Define Variables

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Introduction

In the Prospectus, Proposal, and Direct Practice Improvement Project there are 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

The ten strategic points are developed in table format.

The 10 Strategic Points

The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document includes the following 10 key or strategic points that define the project focus and approach:

1. Topic (10%) – Provides a broad project topic area/title.

2. Literature Review (15%) – Lists primary points for four sections in the Literature Review:

a. Background of the problem/gap and the need for the project based on citations from the literature.

b. Theoretical foundations (models and theories to be foundation for project).

c. Review of literature topics with key theme for each one.

d. Summary.

3. Problem Statement (10%) – Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

4. Sample and Location (10%) – Identifies sample, needed sample size, and location.

5. Clinical/PICOT Questions (10%) – Provides clinical/PICOT questions to collect data to address the problem statement.

6. Variables (5%) – Identifies and describes independent and dependent variables.

7. Methodology and Design (10%) – Describes the selected methodology and specific project design to address problem statement and clinical questions

8. Purpose Statement (10%) – Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

9. Data Collection (10%) – Describes primary instruments to answer clinical questions.

10. Data Analysis (10%) – Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

The Process for Defining the 10 Strategic Points

The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement.

Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and is not recommended unless learners have a significant amount of extra time and resources to complete it.

For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 strategic points so they are simpleclear, and correct in order to ensure that anyone who reviews them will easily understand them. It is important to align all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project.

Value of the 10 Strategic Points Document

The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript.

Examples of the 10 Strategic Points Document

It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

Example: 10 Strategic Points Document for a Quantitative Project

The 10 Strategic Points Comments or Feedback
Broad Topic Area 1. Broad Topic Area:

Hint: What would I title my project?

Literature Review 2. Literature Review:

List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

a. Background of the Problem/Gap:

· Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

· Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

· Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

· Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

b. Theoretical Foundations (models and theories to be foundation for study):

· The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

· The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success.

· Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

c. Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Rural Telehealth Services:

· Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015); cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

Population Specific Telehealth Services:

· Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

· Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

· Rural Native American telehealth: Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

· Diabetes education and management: Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

· Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

Settings:

· Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011).

· Home-based (Demiris et al., 2103).

· Community center (Demiris et al., 2103).

· Library (Demiris et al., 2103).

· Smart phone, computer-based (Forchuk et al., 2016).

Certifications:

· National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

· American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

· Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

Network Systems:

· American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

· Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

d. Summary

· Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

· Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas.

· Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

· Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

Problem Statement 3. Problem Statement:

Describe the variables/groups to study, in one sentence.

 

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 not known if and to what degree/extent…” or “It is not known how/why and….”

Other examples are:

· While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

· It is not known how or to what extent ________________.

While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area.

Clinical/ PICOT Questions 4. Clinical/PICOT Questions:

Provide PICOT question to guide the implementation and data collection of findings of the project:

(P) Among adult patients in a rural care setting, (I) how does implementation of a telehealth program (C) compare to traditional commute-for-care (O) impact rate of follow-up with the primary care provider (T) over a period of four weeks.

Sample 5. Sample (and Location):

Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

a. Location: Arizona

b. Population: Two neighboring rural towns equal distance from the nearest primary care provider.

c. Sample: 40 participants include a power analysis if appropriate.

Define Variables 6. Define Variables:

a. Independent Variable: Telehealth program.

b. Dependent Variable: Follow-up rate with primary care provider.

Methodology and Design 7. Methodology and Design:

Name the selected methodology and specific design to address the problem statement and clinical questions:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement 8. Purpose Statement:

Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). 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).

 

 

Data Collection Approach 9. Data Collection Approach:

Describe primary instruments that will be used to answer clinical question.

Data Analysis Approach 10. Data Analysis Approach:

Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

 

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

10 Strategic Points Comments/Feedback
Broad Topic Area
Literature Review
Problem Statement
Clinical/PICO Questions
Sample
Define Variables
Methodology and Design
Purpose Statement  

 

Data Collection Approach
Data Analysis Approach

 

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