various cultures prevalent in the community.
  • Justify the value and relevance of the evidence you used as the basis of your plan.
    • Explain why the evidence is valuable and relevant to the community health concern you are addressing.
    • Explain why each piece of evidence is appropriate and informs the goal of improving the health of the community.
  • Propose relevant and measurable criteria for evaluating the outcomes of your plan.
    • Explain why your proposed criteria are appropriate and useful measures of success.
  • Explain how you will communicate with colleagues and members of the community, in an ethical, culturally sensitive, and inclusive way, with regard to the development and implementation of your plan.
    • Develop a clear communications strategy mindful of the cultural and ethical expectations of colleagues and community members regarding data privacy.
    • Ensure that your strategy enables you to make complex medical terms and concepts understandable to members of the community, regardless of language, disabilities, or level of education.
  • Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

The DNP must have a basic understanding of statistical measurements and how they apply within the parameters of data management and analytics. In this assignment, you will demonstrate understanding of basic statistical tests and how to perform the appropriate test for the project using SPSS or other statistical programs.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Refer to “Setting Up My SPSS,” “SPSS Database,” and “Comparison Table of the Variable’s Level of Measurement,” located in the DNP 830 folder of the DC Network Practice Immersion workspace.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• This assignment uses a rubric. Review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

Directions:

1. Set up your IBM SPSS account and run several statistical outputs based on the “SPSS Database” Use “Setting Up My SPSS” to set up your SPSS program on your computer or device. You may also use programs such as Laerd Statistics or Intellectus, if you subscribe to them.
2. The patient outcome or dependent variables and the level of measurement must be displayed in a comparison table which you will provide as an Appendix to the paper. Refer to the “Comparison Table of the Variable’s Level of Measurement.”
3. Submit a 1,000-1,250 word data analysis paper outlining the procedures used to analyze the parametric and non-parametric variables in the mock data, the statistics reported, and a conclusion of the results.

Provide a conclusive result of the data analyses based on the guidelines below for statistical significance.

1. PAIRED SAMPLE T-TEST: Identify the variables BaselineWeight and InterventionWeight. Using the Analysis menu in SPSS, go to Compare Means, Go to the Paired Sample t-test. Add the BaselineWeight and InterventionWeight in the Pair 1 fields. Click OK. Report the mean weights, standard deviations, t-statistic, degrees of freedom, and p level. Report as t(df)=value, p = value. Report the p level out three digits.
2. INDEPENDENT SAMPLE T-TEST: Identify the variables InterventionGroups and PatientWeight. Go to the Analysis Menu, go to Compare Means, Go to Independent Samples tT-test. Add InterventionGroups to the Grouping Factor. Define the groups according to codings in the variable view (1=Intervention, 2 =Baseline). Add PatientWeight to the test variable field. Click OK. Report the mean weights, standard deviations, t-statistic, degrees of freedom, and p level. Report t(df)=value, p = value. Report the p level out three digits
3. CHI-SQUARE (Independent): Identify the variables BaselineReadmission and InterventionReadmission. Go to the Analysis Menu, go to Descriptive Statistics, go to Crosstabs. Add BaselineReadmission to the row and InterventionReadmission to the column. Click the Statistics button and choose Chi-Square. Select eta to report the Effect Size. Click suppress tables. Click OK. Report the frequencies of the total events, the chi-square statistic, degrees of freedom, and p level. Report ꭓ2 (df) =value, p =value. Report the p level out three digits.
4. MCNEMAR (Paired): Identify the variables BaselineCompliance and InterventionCompliance. Go to the Analysis Menu, go to Descriptive Statistics, go to Crosstabs. Add BaselineCompliance to the row and InterventionCompliance to the column. Click the Statistics button and choose Chi-Square and McNemars. Select eta to report the Effect Size. Click suppress tables. Click OK. Report the frequencies of the events, the Chi-square, and the McNemar’s p level. Report (p =value). Report the p level out three digits.
5. MANN WHITNEY U: Identify the variables InterventionGroups and PatientSatisfaction. Using the Analysis Menu, go to Non-parametric Statistics, go to LegacyDialogs, go to 2 Independent samples. Add InterventionGroups to the Grouping Variable and PatientSatisfaction to the Test Variable. Check Mann Whitney U. Click OK. Report the Medians or Means, the Mann Whitney U statistic, and the p level. Report (U =value, p =value). Report the p level out three digits.
6. WILCOXON Z: Identify the variables BaselineWeight and InterventionWeight. Go to the Analysis Menu, go to Non-parametric Statistics, go to LegacyDialogs, go to 2 Related samples. Add the BaselineWeight and InterventionWeight in the Pair 1 fields. Click OK. Report the Mean or Median weights, standard deviations, Z-statistic, and p level. Report as (Z =value, p =value). Report the p level out three digits.

Include the following in your paper:

1. Discussion of the types of statistical tests used and why they have been chosen.
2. Discussion of the differences between parametric and non-parametric tests.
3. Description of the reported results of the statistical tests above.
4. Summary of the conclusive result of the data analyses.
5. Outputs from the statistical analysis provided as an Appendix to the paper.
6. Comparison table of the variable’s level of measurement provided as an Appendix to the paper.

Use the following guidelines to report the test results:

• Statistically Significant Difference: When reporting exact p values, state early in the data analysis and results section, the alpha level used for the significance criterion for all tests in the project. Example: An alpha or significance level of < .05 was used for all statistical tests in the project. Then if the p-level is less than this value identified, the result is considered statistically significant. A statistically significant difference was noted between the scores before compared to after the intervention t(24) = 2.37, p = .007. 
• Marginally Significant Difference: If the results are found in the predicted direction but are not statistically significant, indicate that results were marginally significant. Example: Scores indicated a marginally significant preference for the intervention group (M = 3.54, SD = 1.20) compared to the baseline (M = 3.10, SD = .90), t(24) = 1.37, p = .07. Or there was a marginal difference in readmissions before (15) compared to after (10) the intervention ꭓ2(1) = 4.75, p = .06.
• Non-Significant Trend: If the p-value is over .10, report results revealed a non-significant trend in the predicted direction. Example: Results indicated a non-significant trend for the intervention group (14) over the baseline (12), ꭓ2(1) = 1.75, p = .26.

The results of the inferential analysis are used for decision-making and not hypothesis testing. It is important to look at the real results and establish what criterion is necessary for further implementation of the project’s findings. These conclusions are a start.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives and is application-based learning using your real-world practice setting. These assignments earn practice immersion hours and are indicated in the syllabus by a Portfolio Practice Hours statement, which reminds you, the learner, to enter in a corresponding case log in Typhon. Actual practice immersion hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using a real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.

To earn portfolio practice hours, enter the following after the references section of your paper:

Practice Hours Completion Statement DNP-830

I, (INSERT NAME), verify that I have completed (NUMBER OF) practice immersion hours in association with the goals and objectives for this assignment. I have also tracked said practice immersion hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.