Aligning the Essentials with a Gap in Practice or Practice Change
In pursuit of a Doctor of Nursing Practice (DNP) degree, addressing gaps in practice or implementing practice changes is critical to improving healthcare quality and patient outcomes. The Essentials of Doctoral Education for Advanced Nursing Practice provides a foundational framework to guide these efforts. This paper focuses on a long-term care facility as the chosen organization type, identifying healthcare-associated infections (HAIs) as a significant gap in practice. By aligning this gap with four Domains of The Essentials, this analysis underscores the strategies for bridging the gap and enhancing care quality and safety: Aligning the Essentials with a Gap in Practice or Practice Change.
Organization Type and Gap in Practice or Practice Change
The type of organization I have chosen is a long-term care facility. Long-term care facilities provide care to vulnerable populations, including older adults and persons with chronic or disabling conditions that require extended care. Essential services offered to these patients are often very critical, including medical care, rehabilitation, and assistance with activities of daily living (Heiks & Sabine, 2022).
One gap in practice that exists in these settings is the high prevalence of healthcare-associated infections (HAIs). These include urinary tract infections, respiratory infections, and multidrug-resistant organism infections; all these occur due to a lapse in infection prevention, such as inadequate staff training or frequent use of invasive devices like catheters.
The impacts of HAIs in long-term care settings are huge, causing increasing morbidity and mortality among the residents, prolonged duration of care, and high costs related to healthcare. Poor compliance with hand hygiene or failure to sterilize equipment properly might raise the chances of infections and threaten the safety and quality of care extended to residents (Alamer et al., 2022). Addressing this will help bridge this gap in service provision, improve patient outcomes, and contribute to attaining organizational objectives. Evidence-based interventions involve comprehensive infection control training programs, compliance monitoring, and real-time feedback systems, which have been identified as crucial elements in reducing the prevalence of HAIs and improving care delivery.
Four Domains that Align with the Gap in Practice or Practice Change
The reduction of these practices in terms of the HAI practice gap directly translates to four domains of The Essentials: interprofessional partnerships, person-centered care, quality and safety, and nursing discipline scholarship. These four domains collectively focus on competencies central to addressing many healthcare challenges and improving patient outcomes. Person-centered care is the care delivery given considering patients’ needs, preferences, and values (Harrison et al., 2021).
The nursing scholarship informs us of the importance of applying research findings into practice to inform change. Interprofessional partnerships suggest collaboration from other professional cadres involved in care towards a common purpose or outcome. Finally, quality and safety focus on reducing patient risk while promoting better care efficacy and reliability. Individually and collectively, each of these domains supports the integrated approach necessary to enhance the quality of care provided in the facilities, addressing the identified gap in practice.
Domain Choices and How Each Aligns with the Practice or Practice Change Gap
The domain prioritizes the patient’s dignity, safety, and preferences. Person-centered care is critical to lowering HAIs in long-term care settings since interventions are tailored to the person’s needs. By infection prevention practices like training staff about proper hand hygiene and frequent cleaning of patient care areas, a safer environment for the residents adds directly to such a focus (Ekpenyong et al., 2021).
Examples include infection control education involving residents and their families and improving compliance with best practices while creating an enabling environment where patients are valued and cared for. By applying person-centered care, the facilities will increase trust and satisfaction among residents and their families while reducing the risk of infections.
The nursing discipline’s domain of scholarship emphasizes incorporating evidence-based practices in the clinical setting. Addressing the gap in infection prevention involves applying robust research to develop and implement effective interventions. Using frameworks like the JHEBP Model allows a systematic approach to identifying, translating, and evaluating best practices.
For example, evidence supports the care bundle practices for preventing CAUTI, such as timely catheter removal and applying sterile insertion techniques (Gupta et al., 2023). The DNP-prepared nurse can ensure that the interventions are practical and sustained by using scholarly knowledge to advance nursing science and improve patient care.
Subsequently, a multifaceted challenge would require the interprofessional partnership approach in dealing with HAIs. This domain represents the service aspect of healthcare professionals, including nurses, physicians, infection control specialists, and support staff. Infection prevention requires coordination, effective communication, and responsibility among care team members (Gregory et al., 2022).
For instance, interdisciplinary infection data review and strategy development meetings can foster accountability and innovation. The DNP-prepared nurse is in an ideal position to facilitate communication, align team goals, and ensure evidence-based practices are followed. The identified gap in practice being aligned with interprofessional partnerships serves to underscore the most critical area of teamwork to deliver better patient outcomes and reduce HAIs.
The domain of quality and safety relates directly to the problem of HAIs since its focus is to provide care that ensures minimal risk and maximizes patient outcomes. According to Sreeramoju et al. (2020), quality improvement methods, like real-time active surveillance and feedback systems aimed at infection prevention, institutionalize making sure protocols are followed the first time, every time, in order to prevent HAIs. For example, monitoring compliance with or without hand hygiene practices coupled with immediate feedback provided to staff can significantly decrease infection rates.
This illustrates a concern and a commitment to high-quality care and patient safety. At this stage, the DNP-prepared nurse assumes the role of leader or plays a leading role because of their specialized knowledge related to quality improvement and the established culture of safety in the healthcare organization.
Summary
To sum up, the gap in healthcare-associated infections in long-term care facilities needs to be addressed from a multilevel perspective that focuses on the domains of person-centered care, scholarship for the nursing discipline, interprofessional partnerships, and quality and safety. These domains empower the DNP-prepared nurse to foster the changes required for improved patient outcomes collaborative practice settings, and integration of continuing quality improvement initiatives. These efforts not only address harm related to HAIs but also promote the next level in the overall quality of care within various settings to solidify the role of DNP-prepared nurses as foundational to safe and effective systems.
References
Alamer, A., Alharbi, F., Aldhilan, A., Almushayti, Z., Alghofaily, K., Elbehiry, A., & Abalkhail, A. (2022). Healthcare-associated infections (HAIs): Challenges and measures the radiology department takes to control infection transmission. Vaccines, 10(12), 2060. https://doi.org/10.3390/vaccines10122060
Ekpenyong, M. S., Nyashanu, M., Ossey-Nweze, C., & Serrant, L. (2021). Exploring the perceptions of dignity among patients and nurses in hospital and community settings: An integrative review. Journal of Research in Nursing, 26(6), 517–537. https://doi.org/10.1177/1744987121997890
Gregory, M. E., MacEwan, S. R., Sova, L. N., Gaughan, A. A., & Scheck McAlearney, A. (2022). A qualitative examination of interprofessional teamwork for infection prevention: Development of a model and solutions. Medical Care Research and Review, 80(1), 107755872211039. https://doi.org/10.1177/10775587221103973
Gupta, P., Thomas, M., Mathews, L., Zacharia, N., Fayiz Ibrahim, A., Garcia, M. L., Simbulan, C., Attia Mohamed, F., & El Hassan, M. (2023). Reducing catheter-associated urinary tract infections in the cardiac intensive care unit with a coordinated strategy and nursing staff empowerment. BMJ Open Quality, 12(2), 1–7. https://doi.org/10.1136/bmjoq-2022-002214
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, 13(2), 85–108.
Heiks, C., & Sabine, N. (2022). Long-term care and skilled nursing facilities. Delaware Journal of Public Health, 8(5), 144–149. https://doi.org/10.32481/djph.2022.12.032
Sreeramoju, P. V., Palmore, T. N., Lee, G. M., Edmond, M. B., Patterson, J. E., Sepkowitz, K. A., Goldmann, D. A., Henderson, D. K., & Kaye, K. S. (2020). Institutional quality and patient safety programs: An overview for the healthcare epidemiologist. Infection Control & Hospital Epidemiology, 42(1), 6–17. https://doi.org/10.1017/ice.2020.409
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Question 
Aligning the essentials with a gap in practice or practice change
In order to fulfil your DNP degree at Walden, you will complete non-clinical coursework, practicum hours, and a DNP Project. Both the clinical hours you will complete as part of your Practicum and your DNP Project will align with specific Domains as defined in The Essentials.
Your DNP Project will focus on a gap in practice or practice change designed to improve quality within the organization at which you are doing your Practicum. The specifics of this will be decided later on, but at this early stage of your program, you should begin thinking about 1) the types of organizations you might select for your practicum experiences and 2) gaps in practice or practice changes that could be identified within these organizations. As you do this, keep in mind how the gaps in practice or practice changes will align with The Essentials.
To prepare:
- Review the Learning Resources for this week, specifically Chapter 4 of Dang and Dearholt addressing the Practice Question, AACN’s The Essentials, the DNP Practicum Manual, and the DNP Project Process Guide.
- Consider the types of organizations you might select for your practicum experiences (e.g., a large acute care health system, a long-term care facility, a pediatric hospital, a community health center, etc.)
- Consider the kinds of gaps in practice or practice changes that could benefit such organizations, including those specific to the organization and those that relate to healthcare practices more generally.
- Consider how the gaps in practice or practice changes you are interested in pursuing align to The Essentials.
- Select one organizational type and one gap in practice or practice change on which to focus for this Assignment.
Aligning the Essentials with a Gap in Practice or Practice Change
Note: You may select a new organizational type and gap in practice or practice change or, if you choose, you may reuse one on which you focused for a previous Assignment, Discussion, or Blog in this course.
Also Note: These may or may not be the same organizational type and gap in practice or practice change as those you will focus on for your Practicum and DNP Project.
Note: Be sure to review the grading rubric for this Assignment so you fully understand what is expected of you. To access the rubric, scroll down to the bottom of the Assignment page.The Assignment: (2–3 pages)
Write a paper in which you address the following:
- Describe the organization type and the gap in practice or practice change that you selected for this Assignment.
- Identify the four Domains from The Essentials you identified which closely align with the gap in practice or practice change.
- Justify your Domain choices, explaining how each aligns with the gap in practice or practice change you selected.
Note: Us this week’s Learning Resources to support your Assignment. Use proper APA format and style for all references and citations. The College of Nursing requires that all papers include a title page, introduction, summary, and references. Use the College of Nursing Writing TemplateLinks to an external site. for your Assignment submission.
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