Week 6 Final DNP Project Manuscript
Week 6 Final DNP Project Manuscript
(Week 6 Final DNP Project Manuscript)
Methodology
This section describes organizational setting, project population translation science model and project management, plans for sustainability, and anticipated outcomes.
Organizational Setting
The healthcare setting is a general mental health facility for treating various mental health disorders. The organization adopts mental health teams based in communities, especially for schizophrenia patients, that offer daily support and treatment while helping schizophrenia patients gain as much independence as possible. Mental health teams based in communities are more suitable for the patient population because most schizophrenia patients live with their families. The teams include nurses, therapists, psychiatrists, psychologists, and social workers. The healthcare organization is located in Los Angeles, California. The healthcare organization is located in Los Angeles, California.
The study focuses on schizophrenia patients with schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between the ages of 16 and 25 years are the most vulnerable, although new schizophrenia cases begin increasing in their teenage years. Most patients present with hallucinations, delusions, and confused or disturbed thoughts that impact behavior and social and occupational functioning. About 150-230 schizophrenia patients are seen each month either at the facility or in their respective homes by the mental health teams based in the communities. On average, a hospitalized schizophrenia patient can stay in the hospital for days, ranging between 11 days to 23 days, depending on the condition and symptoms severity. A full-team approach is adopted in addressing schizophrenia at the healthcare organization. A combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome. The psychiatrist experienced or specialized in treating schizophrenia guides disease treatment and management, supported by other members of the treatment team that help coordinate care. (Week 6 Final DNP Project Manuscript)
Population
The project population typically includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems. The patient population consists of both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The study will include 50 consecutive schizophrenia patients following up with treatment at the facility or home. The inclusion criteria required patients diagnosed with schizophrenia according to the International Statistical Classification of Diseases-10 criteria, patients aged between 18 and 65 years, patients receiving treatment for the last 6 months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after nonadherence to treatment. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. Existing users of health services at the facility will be requested to participate in the study. Informed consent will be required to collect data on the participants. Any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments will be recruited for the study after consent. The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. Participation requests and details of the study will first be communicated via text messages, which are suitable even for older patients. (Week 6 Final DNP Project Manuscript)
Translational Science Model and Project Management Plan
The Iowa model of evidence-based practice will help implement motivational interviewing to enhance medication adherence among schizophrenia patients. It supports evidence-based practice implementation, research utilization, and knowledge transformation processes (Duff et al., 2020). The Iowa model offers a systematic approach to synthesizing knowledge and research findings transformation to enhance patient outcomes and quality of care. The primary purpose of this model is to increase research findings’ meaningfulness and utility in clinical decision-making (Iowa Model Collaborative et al., 2017). The Iowa model is an application-oriented EBP process guide with the following primary steps:
- Identifying either a knowledge-focused or problem-focused trigger that warrants EBP adoption.
- Determining if the identifying problem is a priority for the institution, practice, department, or clinical setting (Cabarrus College of Health Sciences, 2023).
- Establishing a team to develop, examine, and implement the required EBP change. This must be representative and interdisciplinary to evaluate and adopt the EBP change better.
- Gathering and analyzing evidence related to the identified change, including developing the research question and performing a literature search using identified keywords.
- Critiquing and synthesizing the collected research evidence to determine whether the EBP change is scientifically supported, sound, and clinically significant.
- Assessing whether the evidence is sufficient to implement the EBP change.
- Implementing the EBP change into a pilot program rather than a full practice change, for instance, implementing the change in a single nursing unit rather than the entire organization.
- Evaluating outcomes or results to determine whether the change achieves its objectives, is feasible, and if it is appropriate to adopt it within the organization. Implementation results’ observation, evaluation, and analysis should continue even after full-practice implementation (Cabarrus College of Health Sciences, 2023).
Per the Iowa model, the DNP practice project development and implementation includes the following steps:
- I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
- Medication non-adherence is a priority for the organization as it is linked with increased treatment failure, hospitalization, readmission, and mortality rates. Addressing this problem would improve hospital and patient health outcomes.
- I developed a team comprised of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers to develop, examine, and implement motivational interviewing to address medication non-adherence among schizophrenia patients.
- I developed a practice question “For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication nonadherence (O) in 8-10 weeks (T)?” to guide literature search and the DNP project. I searched for peer-reviewed articles from various databases, including PubMed, MEDLINE, and CINAHL, addressing the impact of motivational interviewing on medication adherence.
- I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level and quality and presented results of 10 articles on the evidence synthesis summary tool/table. Based on the evidence, motivational interviewing is scientifically supported, sound, and clinically significant.
- Ten articles were identified as providing the best evidence to help answer the research question. Based on the assessment, the evidence is sufficient to guide and inform the implementation of motivational interviewing at the healthcare facility.
- The project team and I will implement motivation interviewing into a pilot program that include follow-up schizophrenia patients only.
- The team and I will evaluate the implementation results to determine the impact of motivational interviewing on medication adherence among schizophrenia patients. Clinically significant results will warrant the implementation of motivational interviewing organization-wide. (Week 6 Final DNP Project Manuscript)
Project Management Plan
The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. In week 2, steps 1, 2, and 3 will be completed, which include problem identification, determination of priority, and team development. In week 3, steps 4, 5, and 5, involving evidence gathering and analysis, research articles critiquing and synthesis, and evidence assessment for adequacy will be completed. The implementation of motivational interviewing will begin in week 4 and through weeks 5, 6, 7, 8, 9, 10, and 11. In week 12, post-summative data after intervention implementation will be collected and outcomes evaluated, which is step 8 of the project implementation plan, to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients and whether it is suitable to implement in the rest of the organization and patient populations. (Week 6 Final DNP Project Manuscript)
Table 1: Implementation Plan
| Week | Activity |
| Week 1 | Pre-implementation data collection. |
| Week 2 | Step 1: Problem identification
Step 2: Determining whether the problem is priority to the organization Step 3: Team development |
| Week 3 | Step 3: Evidence gathering and analysis
Step 4: Research articles critique and synthesis Step 5: Evidence assessment for adequacy |
| Week 4 | Step 7: Intervention implementation |
| Week 5 | Step 7: Intervention implementation |
| Week 6 | Step 7: Intervention implementation |
| Week 7 | Step 7: Intervention implementation |
| Week 8 | Step 7: Intervention implementation |
| Week 9 | Step 7: Intervention implementation |
| Week 10 | Step 7: Intervention implementation |
| Week 11 | Step 7: Intervention implementation |
| Week 12 | Post-summative data collection
Step 8: Outcome evaluation |
Formative Evaluation Plan
The formative evaluation will include individual evaluation conducted before, during, and after intervention implementation aiming to improve project development and implementation design and performance and ensure activities are completed effectively and efficiently. This formative evaluation will help understand why and how the project works and other factors at work during project development and implementation. This evaluation plan will increase the likelihood of attaining successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. (Week 6 Final DNP Project Manuscript)
Table 2: Formative Evaluation Plan
| Week | When | Why | How (Oversight) |
| Week 1 | Pre-project implementation | · Understand the need for the project | · Leadership meetings |
| Week 2 | Project development | · Clarify the need for the project | · Problem tree analysis
· Priority Matrix · Stakeholder analysis |
| Week 3 | Project development | · Clarify the need for the problem
· Identify problem impact · Clarify intervention selected |
· Literature review
· Solution tree analysis |
| Week 4 | Project implementation | · Develop project design before roll-out | · Focus group
· Discussions |
| Week 5 | Project implementation | · Improve project design as it is rolled out | · Semi-structured interview
· ORID · Project diary |
| Week 6 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles |
| Week 7 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles |
| Week 8 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles |
| Week 9 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles |
| Week 10 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles and meetings |
| Week 11 | Project implementation | · Ensure project implementation activities are delivered efficiently and effectively. | · Schedule tracking
· Budget tracking · Observation · Dartboard · Questionnaire · Huddles and discussions |
| Week 12 | Post-project implementation | · Ensure project is completed successfully. | · Leadership meetings
· Project team discussions · Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire |
Plans for Sustainability
The sustainability objective is to ensure motivational interviewing is adopted organization-wide and the organization continues to enjoy its benefits in improving medication adherence over time. The sustainability plan will ensure the sustainability objective is achieved. Continuous quality and performance improvement is a post-implementation objective to help ensure the project’s sustainability. First, critical success factors will be developed, including medication adherence measures that will help assess the continued effectiveness of the intervention. Critical success factors include a substantial decrease in treatment failure, hospitalization, readmission, and mortality rates among schizophrenia patients. Consistent improvement of medication adherence and persistent behavior, including patient motivation, self-efficacy, and change and sustain talk, are critical success factors that will also help determine sustainability.
Data collection, observation, and analysis will allow the organization to measure the continual effectiveness of the intervention. Patient records and the organization’s medical data will provide information regarding treatment failure, hospitalization, readmission, and mortality rates over time. Self-reported surveys and interviews will help gather qualitative data to determine changes in medication adherence behavior over time. Project auditing and feedback collection from various stakeholders will also offer insights into the performance of the intervention after implementation and over time. The team selected for patients’ health management and outcome, patients, leaders, and observers will offer feedback regarding the project to help with continuous improvement. Opinion leaders’ involvement and evaluation will help improve the intervention and ensure sustainability. Opinion leaders include external and internal experts, educators, and organizations that advocate for the project; their insights will be critical. The data from these data and insight sources will inform sustainability strategies for continuous quality improvement. Additionally, continuous quality and performance improvement and suitability over time will be achieved through continuous patient and provider education on motivational interviewing and medication management and summative evaluation of education outcomes. Ongoing provider and patient education will help ensure the sustainability of project benefits over time. (Week 6 Final DNP Project Manuscript)
Anticipated Outcomes
Relationship between Motivational Interviewing and Medication Adherence
The primary purpose of motivational interviewing is to enhance medication adherence among schizophrenia patients. Motivation interviewing and medication adherence have a direct relationship, which involves one value directly affecting another, such as variables increasing and decreasing together. In this case, motivational interviewing has no values that increase or decrease, and the presence or absence of it will be analyzed in this paper. Data will be collected for medication adherence measures, which include treatment failure rate, readmission rates, hospitalization rates, and mortality rates, before implementing motivational interviewing and after the implementation. The expectation is a direct causal relationship such that when motivational interviewing is implemented, medication adherence behavior, which will be measured using the indicated medication adherence measures. This direct causal relationship is described as “the implementation of motivational interviewing improved medication adherence” or “motivational interviewing was positively associated with medication adherence.” (Week 6 Final DNP Project Manuscript)
Expected Change after Implementing Motivational Interviewing
Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure rate, readmission rates, hospitalization rates, and mortality rates. The desired changes based on these measures include decreased treatment failure rate, reduced readmission rate, decreased hospitalization rates, and decreased mortality rate associated with schizophrenia. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Additionally, Zomahoun (2018) established that MI interventions might help improve medication adherence for chronic conditions in adults. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (Week 6 Final DNP Project Manuscript)
References
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