This is the initial stage and the development of Chapter 4 and ongoing working versions of Chapter 4 of the DPI Project.

Please use the CRITERION on the manuscript. The response MUST be immediately written under the Criterion. Please see the attached Manuscript.

Please include in-text citation for all quotes and include references on the reference page. I am expecting this to be about 12 to 15 pages

Please see the attached Chapters 1, 2 & 3.

TOPIC: Improving Medication Adherence in Diabetic Patients in Home Health Care Settings 

Manuscript to start Chapter 4 is Attached 

Previous Chapters 1, 2 & 3 is Attached

Once IRB approval for your Proposal is obtained, learners will commence the implementation phase of the DPI Project. For the remainder of the course, learners are required to develop working drafts of Chapters 4 and 5 of the final DPI Project. These chapters will undergo further revision in DNP-965 with the requirement that the entire DPI Project will be submitted to the DPI Committee at the end of DNP-965.

General Requirements:

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

• Remember to use the appropriate forms and templates (if required) for completing this assignment. These are available on the PI Workspace of the DC Network.
• Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
• You are required to submit this assignment to LopesWrite. 

Directions:

Submission of the completed DPI Project – Working Draft Chapter 4 is the required deliverable to progress through the DPI Project implementation phase. Locate the “Final DPI Project Template” in the PI Workspace area of the DC Network and utilize it to develop and submit initial and ongoing working versions of Chapter 4 of your DPI Project.

You are required to complete your assignment using 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.

Template Explanation on the Direct Practice Improvement (DPI) Project

Proposal and the DPI Final Manuscript Template (all-in-one)

This template is used for both the DPI Project Proposal as well as the Final Manuscript.

You are required to refer to yourself as the Primary Investigator throughout the proposal and final manuscript. It is preferred that you write your manuscript in the third person, but when necessary, you must refer to yourself as the Primary Investigator.

In your proposal, you will write in the future tense (present tense, i.e., the purpose of this quantitative quasi-experimental project is to…). In contrast, in the final manuscript , you will write in the past tense (the purpose of this quantitative quasi-experimental project was to… as now you have implemented your project)

In DNP 955, you will be writing chapters 1-3 which also includes your 10-Strategic Points as an appendix. The learner is required to submit to AQR-1

by

the due date week 8 (or you will not pass the course) with your manuscript in the present (future tense). In addition, in DNP 955, the appendices are as follows:

· Appendix A is your 10 Strategic Points – REQUIRED

·

Appendix B is your instrument/tools -REQUIRED (if your project includes the use of an instrument/Tool)

· Appendix C is your permission to use your instrument/tools -REQUIRED (if your project includes the use of an instrument)

· Appendix D is a detailed process you as the learner will use to prepare staff/health care providers to implement the practice improvement intervention. This should include specific information obtained from the literature and from developers of the evidence-based practice guideline, protocol, toolkit, or screening tool, etc. An agenda may be included as well as an outline of materials to be used, delivery method, handouts, ppts., when, & where.

Remember when you submit to AQR-1, you will include your completed cover page, abstract, TOC, chapters 1-3, and your appendices in the current APA edition.

DO NOT DELETE CHAPTERS 4 AND 5 FROM THE PAPER OR YOU WILL LOSE THE FORMATTING. THE REVIEWERS ARE AWARE THEY WILL BE INCLUDED BUT ARE NOT GOING TO BE REVIEWED DURING AQR-1.

In DNP 960, you are required to make all recommended changes listed within your AQR-1 review for chapters 1-3. This is not optional; failure to do so may result in a failing grade for DNP-960. Address all comments in the 10-Strategic Points. All edits from your AQR-1 revisions are to remain in the present (future tense) until you have received the written GCU DNP IRB Outcome Letter (typically between weeks 3-7). After you have begun implementation, you may start to write in the past tense for all 5 chapters. While waiting for the outcome letter, it is expected that all learners will write chapters 4 (including tables and figures) and 5 as a draft in preparation for the data they will be collecting in implementation.

In DNP 965, all writing in the manuscript is written in the past tense (as long as you have received the GCU DNP IRB Outcome Letter. Submission to AQR-2 occurs at the end of week 5 in DNP 965
(required to progress to final manuscript review, no AQR- 2= continuation course).

In this AQR-2 submission, you will submit all five chapters with the actual data (not the made update from DNP-960) along with your cover page, copywrite page, title page, abstract (paragraph form), TOC (updateable), the body of the manuscript, and all applicable appendices:

· Appendix A GCU IRB Outcome Letter

· Appendix B is your instrument/tools -REQUIRED (if your project includes the use of an instrument/Tool)

· Appendix C is your permission to use your instrument/tools -REQUIRED (if your project includes the use of an instrument)
· Appendix D is a detailed process you as the learner will use to prepare staff/health care providers to implement the practice improvement intervention. This should include specific information obtained from the literature and from developers of the evidence-based practice guideline, protocol, toolkit, or screening tool, etc. An agenda may be included as well as an outline of materials to be used, delivery method, handouts, ppts., when, & where.

· No other appendices are needed unless you have multiple tools (which is not recommended).

*Please make certain that you have used programs such as Grammarly (check into investing in Grammarly Premium), ThinkingStorm (GCU), an editor, a formatter, statistician, and any additional resources you feel like you need to be successful before you submit to AQR-2 and most importantly, before final manuscript review.

Feel free to contact the AQR Manager for any questions or concerns related specifically to AQR-1 or AQR-2. Meet regularly with your Chair, mentor, and/or content expert to ensure that your manuscript meets all requirements, deadlines, and revisions. Your DNP faculty, Chairs, and Program Lead want you to be successful and are here to support you each step of the way! Please use your University Policy Handbook on your chain of command and any appeal you feel you might need.

Blessed are those who have learned to acclaim you, who walk in the light of your presence, O Lord. – Psalm 89:15

DELETE THESE FIRST TWO PAGES!!!!!

The Direct Practice Improvement Project Title Appears in Title Case and Is Centered Comment by Author: NOTE: All notes and comments are keyed to the 7th edition of the Publication Manual of the American Psychological Association.
American Psychological Associatio6n (APA) style is most commonly used to cite sources within the social sciences. This resource, revised according to the 7th edition of the Publication Manual of the American Psychological Association, offers examples for the general format of APA research papers, in-text citations, footnotes, and the reference page. For specifics, consult the Publication Manual of the American Psychological Association. For additional information on APA Style, consult the APA website:
http://apastyle.org/learn/index.aspx
GENERAL FORMAT RULES:
Manuscripts must be 12-point Times New Roman typeface, double-spaced on quality standard-sized paper (8.5″ x 11″) with 1-inch margins on the top, bottom, and right side. For binding purposes, the left margin is 1.5 in.. To set this in Word, go to:
Page Layout >
Page Setup>
Margins >
Custom Margins>
Top: 1” Bottom: 1”
Left: 1.5” Right: 1”
Click “Okay”
Page Layout>
Orientation>
Portrait>
NOTE: All text lines are double-spaced. This includes the title, headings, formal block quotes, references, footnotes, and figure captions.
The first line of each paragraph is indented 0.5 inch. Use the tab key which should be set at 5 to 7 spaces. If a white tab appears in the comment box, click on the tab to read additional information included in the comment box.
Please note: The section citations to APA Manual are provided in brackets throughout template. These brackets are not to be modeled for APA formatting. The information is included to help you locate material. Comment by Author: Formatting note: The effect of the page being centered with a 1.5″ left margin is accomplished by the use of the first line indent here. However, it would be correct to not use the first line indent, and set the actual indent for these title pages at 1.5″. Comment by Author: If the title is longer than one line, double-space it. As a rule, the title should be approximately 12 words. Titles should be descriptive and concise with no abbreviations, jargon, or obscure technical terms. The title should be typed in uppercase and lowercase letters.

Submitted by

Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Comment by Author: For example: Jane Elizabeth Smith

Equal Spacing

Comment by Author: Delete yellow highlighted “Helps” as project develops.

~2.0” –

(7 lines)

A Direct Practice Improvement Project Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Nursing Practice

Equal Spacing
~2.0” –
(7 lines)

Grand Canyon University

Phoenix, Arizona

[Insert Current

Date

]

© by Your Full Legal Name (No Titles, Degrees, or Academic Credentials), 2020 Comment by Author: NOTE: The copyright page is included in the final practice improvement project. Comment by Author: For example: © by Jane Elizabeth Smith, 2012
This page is centered. This page is counted, not numbered and should not appear in the Table of Contents.

All rights reserved.

GRAND CANYON UNIVERSITY

The Direct Practice Improvement Project Title Appears in Title Case and is Centered Comment by Author: If the title is longer than one line, double-space it. The title should be typed in upper and lowercase letters.

by
Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Comment by Author: For example: Jane Elizabeth Smith

has been approved

September 22, 2020 Comment by Author: Date of Dean’s signature. Until then, use the current date to fill this space. Upon final submission, this date should match the date on the title page.

APPROVED:

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Chairperson

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Mentor

Full Legal Name, Ed.D., DBA, or Ph.D., DPI Project Content Expert

ACCEPTED AND SIGNED:

________________________________________

Lisa Smith, PhD, RN, CNE

Dean and Professor, College of Nursing and Health Care Professions

_________________________________________

Date

Abstract Comment by Author: On the first line of the page, center the word “Abstract” (boldface font, italics, underlining, or quotation marks).
Beginning with the next line, write the abstract. Abstract text is one paragraph with no indentation and is double-spaced. This page is counted, not numbered, and does not appear in the Table of Contents.
Abstracts do not include references or citations.
The abstract should be one page
Comment by Author: Comment by Author: You will notice a difference between the proposal template and final manuscript template. The final template allows the option to remove headers if you need more room.

The first sentence or two outlines the problem; why is this being addressed? Do not make statements that require a citation as there are no citations in an abstract! The second statement is the supporting what is happening at the site. The purpose of this quantitative quasi-experimental project was to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to current practice among ___________(population) in a ________ (setting i.e.: primary care clinic, ER, OR) in ________ (state) over four-weeks. State the nursing model/theory and other frameworks used in ONE SENTENCE! Data analysis and the sample size is next Now you want to state how the results were statistically and clinically significant. How did these results impact patient outcomes impact the practice at the site and recommendations for what should be done in the future based on the project findings Comment by Author: See the DC Network, Templated Abstract in writing resources Comment by Author: Whose intervenstion? Example: Sutter’s Oral Hygeine Tool or the Institute of Medicinxes XYZ tool. Comment by Author: this is your measurable PATIENT outcome. Comment by Author: Make sure you take this statement and replace it throughout the manuscript to ensure it matches everywhere you discuss the purpose 🙂 From this statement you will need to make certain that the problem statement and clinical questions match (align) with this statement as well. Comment by Author: – DO NOT SAY p> 0.05 or p<0.05 Must say p= VALUE (EXAMPLE: Data on the motivation to quit was measured by TTM and nicotine dependence was measured by the Fagerstrom Test for Nicotine Dependence (FTND) questionnaire in diabetic adult smokers aged 18 years and older, (n=16) were compared at baseline, two weeks, and four weeks post-implementation of the Five A's model. A paired t-test showed that there was a statistically significant improvement in patient's motivation to quit smoking (M=-2.86; SD=1.29; p=0.003), a substantial decrease in nicotine dependence (M= -1.86; SD=1.41; p=0.001), and 100% of the healthcare providers (n=6) were compliant in assessing tobacco use p=0.000). Comment by Author: (Based on the results, the Five A's model may result in increased patient motivation to quit smoking as well as a decrease in nicotine dependence. Recommendations include the continuation of the program and possible repetition of the project at another clinical site over an extended monitoring period as well as with larger sample sizes.) or maybe if there was no significance (Even though statistical significance was not found STATS, the INTERVENTION provided needed areas for reinforcement measurement and enhanced nursing staff awareness. Therefore, the findings suggest that continuous utilization of INTERVENTION may DO WHAT to IMPROVE WHAT. Replication of the project is needed in larger settings and over a longer period of time.) Keywords: Abstract, theory, theorists, tools, instruments, assist future investigators, vital information Comment by Author: Make sure to add the keywords at the bottom of the abstract to assist future investigators. Criterion Comment by Author: All of the criterion tables must be removed prior to all AQR, IRB, and final submissions. Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback The abstract provides a succinct summary of the project including the problem statement, clinical questions, methodology, design, data analysis procedures, location, sample, theoretical foundations, results, and implications. The abstract is written in APA format, 1 paragraph, no indentations, double spaced with no citations, and includes key search words. The abstract is fully justified. Abstract is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Comment by Author: Make sure to add the keywords at the bottom of the abstract to assist future investigators.
Librarians and investigators use the keywords to catalogue and locate vital research material.

Dedication Comment by Author: Title in bold font
An optional dedication may be included here. While a practice improvement project is an objective, scientific document, this is the place to use the first person and to be subjective. The dedication page is numbered with a Roman numeral, but the page number does not appear in the Table of Contents. It is only included in the final practice improvement project and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below. If you cannot see the page break, click on the ¶Show/Hide button (go to the Home tab and then to the Paragraph toolbar).

Acknowledgments Comment by Author: Title is bolded.
An optional acknowledgements page can be included here. This is another place to use the first person. If it applies, acknowledge and identify grants and other means of financial support. Also acknowledge supportive colleagues who rendered assistance. The acknowledgments page is numbered with a Roman numeral, but the page number does not appear in the Table of Contents. This page provides a formal opportunity to thank family, friends, and faculty members who have been helpful and supportive. The acknowledgements page is only included in the final practice improvement project, and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below. If you cannot see the page break, click on the Show/Hide button (go to the Home tab and then to the Paragraph toolbar).
Table of Contents
Chapter 1: Introduction to the Project 1
Background of the Project 5
Problem Statement 6
Purpose of the Project 7
Clinical Question(s) 9
Advancing Scientific Knowledge 11
Significance of the Project 13
Rationale for Methodology 14
Nature of the Project Design 15
Definition of Terms 17
Assumptions, Limitations, Delimitations 20
Summary and Organization of the Remainder of the Project 23
Chapter 2: Literature Review 25
Theoretical Foundations 27
Review of the Literature 30
Theme 1. 32
You may want to organize this section by themes and subthemes. To do so, use the pattern below. 32
Theme 2 33
Summary 37
Chapter 3: Methodology 41
Statement of the Problem 42
Clinical Question 43
Project Methodology 45
Project Design 48
Population and Sample Selection 50
Instrumentation or Sources of Data 52
Validity 54
Reliability 55
Data Collection Procedures 56
Data Analysis Procedures 58
Potential Bias and Mitigation 60
Ethical Considerations 64
Limitations 66
Summary 67
Chapter 4: Data Analysis and Results 69
Descriptive Data 70
Data Analysis Procedures 73
Results 74
Summary 80
Chapter 5: Summary, Conclusions, and Recommendations 82
Summary of the Project 83
Summary of Findings and Conclusion 84
Implications 86
Theoretical Implications 86
Practical Implications 86
Future Implications 86
Recommendations 87
Recommendations for Future Projects 88
Recommendations for Practice 89
References 91
Appendix A 93
The Parts of a Practice Improvement Project 93
Preliminary Pages 93
Main Text 93
Supplementary Pages 94
Appendix B 95
What is my DPI project design? 95
Appendix C 97
Power Analysis Using G Power 97
Appendix D 98
Example SPSS Dataset & Variable View 98
Appendix E 99
How to Make APA Format Tables and Figures Using Microsoft Word 99
Appendix F 109
Writing up your statistical results 109

List of Tables Comment by Author: This is an example of a List of Tables “boiler plate.” To create an automatic list of tables, go into the “References” tab on Word. For each table and figure, use the “Insert Caption” function. Choose “table” from the dropdown menu. Then, when your tables and figures have been inserted into the final manuscript, use the “Insert Table of Figures” tool in the Caption section. Choose “table” from the dropdown menu.
The List of Tables follow the Table of Contents.
The List of Tables is included in the Table of Contents and shows a Roman numeral page number at the top right. The page number is right justified with a 1 in. margin on each page. Dot leaders must be used. The title is bolded.
On the List of Tables, single-space table titles, double-spaced between entries. See Chapter 7 of the APA Style Manual for details and specifics on Tables and Data Display.
All tables are numbered with Arabic numerals in the order in which they are first mentioned.
Table 1
.
Characteristics of Variables

42

Table 2
.
Type of Methodology and Rationale for Selecting It

45

Table 3
.
A Sample Data Table Showing Correct Formatting

71

Table 4
.
t
–
Test for Equality of Emotional Intelligence Mean Scores by Gender

75

Table 5
.
The Servant Leader

76

(Note: single-space table titles; use “Add a Space After Paragraph” (12pt) in Line Spacing Options between table titles)

List of Figures Comment by Author: This is an example of a List of Figures “boiler plate.” To create an automatic list of tables, go into the “References” tab on Word. For each table and figure, use the “Insert Caption” function. Choose “figure” from the dropdown menu. Then, when your tables and figures have been inserted into the final manuscript, use the “Insert Table of Figures” tool in the Caption section. Choose “figure” from the dropdown menu.
The List of Figures follows the List of Tables.
The List of Figures is included in the Table of Contents and shows a Roman numeral page number at the top right. The page number is justified with a 1 in. margin on each page. The title is bolded.
Figures include graphs, charts, maps, drawings, cartoons, and photographs. In the List of Figures, single-space figure titles and double-space between entries. See 6APA Manual Chapter 7 for details and specifics on Figures and Data Display.
All figures are numbered with Arabic numerals in the order in which they are first mentioned. The figure title included in the Table of Contents should match the title found in the text.
Figure 1. Approaches to
C
ollecting the
D
ata to
A
nswer the
C
linical
Q
uestions.

43

Figure 2. Parametric
S
tatistics for
A
nalysis of
R
atio or
I
nterval
L
evel
D
ependent

V
ariabl
e

58

Figure 3. Non-
P
arametric
S
tatistics for
A
nalysis of
N
ominal or
O
rdinal
L
evel
D
ependent
V
ariable

59

Figure 4.
Scattor Plot Example – Strong Negative Correlation

78

(Note: single-space figure titles; use “Add a Space After Paragraph” (12pt) in Line Spacing Options between table titles) double-space between entries)

Chapter 1: Introduction to the Project Comment by Author: This heading is tagged with APA Style Level 1 heading. Comment by Author: Headers 7th Edition
The Introduction section of Chapter 1 briefly overviews the project focus or practice problem, states why the project is worth conducting, and describes how the project will be completed. The introduction develops the significance of the project by describing how the project translates existing knowledge into practice, is new or different from other works and how it will benefit patients at your clinical site. This section should also briefly describe the basic nature of the project and provide an overview of the contents of Chapter 1. This section should be three or four paragraphs, or approximately one page, in length.
Keep in mind that you will write Chapters 1 through 3 as your direct practice improvement (DPI) project proposal and Chapters 1 through 5 for your final project manuscript. (see Appendix A) However, there are changes that typically need to be made in these chapters to enrich the content or to improve the readability as you write the final DPI project manuscript. Often, after data analysis is complete, the first three chapters will need revisions to reflect a more in-depth understanding of the topic, change the tense to past tense, and ensure consistency.
To ensure the quality of both your proposal and your final practice improvement project and reduce the time for Academic Quality Review (AQR) reviews, your writing needs to reflect standards of scholarly writing from your very first draft. Each section within the proposal or final DPI project should be well organized and presented in a way that makes it easy for the reader to follow your logic. Each paragraph should be short, clear, and focused. A paragraph should (a) be three to eight sentences in length, (b) focus on one point, topic, or argument, (c) include a topic sentence the defines the focus for the paragraph, and (d) include a transition sentence to the next paragraph. Include one space after each period. There should be no grammatical, punctuation, sentence structure, or American Psychological Association APA formatting errors. Be sure to use the check document feature in the Microsoft Word Review Menu. This feature will check for spelling errors and grammatical issues.
Verb tense is an important consideration for Chapters 1 through 3 versus the final manuscript. For the proposal, the investigator uses present tense (e.g., “The purpose of this project is to…”), whereas in the practice improvement final project, the chapters are revised into past tense (e.g., “The purpose of this project was to…”). Taking the time to put quality into each draft will save you time in all the steps of the development and review phases of the practice improvement project process. It will pay to do it right the first time. Comment by Author: Consider where you are in the process when determining past or present tense. If your project has been implemented, and you have finished your data collection, then the entire manuscript should be written in past tense.

As a doctoral investigator, it is your responsibility to ensure the clarity, quality, and correctness of your writing and APA formatting. The DC Network provides various resources to help you improve your writing. Neither your chairperson nor your committee members will provide editing of your documents, nor will the AQR reviewers provide editing of your documents. If you do not have outstanding writing skills, you will need to identify a writing coach, editor, or other resources such as GrammarlyTM or ThinkingstormTM (GCU service) to help you with your writing and to edit your documents. The most important outcome is a scholarly product.
The quality of a DPI project is not only defined by the quality of writing. It is also defined by the criteria that have been established for each section of the project. The criteria describe what must be addressed in each section within each chapter. As you develop a section, first read the section description. Then review the criteria contained in the table below the description. Use both the description and criteria as you write the section. It is important that the criteria are addressed in a way that it is clear to your chairperson, committee, and an external reviewer to illustrate that the criteria have been met. You should be able to point out where each criterion was met in each section. Prior to submitting a draft of your proposal or practice improvement project, or a single chapter to your chairperson, please assess yourself on the degree to which criteria have been met. There is a table at the end of each section for you to complete this self-assessment. Your chairperson may also assess each criterion when returning the document with feedback. The following scores reflect the readiness of the document: Comment by Author: Please complete the table below with your ratings to show achievement of the criterion.
· 3 = The criterion has been completely met. It is comprehensive and accurate. The section meeting the criterion is comprehensive and clear. The criterion information is very well written. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. The criterion is immediately obvious to an external reviewer. In terms of writing, the section is perfect and ready to go into a journal article.
· 2 = The criterion is very close to being completely met. The section meeting the criterion is comprehensive but may need to be further clarified. The criterion information is fairly well written but may need minor editing. The section addressing a criterion is located in a single spot; it is not distributed across various paragraphs. It may not be obvious to an external reader and so may require some clarification. In terms of writing it is near perfect but may need minor edits for clarity or APA formatting.
· 1 = The criterion is present, but the section needs significant work to completely meet expectations. The section meeting the criterion is not comprehensive and may need to be further clarified. The criterion information is fairly well written but may need minor editing. The section addressing a criterion is not clearly located in a single spot; it appears to be distributed across various paragraphs. It may not be obvious to an external reader and requires some clarification. It needs some changes to the structure, flow, paragraph structure, sentence structure, punctuation, and APA format.
· 0 = The criterion is not addressed because it is missing or is not appropriate.
Once the document has been approved by your chairperson and your committee and is ready to submit for the AQR review, please remove all of these assessment tables from this document.

Criterion Comment by Author: All of the criterion tables must be removed prior to all AQR, IRB, and final submissions.

^ To remove the table, click on the icon noted when the table is clicked on. Right click on this icon and delete table.

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Introduction
This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (Three or four paragraphs or approximately one page)

A practice improvement project topic is introduced.

Discussion provides an overview of what is contained in the chapter.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Background of the Project Comment by Author: This heading is tagged with APA Style Level 2 heading.
The background section of Chapter 1 explains both the history of and the present state of the problem and the DPI project focus. This section summarizes the Background section which will be expanded upon in Chapter 2 and is two or three paragraphs in length.

Criterion

Learner Score (0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Background of the Project
The background section explains both the history and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (Two or three paragraphs)

This section provides an overview of the history of and present state of the problem and project focus.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Problem Statement
This section of the final manuscript is two or three paragraphs long. It clearly states the problem or project focus, the population affected, and how the project will contribute to solving the problem. This section of Chapter 1 should be comprehensive yet simple, providing context for the practice project.
A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower, and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as “It is/was not known if or to what degree the implementation of ___________ (intervention) would impact ______________(outcome) when compared to current practice among ___________ (population). in (urban/rural)________ (state). Comment by Author: Problem statement format update from Revised Strategic Points.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Problem Statement
This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (Two or three paragraphs)

This section states the specific problem for investigation by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent…,” or “It is not known how/why and….”

This section identifies the need for the project.

This section identifies the broad population affected by the problem.

This section suggests how the project may contribute to solving the problem.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Purpose of the Project
The Purpose of the Project section of Chapter 1 should be two or three paragraphs long, provide a reflection of the problem statement, and identify how the project will be accomplished. It explains how the project will contribute to the field. The section begins with a declarative statement, “The purpose of this project is….” Included in this statement are also the project design, population, variables to be investigated, and the geographic location. For example, “the purpose of this quantitative quasi-experimental project is to examine the impact of a preoperative anxiety assessment tool on non-pharmacologic anxiolytic interventions for a subset of pediatric patients in a midwestern academic medical center” (Overly, 2020). Further, the section clearly defines the dependent and independent variables, relationship of variables, or comparison of groups (comparison versus intervention) for quantitative analyses. Keep in mind that the purpose of the project is restated in other chapters of the practice improvement project and should be worded exactly as presented in this section of Chapter 1.
Creswell and Creswell (2018) provided a sample template for the purpose statements aligned with the quasi-experimental design. Please see the template for quantitative method as follows: The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of _________________ (intervention) would impact ______________(what) when compared to current practice among ___________(population) in a ________ (setting i.e.: primary care clinic, ER, OR) in ________ (state). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The (dependent variable) will be defined/measured as/by ______ (provide a general definition). This purpose statement aligns to the PICOT components from previous courses. Comment by Author: Please note that DPIs are quantitative. You may see reference to qualitative and mixed methodologies throughout the curriculum and in the templates as these are other methods. However, a DPI measures or tests an intervention on a patient outcome. Therefore, a quantitative method is the most feasilble method for doing so. Comment by Author: Please format your purpose statement to this templated declarative sentence and use throughout the manuscript.

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Purpose of the Project
The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the project will contribute to the field. (Two or three paragraphs)

This section presents a declarative statement: “The purpose of this project is….” that identifies the project design, population, variables (quantitative) to be investigated, and geographic location.

This section identifies project method as quantitative and identifies the specific design.

This section describes the specific population group and geographic location for the project.

This section defines the dependent and independent variables, relationship of variables, or comparison of groups (quantitative).

This section explains how the project will contribute to the field.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Clinical Question(s) Comment by Author: Make sure you customize this. It is either Clinical Question or Clinical Questions depending on whether or not you have more than one.
This section should be two or three paragraphs in length, narrow the focus of the project, and specify the clinical questions to address the problem statement. Based on the clinical questions, the section describes the variables or groups. The clinical questions should be derived from, and are directly aligned with, the problem and purpose statements, methods, and data analyses. The Clinical Questions section of Chapter 1 will be presented again in Chapter 3 to provide clear continuity for the reader and to help frame your data analysis in Chapter 4.
In a paragraph prior to listing the clinical questions, include a discussion of the clinical questions, relating them to the problem statement. Templated statement: To what degree does the implementation of _______________ (intervention) impact(s) __________________ (what) when compared to _____________ among _____________ (population) patients in a ______ (setting) in _______ (state) over four-weeks? Comment by Author: Format your clinical question in this manner.
Then, include a leading phrase to introduce the questions such as: The following clinical questions guide this quantitative project:
Q1:
Q2:

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Clinical Question(s)
This section narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables or groups for a quantitative project. (Two or three paragraphs)

This section states the clinical questions the project will answer, identifies the variables, and predictive statements using the format appropriate for the specific design.

This section includes a discussion of the clinical questions, relating them to the problem statement.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Advancing Scientific Knowledge
The Advancing Scientific Knowledge section should be two or three paragraphs in length, and specifically describe how the project will advance population health outcomes on the topic. This advancement can be a small step forward in a line of the current clinical site practice, but it must add to the current body of knowledge in the literature. This section also identifies the gap or need based on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section from Chapter 2 by identifying the theory or model upon which the project is built. It also describes how the project will advance that theory or model.

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Advancing Scientific Knowledge
This section specifically describes how the project will advance population health outcomes on the topic. It can be a small step forward in a line of current project, but it must add to the current body of knowledge in the literature. It identifies the gap or need based on the current literature and discusses how the project will address that gap or need. This section summarizes the Theoretical Foundations section from Chapter 2. (Two or three paragraphs)

This section clearly identifies the gap or need in the literature that was used to define the problem statement and develop the clinical questions.

This section describes how the project will address the gap or identified need in the literature.

.

This section identifies the theory or model upon which the project is built.

This section describes how the project will advance the theory or model upon which the project is built.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Significance of the Project
This section identifies and describes the significance of the project. It also discusses the implications of the potential results based on the clinical questions and problem statement. Further, it describes how the project fits within and will contribute to the current literature or the clinical site practice. Finally, it describes the potential practical applications from the project. This section should be three or four paragraphs long and is of particular importance because it justifies the need for, and the relevance of, the project.

Criterion

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Significance of the Project
This section identifies and describes the significance of the project and the implications of the potential results based on the clinical questions and problem statement. It describes how the project fits within and will contribute to the current literature or the clinical site practice. It describes potential practical applications from the project. (Three or four paragraphs)

This section provides overview of how the project fits within other current literature in the field, relating it specifically to other studies.

This section describes how addressing the problem will impact and add value to the population, community, or society.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Rationale for Methodology
This section introduces the methodology for the DPI project and explains the rationale for selecting this quantitative methodology. The Rationale for Methodology section of Chapter 1 clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. Finally, it contains citations from textbooks and articles on the DPI project methodology or articles on related studies (Creswell & Creswell, 2018). DPI project are typically quantitative due to the nature of measuring a practice improvement.
This section describes the clinical questions the project will answer and identifies the variables using the format appropriate for the specific design. Finally, this section includes a discussion of the clinical questions, relating them to the problem statement. This section should be two or three paragraphs long and illustrate how the methodological framework is aligned with the problem statement and purpose of the project, providing additional context for the project.

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Rationale for Methodology
This section clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on DPI project methodology or articles on related studies. (Two or three paragraphs)

This section identifies the specific project method for the project.

This section justifies the method to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement.

This section uses citations from textbooks or literature on the DPI project methodology to justify the use of the selected methodology.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Nature of the Project Design
This section describes the specific project design (quasi-experimental) to answer the clinical questions and why this approach was selected. (see Appendix B) Here, the learner discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs. You should be focusing on the design rather than the methodology in this section. Briefly describes how the design supports the intervention and solution to the practice problem. This section also contains a description of the project sample being investigated, as well as the process that will be used to collect the data on the sample. In other words, this section provides a preview of Chapter 3 and succinctly conveys the project approach to answer clinical questions.

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Nature of the Project
This section describes the specific project design to answer the clinical questions and why this approach was selected. It describes the project sample as well as the process that will be used to collect the data on the sample.

This section describes the selected design for the project.

This section discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs.

This section briefly describes the specific sample and the data collection procedure to collect information on the sample. Briefly describes how the design supports the intervention and solution to the practice problem.

This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Definition of Terms
The Definition of Terms section of Chapter 1 defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. Each definition may be a few sentences to a paragraph in length. This section includes any words that may be unknown to a lay person (words with unusual or ambiguous meanings or technical terms) from the evidence or literature. It provides a rationale for each assumption and defines the variables.
Definitions must be supported with citations from scholarly sources. Do not use Wikipedia to define terms. This popular “open source” online encyclopedia can be helpful and interesting for the layperson, but it is not appropriate for formal academic scholarly writing. Additionally, do not use dictionaries to define terms. A paragraph introducing this section prior to listing the definition of terms can be inserted. However, a lead in phrase is needed to introduce the terms such as: “The following terms were used operationally in this project.” This is also a good place to operationally define unique phrases specific to this project. See below for the correct format:

Term.
Comment by Author: This is how each of your terms should be listed in this section.
Write the definition of the word. This is considered a Level 3 heading. Make sure the definition is properly cited (Author, 2010).

Clinical Significance.
Clinical significance (also known as clinical relevance) indicates whether the results of a project are meaningful or not for several stakeholders. Statistical significance does not assure that the results are clinically relevant. Indeed, the use of significance testing rarely determines the practical importance or clinical relevance of findings (Armijo-Olivo, 2018)

Comparison and Intervention Group.
Refers to the sample groups of data in your project as the comparison group and the intervention group. These groups can be used to compare the baseline practice to the direct practice improvement. There are two approaches to the data of these groups. Between-group differences show how two or more groups of the data are sampled or participants are different, whereas within-group differences show differences among data or participants who are in the same single group of the sample (Creswell & Creswell, 2018). Further, within-group differences can come to light when looking at the results of a between-groups approach including individual differences associated with the sample or group. (see Figure 1). Please note that there are no control groups in the DPI. If the learner writes control groups as a comparison group, the DPI will not move forward.

Statistical Significance.
Statistical significance shows a result is unlikely due to chance. It is a result which indicates a level of confidence a result did not occur solely from sample selection. The investigator determines the level of significance for the project (e.g. p<.05 or p<.01). The p-value is the probability of obtaining the difference measured from a sample if there really is not a difference for all users. If the p-value obtained is less than this level determined in the proposal by the investigator, it would be considered statistically significant. The investigator would infer the intervention caused the difference. Statistical significance is not clinical significance or whether the results of a project are meaningful or not for several stakeholders (Creswell & Creswell, 2018). Terms often use abbreviations. According to APA (2010), abbreviations are best used only when they allow for clear communication with the audience. Standard abbreviations, such as units of measurement and names of states, do not need to be written out. Only certain units of time should be abbreviated. Abbreviate hr. (hour), min (minute), ms (millisecond), ns (nanosecond), or s (second). However, do not abbreviate day, week, month, and year [4.27]. To form the plural of abbreviations, add “s” alone without apostrophe or italicization (e.g., vols., IQs, Eds.). The exception to this rule is not to add “s” to pluralize units of measurement (12 m not 12 ms) [4.29]. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Definitions of Terms This section defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. (Each definition may be a few sentences to a paragraph in length.) This section Defines any words that may be unknown to a lay person (words with unusual or ambiguous means or technical terms) from the evidence or literature. This section defines the variables for a quantitative project. Definitions are supported with citations from scholarly sources. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Assumptions, Limitations, Delimitations This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. It should be four to six paragraphs in length. An assumption is a self-evident truth. Assumptions are things that are accepted as true, or at least plausible, by other researchers, peers, and generally to most people will read your project. In other words, any scholar reading your paper will assume that certain aspects of your project are true given your population, statistical test, project design, or other delimitations. For example, if you tell your friend that your favorite restaurant is an Italian place, your friend will assume that you don’t go there for the sushi. It’s assumed that you go there to eat Italian food. Because most assumptions are not discussed in-text, assumptions that are discussed in-text are discussed in the context of the limitations of your project, which is typically in the discussion section. This is important, because both assumptions and limitations affect the inferences you can draw from your project. This section should list what is assumed to be true about the information gathered in the project. State the assumptions being accepted for the project as methodological, theoretical, or topic specific. For each assumption listed, you must also provide an explanation. Provide a rationale for each assumption, incorporating multiple perspectives, when appropriate. For example, the following assumptions were present in this project: 1. It is assumed that survey participants in this project were not deceptive with their answers, and that the participants answered questions honestly and to the best of their ability. Provide an explanation to support this assumption. 2. It is assumed that this project is an accurate representation of the current situation in rural southern Arizona. Provide an explanation to support this assumption. Limitations are things that the investigator has no control over, such as bias. It is important to remember that your limitations and assumptions should not contradict one another. Assumptions are also present with the statistical tests performed in the DPI. These assumptions refer to the characteristics of the data, such as distributions, trends, and variable type, just to name a few. Violating these assumptions can lead to drastically invalid results, though this often depends on sample size and other considerations. Limitations are a systematic bias that you did not or could not control which could inappropriately affect the results. Delimitation is a systematic bias intentionally introduced into the study design or instrument by you. Possible limitations and delimitations in study design or impact and statistical or data limitations: For example, sample choice and size of the sample, the availability and reliability of data , access to protected or proprietary data, methods/instruments/techniques used to collect the data, the use of self‐reported data, time constraints or cultural and other communication issues. Delimitations are things over which the investigator has control, such as location of the project, population and sample, and data collection tools like the electronic health record (EHR). Identify the limitations and delimitations of the project design. Discuss the potential generalizability of the project findings based on these limitations. For each limitation and delimitation listed, make sure to provide an associated explanation. For example: The following limitations/delimitations were present in this project: 1. Lack of funding limited the scope of this project. Provide an explanation to support this limitation. 2. The survey of high school students was delimited to only rural schools in one county within southern Arizona, limiting the demographic sample. Provide an explanation to support this delimitation. Identify the limitations of your project and explain the importance of each. Reflect on the nature of the limitations and justify the choices made during the project. Advance the evidence by suggesting how such limitations could be overcome in future. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Assumptions, Limitations and Delimitations This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the project. (3-4 paragraphs) This section states the assumptions being accepted for the project (methodological, theoretical, and topic-specific). This section provides rationale for each assumption, incorporating multiple perspectives, when appropriate. This section identifies limitations and delimitations of the project design. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Summary and Organization of the Remainder of the Project This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion to Chapter 2 followed by a description of the remaining chapters. For example, Chapter 2 will present a review of current evidence on the centrality of the practice improvement project literature review and the existing evidence available to guide project preparation. Chapter 3 will describe the methodology, design, and procedures for this investigation. Chapter 4 details how the data was analyzed and provides both a written and graphic summary of the results. Chapter 5 is an interpretation and discussion of the results, as they relate to the existing body of evidence related to the practice improvement project topic. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Organization of the Remainder of the Project This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion to Chapter 2, followed by a description of the remaining chapters. This section summarizes key points presented in Chapter 1. This section provides citations to support key points. Chapter 1 summary ends with transition discussion to Chapter 2. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Chapter 2: Literature Review Comment by Author: This section should be a minimum of 20-25 pages. This chapter presents the theoretical framework for the project and develops the topic, specific practice problem, question(s), and design elements. In order to perform significant practice improvement projects, the learners must first understand the literature related to the project focus. A well-articulated, thorough literature review provides the foundation for substantial, contributory projects or evidence. The purpose of Chapter 2 is to develop a well-documented argument for the selection of the project topic, formulate the clinical questions, and justify the choice of methodology as introduced in Chapter 1. A literature review is a synthesis of what has been published on a topic by accredited scholars and investigators. It is not an expanded annotated bibliography or a summary of peer reviewed articles related to your topic. The literature review will place the project focus into context by analyzing and discussing the existing body of knowledge and effectively presenting the reader with an exhaustive review of known information. The comprehensive presentation should include as much information as possible pertaining to what has been discovered in the evidence about that focus, and where the gaps and tensions in the evidence exist. As a piece of writing, the literature review must convey to the reader what knowledge and ideas have been established on a topic and build an argument in support of the practice problem. This section describes the overall topic to be investigated, outlines the approach taken for the literature review, and defines the evolution of the problem based on the evidence to cover the gap or need to improve population health outcomes. Make sure the Introduction and Background section of your literature review addresses the following required components: · Introduction: States the overall purpose of the project. · Introduction: Provides an orienting paragraph so the reader knows what the literature review will address. · Introduction: Describes how the chapter will be organized (including the specific sections and subsections). · Introduction: Describes how the literature was surveyed, so the reader can evaluate the thoroughness of the review. · Background: Provides a historical overview of the problem based on the gap or need defined in the literature and how it originated. This section must contain empirical (original research) citations. Present strong evidence for the intervention. · Background: Discusses how the problem has evolved historically into its current form. Criterion Comment by Author: All of the criterion tables must be removed prior to all AQR, IRB, and final submissions. Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Introduction (to the Chapter) and Background (to the Problem) This section describes the overall topic to be investigated, outlines the approach taken for the literature review, and defines the evolution of the problem based on the gap or need defined in the literature from its origination to its current form. Introduction states the overall purpose of the project. Introduction provides an orienting paragraph so the reader knows what the literature review will address. Introduction describes how the chapter will be organized (including the specific sections and subsections). Introduction describes how the literature was surveyed so the reader can evaluate the thoroughness of the review. Background provides the historical overview of the problem based on the gap or need defined in the literature and how it originated. Background discusses how the problem has evolved historically into its current form. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Theoretical Foundations This section identifies the nursing theories and evidence-based practice change models that provide the foundation for the Direct Practice Improvement (DPI) Project. It also contains an explanation of how the problem under investigation relates to the nursing theories and evidence-based practice change models. The seminal source for each nursing theory and evidence-based change model should be identified and described. Please note: models and theories are not capitalized in APA style. The theories or models(s) guide the clinical questions and justify what is being measured (variables), as well as how those variables are related. This section also must include a discussion of how the clinical question(s) align with the a nursing theory or nursing model and illustrates how the project fits within other evidence, based on the theories or models. You are encouraged to use a change model to outline how the DPI project would be implemented in a healthcare organization. Please outline and define the change model steps or processes and how those steps are implemented for the DPI project. The learner should cite references reflective of the foundational, historical, and current literature in the field. Overall, the presentation should reflect that the learner understands the theory or model and its relevance to the project. The discussion should also reflect knowledge and familiarity with the historical development of the theories or models. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback theoretical Foundations This section identifies the nursing theory and (if used) change model that provide the foundation for the project. This section should present the theories or models(s) and explain how the problem under investigation relates to the theory or model. The theories or models(s) guide the clinical questions and justify what is being measured (variables) as well as how those variables are related. This section identifies the nursing theory and (if used) change model that provide the foundation for the project. This section identifies and describes the seminal source for each theory or model. This section discusses how the clinical question(s) align with the respective theories or models. This section illustrates how the project fits within other evidence-based literature on the theory or model. This section reflects understanding of the theory or model and its relevance to the project. This section cites references reflecting the foundational, historical, and current literature in the field. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Review of the Literature This section provides a broad, balanced overview of the existing literature related to the topic. It identifies themes, trends, and conflicts in methodology, design, and findings. It provides a synthesis of the existing literature, examines the contributions of the literature related to the topic, and presents an evaluation of the overall methodological strengths and weaknesses of the evidence. Through this synthesis, the gaps in evidence should become evident to the reader. This section describes the literature in related topic areas and its relevance to the project topic. It provides an overall analysis of the existing literature examining the contributions of this literature to the field, identifying the conflicts, and relating the themes and results to the project. Citations are provided for all ideas, concepts, and perspectives. The investigator’s personal opinions or perspectives are not included. The required components for this section include the following: · Chapter 2 needs to be at least 20-25 pages in length. It needs to include a minimum of 50 scholarly sources with 85% of sources published within the past 5 years. Additional sources do not necessarily need to be from the past 5 years. · Quantitative project: Describes each project variable in the project and discusses the prior evidence that has been done on the variable. Comment by Author: Please note that you may also use seminal works and other relevant literature that supports your topic concept. · Discusses the various methodologies and designs that have been used to provide evidence on topics related to the project. Uses this information to justify the design. · Relates the literature back to the DPI-project topic and the practice problem. · Argues the appropriateness of the practice improvement project’s instruments, measures, or approaches used to collect data. · Discusses topics related to the practice improvement project topic. This section may include (a) studies relating the variables (quantitative); (b) studies on related evidence-based research, such as factors associated with the topic; (c) studies on the instruments used to collect data; and (d) studies on the broad population for the project. · Set of topics discussed in the Review of Literature demonstrates a comprehensive understanding of the broad area in which the project topic exists. · Argues the appropriateness of the practice improvement project’s instruments, measures, or approaches used to collect data. · Each section within the Review of Literature includes an introductory paragraph that explains why the particular topic was explored relative to the practice improvement project topic. · Each section also requires a summary paragraph(s) that (a) compares and contrasts alternative perspectives on the topic, (b) provides a summary of the themes relative to the topic discussed that emerged from the literature, (c) discusses data from the various studies, and (d) identifies how themes are relevant to your practice improvement project topic. · The types of references that may be used in the literature review include empirical (original research) articles (MUST HAVE) evidence-based research, meta-analysis, systematic reviews, randomized control trials, or seminal works, peer-reviewed or scholarly journal articles, and books that are cutting-edge views on a topic. he body of a literature review can be organized in a variety of ways depending on the nature of the project. Work with your committee chairperson to determine the best way to organize this section of Chapter 2, as it pertains to your overall project design. This template organizes the evidence thematically as illustrated below. Theme 1. Comment by Author: This heading is tagged with APA Style Level 3 heading [3.03]. To differentiate the Level 3 heading from the normal style of the text, write the Level 3 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 3 heading and the normal paragraph do not connect but are formatted correctly on the same line. Comment by Author: Make sure you are replacing “Theme 1” (or subtheme) with the actual title of theme one. Do not include “Theme 1” in the title as it is just a placeholder. You may want to organize this section by themes and subthemes. To do so, use the pattern below. Subtheme 1. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 1. Subtheme 2. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 1. Subtheme 3. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 1. In a concluding paragraph, provide a synthesis of the evidence studies presented in Theme 1. Discuss the strengths and weaknesses of each project, as well as the variables, instrumentation, and findings of each project as they relate to each other and use the findings of the studies in the subtheme to build an argument for your project. Discuss what is missing or how the design or methodology could have changed in studies to improve the quality of the project. Discuss inconsistencies or gaps that emerge in the evidence providing opportunity for additional projects. Provide a transition sentence to the next theme. Comment by Author: This was updated. please check formatting! Theme 2. Please follow the same Theme-subtheme process as outlined above. Subtheme 1. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 2. Subtheme 2. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 2. Subtheme 3. Comment by Author: This heading is tagged with APA Style Level 4 heading [3.03]. To differentiate the Level 4 heading from the normal style of the text, write the Level 4 heading and tag it. Then, create the first paragraph of the subsection on the line below the theme heading. Then, place the cursor next to the theme heading. Hit the keys “cntrl + alt + enter.” This will create a “style break” so that the Level 4 heading and the normal paragraph do not connect but are formatted correctly on the same line. Grouped findings related to Theme 2. In a concluding paragraph, provide a synthesis of the evidence studies presented in Theme 2. Discuss the strengths and weaknesses of each project, as well as the variables, instrumentation, and findings of each project as they relate to each other and use the findings of the studies in the subtheme to build an argument for your project. Discuss what is missing or how the design or methodology could have changed in studies to improve the quality of the project. Discuss inconsistencies or gaps that emerge in the evidence providing opportunity for additional projects. Provide a transition sentence to the next theme. Need at least three themes. Chapter 2 can be particularly challenging with regard to APA format for citations and quotations. Refer to your APA manual frequently to make sure your citations are formatted properly. It is critical that each in-text citation is appropriately listed in the References section. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Review of the Literature This section provides a broad, balanced overview of the existing literature related to the project topic. It identifies themes, trends, and conflicts in methodology, design, and findings. It describes the literature in related topic areas and its relevance to the project topic. It provides an overall analysis of the existing literature examining the contributions of this literature to the field, identifying the conflicts, and relating the themes and results to the project. Citations are provided for all ideas, concepts, and perspectives. The investigator’s personal opinions or perspectives are not included. Chapter 2 needs to be at least 20-25 pages in length. It needs to include a minimum of 50 scholarly sources with 85% from the sources published within the past 5 years. Additional sources do not necessarily need to be from the past 5 years. It should not include any personal perspectives. This section describes each variable in the project discussing the prior evidence that has been done on the variable. This section Discusses the various methodologies and designs that have been used to understand evidence presented on topics related to the project. Uses this information to justify the design. This section argues the appropriateness of the practice improvement project’s instruments, measures, and/or approaches used to collect data. This section discusses topics related to the practice improvement project topic and may include (a) studies relating the variables (quantitative) or exploring related phenomena (qualitative), (b) evidence –based studies on related factors associated with the topic, (c) Relates the literature back to the DPI-project topic and the practice problem. d) studies on the instruments used to collect data, and (e) studies on the broad population for the project. Set of topics discussed in the Review of Literature demonstrates a comprehensive understanding of the broad area in which the topic exists. Each section within the Review of Literature includes an introductory paragraph that explains why the particular topic was explored relative to the practice improvement project topic. Each section within the Review of Literature requires a summary paragraph that (a) compares and contrasts alternative perspectives on the topic, (b) provides a summary of the themes relative to the topic discussed that emerged from the literature, and (c) identifies how themes are relevant to your practice improvement project topic. The types of references that may be used in the literature review include empirical (original research) articles (MUST HAVE) evidence-based research, meta-analysis, systematic reviews, randomized control trials, or seminal works, peer-reviewed or scholarly journal articles, and books that are cutting-edge views on a topic. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). For a quote within a quote, use a set of single quotation marks. [4.08]. As a rule, if a quote comprises 40 or more words, display this material as a freestanding block quote. Start formal block quotes on a new line. They are indented one inch in from the left margin. The entire block quote is double-spaced. Quotation marks are not used with formal block quotes. The in-text citation is included after the final punctuation mark. [6.03]. Below is an example of a block quote: In an important biography, The First American: The Life and Times of Benjamin Franklin, historian H. W. Brands writes: Comment by Author: Caution! Make sure you do not overuse titles in the literature review. You can use them in certain instances, but do not rely on them to convey content. In February 1731, Franklin became a Freemason. Shortly thereafter, he volunteered to draft the bylaws for the embryonic local chapter, named for St. John the Baptist; upon acceptance of the bylaws, he was elected Warden and subsequently Master of the Lodge. Within three years, he became Grandmaster of all of Pennsylvania's Masons. Not unforeseeable he—indeed, this was much of the purpose of membership for everyone involved—his fellow Masons sent business Franklin’s way. In 1734 he printed The Constitutions, the first formerly sponsored Masonic book in America; he derived additional [printing] work from his brethren on an unsponsored basis. (Brands, 2000, p. 113) Summary This section restates what was written in Chapter 2 and provides supporting citations for key points. It synthesizes the information from the chapter using it to define the “gaps” in or “project needs” from the literature, the theories or models to provide the foundation for the project, the problem statement, the primary clinical question, the methodology, the design, the variables or phenomena, the data collection instruments or sources, and population. It then provides a transition discussion to Chapter 3. Overall, this section should: · Synthesize the information from all of the prior sections in the literature review and use it to define the key strategic points for the project. · Summarize the gaps and needs in the background and introduction and describe how it informs the problem statement. · Identify the theories or models describing how they inform the clinical questions. · Use the literature to justify the design, variables, data collection instruments or sources, and population to be evaluated. · Relates the literature back to the DPI-project topic and the practice problem. · Build a case (argument) for the project in terms of the value of the project and how the clinical questions emerged from the review of literature. · Explain how the current theories, models, and topics related to the project will be advanced through your project. · Summarize key points in Chapter 2 and transition into Chapter 3. This section should help the reader clearly see and understand the relevance and importance of the project to be conducted. The Summary section transitions to Chapter 3 by building a case for the project, in terms of project design and rigor, and it formulates the clinical questions based on the gaps and tensions in the literature. Comment by Author: Use INSERTPage Break to set new page for new chapter. Do not use hard returns to get there. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Summary This section restates what was written in Chapter 2 and provides supporting citations for key points. It synthesizes the information from the chapter using it to define the “gaps” in or “evidence –based practice needs” from the literature, the theories or models to provide the foundation for the project, the problem statement, the primary clinical question, the methodology, the design, the variables or phenomena, the data collection instruments or sources, and population. It then provides a transition discussion to Chapter 3. This section synthesizes the information from all of the prior sections in the Review of Literature and uses it to define the key strategic points for the project. This section summarizes the gaps and needs in the background and introduction and describes how it informs the problem statement. This section identifies the theories or models and describes how they inform the clinical questions. This section uses the literature to justify the design, variables or phenomena, data collection instruments or sources, and answer the clinical questions on your selected intervention protocol, clinical setting and patient population.be evaluated. This section builds a case for the project in terms of the value of the project. This section explains how the current theories, models, and topics related to the DPI project will be advanced through your intervention and outcomes. This section summarizes key points in Chapter 2 and transition into Chapter 3. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Chapter 3: Methodology Chapter 3 documents how the project is conducted in enough detail so that replication by others is possible. The introduction begins with a summary of the project focus and purpose statement to reintroduce the reader to the need for the project. This can be summarized in three or four sentences from Chapter 1. Summarize the clinical questions in narrative format, and then outline the expectations for this chapter. Remember, throughout this chapter depending on where you are in your project, the verb tense must be changed from present tense (proposal) to past tense (DPI Project manuscript). Furthermore, consider will happen during data collection and analysis as it is planned here. Sometimes, the DPI project protocol ends up being modified based on committee, Academic Quality Review (AQR), or Institutional Review Board (IRB) recommendations. After the practice project is complete, make sure this chapter reflects how the project was actually conducted. Criterion Comment by Author: All of the criterion tables must be removed prior to all AQR, IRB, and final submissions. Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Introduction This section includes both a restatement of project focus and purpose statement for the project from Chapter 1, to reintroduce reader to the need for the project and a description of contents of the chapter. A brief introduction to the chapter describes the chapter purpose and how it is organized and summarizes the project focus and problem statement to reintroduce reader to the need for the project. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Statement of the Problem This section restates the problem for the convenience of the reader. Copy and paste the Statement of the Problem from Chapter 1. Then, edit, blend, and integrate this material into the narrative. Change future tense to past tense for DPI Project manuscripts. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Statement of the Problem: This section restates the Problem Statement from Chapter 1. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Clinical Question This section restates the clinical question(s) for the project from Chapter 1. The following clinical questions guide this quantitative project: Q1: Q2: It then presents the matching of the variables. This discussion includes the independent variable (intervention or practice change) and the dependent variable (outcome of the DPI) (see Table 1) Table 1 Characteristics of Variables Comment by Author: This table is not required but does illustrate the different levels of measurement aligned to each type of variable. It is important for the doctoral learner explore the level of measurement of each variable so accurate statistical tests can be selected for analysis. Variable Variable Type Level of Measurement Project Groups (Pre-Intervention & Post Intervention) Independent Nominal Rates or events (Outcome) Dependent Nominal Socio-economic status or categories in order Dependent Ordinal Time, Temperature Dependent Interval Age, height, Scores of tests (Outcome) Dependent Ratio Note: An outcome variable can be any of the four levels of measurement. (Creswell & Creswell, 2018). The section also briefly reviews the approaches to collecting the data to answer the clinical questions (see Figure 1). Figure 1 Approaches to Collecting the Data to Answer the Clinical Questions Between-subjects (or between-groups) designs include different people or data in each collection so that each person is only in one group or the other. Within-subjects (or repeated-measures) design include the same person in all collections both before and after the intervention. The section should describe the instrument(s) or data source(s) to collect the data for each variable. It also discusses why the design was selected to be the best approach to answer the clinical question(s). Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Clinical Question(s) This section restates the clinical questions for the project from Chapter 1. It then explains the variables. This section describes the approaches used to collect the data to answer the clinical questions. For a quantitative project, it describes the instrument(s) or data source(s) to collect the data for each variable. This section discusses why the design was selected to be the best approach to answer the clinical questions. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Project Methodology This section describes the methodology for the DPI project and explains the rationale for selecting this quantitative methodology. It also describes why this methodology was selected as opposed to the alternative methodologies. (see Table 2) DPI projects are typically quantitative due to the nature of measuring a practice improvement. Table 2 Type of Methodology and Rationale for Selecting It Method Rationale for Selection Quantitative The data from a quantitative method is in a numeric form and statistical tests can be applied in making statements about the data. Quantifiable, objective, and easy to interpret results. Identifying the scale of measurement (e.g. nominal, ordinal, interval, or ratio) helps determine how best to organize the data for analysis. Qualitative The data from a qualitative method is a description of the qualities or characteristics of something. Thematic, subjective and subject to interpretation are the results. These descriptions cannot be easily reduced to numbers—as the findings from quantitative methods can. Qualitative methods discover new perspectives and are not feasible for testing a DPI. Comment by Author: Not an approved design for the DPI Mixed: The data from a mixed method is a combination of the quantitative and qualitative method. Mixed method can use qualitative designs to identify the factors under investigation, then use that information to devise quantitative designs to further measure it. Or findings from quantitative methodology can be further explored using a qualitative method. Mixed methods can be time consuming and not feasible for testing a DPI. Comment by Author: Not an approved design for the DPI Note: Quantitative methods are recommended for DPI projects due to feasibility and clinical relevance associated with the measurement of a practice improvement. Reference: Creswell, J.W. & Creswell, J.D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.) Thousand Oaks: CA. Sage Publications. This section should elaborate on the Methodology section (from Chapter 1) providing the rationale for the selected project method (e.g. quantitative). Arguments are supported by citations from articles and books on methodology or design. It is also proper in this section to outline the predicted or expected results in relation to the clinical questions based on the existing literature. Describe how the method selected supports the attainment of information that will answer the clinical questions. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Project Methodology This section elaborates on the Methodology section (from Chapter 1), providing the rationale for the selected project method (e.g. quantitative) and includes a discussion of why the selected method was chosen instead of another method. Arguments are supported by citations from articles and books on project methodology or design. Describe how the methodology selected supports the attainment of information that will answer the clinical questions. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Project Design This section elaborates on the nature of the Project Design section from Chapter 1. In most DPI projects, a quasi-experimental design is the recommended due to measurement of a direct practice improvement. If other methods are considered, it should be discussed with your chair/committee including the capacity to measure a practice improvement and time frame needed to complete it. This section includes a detailed description of, and a rationale for, the specific design for the project. Quantitative designs include descriptive, correlation, quasi-experimental, and experimental designs (Creswell & Creswell, 2018). Each associated with an approach to the data being collected. See Appendix B for an algorithm to assist with design determination. Designs involving a practice change or intervention are either a quasi-experimental or experimental type. However, an experimental design is usually not feasible for a DPI due to the requirement for randomization and manipulation of the intervention within and between the project groups to address the statistical assumptions. This section further describes how it aligns to the selected methodology indicated in the previous section. Additionally, it describes why the selected design is the best option to collect the data to answer the clinical need for the project. The section explains exactly how the selected design will be used to collect data for each variable. It identifies the specific instruments and data sources to be used to collect all of the different data required for the project. Arguments are supported by citations from articles and books on DPI project method or design. This section should specify the independent, dependent, or classificatory variables, as appropriate. These variables should be defined in Chapter 1. Be sure to relate the variables back to the clinical questions. A brief discussion of the type of data collection tool chosen (survey, interview, observation, etc.) can also be included in this section as related to the variables. Collecting data using an instrument may require a consent versus collecting data from the EHR may require a HIPAA waiver. These considerations should be addressed later in the proposal. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Project Design This section elaborates on the Nature of the Project Design for the Project (from Chapter 1) providing the rationale for the selected project design and includes a discussion of why the selected design is the best one to collect the data needed. Arguments are supported by citations from articles and books on methodology or design. This section describes how the specific selected DPI project design will be used to collect the type of data needed to answer the clinical questions and the specific instruments or data sources that will be used to collect or source this data. This section discusses why the design was selected to be the best approach to answer the clinical question(s). This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Population and Sample Selection This section discusses the setting, total population, project population, and project sample. The discussion of the sample includes the project terminology specific to the type of sampling for the project. This section should include the following components: · Describes the characteristics of the total population and the project population from which the project sample (project participants) is drawn. · Describes the characteristics of the project population and the project sample. · Clearly defines and differentiates the sample for the project versus the number of people completing instruments on the project sample. · Describes the project population size and project sample size and justifies the project sample size (e.g., power analysis) based on the selected design. Clearly defines and differentiates between the number for the project population and the project sample versus the number for the people who will complete any instruments. Details the sampling procedure including the specific steps taken to identify, contact, and recruit potential project sample participants from the project population. Describes the informed consent process, confidentiality measures, project participation requirements, and geographic specifics. · Discusses the intervention protocol to answer the clinical question(s). · If subjects withdrew or were excluded from the project, you must provide an explanation. This would be added for the final manuscript and would not be present in the proposal. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Population and Sample Selection This section discusses the setting, total population, project population, and project sample. The discussion of the sample includes the project terminology specific to the type of sampling for the project. This section describes the characteristics of the total (general) population and the project (target) population from which the project sample (sample) (project participants) is drawn. This section describes the characteristics of the project population and the project sample and clearly defines and differentiates the sample for the project versus the number of people completing instruments on the project sample. This section describes the project population size and project sample size and justifies the project sample size (e.g., power analysis) based on the selected design. This section clearly defines and differentiates between the number for the project population and the project sample versus the number for the people who will complete any instruments. This section details the sampling procedure, including the specific steps taken to identify, contact, and recruit potential project sample participants from the project population. This section describes the informed consent process, confidentiality measures, project participation requirements, and geographic specifics. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Instrumentation or Sources of Data Comment by Author: Clarify if the project is collecting data using instrumentation, a source of data from the EHR or existing records, or both. This heading should be accurate on which was used to collect data. This section fully identifies and describes the types of data that will be collected, as well as the specific instruments and sources used to collect those data (tests, questionnaires, interviews, databases, media, etc.). Discuss the specific instrument or source to collect data for each variable or group. Use subheadings for each data collection instrument or source of data and provide a copy of all instruments in a separate appendix. If you are using an existing instrument, make sure to discuss in detail the characteristics of the instrument. For example, on a preexisting survey tool describe the way the instrument was developed and constructed, the validity and reliability of the instrument, the number of items or questions included in the survey, and the calculation of the score as appropriate. If you are using a source of data, discuss the detail on how the source of data was accessed, the validity and reliability of the source of data and how the information was collected and stored. If the learner is acquiring data from medical records or databases, e.g. electronic health records including being provided a delimited database of data, this access and permission should be specified and how the identifiable patient information is being protected within the project. A HIPAA waiver may be specified. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Instrumentation or Sources of Data This section describes, in detail, all data collection instruments and sources (tests, questionnaires, interviews, databases, media, etc.); the specific instrument or source to collect data for each variable or group (quantitative project) This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Validity This section describes and defends the procedures used to determine the validity of the data collected. Validity refers to the degree to which a project accurately reflects or assesses the specific concept that the investigator is attempting to measure. Ask if what is actually being measured is what was set out to be measured. As an investigator, you must be concerned with both external and internal validity. For this section, provide specific validity statistics found in the literature for quantitative instruments, identifying how they were developed. NOTE: Learners should not be developing any quantitative instruments without permission from the DNP department. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Validity This section provides specific validity statistics for quantitative instruments, identifying how they were developed, and explains how validity will be addressed during data collection approaches. NOTE: Learners should not be developing nor modifying any quantitative instruments. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Reliability This section describes and defends the procedures used to determine the reliability of the data collected. Reliability is the extent to which an experiment, test, or any measuring procedure is replicable and yields the same result with repeated trials. For this section, provide specific reliability statistics for quantitative instruments, identifying how the statistics were developed from the literature. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Reliability This section provides specific reliability statistics for quantitative instruments, identifying how the statistics were developed, and explains how reliability will be addressed during data collection approaches. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Data Collection Procedures This section details the entirety of the process used to collect the data. Describe the step-by-step procedures used to carry out all the major steps for data collection for the project in a way that would allow another investigator to replicate the project. The key elements of this section include: · A description of the procedures for project sample recruitment, sample selection, and assignment to groups (e.g. comparison versus intervention). · A description of the procedures for obtaining informed consent and for protecting the rights and well-being of the project sample participants, as well as those completing instruments on them. · A description of the procedures adopted to maintain data securely, including the length of time data will be retained, where the data will be retained, and how the data will be destroyed. · A description of the procedures for data collection, including how each instrument or data source was used, how and where data were collected, and how data were recorded. · An explanation of the independent and dependent variables (if applicable), and how the resulting change in those variables is measured (if applicable), · An explanation of how variables were compared (if applicable). Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Data Collection Procedures This section details the entirety of the process used to collect the data. It describes each step of the data collection process in a way that another investigator could replicate the project. This section describes the step-by-step procedures used to carry out all the major steps for data collection for the project in a way that would allow another investigator to replicate the project. This section describes the procedures for project sample recruitment, sample selection, and assignment to groups (if applicable). This section describes the procedures for obtaining informed consent and for protecting the rights and well-being of the project sample participants, as well as those completing instruments on them. This section describes the procedures adopted to maintain data securely, including the length of time data will be retained, where the data will be retained, and how the data will be destroyed. This section describes the procedures for data collection, including how each instrument or data source was used, how and where data was collected, and how data were recorded. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Data Analysis Procedures This section provides a step-by-step description of the procedures to be used to conduct the data analysis. The key elements of this section include: · A description of how the data were collected and organized for each variable or group. · A description of the type of data to be analyzed, identifying the descriptive, inferential, or nonstatistical analyses. · Demonstration that the project analysis is aligned to the specific project design. · A description of the clinical question(s). · A detailed description of the relevant data collected and analyzed for each stated clinical question. · A description of how the raw data were organized and prepared for analysis. Provides a step-by-step description of the procedures used to conduct the data analysis. A detailed description of any statistical and nonstatistical analysis to be employed. (see Figure 2 & 3) A rationale is provided for each of the data analysis procedures (statistical and nonstatistical) employed in the project. A demonstration that the data analysis techniques align with the DPI project design. The level of the statistical significance used for the quantitative analyses is identified a priori (p<.05). References to the software used for the data analyses and assurance that the language used to describe the data analysis procedure is consistently used in Chapters 4 and 5. Figure 2 Parametric Statistics for Analysis of Ratio or Interval Level Dependent Variable Note. Image taken from Creswell and Creswell (2018). Comment by Author: Remove these figures from your manuscript. See APA 7th edition to format tables and figures. The independent variable within a quasi-experimental design will be a nominal or categorical level variable identifying the sample or group associated with the intervention. It is the dependent variable’s level of measurement which will direct the type of statistical analysis e.g. parametric versus non-parametric. If the dependent variable is a ratio, interval, the test to be used would be a parametric one. If the dependent variable is an ordinal or nominal level, a non-parametric test would be used. Figure 3 Non-Parametric Statistics for Analysis of Nominal or Ordinal Level Dependent Variable Note. Image taken from Creswell and Creswell (2018). Comment by Author: Remove these figures from your manuscript. See APA 7th edition to format tables and figures. Be specific on the type of analysis being performed, the type of variables analyzed, the level of measurement, and the statistical test performed to answer the clinical question. Potential Bias and Mitigation When we refer to bias in quantitative methodology, we are often referring to threats to the internal validity of a study. Internal validity is the degree to which the results are accurate and the procedures of the experiment support the ability to draw correct assumptions or inferences about the results (Roush, 2020). Bias can be intentional or unintentional, and intentional is not moral and invalidates your projects results. So let’s stick to how bias can occur! Bias in sampling can occur. A sampling method is called biased if it systematically favors some outcomes over others. The following example shows how a sample can be biased, even though there is some randomness in the selection of the sample. Example: If my project employs an intranet survey and there are people who meet the criteria but do not have access to the internet to take the survey, I will miss all those people who met the criteria for participation! Here are some common sources and consequences of bias: Convenience samples: Sometimes it is not possible or not practical to choose a random sample. In those cases, a convenience sample might be used. Sometimes it is plausible that a convenience sample could be considered as a random sample, but often a convenience sample is biased. If a convenience sample is used, inferences are not as trustworthy as if a random sample is used. Bias may be present in data collection. While collecting data for the DPI, there are numerous ways by which the Learners may introduce bias to the project. If, for example, during patient recruitment, some patients are less or more likely to participate in the project such sample would not be representative of the population in which this project is done (Roush, 2020). In that case, these subjects who are less likely to enter the study will be underrepresented and those who are more likely to enter the study will be over-represented relative to others in the general population, to which conclusions of the study are to be applied to (Roush, 2020). This is what we call a selection bias. To ensure that a sample is representative of a population, sampling should be random, i.e. every subject needs to have equal probability to be included in the DPI. It should be noted that sampling bias can also occur if sample is too small to represent the target population. For example, if the aim of the DPI is to assess the if motivational interviewing in psychiatric patients improves medication adherence the Learners may only be able to recruit otherwise healthy, stable patients during a regularly scheduled well check-up. By recruiting only well patients and the inability to use all psychiatric clients that can consent this is another bias. Bias can also occur in the data analysis right? We often are only looking at data that gives preference to answering the clinical question. If the data is misrepresented or not fully reported or even manipulated this is a bias (Fox & Lash, 2020). Comment by Author: Make sure all citations are entered in the reference list as the reviewers will check all citations and references for accuracy. Bias may occur in the data interpretation. It is imperative to run the correct statistical analysis (Fox & Lash, 2020). The data must be correctly analyzed and presented as is. Do not report only what was significant or discuss what was not significant. Consider a project where your pre and post-knowledge test for nurses did not show a statistical significance in using the tool. However, if the tool decreased readmission rates by 50% was it clinically significant? This observation should be discussed in detail. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Data Analysis Procedures and potential bias and mitigation This section describes how the data was collected for each variable or group. It describes the type of data to be analyzed, identifying the descriptive, inferential, or nonstatistical analyses. This section demonstrates that the project analysis is aligned to the specific project design. This section describes the clinical question(s). This section describes, in detail, the relevant data collected for each stated clinical question or variable. This section describes how the raw data were organized and prepared for analysis. This section provides a step-by-step description of the procedures used to conduct the data analysis. This section describes, in detail, any statistical and nonstatistical analysis to be employed. This section provides the rationale for each of the data analysis procedures (statistical and nonstatistical) employed in the project. This section demonstrates that the data analyses techniques align with the DPI project research design. This section states the level of statistical significance for quantitative analyses as appropriate. POTENTIAL BIAS: This section describes the threats to the internal validity of a study. Bias can be intentional or unintentional, and intentional is not moral and invalidates your projects results. Discuss any bias there may be in the projects sampling and how this was mitigated Discuss possible bias the project’s data collection and how this was mitigated. Discuss possible bias in data analysis and how this was mitigated. Discuss how bias can occur in data interpretation and how this was mitigated. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Ethical Considerations This section discusses the potential ethical issues surrounding the project, as well as how human subjects and data will be protected. The key ethical issues that must be addressed in this section include: · Identify how any potential ethical issues will be addressed. · Provide a discussion of ethical issues related to the project and the sample population of interest, institution, or data collection process. · Address anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflict of interest. · Demonstrate adherence to the key principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, and within the theoretical framework, practice or patient problem, and clinical questions. · Discuss how the data will be stored, safeguarded, and destroyed. · Discuss how the results of the project will be published. · Discuss any potential conflict of interest on the part of the investigator. · Reference IRB approval to conduct the project, which includes subject recruiting and informed consent processes, in regard to the voluntary nature of project. · Include the IRB approval letter with the protocol number, informed consent/subject assent documents, or any other measures required to protect the participants or institutions in an appendix. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Ethical Considerations This section discusses the potential ethical issues surrounding the DPI project, as well as how human subjects and data will be protected. It identifies how any potential ethical issues will be addressed. This section provides a discussion of ethical issues related to the project and the sample population of interest. This section addresses anonymity, confidentiality, privacy, lack of coercion, informed consent, and potential conflict of interest. This section demonstrates adherence to the key principles of the Belmont Report (respect, justice, and beneficence) in the project design, sampling procedures, and within the theoretical framework, problem, and questions. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Limitations While Chapter 1 addresses the broad, overall limitations of the project, this section discusses in detail the limitations related to the DPI project approach and methodology and the potential impacts on the results. This section describes any limitations related to the methods, sample, instrumentation, data collection process, and analysis. Other methodological limitations of the project may include issues with regard to the sample in terms of size, population and procedure, instrumentation, data collection processes, and data analysis. This section also contains an explanation of why the existing limitations are unavoidable and are not expected to affect the results negatively. Here you need to consider potential limitations and delimitations, which could impact your proposed project’s implementation. Are the nursing staff resistant to change? Is there currently a culture inherent in the site where the use of evidence-based practice is openly used/welcomed by staff? What strategies might you use to overcome any barriers you might face? How will you capitalize upon any facilitators you have identified? Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Limitations This section discusses, in detail, the limitations related to the project approach and methodology and the potential impacts on the results. This section describes any limitations related to the methods, sample, instrumentation, data collection process, and analysis. This section explains why the existing limitations are unavoidable and are not expected to affect the results negatively. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Summary This section restates what was written in Chapter 3 and provides supporting citations for key points. Your summary should demonstrate an in-depth understanding of the overall project design and analysis techniques. The Chapter 3 summary ends with a discussion that transitions the reader to Chapter 4. Comment by Author: Use INSERTPage Break to set new page for the reference list. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback Summary This section restates what was written in Chapter 3 and provides supporting citations for key points. This section summarizes key points presented in Chapter 3 with appropriate citations. This section demonstrates in-depth understanding of the overall project design and data analysis techniques. This section ends with a transition discussion focus for Chapter 4. This section is written in a way that is well structured, has a logical flow, and uses correct paragraph structure, sentence structure, punctuation, and APA format. NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document. Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready). Chapter 4: Data Analysis and Results The purpose of this chapter is to summarize the collected data, how it was analyzed and then to present the results. This section of Chapter 4 briefly restates the problem statement, the methodology, the clinical question(s) or phenomena, and then offers a statement about what will be covered in this chapter. Chapter 4 should present the results of the project as clearly as possible, leaving the interpretation of the results for Chapter 5. Make sure this chapter is written in past tense and reflects how the project was actually conducted. This chapter typically contains the analyzed data, often presented in both text and tabular or figure format. To ensure readability and clarity of findings, structure is of the utmost importance in this chapter. Sufficient guidance in the narrative should be provided to highlight the findings of greatest importance for the reader. Most investigators begin with a description of the sample and the relevant demographic characteristics presented in text or tabular format. Ask the following general questions before starting this chapter: Comment by Author: Edit the style (FORMAT-->STYLE–> Modify–>(drop down box that says format)–>Paragraph–> set indentation Left 0.25″, Special = hanging; by= 0.5″ THEN click on TABS (lower left corner) and make sure it is set at .75″ edit the style (FORMAT–>STYLE–> Modify–>(drop down box that says format)–>Paragraph–> set indentation Left 0.25″, Special = hanging; by= 0.5″ THEN click on TABS (lower left corner) and make sure it is set at .75″
Is there sufficient data to answer each of the clinical question(s) asked in the project? (see Appendix C) One procedure for determining a sample size ahead of the project is a power analysis.
Is there sufficient data to support the conclusions you will make in Chapter 5? (see Appendix D) If using SPSS version 26 to perform analyses, the data is entered and coded using numbers or numerical codes.
Is the project written in the third person? Never use the first person.
Is the data clearly explained using a table, graph, chart, or text? (see Appendix E)
Visual organizers, including tables and figures, must always be introduced, presented and discussed within the text first. Never insert them without these three steps. It is often best to develop all of the tables, graphs, charts, etc. before writing any text to further clarify how to proceed. Point out the salient results and present those results by table, graph, chart, or other form of collected data. See Appendix E for examples of APA formatted tables and figures.

Criterion Comment by Author: All of the criterion tables must be removed prior to all AQR, IRB, and final submissions.

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INTRODUCTION (TOTHE CHAPTER)
This section of Chapter 4 briefly restates the problem statement, the methodology, the clinical question(s) or phenomena, and offers a statement about what will be covered in this chapter.

Re-introduces the purpose of the practice project.

Briefly describes the project methodology and/or clinical question(s) tested.

Provides an orienting statement about what will be covered in the chapter.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Descriptive Data
This section of Chapter 4 provides a narrative summary of the population or sample characteristics and demographics of the participants in the project. It establishes the number of subjects, gender, age, education level or employee classification, (if appropriate), organization, or setting (if appropriate), and other appropriate sample characteristics (e.g. education level, program of project, employee classification etc.). The use of graphic organizers, such as tables, charts, histograms and graphs to provide further clarification and promote readability, is encouraged to organize and present coded data. Ensure this data cannot lead to anyone identifying individual participants in this section or identifying the data for individual participants in the data summary and data analysis that follows.
For numbers, equations, and statistics, spell out any number that begins a sentence, title, or heading – or reword the sentence to place the number later in the narrative. In general, use Arabic numerals (10, 11, 12) when referring to whole numbers 10 and above, and spell out whole numbers below 10. There are some exceptions to this rule:
If small numbers are grouped with large numbers in a comparison, use numerals (e.g., 7, 8, 10, and 13 trials); but, do not do this when numbers are used for different purposes (e.g., 10 items on each of four surveys).
Numbers in a measurement with units (e.g., 6 cm, 5-mg dose, 2%).
Numbers that represent time, dates, ages, sample or population size, scores, or exact sums of money.
Numbers that represent a specific item in a numbered series (e.g., Table 1).
A sample table in APA style is presented in Table 3. Be mindful that all tables fit within the required margins, and are clean, easy to read, and formatted properly using the guidelines found in Chapter 5 (Displaying Results) of the APA Publication Manual 6.0. Comment by Author: Each table must be numbered in sequence throughout the entire practice improvement project (Table 1, Table 2, etc.), or within chapters (Table 1.1, Table 1.2 for Chapter 1; Table 2.1, Table 2.2 for Chapter 2 etc.).

Table 3

A Sample Data Table Showing Correct Formatting

Column A
M (SD
) Comment by Author: Statistical symbols in tables must be italicized

Column B
M (SD)

Column C
M (SD)

Row 1

10.1 (1.11)

20.2 (2.22)

30.3 (3.33)

Row 2

20.2 (2.22)

30.3 ( 3.33)

20.2 (2.22)

Row 3

30.3 (3.33)

10.1 (1.11)

10.1 (1.11)

Note. Adapted from “Sampling and Recruitment in Studies of Doctoral Students,” by I.M. Investigator, 2010, Journal of Perspicuity, 25, p 100. Reprinted with permission. Comment by Author: Permission must be obtained to reprint information that is not in the public domain. Letters of permission are included in the appendix.

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DESCRIPTIVE DATA
This section of Chapter 4 provides a narrative summary of the population or sample characteristics and demographics of the participants in the project. It establishes the number of subjects, gender, age, level (if appropriate), organization, or setting (if appropriate). The use of graphic organizers, such as tables, charts and graphs to provide further clarification and promote readability, is encouraged.

Provides a narrative summary of the population or sample characteristics and demographics.

Graphic organizers are used as appropriate to organize and present coded data, as well as descriptive data such as tables, histograms, graphs, and/or charts.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Data Analysis Procedures
This section presents a description of the process that was used to analyze the data. If clinical question(s) guided the project, data analysis procedures can be framed relative to each clinical question. Data can also be organized by chronology of phenomena, by themes and patterns, or by other approaches as deemed appropriate according for the project. The key components included in this section are:
A detailed description of the data analysis procedures.
An explanation of how the raw data relates to the clinical questions(s) asked in the project for a quantitative project.
A discussion of the identification of sources of error and their effect on the data.
An explanation and justification of any differences in why the data analysis section does not match what was approved in Chapter 3 (if appropriate).
An analysis of the reliability and validity of the data in statistical terms, for quantitative projects.

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DATA ANALYSIS PROCEDURES
This section presents a description of the process that was used to analyze the data. If clinical question(s) guided the project, data analysis procedures can be framed relative to each clinical question. Data can also be organized by chronology of phenomena, by themes and patterns, or by other approaches as deemed appropriate

Describes in detail the data analysis procedures.

Explains and justifies any differences in why the data analysis section does not match what was approved in Chapter 3 (if appropriate).

Provides validity and reliability of the data in statistical terms for quantitative methodology.

Identifies sources of error and potential impact on the data.

For a quantitative project, justifies how the analysis aligns with the clinical question(s) and is appropriate for the DPI project design.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Results Comment by Author: When reporting statistics in the narrative, be sure to italicize statistical and mathematical variables, e.g., F test, t test, population size N, p = .03. Use commonly accepted abbreviations for statistical symbols.
This section, which is the primary section of this chapter, presents a summary and analysis of the data in a non-evaluative, unbiased, organized manner that relates to the clinical question(s). List the clinical question(s) as you are discussing them in order to ensure that the readers see that the question has been addressed. Answer the clinical question(s) in the order that they are listed for quantitative studies. The key components included in this section are:
The data and the analysis of that data should be presented in a narrative, non-evaluative, unbiased, organized manner by clinical question(s).
The section should also include appropriate graphic organizers, such as tables, charts, graphs, and figures.
The amount and quality of the data or information is sufficient to answer the clinical question(s) is well presented, and is intelligently interpreted.
Quantitative: Findings are presented by clinical question using section titles. They are presented in order of significance, if appropriate.
Quantitative: Results of each statistical test are presented in appropriate statistical format with tables, graphs, and charts.
Quantitative: For inferential statistics, p-value and test statistics are reported.
Quantitative: Control variables (if part of the design) are reported and discussed. Outliers, if found, were reported.
The results must be presented without implication, speculation, assessment, evaluation, or interpretation. Discussion of results and conclusions are left for Chapter 5. Refer to the APA Style Manual for additional lists and examples. In quantitative practice improvement projects, it is not required for all data analyzed to be presented; however, it is important to provide descriptive statistics and the results of the applicable statistic tests used in conducting the analysis of the data. It is also important that there are descriptive statistics provided on all variables. Nevertheless, it is also acceptable to put most of this in the Appendix if the chapter becomes too lengthy.
Required components include descriptive and inferential statistics. Descriptive statistics describe or summarize data sets using frequency distributions (e.g., to describe the distribution for the IQ scores in your class of 30 pupils) or graphical displays such as bar graphs (e.g., to display increases in a school district’s budget each year for the past five years), as well as histograms (e.g., to show spending per child in school and display mean, median, modes, and frequencies), line graphs (e.g., to display peak scores for the classroom group), and scatter plots (e.g., to display the relationship between two variables). Descriptive statistics also include numerical indexes such as averages, percentile ranks, measures of central tendency, correlations, measures of variability and standard deviation, and measures of relative standing.
Inferential statistics describe the numerical characteristics of data, and then go beyond the data to make inferences about the population based on the sample data. Inferential statistics also estimate the characteristics of populations about population parameters using sampling distributions, or estimation. Table 4 presents example results of an independent t test comparing Emotional Intelligence (EI) mean scores by gender.

Table 4

t-Test for Equality of Emotional Intelligence Mean Scores by Gender

t test for equality of means

t

Df

p

EI

1.908

34

.065

After completing the first draft of Chapter 4, ask these general questions: Comment by Author: Use Line Spacing Options to “Add a Space Between Paragraph” between tables and the text following it
1. Are the findings clearly presented, so any reader could understand them?
Are all the tables, graphics or visual displays well-organized and easy to read?
Are the important data described in the text?
Is factual data information separate from analysis and evaluation?
Are the data organized by clinical questions?
Chapter 4 can be challenging with regard to mathematical equations and statistical symbols or variables. When including an equation in the narrative, space the equation as you would words in a sentence: x + 5 = a. Punctuate equations that are in the paragraph, as you would a sentence. Remember to italicize statistical and mathematical variables, except Greek letters, and if the equation is long or complicated, set it off on its own line.
Refer to your APA manual for specific details on representation of statistical information. Basic guidelines include:
Statistical symbols are italicized (t, F, N, n)
Greek letters, abbreviations that are not variables and subscripts that function as identifiers use standard typeface, no bolding or italicization
Use parentheses to enclose statistical values (p = .026) and degrees of freedom t(36) = 3.85 or F(2, 52) = 3.85
Use brackets to enclose limits of confidence intervals 95% CIs [- 5.25, 4.95]
Make sure to include appropriate graphics to present the results. Always introduce, present, and discuss the visual organizers in narrative form. Never insert a visual organizer without these three steps.
A figure is a graph, chart, map, drawing, or photograph. Below is an example of a figure labeled per APA style. Do not include a figure unless it adds substantively to the understanding of the results or it duplicates other elements in the narrative. If a figure is used, a label must be placed under the figure. As with tables, refer to the figure by number in the narrative preceding the placement of the figure. Make sure a table or figure is not split between pages. Below is another example of a table and figure for you to review. (see Table 5 and Figure 4) Comment by Author: See Chapter 7 for details on correct APA style. Comment by Author: You must reference tables in the text prior to displaying the graphic.

Table 5

The Servant Leader Comment by Author: In addition to numbering the table, name the table.

Trait

Descriptors

Values People

By believing in people
By serving other’s needs before his or her own
By receptive, non-judgmental listening

Develops People

By providing opportunities for learning and growth
By modeling appropriate behavior
By building up others through encouragement and affirmation

Builds Community

By building strong personal relationships
By working collaboratively with others
By valuing the differences of others

Displays Authenticity

By being open and accountable to others
By a willingness to learn from others
By maintaining integrity and trust

Provides Leadership

By envisioning the future
By taking initiative
By clarifying goals

Shares Leadership

By facilitating a shared vision
By sharing power and releasing control
By sharing status and promoting others

Note. Derived from Laub, J. (1999). Assessing the servant organization: Development of the servant organizational leadership assessment (SOLA) instrument (Doctoral Practice improvement project). Available from ProQuest Practice improvement project and Theses Database. (UMI No. 9921922) Comment by Author: If at all possible, do not break a table across a page break.

Figure 4

Scattor Plot Example – Strong Negative Correlation

Note, An example of a strong negative correlation for SAT composite score and time spent on Facebook for 11th grade high school students enrolled in IMSmart SAT Prep Course.

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RESULTS
This section, which is the primary section of this chapter, presents an analysis of the data in a nonevaluative, unbiased, organized manner that relates to the clinical question(s). List the clinical question(s) as you are discussing them in order to ensure that the readers see that the question has been addressed. Answer the clinical question(s) in the order that they are listed.

The analysis of the data is presented in a narrative, nonevaluative, unbiased, organized manner by clinical question(s).

Includes appropriate graphic organizers such as tables, charts, graphs, and figures.

The amount and quality of the data or information is sufficient to answer the clinical question(s) is well presented, and is intelligently analyzed.

Quantitative: Findings are presented by using section titles. They are presented in order of significance, if appropriate.

Quantitative: Results of each statistical test are presented in appropriate statistical format with tables, graphs, and charts.

Quantitative: For inferential statistics, p-value and test statistics are reported.

Quantitative: Control variables (if part of the design) are reported and discussed. Outliers, if found, were reported.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Summary
This section provides a concise summary of what was found in the project. It briefly restates essential data and data analysis presented in this chapter, and it helps the reader see and understand the relevance of the data and analysis to the clinical question(s). Finally, it provides a lead or transition into Chapter 5, where the implications of the data and data analysis relative to the clinical question(s) will be discussed. The summary of the data must be logically and clearly presented, with the factual information separated from interpretation. For quantitative studies, summarize the statistical data and results of statistical tests in relation to the clinical question(s). Finally, provide a concluding section and transition to Chapter 5. Comment by Author: Use INSERTPage Break to set new page for new chapter. Do not use hard returns to get there.

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Summary
This section provides a concise summary of what was found in the project. It briefly restates essential data and data analysis presented in this chapter, and it helps the reader see and understand the relevance of the data and analysis to the clinical question(s). Finally, it provides a lead or transition into Chapter 5, where the implications of the data and data analysis relative to the clinical question(s) will be discussed.

Summary of data is logically and clearly presented.

The factual information is separated from analysis.

Quantitative: Summarizes the statistical data and results of statistical tests in relation to the clinical question(s).

Provides a concluding section and transition to Chapter 5.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.

Chapter 5: Summary, Conclusions, and Recommendations
This section introduces Chapter 5 as a comprehensive summary of the entire project. It reminds the reader of the importance of the topic and briefly explains how the project intended to contribute to the body of knowledge on the topic. It informs the reader that conclusions, implications, and recommendations will be presented.
Chapter 5 is perhaps the most important chapter in the practice improvement project manuscript because it presents the investigator’s contribution to the body of knowledge. For many who read evidence-based literature, this may be the only chapter they will read. Chapter 5 typically begins with a brief summary of the essential points made in Chapters 1 and 3 of the original DPI project and includes why this topic is important and how this project was designed to contribute to the understanding of the topic. The remainder of the chapter contains a summary of the overall project, a summary of the findings and conclusions, recommendations for future practice, and a final section on implications derived from the project.
No new data or citations should be introduced in Chapter 5; however, references should be made to findings or citations presented in earlier chapters. The investigator can articulate new frameworks and new insights. The concluding words of Chapter 5 should emphasize both the most important points of the project and what the reader should take from them. This should be presented in the simplest possible form, making sure to preserve the conditional nature of the insights. Refer to the Grand Canyon University practice improvement project rubric for guidance on the content of this chapter.

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INTRODUCTION
Provides an overview of why the project is important and how the project was designed to contribute to our understanding of the topic.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Summary of the Project Comment by Author: This section should be a minimum of three paragraphs.
This section provides a comprehensive summary of the overall project that describes the content of the project to the reader in the simplest possible terms. It should recap the essential points of Chapters 1-3, but it should remain a broad, comprehensive view of the project. It reminds the reader of the clinical question(s) and the main issues being evaluated, and provides a transition, explains what will be covered in the chapter and reminds the reader of how the project was conducted.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

SUMMARY OF THE PROJECT
Reminds the reader of the clinical question(s) and the main issues being evaluated.

Provides a transition, explains what will be covered in the chapter and reminds the reader of how the project was conducted.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Summary of Findings and Conclusion
This section of Chapter 5 is organized by clinical question(s), and it conveys the specific findings of the project. The section presents conclusions made based on the data analysis and findings of the project and relates the findings back to the literature, significance of the project in Chapter 1, advancing scientific knowledge in Chapter 1. Significant themes/ findings are compared and contrasted, evaluated and discussed in light of the existing body of knowledge. The significance of every finding is analyzed and related to the significance section and advancing scientific knowledge section of Chapter 1. Additionally, the significance of the findings is analyzed and related back to Chapter 2, and ties the project together. The findings are bounded by the DPI project parameters described in Chapters 1 and 3, are supported by the data and theory, and directly relate to the clinical question(s). No unrelated or speculative information is presented in this section. This section of Chapter 5 should be organized by clinical question(s), theme, or any manner that allows summarizing the specific findings supported by the data and the literature. Conclusions represent the contribution to knowledge and fill in the gap in the knowledge. They should also relate directly to the significance of the project. The conclusions are major generalizations, and an answer to the practice problem developed in Chapters 1 and 2. This is where the project binds together. In this section, personal opinion is permitted, as long as it is backed with the data, grounded in the project methods and supported in the literature.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Summary of Findings and Conclusions
This section is organized by clinical question(s), and it conveys the specific findings of the project. It presents all conclusions made based on the data analysis and findings of the project. It relates the findings back to the literature, significant chapters in Chapter 1, and advancing scientific knowledge in Chapter 1.

Organized by the same section titles as Chapter 4, clinical question(s) or by themes.

Significant themes/ findings are compared and contrasted, evaluated and discussed in light of the existing body of knowledge.

Significance of every finding is analyzed and related to the significance section and advancing scientific knowledge section of Chapter 1.

The conclusion summarizes the findings, refers back to Chapter 1, and ties the project together.

The findings are bounded by the DPI project parameters described in Chapters 1 and 3.

The findings are supported by the data and theory, and directly relate to the clinical question(s).

No unrelated or speculative information is presented in this section.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Implications Comment by Author: This section should be a minimum of three paragraphs.
This section should describe what could happen because of this project. It also tells the reader what the DPI project results imply theoretically, practically, and for the future. Additionally, it provides a retrospective examination of the theoretical framework presented in Chapter 2 in light of the practice improvement project’s findings. A critical evaluation of the strengths and weaknesses of the project, and the degree to which the conclusions are credible given the methodology, project design, and data, should also be presented. The section delineates applications of new insights derived from the practice improvement project to solve real and significant problems. Implications can be grouped into those related to theory or generalization, those related to practice, and those related to future projects. Separate sections with corresponding headings provide proper organization.

Theoretical Implications Comment by Author: This heading is tagged with APA Style > Level 3, i.e., 12 pt Times New Roman, Flush left, Boldface, Italicized, Title case Heading.
Theoretical implications involve interpretation of the practice improvement project findings in terms of the clinical question(s) that guided the project. It is appropriate to evaluate the strengths and weaknesses of the project critically and include the degree to which the conclusions are credible given the method and data. It should also include a critical, retrospective examination of the framework presented in the Chapter 2 Literature Review section in light of the practice improvement project’s new findings.

Practical Implications
Practical implications should delineate applications of new insights derived from the practice improvement project to solve real and significant problems.

Future Implications
Two kinds of implications for future projects are possible: one based on what the project did find or do, and the other based on what the project did not find or do. Generally, future DPI projects could look at different kinds of subjects in different kinds of settings, interventions with new kinds of protocols or dependent measures, or new theoretical issues that emerge from the project. Recommendations should be included on which of these possibilities are likely to be most fruitful and why.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Implications
This section should describe what could happen because of this DPI project results. It also tells the reader what the outcome and results implies theoretically, practically, and for the future.

Provides a retrospective examination of the theoretical framework presented in Chapter 2 in light of the practice improvement project’s findings.

Critically evaluates the strengths and weaknesses of the project, and the degree to which the conclusions are credible given the methodology, project design, and data.

Delineates applications of new insights derived from the practice improvement project to solve real and significant problems.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Recommendations
Summarize the recommendations that result from the project. Each recommendation should trace directly to a conclusion.

Recommendations for Future Projects
This section should contain a minimum of four to six recommendations for future DPI projects, as well as a full explanation for why each recommendation is being made. Additionally, this section discusses the areas of project that need further examination, or addresses gaps or new patient or system needs the project found. The section ends with a discussion of “next steps” in forwarding this line of DPI project evaluations. Recommendations relate back to the project significance and advancing scientific knowledge sections in Chapter 1.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Recommendations for Future PROJECTS
This section should contain a minimum of four to six recommendations for future DPI projects, as well as a full explanation for why each recommendation is being made. The recommended project methodology/design should also be provided.

Contains a minimum of four to six recommendations for future projects.

Identifies and discusses the areas that need further examination, or addresses gaps or new patient or system needs the project found.

Suggests “next steps” in forwarding this line of evidence and clinical implications.

Recommendations relate back to the project significance and advancing scientific knowledge sections in Chapter 1.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Recommendations for Practice
This section should contain two to five recommendations for future practice based on the results and findings of the project, as well as a full explanation for why each recommendation is being made. It provides a discussion of who will benefit from reading and implementing the results of the project and presents ideas based on the results that practitioners can implement in the work or educational setting. Unrelated or speculative information that is unsupported by data is clearly identified as such. Recommendations should relate back to the project significance section in Chapter 1.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

Recommendations for Future Practice
This section should contain two to five recommendations for future practice based on the results and findings of the project, as well as a full explanation for why each recommendation is being made.

Contains two to five recommendations for future practice.

Discusses who will benefit from reading and implementing the results of the project.

Discusses ideas based on the results that practitioners can implement in the work or educational setting.

Unrelated or speculative information unsupported by data is clearly identified as such.

Recommendations relate back to the project significance section in Chapter 1.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for review, please remove all of these assessment tables from this document.
Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

References Comment by Author: The Reference list should appear as a numbered new page at the end of the manuscript. The Reference heading is centered at the top of the page and is bolded.
The Reference list provides necessary information for the reader to locate and retrieve any source cited in the body of the text. Each source mentioned must appear in the Reference list. Likewise, each entry in the Reference list must be cited in the text.
Keep references whole and on one page
This page must be entitled “References.” This title is centered at the top of the page. Do not use bold, underline, or quotation marks for this title. All text should be in 12-point Times New Roman font and double-spaced.
NOTE: References must use a hanging indent of 0.5” and be double-spaced. Examples of common references are provided below. See APA (7th ed.), Chapter 9 for specific reference formatting instructions. For more information on references or APA Style, consult the APA website: at http://apastyle.org
American Psychological Association [APA]. (2019). Publication manual of the American Psychological Association (7th ed.). Washington, DC: Author.
Armijo-Olivo, S. (2018). The importance of determining the clinical significance of research results in physical therapy. Brazilian Journal of Physical Therapy, 22(3): 175-176. https://doi.org/10.1016/j.bjpt.2018.02.001 Comment by Author: must have https:// in front of th doi (lower case) DO NOT HYPERLINK GCU REQUIRMENT!
Brands, H. W. (2000). The first American: The life and times of Benjamin Franklin. New York, NY: Doubleday.
Creswell, J.W. & Creswell, J.D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Thousand Oaks: CA. Sage Publications.
Nock, A. J. (1943). The memoirs of a superfluous man. New York, NY: Harper & Brothers.

Criterion

Learner Score
(0, 1, 2, or 3)

Chairperson Score
(0, 1, 2, or 3)

Comments or Feedback

References

This section provides a minimum of 50 references with minimum of 85% of the 50 references published within the last 5 years. Additional references do not have to be published within the past 5 years.

Range of references includes founding theorists, peer-reviewed articles, books, and journals (approximately 90%).

Reference list is formatted according to current APA formatting. For every reference there is an in-text citation. For every in-text citation there is a reference.

NOTE: Once the document has been approved by your chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.
Score 0 (not present); 1 (unacceptable; needs substantial edits); 2 (present but needs some editing); 3 (publication ready).

Appendix A Comment by Author: The appendices follow the reference list and typically include materials relevant to the DPI project and referenced in the main text, (e.g. raw data, letters of permission, institutional review authorization, surveys or other data collection materials).
Each appendix must begin with a new page, have its own letter designation A, B, C…etc., and a descriptive title.
The appendix heading is centered, with a 1” top margin and is upper and lower case.
The content or text for each appendix follows right after the title and must fit the practice improvement project margins specifications: 1.5” left, 1” top, right, and bottom.
Text spacing for appendix content depends on the nature of the appendix material. The format of the material should be clean and consistent. Comment by Author: Appendix A should be the Ten Strategic Points when submitting the proposal. When the final paper is submitted, the Ten Strategic Points should be deleted and the GCU IRB Letter of Approval or QI Determination Letter should be included as Appendix A.
The Parts of a Practice Improvement Project
GCU requires the Publication Manual of the American Psychological Association (7th ed.) as the style guide for writing and formatting Direct Practice Improvement (DPI) Projects. . A DPI Project has three parts: preliminary pages, main text, and supplementary pages. Some preliminary or supplementary pages may be optional or not appropriate to a specific project. The learner should consult with his or her practice improvement project chairperson and committee regarding inclusion or exclusion of optional pages.
Preliminary Pages
The following preliminary pages precede the main text of the practice improvement project.
Title Page
Copyright Page (optional)
Approval Page
Abstract
Dedication Page (optional)
Acknowledgements (optional)
Table of Contents
List of Tables (if you have tables, a list is required)
List of Figures (if you have figures, a list is required)
Main Text
The main text is divided into five major chapters. Each chapter can be further subdivided into sections and subsections.
Chapter 1: Introduction to the Project
Chapter 2: Literature Review
Chapter 3: Methodology
Chapter 4: Data Analysis and Results (not included in the proposal)
Chapter 5: Summary, Conclusions, and Recommendations (not included in the proposal)
Supplementary Pages
Supplementary pages, which follow the body text, include reference materials and other required or optional addenda.
References
Appendices
Appendix A for the manuscript is the Grand Canyon University IRB Outcome Letter.
Appendix B is the Instruments/tool used
Appendix C is permission to use the instrument/tool
Appendix D is another tool if applicable (Appendix E is permission for second instrument/tool) otherwise you are done.

Keep in mind that most formatting challenges are encountered in the preliminary and supplementary pages. Allocate extra time and attention for these sections to avoid delays in the electronic submission process. In addition, as elementary as it may seem, run a spell check and grammar check of your entire document before submission.
2

Appendix B Comment by Author: Do not include your site authorization letter, site IRB letter, informed consent, recruitment materials, or any other documents that would implicate the site and/or participants.
Your GCU IRB Letter of Approval or QI Determination Letter should be placed in Appendix A.

What is my DPI project design?

THIS IS NOT PART OF THE PAPER JUST A REFERENCE FOR THE LEARNER

26

Appendix C

Power Analysis Using G Power

Note: Public source G-Power Software available https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower.html

Appendix D
Example SPSS Dataset & Variable View

26
The SPSS database is set up with all variables coded to compare between or within the comparison groups. A comparison may be made within the same individual and it coded 1 for before and 2 after the intervention. Or if measuring between individuals, the data would be coded the same 1 for before and 2 after as noted in the Group Column. Software supplied by Grand Canyon University.

Appendix E
How to Make APA Format Tables and Figures Using Microsoft Word
Tables vs. Figures
0. See APA Publication Manual, Chapter 7 for additional details (APA, 2019).
0. Tables consist of words and numbers where spatial relationships usually do not indicate any numerical information.
0. Tables should be used to present information that would be too wordy, repetitive, or difficult to read as text.
0. Figures typically communicate numerical information using spatial relations. For example, as you move up the Y axis of bar graph the scores usually go up.

1. Examples of APA Tables

A. Descriptive table

Table 1

Characteristics of Variables

Variable

Variable Type

Level of Measurement

Group, Intervention or Tool

Independent

Nominal

Rates or events

Dependent

Nominal

Socio Economic Status or Categories in an order

Dependent

Ordinal

Time, Temperature

Dependent

Interval

Age, height, Scores of tests

Dependent

Ratio

Note. Add notes here = (Provide any reference, 2019).

Table 1

Number of Handoff Per Groups

Group

# of Handoffs (%)

Pre-Intervention Group (Baseline)

150 (50%)

SBAR Group

150 (50%)

Note. SBAR handoff was defined as …. (IHI, 2020)

Table 1

Number of Hours Per Week Spent in Various Activities

Group

Baseline

(n = 30)

Post Intervention (n = 30)

Total Sample

(n = 60)

M (SD)

M (SD)

M (SD)

Schoolwork

18.23 (7.79)

16.23 (3.99)

17.63 (1.2)

Physical activities

19.54 (3.63)

14.23 (2.84)*

18.67 (1.0)

Socializing

16.23 (3.99)

17.63 (1.2)

18.23 (7.79)

Watching television

14.23 (2.84)

18.67 (1.0)

19.54 (3.63)

Extracurricular activities

19.54 (3.63)

18.23 (7.79)

19.22 (5.45)

Note. Schoolwork was defined as time spent doing class work outside of regular class time.
*statistically significant at p <.05 B. Chi-Square example (Group IV x Group DV) Table 1 Crosstabulation of Gender and Chronic Pain Chronic Pain Gender Female Male χ2 Φ Yes 2 (-2.7) 8 (2.7) 7.20** ,60 No 8 (2.7) 2 (-2.7) Note. Adjusted standardized residuals appear in parentheses below group frequencies **= p < .01. C. t-Test Example (Dichotomous Group IV x Score DV) -Notice two separate t-test results have been reported. Table 1 Chronic Paint Score and Exercise time for Males and Females Gender Female Male T df Pain Score 3.33 (1.70) 3.75 (1.79) -2.20* 175 Exercise Time 4.28 (.7509) 3.87 (.9280) 4.2** 176 Note. Standard Deviations appear in parentheses below means. * = p < .05, *** = p < .001. D. One Way ANOVA with 3 Groups Example (Group IV x Score DV) Remember with an ANOVA, you have to report paired comparisons associated with post hoc or planned comparisons) for significant analyses. The results of paired comparisons are indicated by the subscripts on the means within rows. Also, notice in this table that we report the results of four separate analyses. This is the real power of tables: we can convey a large amount of information very concisely. Table 1 Analysis of Variance for Sleep Times and Experimental Groups Experimental Group Aerobic Exercise Weight Lifting No Exercise F η2 Total Sleep Time 8.23a (.55) 7.93b (.90) 7.73ab (.55) 3.98*** .18 Total Wake Time 3.58a (.70) 3.62a (.55) 3.54a (.90) .03 .00 Total Light Sleep 3.19c (.73) 2.80a (.72) 3.02b (.49) 2.95* .06 Total Deep Sleep 3.21b (.19) 3.10a (.28) 3.30a (.19) .20 .01 Standard deviations appear in parentheses bellow means. Means with differing subscripts within rows are significantly different at the p < .05 based on Fisher’s LSD post hoc paired comparisons. * = p < .05, *** = p < .001. E. Factorial ANOVA Example 2 x 3 between subject’s design. Notice that two tables are used here. The first table reports the overall results for the 2x3 factorial ANOVA, which includes the Main Effects for the two IV’s and the Interaction Effect for the two IV’s. The second table reports the means and simple effects tests for the significant interaction effect. Table 1 Experimental Group x Sex Factorial Analysis of Variance for Sleep Scores Source Df F η2 p Experimental Group 2 7.93 .17 .001 Sex 1 31.41 .34 .001 Group x Sex (interaction) 2 7.85 .17 .002 Error (within groups) 30 Table 1 Analysis of Sleep Scores for Experimental Groups by Gender Aerobic Exercise Weight Lifting No Exercise Simple Effects: F df (2, 30) Males 10.37a (2.50) 10.30a (2.34) 10.33a (1.63) .04 Females 4.83a (1.60) 10.50b (2.59) 4.50a (1.52) 15.74** Simple Effects: F df (1, 30) 23.56** .00 23.56** Note. Standard deviations appear in parentheses bellow means. Means with differing subscripts within rows are significantly different at the p < .05 based on Fisher’s LSD post hoc paired comparisons. ** = p < .01 Notice that the simple effect comparing the 3 experiment groups only for females, requires follow up tests in order to determine which groups are significantly different. In this case, Fisher’s LSD test was used, and the results are represented with the different subscripts for each mean. In this case, female participants in the Aerobic exercise group did not differ from the no exercise group so they are given the same subscript (a). However, women in the control group and women in the Weight lifting group significantly differed from the Aerobic watching group and so the Weight Lifting group was labeled with a different subscript (b). The male subjects did not differ from one another, so they all share the same subscript (a). F. Correlations (Scores IV x Scores IV) Table 1 Pearson’s Product Moment Correlations for Chronic Pain Score, Exercise Attitude Scores and Physical Activity Demographic Influences on Exercise Weight Age Chronic Pain Score Pain Level .39*** -.07 Pain Intensity .15 .22* Physical Exercise Type of Exercise -.26** -.19† Time of Exercise -.13 -.21* Intent to Exercise .02 -.10 Note. N = 96 for all analyses. † = p < .10, *= p < .05, **= p < .01, ***= p < .001. 1. Examples of APA Figures Generally, the same features apply to figures as have been previously provided for tables: They should be easy to read and interpret, consistent throughout the document when presenting the same type of figure, kept on one page if possible, and supplement the accompanying text or table. Figure 1 Graph of Scores Before and After Note: Reprinted from S. GCU. Or Adapted from or www.website.com. Reprinted with permission. If the figure is not your own work, note the source or reference where you found the figure. Write, “Reprinted from” or “Adapted from,” followed by the title of the book, article, or website where you found the figure. Include the page number where you found the figure as well if you are citing a figure from a book. If you are citing a figure from a website, you may write, “Reprinted from The Huffington Post.” Or include the author’s first and second initial as well as their surname. Use the author’s first and second initial, if available, rather than the author’s full first name. Note their last name as well. References: American Psychological Association [APA]. (2019). Publication manual of the American Psychological Association. (7th ed.). Washington, DC; Author Microsoft Word ®. (2019). Retrieved from https://products.office.com/ Appendix F Writing up your statistical results Identify the analysis technique. In the results section (Chapter 4), your goal is to report the results of the data analyses used to answer your project question. To do this, you need to identify your data analysis technique, report your test statistic, and provide some interpretation of the results. Each analysis you run should be related to your clinical question or PICOT. If you analyze data that is exploratory or outside your clinical question, you need to indicate this in the results. Format test statistics. Test statistics and p values should be rounded to two decimal places (If you are providing precise p-values for future use in meta-analyses, 3 decimal places is acceptable). All statistical symbols (sample statistics) that are not Greek letters should be italicized (M, SD, t, p, etc.). Indicate the direction of the significant difference. When reporting a significant difference between two conditions, indicate the direction of this difference, i.e. which condition was more/less/higher/lower than the other condition(s). Assume that your audience has a professional knowledge of statistics. Do not explain how or why you used a certain test unless it is unusual (i.e., such as a non-parametric test). How to report p values. Report the exact p value (this is the preferred option if you want to make your data convenient for individuals conducting a meta-analysis on the topic). Example: t(33) = 2.10, p = .03. If your exact p value is less than .001, it is conventional to state merely p < .001. If you report exact p values, state early in the results section the alpha level used as a significance criterion for your tests. For example: “We used an alpha level of .05 for all statistical tests.” If your results are in the predicted direction but are not significant, you can say your results were marginally significant. Example: Results indicated a marginally significant preference for pie (M = 3.45, SD = 1.11) over cake (M = 3.00, SD = .80), t(5) = 1.25, p = .08. If your p-value is over .10, you can say your results revealed a non-significant trend in the predicted direction. Example: Results indicated a non-significant trending in the predicted direction indicating a preference for pie (M = 4.25, SD = 2.21) over cake (M = 3.25, SD = 2.60), t(5) = 1.75, p = .26. Descriptive Statistics Mean and Standard Deviation are most clearly presented in parentheses: The sample as a whole was relatively young (M = 19.22, SD = 3.45). The average age of students was 19.22 years (SD = 3.45). Percentages are also most clearly displayed in parentheses with no decimal places: Nearly half (49%) of the sample was married. Frequencies or rates are reported including the range, mode, or median. t-tests There are several different designs that utilize a t-test for the statistical inference testing. The differences between one-sample t-tests, related measures t-tests, and independent samples t tests are clear to the knowledgeable reader so eliminate any elaboration of which type of t-test has been used. Additionally, the descriptive statistics provided will identify which variation was employed. It is important to note that we assume that all p values represent two-tailed tests unless otherwise noted and that independent samples t-tests use the pooled variance approach (based on an equal variances assumption) unless otherwise noted: There was a significant effect for gender, t(54) = 5.43, p < .001, with men receiving higher scores than women. Results indicate a significant preference for pie (M = 3.45, SD = 1.11) over cake (M = 3.00, SD = .80), t(15) = 4.00, p = .001. The 36 study participants had a mean age of 27.4 (SD = 12.6) were significantly older than the university norm of 21.2 years, t(35) = 2.95, p = .01. Students taking statistics courses in psychology at the University of Washington reported studying more hours for tests (M = 121, SD = 14.2) than did UW college students in general, t(33) = 2.10, p = .034. The 25 participants had an average difference from pre-test to post-test anxiety scores of -4.8 (SD = 5.5), indicating the anxiety treatment resulted in a significant decrease in anxiety levels, t(24) = -4.36, p = .005 (one-tailed). The 36 participants in the treatment group (M = 14.8, SD = 2.0) and the 25 participants in the control group (M = 16.6, SD = 2.5), demonstrated a significance difference in performance (t[59] = -3.12, p = .01); as expected, the visual priming treatment inhibited performance on the phoneme recognition task. UW students taking statistics courses in Psychology had higher IQ scores (M = 121, SD = 14.2) than did those taking statistics courses in Statistics (M = 117, SD = 10.3), t(44) = 1.23, p = .09. Over a two-day period, participants drank significantly fewer drinks in the experimental group (M= 0.667, SD = 1.15) than did those in the wait-list control group (M= 8.00, SD= 2.00), t(4) = -5.51, p=.005. ANOVA and post hoc tests ANOVAs are reported like the t test, but there are two degrees-of-freedom numbers to report. First report the between-groups degrees of freedom, then report the within-groups degrees of freedom (separated by a comma). After that report the F statistic (rounded off to two decimal places) and the significance level. One-way ANOVA: The 12 participants in the high dosage group had an average reaction time of 12.3 seconds (SD = 4.1); the 9 participants in the moderate dosage group had an average reaction time of 7.4 seconds (SD = 2.3), and the 8 participants in the control group had a mean of 6.6 (SD = 3.1). The effect of dosage, therefore, was significant, F(2,26) = 8.76, p=.012. An one way analysis of variance showed that the effect of noise was significant, F(3,27) = 5.94, p = .007. Post hoc analyses using the Scheffé post hoc criterion for significance indicated that the average number of errors was significantly lower in the white noise condition (M = 12.4, SD = 2.26) than in the other two noise conditions (traffic and industrial) combined (M = 13.62, SD = 5.56), F(3, 27) = 7.77, p = .042. Tests of the four a priori hypotheses were conducted using Bonferroni adjusted alpha levels of .0125 per test (.05/4). Results indicated that the average number of errors was significantly lower in the silence condition (M = 8.11, SD = 4.32) than were those in both the white noise condition (M = 12.4, SD = 2.26), F(1, 27) = 8.90, p =.011 and in the industrial noise condition (M = 15.28, SD = 3.30), F (1, 27) = 10.22, p = .007. The pairwise comparison of the traffic noise condition with the silence condition was nonsignificant. The average number of errors in all noise conditions combined (M = 15.2, SD = 6.32) was significantly higher than those in the silence condition (M = 8.11, SD = 3.30), F(1, 27) = 8.66, p = .009. Multiple Factor (Independent Variable) ANOVA There was a significant main effect for treatment, F(1, 145) = 5.43, p < .01, and a significant interaction, F(2, 145) = 3.13, p < .05. The cell sizes, means, and standard deviations for the 3x4 factorial design are presented in Table 1. The main effect of Dosage was marginally significant (F[2,17] = 3.23, p = .067), as was the main effect of diagnosis category, F(3,17) = 2.87, p = .097. The interaction of dosage and diagnosis, however, has significant, F(6,17) = 14.2, p = .0005. Attitude change scores were subjected to a two-way analysis of variance having two levels of message discrepancy (small, large) and two levels of source expertise (high, low). All effects were statistically significant at the .05 significance level. The main effect of message discrepancy yielded an F ratio of F(1, 24) = 44.4, p < .001, indicating that the mean change score was significantly greater for large-discrepancy messages (M = 4.78, SD = 1.99) than for small-discrepancy messages (M = 2.17, SD = 1.25). The main effect of source expertise yielded an F ratio of F(1, 24) = 25.4, p < .01, indicating that the mean change score was significantly higher in the high-expertise message source (M = 5.49, SD = 2.25) than in the low-expertise message source (M = 0.88, SD = 1.21). The interaction effect was non-significant, F(1, 24) = 1.22, p > .05.
A two-way analysis of variance yielded a main effect for the diner’s gender, F(1,108) =
3.93, p < .05, such that the average tip was significantly higher for men (M = 15.3%, SD = 4.44) than for women (M = 12.6%, SD = 6.18). The main effect of touch was nonsignificant, F(1, 108) = 2.24, p > .05. However, the interaction effect was significant,
F(1, 108) = 5.55, p < .05, indicating that the gender effect was greater in the touch condition than in the non-touch condition. Chi Square Chi-Square statistics are reported with degrees of freedom and sample size in parentheses, the Pearson chi-square value (rounded to two decimal places), and the significance level: The percentage of participants that were married did not differ by gender, X2(1, N = 90) = 0.89, p > .05.
The sample included 30 respondents who had never married, 54 who were married, 26
who reported being separated or divorced, and 16 who were widowed. These frequencies
were significantly different, X2 (3, N = 126) = 10.1, p = .017.
As can be seen by the frequencies cross tabulated in Table xx, there is a significant
relationship between marital status and depression, X2 (3, N = 126) = 24.7, p < .001. The relation between these variables was significant, X2 (2, N = 170) = 14.14, p < .01. Catholic teens were less likely to show an interest in attending college than were Protestant teens. Preference for the three sodas was not equally distributed in the population, X2 (2, N = 55) = 4.53, p < .05. Correlations Correlations are reported with the degrees of freedom (which is N-2) in parentheses and the significance level: The two variables were strongly correlated, r(55) = .49, p < .01. Regression analyses Regression results are often best presented in a table. A PA doesn't say much about how to report regression results in the text, but if you would like to report the regression in the text of your Results section, you should at least present the standardized slope (beta) along with the t-test and the corresponding significance level. (Degrees of freedom for the t-test is N-k-1 where k equals the number of predictor variables.) It is also customary to report the percentage of variance explained along with the corresponding F test. Social support significantly predicted depression scores, b = -.34, t(225) = 6.53, p < .01. Social support also explained a significant proportion of variance in depression scores, R2 = .12, F(1, 225) = 42.64, p < .01. Tables Add a table or figure. Adding a table of figure can be helpful to the reader. See the current APA Publication manual for examples. In reporting the results of statistical tests, report the descriptive statistics, such as means and standard deviations, as well as the test statistic, degrees of freedom, obtained value of the test, and the probability of the result occurring by chance (p value). •APA style tables do not contain any vertical lines •There are no periods used after the table number or title. •When using columns with decimal numbers, make the decimal points line up. •Use MS Word tables to create tables American Psychological Association [APA]. (2019). Publication manual of the American Psychological Association (7th ed.). Washington, DC: Author. Before 38 36 43 35 37 37 39 36.027027027027025 35.054054054054056 39 42.05263157894737 36 37 36 37 36 36.027027027027025 36 36 37 37 After 25 24 23 22 27 30 27 33 29 37 30 22 23 29 33 34 30 29 31 35 32

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6

Improving Medication Adherence in Diabetic Patients in Home Health Care Settings

Comment

by

Author: Bola, please use the updated DPI template that I shared with you previously. There are specific things within the template that are required. Your cover pages for example needs to follow the template.

Submitted by

Bola Odusola-Stephen

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

January 30, 2021

GRAND CANYON UNIVERSITY

Improving Medication Adherence in Diabetic Patients in Home Health Care Settings
by
Bola Odusola-Stephen

Proposed

January 30, 2021

DPI PROJECT COMMITTEE:

Mary Guhwe, DNP, Manuscript Chair

Bamidele Jokodola, DNP, Committee Member

Abstract

Home healthcare programs have been effective in the current environment as they provide a technique for improving health outcomes for diabetes patients. At the project site, although staff consistently assesses for patient medication adherence, there is no standardized process for addressing medication adherence when it is identified. Medication adherence project (MAP) resources have been utilized to improve medication adherence in chronic disease management. The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of Medication Adherence Project resources that include the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Padimpact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, at a home healthcare organization located in urban Texas. The theoretical frameworks guiding the project include ………….This paper shall assess the program in line with various articles that promote adoption of the technique. The peer reviewed journal articles would ensure the paper has factual information that ensure implementation of the home healthcare program would occur seamlessly. The inclusion of home healthcare providers promotes the validity of the program. Medication adherence rates will be abstracted from the EHR based on documentation from home health personnel and compared with baseline medication adherence rates.The project would use the proposed initiatives to enhance home healthcare provision based on the need to improve health departments. The project shall assess the validity of the proposed home healthcare initiative based on the availability of trained personnel to monitor patient outcomes. The methodology that shall get applied is using quantitate approach by studying various research articles about diabetes and home-based care. The quantitative approach shall get applied to determine how the proposed MAP resources would promote patient outcomes. The population size for the project shall be persons living with Diabetes in Texas. It shall be possible to enhance the project’s outcome based on the metrics mentioned.

Keywords: home-based care, MAP resources, quantitative approach, medication adherence, diabetes mellitus type II.

Table of Contents

Chapter 1: Introduction to the Project 1
Background of the Project 5
Problem Statement 6
Purpose of the Project 7
Clinical Question(s) 9
Advancing Scientific Knowledge 11
Significance of the Project 13
Rationale for Methodology 14
Nature of the Project Design 15
Definition of Terms 17
Assumptions, Limitations, Delimitations 20
Summary and Organization of the Remainder of the Project 23

Chapter 2: Literature Review

25
Theoretical Foundations 27
Review of the Literature 29
Theme 1 31
Theme 2 32
Summary 36
Chapter 3: Methodology 40
Statement of the Problem 41
Clinical Question 42
Project Methodology 44
Project Design 46
Population and Sample Selection 48
Instrumentation or Sources of Data 51
Validity 52
Reliability 53
Data Collection Procedures 54
Data Analysis Procedures 56
Potential Bias and Mitigation 59
Ethical Considerations 62
Limitations 64
Summary 66

References

68

Appendix A

70
Appendix B 72

Appendix C

74

2

Chapter 1: Introduction to the Project

According to the CDC (2020) diabetes impacts one in 10 Americans. Furthermore, the prevalence of diabetes continues to rise and is projected to increase by 0.3 % per year until 2030 (Lin et al., 2018). There are two types of diabetes that plague a large proportion of Americans. Type I diabetes is dependent on insulin whereby the pancreas produces little amounts of insulin (Bellou, 2018). Type II diabetes is impairment related to the body’s ability to regulated glucose (Bellou, 2018). There are ways to curtail the onset of Type II diabetes; however, once individuals are diagnosed with diabetes, there is no cure (Kvarnström, 2017).

Among individuals with Type II diabetes, proper and effective medication adherence is critical (Kvarnström, 2017). According to the World Health Organization (2003), “increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvements in specific medication treatment.” Furthermore, Kvarnström (2017) stated that more than half of the population does not adhere to the prescribed medication regiment, thereby resulting in various health-related challenges. Health-related challenges associated with poor medication adherence include limited knowledge of patients, lack of proper technique of providing dosage, lac of patient self-management, and lifestyle constraints (Kvarnström, 2017). For individuals with Type II diabetes, lacking medication adherence can mean the difference between life and death (Rathish, 2019).

Various researchers have denoted the critical role that home healthcare providers play in promoting enhanced medication adherence (Bussell et al., 2017). Furthermore, the World Health Organization (WHO), as cited by Brown and Bussell (2011), explained that there are five factors that impact medication adherence, which include: (1) patient-related factors, (2) socioeconomic factors, (3) therapy-related factors, (4) condition-related factors, and (5) the health system/health care team-related factors. For the purpose of this project, the project investigator (PI) will explore focus on the role that health care team members play in addressing patient related factors that affect medication adherence enhancing medication adherence among home health care diabetic patients.

Background of the Project

Home-based healthcare has existed since 1909 (Choi et al., 2019). Since its inception, home-based healthcare has been perceived as a more costly method of patient care as compared to expenses associated with hospitalization (Singletary, 2019). In the early 20th century, home-based healthcare was mainly practiced due to financial disparities, specifically since many individuals were unable to afford hospitalized care. Furthermore, home-based healthcare was also practiced due to medical inaccessibility, which often existed in African-American communities to due to limited access to resources (Choi et al., 2019).

Present day, home-based healthcare is often selected due to an individual’s personal preferences. There are some situations in which individuals prefer the comforts of their own home as compared to that of a hospital or group home. As older generations continue to age, they often prefer to remain in their home for as long as possible. Given the needs of older generations and the impact of advances in healthcare and technology, home-based healthcare has grown exponentially (Wong et al., 2020). While home-based healthcare is not appropriate for all patients, Szanton et al. (2016) noted that this care option is best when an individual’s condition can be managed without admission to a hospital. Patients who have diabetes and/or hypertension are often recipients of home-based healthcare (Wong et al., 2020).

Home healthcare providers often visit patients three and engage in assessment of the patient’s blood pressure, cognitive functioning, and adherence to treatment proposals. During patient visits, home healthcare providers are responsible for biological assessment of patients (Wong et al., 2020). One of the paramount functions of home healthcare providers is to ensure that patients are adhering to their medication regiment (Wong et al., 2020). According to Wong et al. (2020), medication adherence is predicated on medication understanding and education, which should be conveyed by home healthcare providers (Wong et al., 2020).

Adhering to diabetes medication regiment requirements can be complex. In fact, in a study by Rauofi et al., (2018), researchers noted that 0.1 % of diabetic patients did not properly monitor their glucose levels nor did they adhere to medication requirements. Dr. Goldbach, who is the Chief Medical Officer for Health Dialogue, stated, “Especially for people with chronic illness that are facing challenges like depression, or transportation, or complexity of medication regimens – that these interpersonal, trusted interactions with a nurse tend to be very effective” (Heath, 2019). Patients with diabetes often express difficulties in adhering to medication regimens, thereby reinforcing the critical role of receiving education from home healthcare providers (Wong et al., 2020).

In a study by Wong et al. (2020), home healthcare patients expressed that they did not have sufficient knowledge about the requirements associated with diabetes treatment. Often times, diabetic home healthcare patients fail to practice medication adherence, thereby resulting in health complications, which is due to unmanaged health conditions.

Problem Statement

The issue of implementation of the home healthcare-led Medication Adherence Project resources (e.g., the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Pad; intervention) will impact medication adherence (outcome) when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas. It is not known if or to what degree the implementation of Medication Adherence Project resources that include the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Pad will impact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas.

At the selected project site, which is a home healthcare organization located in urban Texas, the stakeholders have cited that medication adherence among diabetic patients is lacking. In fact, according to data attained from the site’s electronic health record (EHR), home healthcare providers have documented that 0.1 % of diabetic home health care patients are not adhering to their medication regiment. At the project site, failure to adhere to the prescribed medication regiment has resulted in physiological issues. Although this percentage is lower than other percentages cited in the literature for medication non adherence in chronic disease management, Vvarious researchers have noted the implications associated with lacking adherence to medication regiments, specifically among diabetic patients (Heath, 2019), thereby reinforcing the need for this practice improvement project. Comment by Author: This is not such a huge percentage compared to the other percentages cited in the literature for non-medication adherence. Probably better for you to give a number of patients instead of the percentage. Also make sure this percentage is not based on calculations using the home health entire patient population as the denominator but rather only diabetic patients as the denominator and the non-adherent diabetic patients as the numerator.

According to (Kvarnström et al., 2017) healthcare providers play a critical role in ensuring medication adherence. While there are many reasons for lacking adherence among patients, for the purpose of this project, the WHO’s (2019) focus on the role of healthcare team members in enhancing medication adherence will be addressed.

As previously noted, among diabetic patients, lacking medication inherence at the project site is 45 %. Nationally, in home healthcare settings, lacking adherence to diabetic regiment is 14 % (Ong et al., 2018). In hopes of improving patient-related outcomes and reducing preventable issues, home healthcare nursing staff members will utilize medication adherence project tools, which were created by Starr and Sacks (2010). The tools utilized in this study, which are from the MAP Toolkit and Training Guide resources (Starr & Sacks, 2010), include: (1) a Questions to Ask Pad, (2) A Questions to Ask Poster, (3) a Medication Adherence Pad, and (4) the My Medications List. Before implementing these tools, the project investigator (PI) will provide a 30 minute information session on this project as well as the MAP resources educate home healthcare staff members about how to properly utilize these resources. Comment by Author: Please review your manuscript for inconsistencies and make sure the details are aligned. On page 4, you said this percentage was 0.1% and I even remarked that the percentage was small, please review and edit for the final percentage and make sure it aligns throughout. If it is really 45% then please edit the number on the previous page and the sentence that follows that addresses the prior small percentage that was listed Comment by Author: You need to edit your entire project and make sure you take out any references of the project as a study. I will not highlight all instances Comment by Author: Make sure you edit the rest of your manuscript to make sure that you do not use the word educate for the information session you will have the staff about the project. If you refer to it as education, you will need to measure an outcome for that education. So really important to keep it as an information session and edit that throughout your manuscript

During the onset of this project, once home healthcare nursing staff members have attended the educational training session, patients will be assessed for patient specific medication adherence barriers using the medication adherence pad and then educated about the importance of diabetes-related medication adherence as well as other medication related questions that they can ask their healthcare provider or pharmacist. Specifically, nursing staff members will address the items of using the Questions to Ask Pad and the Questions to Ask Poster. Then, patients will be asked the question noted on the Medication Adherence Pad, which states, “What gets in the way of taking your diabetes medicines?” To further understand some of the challenges associated with medication adherence, and to answer any additional questions or concerns noted by patients, the nursing staff members will keep detailed notes about rationale for medication non-adherence which is noted by patients All of this assessment and education will be documented in the HER per current documentation process.. Finally, after providing patient-specific education, home healthcare nursing staff members will ask patients to complete the My Medications List to ensure an accurate medication list is maintained in the EHR. During every home healthcare meeting, nursing staff members will explore medication adherence concerns and adjust the My Medications List accordingly.

To explore the impact of the intervention, the PI will compare pre implementation medication non adherence rates in diabetic patients receiving home health services at the project site to post implementation medication non adherence rates after implementing the MAP resources. pre-project implementation data, from March 1 2021 to April 30th, 2021, to post-project implementation data. Medication adherence data is available through the project site’s EHR. This project will take place over a four-week period from June 1st, 2021 to July l 30th, 2021. The ultimate goal of this project is to enhance medication adherence among Type II diabetes patients, through the involvement of home healthcare providers, thereby resulting in enhanced patient related outcomes. 

Purpose of the Project

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of the MAP resources, which will be delivered by home healthcare nursing staff members, will impact medication adherence when compared to current practice among Type II diabetic patients, ages 35 to 64 in a home healthcare setting in urban Texas.

Medication adherence, which is the independent variable explored in this project, will be measured using data attained through the project site’s EHR. The MAP resources, which serve as the dependent variable explored in this project, include the (1) a Questions to Ask Pad, (2) A Questions to Ask Poster, (3) a Medication Adherence Pad, and (4) the My Medications List. Comment by Author: Make sure this matched your purpose statement from prior pages that I corrected Comment by Author: This is incorrect. Medication adherence is the dependent variable. You have it right in other parts of your manuscript so this is all editing that just needs to be updated. I will not highlight this throughout the manuscript so make sure you edit your manuscript throughout Comment by Author: This is the independent variable. Make sure you edit this throughout your manuscript and ensure it aligns and is corrected throughout. I will not highlight this throughout the manuscript

The selected project site, which is located in urban Texas, serves 100 patients, on average, each month. Of the total number of patients, approximately 20 patients have Type II diabetes. Patients with Type II diabetes, who are between the ages of 35 and 64, and are of sound mental status, will be the target population for this project. The goal of the PI is to improve medication adherence among Type II diabetic patients, through the implementation of the MAP resources. Comment by Author: Anytime you speak of the goal of the project you are discussing the purpose of the project so really to stick to the same purpose statement anything you speak of the goal or objective of the project. Please edit throughout your manuscript and ensure that it aligns throughout

The project is significant since home based healthcare enhances the outcome of treatment initiative. Wong et al. (2020) stated that physicians visit patients to ensure proper status of patient’s blood pressure, cognitive functioning, and adherence to treatment proposals.

Starr and Sacks (2010) explained that engagement with health care providers was imperative to ensure expected outcomes. Biological assessments get conducted to ensure treatment approaches at home would not be affect by social encounters. The project is vital as it enhances positive outcomes after assessing diabetes occurrence, effects, and management.

Clinical Question

This project will explore the impact of the MAP resources, which include the (1) a Questions to Ask Pad, (2) A Questions to Ask Poster, (3) a Medication Adherence Pad, and (4) the My Medications List, on improving medication adherence among diabetic patients, ages 35 to 64, who are receiving home-based care through the selected project site. The PI will explore how the use of the newly implemented MAP protocol contributes to medication adherence among patients over a four-week period. Pre-project data will be analyzed from March to April using the project site’s electronic health record, to determine medication adherence among patients. After the four-week implementation of the newly revised medication adherence protocol, using MAPS, post-project data will be explored. Comment by Author: See comments about when you discuss what goal objective or purpose for the project Comment by Author: Please edit and remove this word throughout the manuscript. Your project is not going to explore….it is going to evaluate ….the two are different in that exploration is more qualitative and evaluation is more quantitative Comment by Author: I edited this in your abstract so please use that edited version and edit this section and throughout your manuscript to make sure it aligns throughout. I will not highlight every instance

Prior to the project’s implementation,Currently, the nursing staff members of the selected project site assessed medication adherence using interviews and observations of the site. Unfortunately, the method of assessing medication adherence differsed among nursing staff members. The medication adherence assessment in documented in the EHRMedication adherence, before the implementation of this project, was documented physicians and home aides using the project site’s electronic health record. Since there is was not site-specific patient protocol developed/utilized to encourage medication adherence among patients, this project is necessary to ensure standardization of the process as well as ensure appropriate addressing of any patient specific medication adherence barriersconduct.

At the selected project site, issues associated with nonadherence to medication regimens, among diabetic patients, has been an ongoing problem. In fact, according to nurses from the project site, 20 % of diabetic home healthcare patients do not adhere to the medication regimen. Therefore, in hopes of improving medication adherence, which can result in improved patient-related outcomes (e.g., control of glucose levels and moderate production of insulin), the PI has selected MAP’s resources. Through introducing MAP resources into practice, when home healthcare providers interact with diabetic patients, it is likely that medication adherence will be improved. Comment by Author: This number keeps changing throughout the manuscript . You 0.1% initially and then it changed to 45% and now it is 20%. Really need to pin this down and be consistent throughout the manuscript as well as the 10 strategic points document.

The following PICOT question will guide this project: To what degree does the implementation of Medication Adherence Project resources that include the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Pad impact medication adherence among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas over a period of 4 weeks.

To what degree does the implementation of the newly implemented MAP protocol (i.e., the [1] a Questions to Ask Pad, [2] A Questions to Ask Poster, [3] a Medication Adherence Pad, and [4] the My Medications List) impact medication adherence when compared to no standardized protocol among Type II diabetic patients, ages 35 to 64, in a home healthcare organization in Texas over four-weeks?

The following clinical question guide this quantitative project:

Q1: Does using the MAP resources improve medication adherence among diabetic patients patients in home healthas compared to no standardized medication adherence protocol?

Advancing Scientific Knowledge

This quality improvement project seeks to enhance medication adherence among diabetic home healthcare patients through the use of the MAP resources. As previously noted, at the selected project site, medication adherence among home healthcare patients is lacking. In fact, according to Polonsky & Henry (2016), of all home healthcare patients, diabetes patients of the project site have the highest rates of medication nonadherence. According to information gathered from the home healthcare’s electronic health record, from 2018 to 2019 10% of diabetic patients did not adhere to their prescribed medication regimen. Issues associated with lacking medication adherence/nonadherence include high medical bills for future management, limited glycemic control, and frequent hospital visits (Polonsky & Henry, 2016).

Various researchers have noted the critical role that patients and providers play in medication adherence. In fact, according to Polonsky & Henry (2016), patients often do not adhere to their medication regimens because ignorance. To enhance medication adherence, providers can provide education about the critical nature of adherence, can offer information about issues associated with nonadherence, can assist patients in overcoming noted medication concerns, and more. For the purpose of this project, the aforementioned provider-specific medication adherence support will be provided using (1) a Questions to Ask Pad, (2) A Questions to Ask Poster, (3) a Medication Adherence Pad, which all comprise aspects of the MAP protocol.

In addition to the important role that nursing staff members play in terms of a patient’s medication adherence, patients also need to be committed to ensuring they are complying with their medication regimen. Lacking adherence to the prescribed medication regimen, by diabetic patients, can result in inability to control glucose and insulin levels (Polonsky & Henry, 2016). At the selected project site, issues associated with lacking diabetes medication adherence have resulted in inability to offer suitable diagnosis to some patients. Through providing patients with resources and support related to medication adherence, through the three MAP resources, and by empowering patients to keep track of their medication regimen, patient adherence can improve. To empower patients to enhance their medication adherence, the My Medications List, which is available through MAP, will be utilized.

In addition to project site-specific medication adherence issues, various researchers have noted that medication adherence among diabetic patients is lacking a great deal. In fact, in a study conducted by Ong et al., (2018), medication adherence among diabetic patients was 7 %. Furthermore, Ong et al., (2018), noted that medication adherence, despite the implementation of nurses’ participation only improved by 50%. Various researchers have cited the benefits associated with patient-provider engagement and collaboration in improving medication adherence. Therefore, to answer a call by researchers (Ong et al., 2018, Polonsky & Henry, 2016 and Wong et al., 2017) to improve medication adherence among diabetic patients, the MAP protocol will be used. Ultimately, through improving medication adherence among diabetic patients, of the selected project site, using the MAP protocol, it is likely that a sitewide protocol can be utilized to enhance medication adherence among all patients. Although the project targets diabetes patients, the findings might provide insight about how to improve medication adherence among other home-based care populations (i.e., those with hypertension, heart disease, etc.).

Significance of the Project

The rise in chronic diseases has resulted in the need for more patient care options (Polonsky & Henry, 2016). Lately, to meet the unique needs of various population groups, home-based care has gained popularity. Individuals who qualify for home-based care options must meet the criteria of having type 1 or type 2 diabetes and have inability to cope well without intervention. When individuals/patients receiving home-based care fail to adhere to the care requirements set forth, negative outcomes can ensue (Polonsky & Henry, 2016).

Medication adherence among home-based healthcare patients is of the upmost importance (Polonsky & Henry, 2016). In fact, in a study conducted by Polonsky & Henry (2016). medication adherence among home healthcare patients was lacking a great deal. Due to lacking medication adherence/nonadherence, home healthcare patients experienced limited conformity to objectives of the study, thereby, at points, resulting in discontinuation of home-based healthcare.

Through empowering healthcare providers to adequately address medication questions and patient concerns and by ensuring the patients keep track of their medication regiment, it is likely that medication adherence can improve, thereby resulting in a reduction in adverse events. According to a study by Holecki et al., (2018) when the MAP resources were utilized, adherence to medication increased by a large margin. The findings noted by Holecki et al., (2018) reinforce the beneficial nature of implementing the MAP resources, as this can improve the quality of patient care received.

Caring for diabetes includes assessment of their grooming and diet. The condition often causes patients to have blisters, gum disease and dry mouth. It is thus imperative for the care giver to ensure proper adherence to the care procedures so that it would be possible to limit stress related to the other outcomes of diabetes. The cost of managing diabetes is often high due to the effects of low- and middle-income areas.

Rationale for Methodology

To answer the PICOT question, the PI will utilize a quantitative methodology. Specifically, the PI will examine if implementing the MAP resources will improve medication adherence over a four-week period as compared to a four-week period before, when no medication adherence protocol was utilized. Medication adherence data, at the selected project site, is available through the site’s electronic health record. When homecare providers meet with patients, they attain information about medication adherence. Before the implementation of this project, there was not universal, site-specific protocol used by providers to encourage medication adherence among patients. Therefore, when meeting with patients, healthcare providers only asked, “Are you taking your medications?” Based upon the response of the patient, the healthcare provider updated the patient’s chart, in the EHR, accordingly.

During the implementation of this project, healthcare providers will begin by addressing patient-specific questions through the use of three MAP resources: a Questions to Ask Pad, (2) A Questions to Ask Poster, and (3) a Medication Adherence Pad. Any patient-specific concerns regarding medication, medication accessibility, etc. will be addressed. These concerns will also be documented by nursing staff members in the patient’s paper-based files and electronic chart. After the patient’s questions and concerns are addressed, the MAP resource entitled the “My Medications List” will be presented to patients. The healthcare provider will explain the My Medications List and determine an appropriate medication timeline for patients to adhere to, which should encourage medication adherence. During each subsequent visit, with the patient, over the four-week period, the healthcare provider will ask patients if they have additional questions about their medication(s) or prescribed regimen. Then, providers will ask if patients are adhering to their “My Medications List” requirements.

Pre-project data and post-project data Pre project and post project medication adherence , following the four-week implementation period of this project, will be analyzed. Specifically, the PI will report the impact of the newly implemented protocol on improving medication adherence among diabetes patients through comparing adherence rates from the month during which the project took place to adherence rates, in in the same each month, during 2020 and 2021.

A quantitative methodology is appropriate for this project, as numerical data regarding adherence will be analyzed. According to Creswell and Creswell (2017), a quantitative methodology is best suited for projects that require data in numerical form. Quantitative research is presented using charts and graphs. These charts and graphs will allow readers to compare medication adherence rates pre-project implementation and post-project implementation.

Nature of the Project Design

A quantitative methodology, which employs a quasi-experimental design, will be used for this project. Quasi-experimental designs are used to compare data before and after the implementation of an initiative/intervention. According to Chiang (2015), “In a pretest-posttest design, the dependent variable is measured once before the treatment is implemented and once after it is implemented” (Chapter 7, para. 6). Often times, quasi-experimental designs are carried out when research occurs in a controlled environment. While this project will not take place in a controlled environment, a quasi-experimental design was selected since this design is more cost-effective than an experimental project design (Schweizer et al., 2016). Furthermore, since data pre-project implementation and post-project implementation needs to be collected and analyzed to explore the impact of the intervention, a quasi-experimental design is most appropriate.

Pre-intervention data that will be attained for this project is available through the project site’s EHR. Specifically, each time that a home healthcare provider engages with patients, the provider asks a variety of questions related to the patient’s health. Examples of questions explored include: (1) have you experienced any increase in thirst? (2) how often do you urinate? (3) do you often feel fatigued even when doing little tasks? and (4) Do you experience blurred vision? Medication adherence is an important topic of exploration. Any information attained about a patient’s medication adherence/nonadherence is documented by the home healthcare provider and is entered into the project site’s EHR. Therefore, pre-project data regarding medication adherence is already available in the EHR. Medication adherence questions are not always asked by healthcare providers, since an organization-wide policy does not exist. Comment by Author: Please adjust this statement. You said you have data on medication adherence because they do ask questions but just that the questions are not standardized. Review your statements earlier in the manuscript so that they align to these statement here and elsewhere throughout the manuscript.

The home healthcare organization, which will serve as the project site, is located in Texas. Patients of the home healthcare organization range in age from 35 to 64. Patients have a variety of health-related diagnoses; however, for the purpose of this project, only patients with diabetes will be included in the sample. According to recent data, attained from the project’s site electronic health record, on January 14th of the 50 who are receiving home healthcare through the project site. Of the patients with diabetes, 5 are eligible to participate in this project. Patients who are eligible to participate in this project are between the ages of 35 to 64, do not have a mental impairment (e.g., anxiety disorder) that would prevent them from understanding the nature of the project or engagement requirements, and have been diagnosed with Type II diabetes. While 5 are eligible to participate, according to data attained from the project site’s EHR on 20th January this data does not reflect the patient census at the time of the project. Comment by Author: Clarify this better here, you said 20 patients have diabetes earlier in your manuscript. So is it that the company has 50 total patients, 20 of whom have diabetes and 5 are non-adherent? You also want to word this as data from the project site indicates that potentially there would be a convenience sample of (number……)participants . Site appropriately if you got this in an email or the source of the data. Because you have not started the project officially you cant be the person to pull the data Comment by Author: Why not? I would expect you to not include people who have cognitive impairment but people with anxiety can be included

Definition of Terms

The following terms were used operationally in this project: Comment by Author: You have other terms eg. MAP resources,

Diabetes. For the purpose of this study, Type II diabetes is the topic of exploration. While there are two types of diabetes (Type I and Type II), unless otherwise specified, the term diabetes references Type II diabetes. Diabetes references a medical condition that is characterized by high levels of sugar in the blood. Once diagnosed with Type II diabetes, patients can manage their diagnosis with medication/insulin (Bellou, 2018).

Home-based healthcare. The term home-based healthcare or home healthcare references the medical care that is provided to patients in the comfort of the patient’s home (Polonsky & Henry, 2016). Home-based healthcare services differ depending on a patient’s needs, diagnosis, and other factors.

Medication adherence. The term medication adherence references the extent to which a patient, caregiver, or home nurse follows the recommended guidelines on managing a medical condition (Ahmed et al., 2018).

Assumptions, Limitations, Delimitations

As with all practice improvement projects, there are assumptions, limitations, and delimitations that must be addressed. For the purpose of this project, the PI assumes that medical non-adherence among diabetes patients is caused by lacking knowledge, inaccessibility to resources, etc., which will be analyzed using the MAP resources. As noted by Polonsky & Henry (2016) through further understanding the needs, concerns, and experiences of patients, health care providers can foster stronger patient-provider relationships, thereby enhancing communication and dialogue, which ultimately improves patient-related outcomes. Additionally, the PI assumes that after engaging in dialogue with patients and thoroughly addressing their concerns, that medication-related barriers will be minimized. Furthermore, in alignment with the literature, the PI assumes that medication adherence will improve when patients are provided with a detailed schedule, which is patient-drive and provider-supported, using the MAP resource entitled the “My Medications List.”

This project is limited because patients are responsible for self-reporting their medication adherence. While the PI assumes that patients will be honest about medication adherence, or lack thereof, there is no way to confirm medication adherence among patients. In addition to self-reporting limitations, the PI is also limited by the fact that COVID-19 is impacting healthcare organizations. Therefore, since COVID-19 guidelines change, fairly regularly, due to new literature and findings, impacts to the home healthcare delivery model may occur. Additionally, this project is limited to an urban location. Therefore, patients who are in rural areas, who may have different needs or challenges, will not be involved in this project. Finally, this project is limited to a four-week data collection period, during which the intervention will take place. Given the complexities, at points, which are associated with behavior modification (Ahmed et al., 2018), medication may not always be the issue when dealing with diabetes.

Project delimitations also exist. This project is delimited in the sense that only patients with diabetes, ages 35 to 64, will be included as participants. Since the main focus of this project is to explore medication adherence among diabetes patients, which is a concern at the project site, the PI has delimited this project to only diabetes patients. Furthermore, as noted previously, this project is only being conducted in one urban area, which is located in the southeastern region of the United States, thereby impacting the generalizability of any findings.

Summary

and Organization of the Remainder of the Project

Chapter 1 provided detailed support for utilizing the MAP resources to aid in improving medication adherence among diabetic patients of the project site. A quantitative, quasi-experimental design will be utilized to explore the impact of the MAP intervention on improving medication adherence among Type II diabetes patients of the selected project site. The project site has a history of lacking medication adherence among diabetic patients, which is due to a multitude of factors (e.g., selection of participants and determining the correct medical provider). Through utilizing the MAP resources, which foster communication among home healthcare providers and patients, and equipping patients to use the “My Medications List,” it is likely that medication adherence will improve.

This project will be carried out over a four-week period. To analyze the impact of the intervention, pre- and post-project data will be attained, by the PI, from the project site’s electronic health record. Data will be analyzed by the PI, with the support of a statistician, through using SPSS. No patient-related data will be attained. There are various benefits associated with this intervention, which impact individuals (patients and providers), groups (family members and communities), and society as a whole.

Chapter 2 provides a detailed summary of the literature collected that is related to the project’s PICOT question. Information about the theoretical framework will be detailed. Furthermore, Chapter 2 is broken down into 5 sections, which highlight information about literature used in the paper that was attained from 2016 to 2021. The information presented in Chapter 2 provides readers with further topic-related knowledge, which has been published in peer-reviewed journals.

Chapter 3 presents research methodology details, which will be employed by the PI. The information presented in Chapter 3 includes information about the selected research detail, the target population, and the sample size. Furthermore, data collection tools (specifically the MAP resources) and data analysis procedures will be discussed. The reliability and validity of the project instruments will be detailed. Furthermore, ethical considerations for collecting data will be addressed.

Chapter 4 will present research findings, which will be analyzed using statistical methods. Results regarding the descriptive and inferential data analyses will be offered. Furthermore, a brief discussion of project-related findings will be provided. Information in Chapter 4 will be presented using graphics and tables. Chapter 5 will present conclusions and recommendations drawn from the project’s results. The impact of the findings, in terms of practical and theoretical knowledge will be offered.

Chapter 2: Literature Review

Diabetes is a medical condition that is characterized by high sugar levels in the blood. It can be managed with drugs and insulin. Blood sugar serves as the major producer of energy in the body. Any condition interfering with blood sugar levels and mechanisms would bring about disruptions to the normal body activities. Optimal diabetes control usually needs patient associated engagement in various types of self-care associated activities, including the adherence of patients to the identified medication associated regimens along with adjustments to various lifestyle associated modifications and even the monitoring of the blood glucose associated levels (Jajarmi et al., 2019).

Since diabetes is a lifestyle disease, it can be easily prevented and avoided by making lifestyle changes. Managing the disease can also be made easier by making lifestyle changes as well as adhering to medication. This is important since it will help in avoiding of many challenges and complications that may arise from diabetes. one of the most problematic issues associated with home care for the patients suffering from Diabetes is Adherence to medications. According to Bonney (2016), patients usually take their identified medication as is prescribed solely 50% of the time. This along with the reluctance to be involved in the sharing of the details associated with medication taking behavior have been identified as less than optimal by healthcare providers. This project hopes to shed light on medication adherence and how it affects the quality of home-based care in diabetes patients. It hopes to understand the role of educating patients on medication adherence in improving their adherence to medication and also understand the impact of improved adherence on the patients.

Chapter 2 provides both a theoretical and empirical framework through which the medication taking behaviors of diabetes patients undergoing home-based healthcare is investigated. The chapter is divided into theoretical and empirical sections. The theoretical section reviews two theories namely attachment theory and social cognitive behavior theory. In the empirical section, literature from previous studies and projects is reviewed and study gaps are identified in them which differentiate the reviewed projects from this project. The DPI project utilized databases as well as literature sources which have been systemically searched for the identified systematic reviews that report various aspects associated with diabetic adherence. A total of eighteen18 systematic reviews, scoping reviews, and narrative were realized as well as utilized in the advancement of the DPI conceptual framework. Overall, the literature review revealed six main sub-themes as well as other sub-themes that promoted the strength of the DPI project. Each of these key sub themes are discussed comprehensively along with in in-depth study. Most of the identified interactions were considered to be within the patient associated elements which usually not only interact with other kinds of theses but are also within the same theme.

Theoretical Foundations Comment by Author: You have two great theories but remember one of your theories needs to be a change theory. Lewin’s theory tends to be a great one for quality improvement project so your cognitive theory is appropriate but I would say change the attachment theory to lewin’s change theory. Also make sure that you cite the original theory source not the secondary sources discussing the theories in the last 2 years.

According to Liu and Butler (2017), medication adherence is considered to be the largest challenge that healthcare workers and patients are facing in their daily lives. This is a critical issue since that requires more attention. The Direct Practice Improvement (DPI) project utilizes two key theories to explain the relationship between medical non-adherence to patients and how medical adherence can be enhanced among the diabetic patients through improved interventions.

Attachment theory. The first theory is the attachment theory. This is defined as being a psychological, evolutionary, and ethological associated theory in relation to the aspects of relationships between individuals. This is a famous theory that had been used in the healthcare practices for a long time thus will be a suitable framework to be used in this case that entails creating the best interventions made for enhancing medical adherence with the diabetic patients.

The most vital tenet concerning the attachment theory is usually considered to be that young children usually need to advance a relationship with at least a single primary caregiver for the identified normal social and emotional advancement. The theory was designed by the prominent psychiatrist and psychoanalyst John Bowlby. Within this theory, the term attachment is usually utilized to refer to an affection bond or tie that is between a person and their attachment figure who in this case is usually considered to be the caregiver (Liu & Butler, 2017).

Some types of bonds may be considered to be reciprocal such as those occurring between two adults, however, the bond between a child and a caregiver are usually on the basis of the need of the child for safety, security and even protection. This is usually considered to be essential in both infancy and childhood phases of life. This given theory usually proposes that children are involved in the creation of attachment to their careers instinctively for the key associated purpose regarding survival along with the untimely as well as genetic replication.

The biological purpose for the use of this theory is the facilitation of survival while the psychological aim about the theory is to offer security thus making it a suitable theory to use. Attachment theory is considered to not be an exhaustive description associated with human relationships nor is it considered to be synonymous with love or affection, however these can be utilized in indication of the fact that bonds still exist. In the child to adult types of relationships, the child is usually referred to as the attachment while the caregiver is usually defined as being the reciprocal equivalent who in this case is called to be the care giving bond (Hunter & Maunder, 2016). 

The modern attachment theory is usually focused on three key principles which entail bonding as an intrinsic human need along with regulation associated with emotion as well as fear to improve vitality and in the promotion of addictiveness along with development. Common attachment behaviors as well as emotions are usually displayed in most of the social primates including humans and are considered to be adaptive. The long-term associated evolution possessed by these types of species usually involves selection for the identified social behaviors which enable people and group survival more likely.

The commonly observed types of attachment behavior in toddlers staying near the familiar individuals are based on safety advantages in the identified environment both in early adaptation and our current world. Bowlby perceived the identified environment associated with the early adaptation as being the same to the current and also similar to the hunter-gatherer communities. There is a survival advantage in the identified capacity to effectively sense possibly dangerous conditions like the issue of unfamiliarity, loneliness, and rapid approach. In the identified internal models is entailed the regulation, interpretation and the prediction of attachment associated behavior in the identified self and the attachment figure.

The advancement of attachment is considered to be a transactional process. Particular attachment associated behavior usually starts with the predictable apparently innate behaviors in the infancy stage of life. They usually alter with age in various ways that are usually determined partly by the identified experience as well as partly by the various sit-upon elements. As the various attachments get altered throughout life, they do so in techniques that are shaped by the identified relationships.

In accordance with Hunter and Maunder (2016), there are two key reasons why the attachment theory is considered as being effective to be utilized in the following DPI. First and foremost, the theory acts as a solid foundation for the enhanced comprehension regarding the identified development of ineffective coping techniques as well as the underlying dynamics associated with the emotional difficulties of the person. Clinicians can help those people that have attachment anxiety and avoidance in the comprehension of the manner in which previous experiences with their caregivers or their significant others have helped in shaping their identified coping patterns to their various experiences of distress.

Secondly, the clinicians can help the people who have attachment anxiety and avoidance to find the best alternative way to meet their various needs. Most of the individuals who usually seek help want to learn the way in which they can employ different strategies for coping with the various dysfunction in their daily lives along with effectively modifying their various dysfunctional or even inappropriate coping techniques. This is an essential aspect since the caregivers need to form attachment first before delivering the advice and interventions to the diabetic patients on how they can adhere to their medications. It is important to note that for effective outcomes to be realized in these diabetic patients, there is the need to ensure that all the basic needs of the patients are effectively met as well as other types of strategies that are considered effective for changing the individual maladaptive techniques used in conjunction with the theory (Hunter & Maunder, 2016). 

Social cognitive theory (SCT). The other vital theory that can be utilized in the facilitation of the DPI project is the social cognitive theory. Social cognitive theory is a famous theory that is usually utilized in the explanation of the manner in which human behavior is associated with dynamic, reciprocal, and progressive types of interaction that exist between the person and the given surrounding (Bosworth, 2015). The common types of theoretical basis associated with the cognitive theory is considered to be learning since it usually posits that the identified human behavior is effectively learned. Therefore, the SCT is famous because it often proposes that identified behavior aspects are an outcome of the cognitive processes which individuals usually develop via the social acquisition associated with knowledge.

According to Bosworth (2015), the theory usually bases its focus on the identified concept regarding behavioral capability which usually states that prior to any individual acting in a certain situation, the individual needs to have knowledge on what they need to do and the manner in which they need to do it. Bandura’s (2019) conceptual model regarding the reciprocal associated determinism is often utilized in addressing all the personal determinants associated with health. Bandura postulated that an identified person or individual is engaged in a cognitive, vicarious, self-reflective, and even a self-regulatory process to attain a given goal. He went further to state that individuals usually effect alterations in themselves via their identified actions in anticipatory and proactive ways through the exercising of control over their given behavior via their well thought types of procedures and even motivations (Bosworth, 2015).

Bandura (2019) asserted that without having any kind of aspirations individuals usually course through life unmotivated and uncertain regarding their specific capabilities. Nonetheless, he also stated that people who take part in health promoting behavior have self-belief which enables them to fully take part in control over their thoughts, feelings, and actions. Bosworth (2015) explained that self-control should get promoted since it improves the ability of individuals to adopt healthy habits. In accordance with Bandura, although the prominent SCT usually acknowledge that the associated knowledge regarding the health associated risks along with the given benefits associated with treatment are considered to be necessary in the performance of health associated behaviors, this is in itself not adequate.

Self-influences are regarded as necessary in the attainment or the various alterations which will lead to the desired health associated outcomes in the identified patients. This concept is usually referred to as self-efficacy. The two types of cognitive processes which are involved in influencing behavior in the identified SCT are usually referred to as the self-efficacy and outcome expectations (Bosworth, 2015)

In accordance with Hadler (2020), the social cognitive theory is considered to be essential during healthcare workers’ counseling regarding various patients that have chronic medical illnesses like HIV and even diabetes. It can be utilized in the offering of help to the given patients in the learning of the vital information associated with HIV and AIDS as well as the related health issues like adherence. Support groups for people who have this could also utilize this social cognitive associated theory along with various behavioral techniques to effectively empower patients to effectively negotiate the various issues that are around medication adherence along with the establishment of effective supportive types of relationship which are efficient in strengthening the ability of the patient to stick to medication plans.

All these are associated with improved adherence as well as effective clinical results. Issues that are around the disclosure associated with the underlying conditions that some patients are subjected to are considered to be skills which could be effectively taught in the identified support groups and which could cause improved medication adherence. The reason why these two theoretical frameworks are used in this situation of diabetic patients who do not adhere to medications is because special intervention is needed to convince diabetic patients to adhere to medications and this will be installed in them as knowledge for behavioral change that will influence a positive change that will cause the patients to adhere to their medications.

Review of the Literature

Medication adherence is considered to be the largest challenge that the healthcare workers as well as their patients are facing in their daily lives. It is often considered to be a critical issue which usually deserves higher level of attention. Inspiration along with the act of supporting of patients to take their identified medications as has been prescribed can be a great issue. The cognitive associated perspective on the identified health associated behavior is usually on the identified assumption that our thoughts along with beliefs usual influence our personal emotions and behavior.

It is important to note that the key focus of people working in the healthcare facility with diabetic patients, consider them as critical patients in the manner in which the identified patients are entailed in the conceptualization of the different health associated threats along with is involved in the appraisal or the elements which are involved in facilitating adherence or even serving as barriers to effective treatment of people.

Although adherence to antiretroviral therapy is considered a predictor of effective clinical associated outcomes among diabetic patients, it is a crucial challenge, and strict adherence is usually considered not to be usual

Medication adherence
.
This refers to the art of taking medication as prescribed by healthcare practitioners. It is the duty of healthcare providers to offer patients prescriptions that are suitable to their conditions. Ahmed et al., (2018) stated that the quality of healthcare can get influenced by the ability of the body to respond to treatment. It is important to conduct physical assessment for patients so that they would receive high quality care.

Enhancing medication adherence. To handle the issue of medication adherence among the diabetic patients who have had an issue with the adherence to medication needs to come up with a variety of strategies that have been attained from scholarly reviews as well as journals for purposes of well researched data on the concept. Appropriate types of medications are usually considered to be the identified cornerstone regarding the prevention as well as disease treatment yet according to numerous research carried out, there is solely about half of the individual patients who adhere the instructions of their prescribed medication (Bosworth, 2015). This usually causes a common as well as a costly public health associated challenge especially for the healthcare system in the US.

Since the aspect and issue of inappropriate as well as inefficient medication adherence is considered to be a complex change with a variety of contributing causes, there is no universal solution (Rodriguez, 2019). The following theme breaks down into three subcategories which form the basis of the sub-themes associated with this theme. The sub-themes are used to offer comprehensive analysis of all the vital types of interventions which are considered to be effective at enhancing medication Adherence among the diabetic patients but were also considered to be potentially scalable that is they are easy to implement in any given scenario in even large population (Bosworth, 2015). Key traits that make these interventions effective are discussed throughout the DPI. The information offered under each sub-theme is vital in enhancing proven as well as low rescue and even the cost-effective solutions to enhance Medication Adherence.

Strengthening the Relationships with Patients Comment by Author: Please see DPI template for appropriate formatting of your headings and subheadings i.e differentiating between themes and subthemes. It is not clear to me which are your themes and which are your subthemes. Your Literature review requires significant work still. Remember that your literature review has specific requirements listed in the template and requires at leats 3 themes that have subthemes. Please call me about this because it seems you are having some issues with this. Also review some examples of literature reviews in DC network within the available manuscript examples in there. The writing in chapter 1 was a great improvement but the writing in this chapter is a little off still. Likely because your lit review is still lacking.

Patients usually put into consideration their identified HCPs the major along with most dependent source of data regarding their health associated condition along with the treatment, and they are usually considered to be highly likely to effectively follow the treatment types of plan when they are involved in having good relationship with their HCP due to confidence and trust that has been built over time. Relationship building in healthcare is considered to be a vital aspect in the day to day lives of healthcare practitioners due to the nature of their job which necessitates that they all maintain long term relationship with their patients for enhanced medication as well as treatment outcomes (Heston, 2018).

Trust is usually developed throughout time with the same types of HCP in any kind of mutual relationship between them and the identified specific patients. The patients in these cases usually consider that their identified HCP possesses the highest level of competence along with actually cares about their identified health. Mistrust usury develops when the given patients attain unrealistic as well as inconsiderate and even insensitive advice from their identified HCPs as well as feel some kind of emotional distance from them.

Medication Nutrition Education Therapy 

Appropriate nourishment assumes a vital function in infection counteraction and treatment. Numerous patients comprehend this connection and seek doctors for direction, diet, and diligent work. Nonetheless, real doctor practice is regularly deficient, intending to the nourishment parts of infections, for example, malignancy, adiposity, and diabetes. Doctors do not feel significant, specific, or sufficiently set up to give nourishment guiding, which might be identified with problematic information on fundamental sustenance science realities and comprehension of potential sustenance intercessions. Truly, nourishment training has been underrepresented at numerous clinical schools and residency programs.

This usually makes it hard for the desired coordination as well as level of friendship that is needed for the effective as appropriate manage the issue of diabetes to be attained. When the caregivers are considered to be not friendly as well as not welcoming, it becomes hard to convince the patients on taking their medicine, yet they have a negative perception and attitude towards their care giver (In Mahmoud, 2019). The identified patients who are usually engaged in some meaningful types of partnerships are usually considered to be highly receptive to the various messages that have been delivered by their identified health care associated team.

As an outcome, the given patients usually tend to be in possession of some kind of anti-ballistic perceptions regarding the identified severity of the disease along with the benefits that come with the treatment of the disease and how medical adherence can attend to enhanced efficiency along with results in the healthcare work with the diabetic patients. Therefore, in this case, the factors that are entailed in impacting medication adherence are referred to as the severity of the diabetes illness along with the advantages associated with the treatment.

It is a vital theme which helps in understanding that the different types of patients that have close relationship with their caregivers are associated with high likelihood of following medications prescribed to them (Sherman & Bednash, 2015). Any patient who is considered to be engaged in an identified partnership or even relationship with the caregiver is usually considered to be highly likely to be entailed in disclosing their various clues which helps the identified HCPs in the employment of numerous personalized models to offering support to medication adherence efforts. Attaining a careful comprehension is considered essential in the comprehension or the needs of patients via appropriate patient- provider types of Communication which are vital in the employment of the practical approaches to enhancing medication adherence as has been suggested throughout this DPI.

Importance of Adhering to Medication Regimen

An estimated American adult of about 35% is considered to possess basic as well as the below-basic health associated literacy. This has been recognized globally and is associated with causing their incapability to read as well as write and understand any kind of message that is indicated on the prescribed medicines or the treatment sheets. Health literacy had been considered to be a vital aspect in the receiving of any kind of services. First and for foremost, it helps in helping the identified diabetic patients to not miss out on any fine detail needed for them to put into consideration and has not been written carefully thus can seek clarification on such aspects unlike if one cannot read not clarify on anything. Literacy is the ability to read as well as be able to understand the different aspects that people highlighted them to them (Glanz& Viswanath, 2015). 

For these same reasons, the world practitioners have been involved in the coming up with different strategies that can be used in the reduction of health literacy levels among taunts that have diabetes. It is vital to put this theme into consideration and should be a first priority since it is what makes the basis along with the foundation of having long term sustained profitability rates as they will be able to explain themselves to the identified people that will help them in making sure that they adhere to all their given medication.

It is always vital to adopt the universally implemented as well as published precautions that are made against the identified medication non-adherence as well as the low health associated literacy. This is famous for its nature of purpose. It is always utilized to offer effective encouragement of the various identified HCPs to carry out an assumption that the given patients are not being involved in taking their identified medications as they are prescribed to. Prescriptions need to be taken seriously for them to offer exceptional results and for the continued well-being for the patients who have critical illnesses like Diabetes.

The use of simple language by HCPs as well as medication manufacturers is another vital way, they can be utilized to help in teaching back types of techniques. These methods have been utilized in the enhancement of adherence among many types of non-adherence medication patients. Most of the times people opt to not take their medication as they cannot read all the instructions written on the medicine and are afraid that they will die especially in the cases that they mistake those drugs for poison or some drug that may look like a famous poison causing deash. This is a key issue that has left most of the people victims of non-adherence (National Academies of Sciences, Engineering, and Medicine, 2018). 

Reading instructions and making a patient understand what is written in a medicine bottle or package should never be taken for granted as it is key for determining the manner in which patients will effectively or ineffectively adhere to the given drugs for treatment and disease control purposes. So that the identified medical practitioner can be aware and sure that what they have explained to the patients has been delivered safely as well as appropriately, there is the need for them to do a verification test. The patients as well as their identified support individuals need to be effectively asked to offer an explanation in their own words what they have understood from everything the practitioner have told them regarding their health along with drug management and intake. This teaching back method is vital in offering additional data on the key topic of interest thus should be used often.

Concerns associated with the issues of side effects can be considered to be challenges to the aspect of medication associated regimen adherence especially when the given advantages associated with taking the identified medication are not properly along with effectively comprehended. To minimize the identified potential associated concerns that are associated with the side effects of drugs since this can be identified as one of the reasons why these patients may opt to not adhere to the medications in fear that they will experience the side effects and be greatly inconvenienced, there is the need for HCPs to offer the relevant data regarding the common types of side effects when they are entailed in the prescription process.

There have been issues of people and patients dying or experiencing very negative and disturbing side effects when it comes to them taking the desired drugs by their doctors. These cases have always been used as forms of examples to explain the reason why people have been reluctant to take the medications for prolonged periods. For most of the critical illnesses, the medication is usually made to be taken for a long time for increased efficiency. This has caused many to withdraw from the medication due to the prolonged side effect issues that is associated with it (Institute of Medicine [IOM], 2016). 

For instance, when offering a prescription or the metformin, there is the need to inform patients that are suffering from diarrhea during their time of prescription to anticipate that the loose bowel issues will be over in about a week if the drug is continued to enable the adherence of the drug. It is also vital to offer brief expansions due to the issue of time limitations along with engaging other members regarding the health care associated team in the provision of more additional education can be essential. This can be in the form of printed handouts as well as websites and in the use of teaching module which should be readily available for use with the identified patients.

In summary, the level of medication illiteracy among Americans is assumed to be high. This significantly contributes to the difficulties faced by patients when they are required to follow instructions. There is need for practitioners to take time and educate the patients on the right measures to take. Learned patients will have better understanding of the actions to take, and which can positively impact what they are after.

Tools for Building Patient Self Efficacy as well as Support Adherence

Using tools along with instruments that are considered effective along with appropriate is vital in supporting adherence in different ways and in achieving self-efficacy among the various patients. Positive family along with social support are considered to be vital aspects associated with adherence to the issue of Diabetes management (Rodríguez, 2019). If vital, the engagement of the family members can enhance self-care activities for the patients suffering from Diabetes, including the eating of effective and healthy foods as well as keeping fit and in monitoring the identified blood glucose and even adherent to medication.

An innovative method that entails patients in the identified medication associated reconciliation process through a given web portal to undertake the verification of their various regimens along with the clarification and the verification of any types of inaccuracies after the identified hospital discharge has been received to enhance Medication adherence as well as in the decrement of the potential adverse drug associated events (Forman & Shahidullah, 2018). 

In this case, there may be higher roles for the engagement of patients with their identified electronic medical types of records so that they can appropriately verify along with help in the maintenance of accuracy associated with their medication list to undertake the reflection of their actual taking of drugs. Also, the use of screening tests is vital in understanding how well patients are taking their drugs. If there is no consistency in medication taking then motivation aspects should be utilized to enhance Adherence (“European Medical & Biological Engineering Conference & Nordic-Baltic Conference on Biomedical Engineering and Medical Physics”, 2018). 

In summary, the utilization of tools and instruments simultaneously plays an essential role in upholding medication adherence. Having a supporting and positive minded family also plays an essential role in supporting self-efficacy of the patients. Innovation should be incorporated in searching for medications. This will be advantageous because of the contemporary rapid advancement in technology.

Diabetes Care Concepts

When dealing with patients that have been considered to be reluctant in taking their medication, it is vital that the various care concepts in diabetes patients is understood. It helps in the effective integration of all the Interventions that have been mentioned in theme 1 for enhanced efficiency in the overall improvement of diabetic patients concerning adherence to medications that she been prescribed to them to help them in quick recovery and in the management of the illness for a longer term.

The following theme offers comprehensive knowledge as well as in depth illustrations on the distinct components associated with the clinical control regarding patients have been diagnosed with diabetes. The review offers effective clinical practice associated guidelines which have been considered to be the key to the enhancement of the population associated health, however for the identified optimal outcomes as well as diabetes care ought to be individualized for every identified patient.

Patient-Centeredness

Patient centeredness entails ensuring that all the identified interventions described in the first theme are focused on the individual patient who is being helped in having effective adherence to the given medication during home care settings. Patients who have been diagnosed with various critical illness and have been asked to go home for home-based care have been associated with lack or poor adherence to the medications they are given when they are discharged from the hospital. It is a global issue that has raised consent for the need to understand how to go about it for enhanced feasibility in treatment of illnesses (Steinberg & Miller, 2015).

Practice recommendations whether they are focused on the identified evidence as well as expert opinion are usually intended to offer the desired guidance on an overall approach to care (Costa & Alvarez-Risco, 2018).  The science as well as the art associated with medicine usually come together when the identified clinician is experiencing or has experienced some sort of situation whereby, they have to make treatment associated recommendations for any patient who would be considered to not have effectively met the eligibility associated criteria for the studies on which the given guidelines were based.

Recognition of what an individual needs is vital, and it can be achieved through the use of the studies that offer standards for when as well as the manner in which to adapt the given recommendations. Since the patients who suffer from diabetes usually possess highly increased risk for the identified cardiovascular illness, a patient centered approach needs to entail a plan that should be utilized in the reduction of the various cardiovascular risk through offering the address of the identified blood associated pressure along with the identified lipid control and even in smoking associated prevention and even creation and other aspects (“Major Topics in Type 1 Diabetes”, 2020).

Diabetes Across the Life Span

An increment in the identified proportion associated with patients that suffer from diabetes are usually considered to be mostly the adults (Balogh, 2015). For the less salutary reasons, the identified incidences associated with Type II diabetes is considered to be highly increasing in the creating in the children as well as the young adults. Patients that possess the Type II diabetes as well as those that have Type I diabetes are considered to be having good lives even in their older age which is regarded as a stage of life whereby there is minimal evidence from the identified clinical traits to be used in the guidance of therapy (Bonney, 2016). All these toes of demographic alterations are usually involved in highlighting another key challenge to the high-quality diabetic patients care. In this case, the identified need is usually considered to be the enhancement of the coordination between clinical teams as well as patients in the effective transitioning via the dysfunction phases enticed in life span (Corcora & Roberts, 2015). 

Advocacy for Individuals with Diabetes

Advocacy is a very vital aspect in healthcare since they deal with patients that need their utmost help as well as care for them to go back to their previous health state (D’Onofrio & Sancarlo, 2018). Advocacy is an aspect that can be referred to as an active support as well as engagement to effectively develop a cause as well as a policy (Mollaoglu, 2018). Furthermore, advocacy is usually needed to enhance the loves of individuals suffering from patients. Given the various issues in diabetic patients such as the issue of obesity as well as physical inactivity and even the various alterations that take place in the society determinants at the identified root regarding these issues can be solved using advocacy (Stanislaw & Michael, 2017). 

Summary

The existence of chronic illnesses such as diabetes requires study of affected persons in order to limit negative events. The proposed intervention techniques should get studied in order to limit the occurrence of diabetes related issues like frequent urination, fatigue, and thirst. The issues affect an individual’s capability to function in life. Optimal adherence to the identified prescribed medications can be entailed in the decrement of complications along with enhancing clinical outcomes and in saving healthcare associated costs.

The DPI project has been constructed using careful techniques that promote the development of patient initiatives. The purpose of the project is to ensure diabetic patient care techniques get applied to enhance the validity of treatment proposals. There are practical solutions to limiting the effects of diabetes which require careful adherence (“Major Topics in Type 1 Diabetes”, 2020).

Medication adherence is considered to be the largest challenge that the healthcare workers as well as their patients are facing in their daily lives. It is often considered to be a critical issue which usually deserves higher level of attention. Inspiration along with the act of supporting of patients to take their identified medications as has been prescribed can be a great issue, however it is considered to possess the capability to possess the highest effect on their identified long term associated health as the well as on the economic well-being regarding the healthcare system of the nation.

The identified theories point to the possibility of solving the problem of poor medication taking behaviors by the use of attachment and social learning. The theories point out that medication taking is learnt and can be enhanced through the use of cognitive behavior change.

The empirical review point to the complications caused by lack of medication adherence in diabetes patients. It also highlights possible ways in which health care providers can help patients better adhere to medication through strategies such as advocacy and patient centeredness. Overall, medication adherence is important to the treatment and effective management of diabetes in patients and health care providers can play a vital role in ensuring that diabetes patients learn the importance of adherence.

Chapter 3: Methodology

Medication adherence is a critical aspect in minimizing the impact of negative patient-related outcomes among those with chronic illnesses. According to Ahmed et al. (2018), medication adherence, for the purpose of this practice improvement project, refers the extent to which a home-based care patient can correctly take his/her medication in the absence of health practitioners. Medication adherence requires the patient to totally adhere and comply with all the medical instructions given (Bellou, 2018).

According to Ahmed et al. (2018), diabetes impacts one in 10 Americans. Furthermore, the prevalence of diabetes continues to rise and is projected to increase by 0.3 % by 2030 (Lin et al., 2018). There are two types of diabetes that plague a large proportion of Americans. Type I diabetes is insulin-dependent (Bellou, 2018). Type II diabetes is glucose related (Bellou, 2018). There are ways to curtail the onset of Type II diabetes; however, once individuals are diagnosed with diabetes, there is no cure (Bellou, 2018).

At the selected project site, patients with Type II diabetes often failed to adhere to their prescribe medication regimen. In fact, among all home-based healthcare patients, of the project site, diabetes patients do not adhere to their medication regimens approximately 30% of the time. Various researchers have noted the importance of educating patients about medication adherence, partaking in patient provider conversations about the importance of medication adherence, and creating methods to assist patients in further adhering to their prescribe medication regimen (Ahmed et al. 2018). Through the use of the MAP resources, which incorporate education and patient accountability, it is the hope of the PI that medication adherence, at the project site, among Type II diabetes patients, ages 35 to 64 will improve. Comment by Author: See feedback about this in chapter 1

This quality improvement project will be guided by the PICOT question, which seeks to explore the impact of a intervention and improving medication adherence among Type II diabetes patients. The question explored reads: To what degree does the implementation of the newly implemented MAP protocol (i.e., the [1] a Questions to Ask Pad, [2] A Questions to Ask Poster, [3] a Medication Adherence Pad, and [4] the My Medications List) impact medication adherence when compared to no standardized protocol among Type II diabetic patients, ages 35 to 64, in a home healthcare organization in Texas over four-weeks? Comment by Author: Most of the data you need in this chapter was already edited in chapter 1 so please edit this chapter based on previous chapter edits especially with the standardized things like the PICOT question, purpose and problem statements

This quality improvement project will be guided by the following question: To what degree does the implementation of family-led strategies impact medication (what) compared to pharmaceutical-led strategies among diabetic patients in home-based care in Texas over four weeks? The issue of implementation of the home healthcare-led Medication Adherence Project resources (e.g., the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Pad; intervention) will impact medication adherence (outcome) when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64 of a home healthcare organization located in urban Texas. Comment by Author: Is this your clinical question or is this your problem statement? Also please review the DPI template, based on what the template says you do not need to state your PICOT question, purpose statement and problem statement all together in the introduction here

The purpose of this quantitative quasi-experimental project is to determine if or to what degree the implementation of the MAP resources, which will be delivered by home healthcare nursing staff members, will impact medication adherence when compared to current practice among Type II diabetic patients, ages 35 to 64 in a home healthcare setting in urban Texas.

Chapter 3 will detail the project methodology. Information about the project’s design, selection of the sample, instrumentation, validity, and reliability will be presented. Additionally, data collection procedures, data analysis procedures, ethical considerations, and limitations will be included in this chapter.

This chapter will be explaining the methodology of this project. Information such as the project design, selection of the sample, instrumentation, validity, and reliability, data collection procedures, data analysis procedures, ethical considerations, and limitations will be included in this chapter.

Statement of the Problem

It is not known if or to what degree the implementation of the home healthcare-led Medication Adherence Project resources (e.g., the Questions to Ask Pad, the Questions to Ask Poster, and the Adherence Assessment Pad; intervention) will impact medication adherence (outcome) when compared to current practice among Type II diabetic home healthcare patients, ages 35 to 64, of a home healthcare organization located in urban Texas.

At the selected project site, which is a home healthcare organization located in urban Texas, the stakeholders have cited that medication adherence among diabetic patients is lacking. In fact, according to data attained from the site’s electronic health record (EHR), home healthcare providers have documented that 50 % of diabetic home health care patients are not adhering to their medication regiment. At the project site, failure to adhere to the prescribed medication regiment has resulted in limited capability to deal with diabetes related issues. Various researchers have noted the implications associated with lacking adherence to medication regiments, specifically among diabetic patients (Ahmed et al., 2018), thereby reinforcing the need for this practice improvement project.

Clinical Question

Prior studies have demonstrated that medication adherence for patients in home-based care has not been a smooth process. Evidence shows that this is usually because there is nobody to monitor the progress of these patients. There is usually nobody to remind them to take medication the right way or adhere to their dietary instructions (Wolff & Baker, 2019). However, there are chances of improvement in this. The implementation of family-based medical adherence strategies can help to enhance medication adherence among diabetic patients in home-based programs. A family-led health education intervention will be carried out by the health care providers who will educate patients on the disease and how-to manage it, medication they should be taking and also the importance of adherence. This will be done during follow up sessions with patients in home-based healthcare.

There are a number of strategies and the outcome is strict medication adherence. A quantitative, quasi-experimental design approach has been chosen for this report. This approach will help to assess the effectiveness of family-led strategies in enhancing medication adherence among diabetic patients in home-based care as compared to pharmaceutical-led strategies. The project will be guided by the following clinical questions: Comment by Author: This is not a report but a project. Please edit the entire manuscript and make sure the terminology is consistent and aligns throughout

To what degree does the implementation of the newly implemented MAP protocol (i.e., the [1] a Questions to Ask Pad, [2] A Questions to Ask Poster, [3] a Medication Adherence Pad, and [4] the My Medications List) impact medication adherence when compared to no standardized protocol among Type II diabetic patients, ages 35 to 64, in a home healthcare organization in Texas over four-weeks?

The following table shows the characteristics of the variables involved.

Table 1

Characteristics of Variables

Variable

Variable Type

Level of Measurement

Family-led strategiesMAP resources

Independent

Nominal

Pharmaceutical-led strategies

Independent

Nominal

Medication adherence

Dependent

Project Methodology

A quantitative methodology is appropriate for use in this project because of the feasibility and clinical relevance associated with the practice improvement measurement. The content getting studies is various literature reviews that are connected to the research topic. This will facilitate the discovery of the effectiveness of family-led strategies as in comparison to pharmaceutical-led strategies in medication adherence of diabetic patients in home-based care. It will get quantifiable and objective data related to the research question through the statistical analysis. This methodology was preferred rather than the qualitative methodology in this project because there will be a need to collect numeric data to assess the effectiveness of family-led strategies. The numerical data will be collected before and after the study. The results will then be compared and contrasted prior to making the necessary conclusions from the study. Qualitative data cannot be used to conduct this comparison. The quantitative methodology also allows for the numerical representation of the DPI findings so that specific and observable conclusions can be drawn. Descriptive statistics will be used to determine the relationship between the variables and to explain the differences in the two strategies and their impact (Queiros et al., 2017).

The quantitative methodology aims to predict, control, or explain certain theories. To analyze data, this research methodology relies heavily on statistical analysis. According to Fain (2017), this research methodology focuses on objective measurements and analyzes the data collected through statistical, numerical, or mathematical analysis. It also uses computational techniques to manipulate preexisting statistical data. Usually, it is applied to test if or confirm whether certain theories and assumptions are true or false. According to Zaccagnini and Pechacek (2019), the two important foundational aspects of projects that use this research methodology are that they build on results and evidence from past research and that they usually form the basis for future research.

Project Design

This quality improvement project will use the quasi-experimental design as the principal evaluation method (Handley et al., 2018), while the design will assess how family-led strategies compare with pharmaceutical-led strategies in ensuring ensure medication adherence among patients with diabetes in home-based care programs. This approach will be used to determine if family-led strategies make a difference in medication adherence among diabetes patients in home-based care programs. Since this project aims to find out how the two interventions compare, measurement of numerical data will be necessary. An evaluation of the impact of each of the two strategies on medication adherence among diabetic patients in home-based care will also be conducted before and after the application of the strategy.

Family-led strategies among diabetic patients in home-based care have very notable differences with pharmaceutical-led strategies among patients in this care. The design of this project is a two-group pre- and post-intervention quasi-experiment design. The project design chosen for this project is a quantitative quasi-experimental design which will be used to assess the impact of family-led strategies on medication adherence among diabetic patients in home-based care programs. This research design is suitable for this project because the variables cannot be changed by the researcher (Handley et al., 2018).

Information on the gender and age of the patients identified for this project will be collected. A population of 50 diabetic patients has been identified for the project. The project research intends to use entire population as a sample diabetic patient in home-based care and the most valid and reliable instrument to be used in this project is questionnaires. Close- ended questionnaires will be utilized in this case. The project lead, in this case, is a comparison between the impact of family-led strategies and pharmaceutical-led strategies on medication adherence among diabetic patients in home-based care programs. Meanwhile, the pretest and posttest data that will be collected using questionnaires will be analyzed using the Statistical Package for the Social Sciences (SPSS) software. Comment by Author: Please see previous chapter feedback on this number as it has varied throughout the manuscript. Comment by Author: Why the discussion on questionaries when you are using the MAP tools to guide assessment by the staff nurse and not the patient? Comment by Author: Why is this still being discussed in the manuscript since this is not really what you are doing now based on what you said in chapter 1. It seems that the editing doe on your manuscript may have been done by separate people for each chapter. Chapter 1 varies significantly from the other chapters and all chapters do not align well . Comment by Author: Use pre-project or pre implementation and post project or post implementation instead of this terminology

An impact assessment of the strategies will be conducted before the implementation of the strategies and four weeks after the implementation of the strategies. This design will be applied to determine the relationship between the variables in the study. The project design chosen will facilitate the analysis of the comparison in the impact of family-led strategies and pharmaceutical-led strategies.

Population and Sample Selection

The population from which the sample to be used in this project is diabetic patients in home-based care programs in Texas. This sample is convenient because it includes participants who would be directly impacted by the interventions involved in this research. For this project, patients in home-based care who are interested in increasing their knowledge of medication adherence will be the participants. The population will comprise of diabetic patients aged 35 years and above. The population will comprise of patients who are not in a position of being admitted to hospitals. According to a Texas Medicaid and Texas Diabetes council report (2018), there were 8,700 inpatient hospital claims and 88,988 outpatient hospital claims made by diabetes patients in the year 2018. This figure of The figure that will be used as target population in this project is the 88,988 outpatient claims was considered for a calculation of power for the project but this was not pursued as the convenience sample that the project PI has is only ……..patients that are currently under the care of the project site. The sample size if a power were to be calculated would be will be determined using the Taro Yamane formula: Comment by Author: I think you had a limit here in chapter 1, please edit to be consistent

n=N/1+ N(e)2

Where:

n= sample size

N= target population (88,988)

e=error term in this case 10% (0.1)

Thus, sample size is determined to be 99.88 rounded off to 100 patients.

Before data is collected from patients, they will be asked to sign an informed consent form which will explain to them the purpose of the project and also assure them of their confidentiality should they choose to participate in the study. The informed consent form will be administered with care making sure that patients are not coerced or promised benefits for participation. Only patients who agree to participate and sign the informed consent form will be included in the project. Comment by Author: Since you said this is an organizational change that every patient with diabetes medication non adherence is going to be getting , then you do not need informed consent.

Sources of Data

Data in this project will be collected through a pre-implementation and a post-implementation survey. Questionnaires and the MMAS-8 tool will be used in this project to gather information about the impact of the family-led strategy on medication adherence among diabetic patients in home-based care programs (Krosnick, 2018). Patients in home-based care programs will be given questionnaires to fill. There will also be questionnaires for family members offering direct support to these patients to fill. The questionnaires in this case will require ‘yes’ or ‘no’ responses. There will also be scaling questions in the questionnaire where participants will be required to assess certain information on a scale of 5 (1 = Strongly Disagree, 2 = slightly disagree, 3=neither agree nor disagree, 4=slightly agree, and 5=strongly agree). A questionnaire like this fit perfectly and it is the most effective for this project because it is easy to statistically analyze (Krosnick, 2018). The MMAS-8 questionnaire on the other hand will measure the medication adherence of patients and will be used in both pre and posts assessment. Comment by Author: Too many inconsistencies in your manuscript. You said in chapter 1 that the outcome data i.e the medication adherence rates will be abstracted from the EHR why are we using this questionnaire still now that you are using the MAP resources? Please edit your manuscript throughout so that it aligns throughout. Chapter 1 lays the foundation and then you build on that foundation. You can not have chapter 1 saying you will do this a certain way but then chapter 2 and 3 mentions something else.

The questionnaires will include two sections, the first section is where the socio-demographic information of the participants will be captured. This will include information on gender and race, while the other section will capture information about the impact of the respective intervention strategies on the medication adherence of the patients. It will involve getting data from the assessment, which will be compiled in a spreadsheet. The SPSS software will then be used to analyze the data so that conclusions can be drawn from it.

Validity

The validity of the questionnaire will be established through the exploration of its social theoretical construction. The validity of closed-ended and scaling questionnaires has been confirmed through research. According to research, the test for the validity of these types of questionnaires would be a normal distribution curve. The research found the use of closed-ended and scaling questionnaires to be acceptable. According to research, these questionnaires are effective in linking existing knowledge to current findings. Questionnaires will be the only source of data in this research. Research on the validity of these types of questionnaires shows that existing theoretical, as well as empirical constructs, should be well represented in the questionnaires to increase their validity (Francis et al., 2017). For the standard questionnaire that uses Likert scale, Cronbach’s alpha will be used to determine the validity of the questionnaire items. The value of Cronbach’s alpha will be at 0.7 for the questions to be deemed valid. For the MMAS-8 questionnaire, factor analysis will be used to both asses the validity of the items as well as analyze the adherence levels of the patients. Comment by Author: You are discussing the MAP resources here and their validity same with the reliability because that is your tool that you are utilizing. Please edit accordingly

Reliability

The reliability of this project, just like the validity of questionnaires impacts the research findings and consequently the conclusions drawn from the research to a great extent. Reliability is the extent to which a questionnaire produces similar results in different trials. Regarding the reliability of these types of questionnaires, reliability cannot be achieved unless the measurements are based on numerical values. Reliability is closely related to the objectivity of the research. Since this is quantitative research, the objectivity lies in the instrumentation used in the research. Research shows that there are several threats to the reliability of questionnaires in research. These include using unclear and complicated questions, the use of arbitrary and illogical codes, and giving unclear response options (Francis et al., 2017). To ensure that reliability of the standard questionnaire is met, the questionnaire will be given to a few experts in the diabetes management sector to determine if the questions are appropriate and if there are any internal inconsistencies in them. Their opinions will be incorporated into the final questionnaire. Use of the MMAS-8 questionnaire ensures reliability because it is a widely used and tested tool for collecting information on adherence.

Data Collection Procedures

Informed consent will first be sought from the participants in this research. This will be after informing all the participants in detail what this project is all about. The participants will be provided with a letter explaining the purpose of the project and its benefit to them and the nursing profession. Participants will be notified how their data will be used and will be assured of confidentiality. Personal data regarding the patients and other participants will not be collected and their medication plans will not be affected.

The participants will be asked to complete a pretest and post-test survey which will be anonymous. Participants will be identified using numbers rather than names to protect anonymity. The pre-test will be conducted before the family-led health education strategy is introduced to patients. This will give baseline I formation on adherence. The post-test will be carried out after three months of constant reminders and follow up on the patients to evaluate of the intervention was successful. Post-test and pretest results will be identified in such a way that they correlate for easier and right analysis. Comment by Author: Please see prior feedback on the informed consent as well as the questionnaires. This will need to be edited to reflect what you re actually planning to do based on what you said in chapter 1

The data will be collected using a questionnaire that is already set by other stakeholders in the health sector so that the right information can be collected so that the research

Data Analysis Procedures

The data will be collected electronically and analyzed using the SPSS software. Through descriptive statistics, the numeric and categorical variables in the questionnaires will be summarized.

Descriptive statistics will be used to describe the patient’s demographic information such as age, weight, gender, level of education and marital status. This ensures the promotion of home-based care if the patient has a spouse. Central measures of tendency such as mean and standard deviation will be used to describe the population under study and also in the adherence-based questions. Comment by Author: Provide a citation

The analysis is important in quality improvement project will begin only after the nature and statuses of the patients and their caregivers are understandable. The SPSS software that will be used in this project will help to determine the relationship between the different variables in the research. It will establish the relationship between family-led strategies of intervention and medication adherence among diabetic patients in home-based care.

It shall be possible to assess impact of pharmaceutical-led strategies of intervention on medication adherence among diabetic patients in home-based care. This software will further be used to predict the possible application of the results drawn from this research.

The data will be analyzed by comparing the results of the pretest and those of the post-test. The characteristic of this research design is to apply an intervention so that it can help to determine the relationship between two variables in the research. The quasi-experimental design that will be used in this project will help to analyze the impact of family-led strategies on medication adherence among diabetic patients in home-based care. It will also help to analyze how this impact compares to that of pharmaceutical-led therapies on medication adherence among diabetic patients.

Potential Bias and Mitigation

There exists a number of possible sources of bias throughout the project. However, the most important issues is formulating solution strategies on how the bias can be addressed. One potential source of bias is recall bias causes. This will emerge from the responses that the respondents will be required to provide. For instance, the diabetic patients will be required to respond to self-report survey based on the medication adherence. In such situations, the researchers normally rely on the information that has been issues out by the respondents, and majorly their memory.

Based on the patients’ memory, the information might or might not be accurate, but the investigator will have to rely on it. Two mitigation strategies to recall bias are empathy and acknowledgement. Empathy would ensure the researchers connect with the project’s participants. It would also be possible to acknowledge the project’s validity based on first-hand account of the mitigation techniques.

Ethical Considerations

An authorization letter has been obtained from the project site (appendix …). The project has also been submitted to the project site IRB exemption ( Appendix…..). The project will need to be submitted to GCU IRB for review. The participants will be informed on all aspects of the project including how the data will be collected, analyzed, and used. They will also be informed about the importance of this project to them and the nursing field in general. Comment by Author: See feedback on informed consent earlier in the chapter

Written informed consent will then be sort from all the participants in this research. Fiesler (2019) stated that the development of the research project is concerned with principles of ethics. It is imperative to create effective programs that ensure integrity of the participants. Comment by Author: See feedback above. Please edit the entire chapter to reflect changes to align with chapter 1

The participants will answer the questionnaire questions anonymously and they will be assigned numbers will be used to identify participants to further protect anonymity. Also, the questionnaires will be handled with great care to ensure privacy. Data collected for the project will be kept on a password protected computer only accessible to the DPI investigator. Aggregate data will only be shared among people who are directly affected by the project, mainly the family of the diabetic persons. Personal information about the participants will not be collected in this research since that would offer restricted viewpoints. The participants will be informed of the results of this project via the contact information they would have been provided in the questionnaires. After completion of the project, the questionnaires containing participant information will be disposed of safely (Fiesler, 2019).

Limitations

The quantitative quasi-experimental approach that was chosen for this project is the best in determining the relationship between variables in this research and showing how the two main interventions compare. However, there are several limitations to this project. One of them is that the time frame set for this project may not be enough to show the impact of an intervention. Four weeks is a relatively short time to determine whether an intervention has had any impact or not. The second limitation is that the sample size set for this research project is also relatively small. This will make it difficult to generalize the results of this project.

The fact that only diabetic patients will be participating in this quality improvement project also makes it difficult to establish whether family-led strategies can be effective among other patients with chronic illnesses and those who are in home-based care. The method of data collection chosen for this research could also be a limitation. Participants can give wrong information in their questionnaires which will affect the overall results of the study (Brown et al., 2018). Errors are common in research and should get identified early.

Summary

Medication adherence among patients with diabetes remains a crucial determiner of their well-being. The purpose of this project is to determine to what extent the implementation of family-led strategies would impact medication adherence when compared to pharmaceutical-led strategies among diabetic patients’ in-home care settings in Texas over four weeks. The problem that aims to be solved in this research is to bridge the gap in knowledge about the impact of family-led strategies on medical adherence among diabetic patients in home-based care programs as compared to pharmaceutical-led strategies. Moreover, the methodology that has been selected for this project is the quantitative methodology (Fain, 2020). A quasi-experimental design will be used in this quality improvement project. The design will facilitate the identification of the relationship between the variables in the research. Questionnaires will be used as the only method of data collection in this research. The validity and reliability of questionnaires for data collection in this research has already been established.

The pretest-posttest approach will be used to collect data in this research. Data will be collected before the application of the intervention and after. An analysis of the two sets of data will be used to determine the impact of the independent variables of this research on the dependent variable. The data gathered will be compiled in excel spreadsheets. The SPSS software will be used to analyze data in this research. This software will ensure that the dependent variables in the research are not manipulated.

To ensure that ethical research is conducted, this project will follow to the latter the principles and standards of ethical research. It will also ensure that written informed consent is sought from the participants prior to beginning the research. The anonymity of the participants and the privacy of data will be upheld at all costs. Among the limitations of this project is the small number of participants used in the research. The short duration of the project and the use of questionnaires as the only method of data collection are also limitations in the study. In chapter four, this project will present the data analysis and results. The chapter will also discuss the findings and results. Chapter five of this project will conclude the project and give directions for future use.

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Appendix A

The Parts of a Practice Improvement Project

GCU requires the Publication Manual of the American Psychological Association (6th ed.) as the style guide for writing and formatting Direct Practice Improvement (DPI) Projects. . A DPI Project has three parts: preliminary pages, main text, and supplementary pages. Some preliminary or supplementary pages may be optional or not appropriate to a specific project. The learner should consult with his or her practice improvement project chairperson and committee regarding inclusion or exclusion of optional pages.

Preliminary Pages. The following preliminary pages precede the main text of the practice improvement project.

Title Page

Copyright Page (optional)

Approval Page

Abstract

Dedication Page (optional)

Acknowledgements (optional)

Table of Contents

List of Tables (if you have tables, a list is required)

List of Figures (if you have figures, a list is required)

Main Text. The main text is divided into five major chapters. Each chapter can be further subdivided into sections and subsections.

Chapter 1: Introduction to the Project

Chapter 2: Literature Review

Chapter 3: Methodology

Chapter 4: Data Analysis and Results (not included in the proposal)

Chapter 5: Summary, Conclusions, and Recommendations (not included in the proposal)

Supplementary Pages. Supplementary pages, which follow the body text, include reference materials and other required or optional addenda.

References

Appendices

Keep in mind that most formatting challenges are encountered in the preliminary and supplementary pages. Allocate extra time and attention for these sections to avoid delays in the electronic submission process. In addition, as elementary as it may seem, run a spell check and grammar check of your entire document before submission.

Appendix B

What is my DPI project design?

THIS IS NOT PART OF THE PAPER JUST A REFERENCE FOR THE LEARNER

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Appendix C

Enter the Title here