Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesi

Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesi
Running head: DNP- TRANSLATIONAL RESEARCH AND EVIDENCE-BASED PRACTICE  DNP- Translational Research and Evidence-Based Practice Name of Student Institution Affiliation Literature Review Literature review of scholarly articles will entail synthesizing and analyzing information on the impacts of medication administration errors in children between the age of 3-4 years. The review will cover major concepts in the identified theme of the PICOT question. The sensitivity of the PICOT question is that children under the age of 3-4 have little power of choice or identification of wrongdoing against them during medical administrations. The sub-themes to be tackled in this study include prescription of both drugs and chemotherapy doses, the dispensation of drugs, and the parental administration of the said drugs. Under the prescription of drugs and chemo doses, it is essential to make considerations of several aspects. The body compositions matter in the prescription of drugs. The weight, build, and physical conditions are crucial. When the wrong doses of drugs or chemo are prescribed, adverse effects may be encountered (Pui, Pei, Raimondi, Coustan-Smith, Jeha, Cheng, & Inaba, 2017). Besides the body compositions, age matters. In this case, the consideration being made is that of children between 3-4 years. Therefore, it is critical to note that organs are not fully developed. Relatively smaller doses should be administered. Other issues of consideration, while prescribing drugs include metabolism and fluid retention. Considering these issues promote evidence-based treatments of leukemia in the said age group. In drug dispensations, several errors may emanate as a result. Sometimes, dispensing physicians may prescribe similar drugs rather than the correct medicines. These errors may lead to the contraindications of drugs as well as poor outcomes of treatment. Abbreviations from prescriptions may be detrimental to patients. Patients may suffer adverse outcomes as a result of being abbreviated wrongly. The impacts of such occurrences will be assessed through scholarly materials. Research indicates that at least 15% of prescription errors result from incorrect entry of prescriptions. The effects of these errors will also be assessed through scholarly materials. Parental administration of the said drugs is vital. Better outcomes are only to be realized when parents administer prescriptions correctly. Critical considerations such as physician advise on the administration of drugs to children play a fundamental role (Millot, Guilhot, Baruchel, Petit., Bertrand, Mazingue. & Sirvent, 2014). With the proper advice, parents can administer drugs efficiently. Considerations such as time intervals of prescriptions play a significant role. This literature review will help in the establishment of the impacts such actions have on patients’ outcomes. Drug Prescriptions The role of antibacterial prophylaxis use has been misunderstood over time. Commonly, antibacterial prophylaxis has been used in preoperative procedures. Antibacterial prophylaxis has often been used for children as it harnesses the recovery while undergoing chemotherapy (Saxena, Jain, & Gupta, 2018). However, the dosage and manner of practice contribute highly to the efficiency of the procedure. In cases where regiments are offered appropriately, the outcomes are good. However, for improper regiments, patients suffer increased risks for morbidity and mortality. Results from various studies have indicated that antibacterial prophylaxis is essential for treatment with leukemia. However, the prescription of drugs used during the prophylaxis process is critical in determining the success of the ttherapy (Yeh, Liu, Hou, Chen, Huang, Chang, & Liang, 2014). Therefore, from these researches, prescriptions of drugs are vital for better outcomes of treatment for leukemia patients. Research indicates that children who have leukemia are prescribed broad-spectrum antibiotics. The antibiotics are used to prevent the contraction of bacterial infection (Sulis, Blonquist, Stevenson, Hunt, Kay‐Green, Athale, & Leclerc, 2018). Alternately patients receive fluoroquinolone prophylaxis for the same purpose. Results of the research indicate that fluoroquinolone prophylaxis patients reported fewer rates of bacterial infection than counterparts who received broad-spectrum antibiotics. The importance of prophylaxis is underlined by more research that shows that fluoroquinolone prophylaxis is essential for pediatric leukemia patients suffering from acute bacterial infections. Bacterial infections become resistant to antibiotics (Hallböök, Lidström, & Pauksens, 2016). Thus, the prescription of treatment of bacterial infection is essential considering the efficiency of the two methods of treatment. Research has made it factual that children with down syndrome are likely to contract myeloid leukemia and, subsequently, lymphoblastic leukemia (Murphy, Roth, Kolb, Alonzo, Gerbing, & Wells, 2019). The inferences of research have it that there is a connection between down syndrome mutations and leukemia. These mutations have been proven to promote leukemia mutations. GATA1 mutations of the down syndrome have been confirmed to have more overly sensitivity to cytosine arabinoside, a cancer-fighting drug. Overall, the GATA1 protein is less sensitive to leukemia drugs (Ono, Hasegawa, Hirabayashi, Kamiya, Yoshida, Yonekawa, & Ito, 2015). With these indications of research, prescriptions of children with a history of downs syndrome are critical as GATA1 mutation may increase risks for leukemia or promote better rates of survival. Radiations provide an increase in the development of secondary cancer in children. There are cases where patient-specific apertures are put in place in diagnosis (Geng, Moteabbed, Xie, Schuemann, Yock, & Paganetti, 2015). At the point of developing these apertures, the radiation subjected to patients mustn’t be destructive. Destructive emissions may lead to secondary cancers. Besides, exposure to dexrazoxane may lead to secondary cancer for leukemia patients. With this in mind, it is therefore critical to consider the safe practice of chemotherapy for children who have leukemia (Seif, Walker, Li, Huang, Kavcic, Torp, & Aplenc, 2015). Conclusively, prescriptions of chemotherapies should be done with care to avoid secondary cancers for patients. Dispensation of Drugs Getting the right prescription is one thing: a dispensation is another. Allocation of prescribed drugs plays a significant role in the management of Leukemia (Toft, Birgens, Abrahamsson, Griškevičius, Hallböök, Heyman, & Quist-Paulsen, 2018). Therapies are commonly used in the management of leukemia. These therapies being so, physicians dispensing therapies through their skills are needed to be watchful. Research indicates that the success of outcomes of treatment solely lies in the dispensation of therapies; the better the dispensation, the better the results observed. Targeted therapy presents the best approaches to dispensing medicine. Targeted therapy is specific to the problems facing patients. Guidelines for administering targeted drugs should be followed (Byrd, Jones, Woyach, Johnson, & Flynn, 2014). It is, therefore, evident that the choice of therapy dispensation contributes immensely to patients’ outcomes. Medical safety practice is among the critical considerations for drug dispensations. Research indicates that pediatric oncology is high risk and requires a lot of attention (Mulatsih, & Iwan Dwiprahasto, 2018). Research carried out on children who have leukemia indicates that patients who received controlled interventions had better outcomes than those who received uncontrolled interventions. These results were obtained through pretest and posttest trials. Further research reported that patients who bought drugs from pharmacies with electronic systems had better outcomes than those who bought from pharmacies without automated systems. This phenomenon is attributed to the accuracy of dispensing drugs promoted by electronic methods (Schmidt, 2019). These indications, therefore, prove that accurate dispensation of drugs promotes better outcomes for patients. Administration of Drugs Research attributes at least 40% of the medical errors to be administrative. In this regard, parents are most responsible for this as they spend the most significant percentage of time with their kids. Administrative errors established included wrong doses (Oberoi, Trehan, & Marwaha, 2014). Research indicates that among the wrong doses administered, more than 60% were above the recommended amounts, while the latter stated fewer doses than recommended. More analysis suggested that the forgetfulness of parents was among the significant administrative errors (Neuss, Gilmore, Belderson, Billett, Conti-Kalchik, Harvey, & Olsen, 2016). These errors were attributed to lead to irregular administration of doses. The problems to do with mistakes harm drug administration. Proper administration of drugs affects leukemic pediatric patients. Research indicates that appropriate medication administration promotes the chances of surviving the condition by 30%. However, survival has an impact on the physical and social functioning of children (Taverna, Tremolada, Bonichini, Basso, & Pillon, 2016). Research indicates that drugs affect the development of children’s physical functions. As a result, children may experience slow growth. Communication, social, and motor abilities are adversely affected. More research indicates that parents have a more prominent role in the development of leukemia surviving patients. Interventions obtained through research propose that parents provide therapies that alleviate these problems (Zhang, Rodday, Kelly, Must, MacPherson, Roberts, & Parsons, 2014). Treatments such as occupational therapy are highly recommended. Post-drug administration is vital in leukemia survivor children. More results of the successful administration of drugs for pediatric leukemia patients are examined. Research indicates that children with leukemia history inhibit cognitive development (Taverna, Tremolada, Bonichini, Tosetto, Basso, Messina, & Pillon, 2017). Therapies of treatment of leukemia can, in certain instances, affect the acquisition of new skills n children. Children fail to grasp reading and communication skills. More research in this field indicates that children who have undergone Hematopoietic Stem Cell Transplantation indicate problems with mastering movements. These children take longer to walk. Other therapies and interventions administered on patients reported better results in motor advancements (Akyay, Olcay, Sezer, & Sönmez, 2014). These indications, therefore, prove that drug and therapy administration play a significant role in the mobility of children. Errors of failure to adhere to prescription rules are a significant concern in the administration of drugs. Research has it that mistakes in the administration of oral chemotherapy play a substantial role in adverse effects experienced by patients (Taylor, Winter, Geyer, & Hawkins, 2016). In research carried out, the parent was observed to administer one tablet of mercaptopurine per day rather than the recommended one tablet per five days per week. Research further indicates that interventions would have better outcomes if errors of adherence are minimized. Further research associated negligence and drug unavailability to be factors contributing highly to failure to adhere to prescriptions (Khalek, Sherif, Kamal, Gharib, & Shawky, 2015). These inferences indicate that adverse outcomes of treatment are experienced as a result of nonadherence in the administration of drugs. Administration of interventions for leukemia may be painful. The research comes handy in determining methods of dealing with pain for children undergoing interventions for leukemia (Tremolada, Bonichini, Basso, & Pillon, 2015). Research indicates that several parameters determine the levels of pain experienced by children. Cognitive factors play a huge role. In the administration of interventions, physicians are required to consider responses that may not lead to post-traumatic disorders. Research indicates that pediatric leukemic patients may experience painful dental formulas. This dental problem becomes a key consideration during treatment (Padmini & Bai, 2014). Chlorhexidine mouthwashes are proven to be among the success of alleviating pain during the administration of interventions of leukemia in children. Families play a huge role in the administration of interventions of leukemia in their children. Research indicates that the stressful conditions family members find themselves in may lead to post-traumatic disorders (PSTD) (Tremolada, Bonichini, Basso, & Pillon, 2016). Research results indicate that family members may continue to suffer even after successful interventions are administered. Dealing with Post-traumatic disorders is among the primary considerations of the administration of interventions. Further research indicates that responses such as theoretical models and post-traumatic stress symptomatology helps family members recover from PSTD (Neu, Matthews, King, Cook, & Laudenslager, 2014). Significant indicators of PSTD include acute stress symptoms. In summary, negative impacts such as PSTD are bored as a result of the administration of leukemia interventions. Studies also assess the impact of perceptions of parents of children undergoing bone marrow aspiration. Procedural pain experienced by children undergoing leukemia treatment is observed to harm parents (Wang, Liu, Yu, Wang, Gao, Dai, & Mu, 2017). These negative impacts are attributed to the failure to know the usage of analgesia. This failure causes immense pain in children. Besides, parents and particularly mothers face the problem of psychological distress. Studies further indicate that there is a need to reduce procedural pain for leukemic patients. Research suggests that topical analgesia is capable of significantly reducing pain (Whitlow, Saboda, Roe, Bazzell, & Wilson, 2015). In summary, procedural pain has negative impacts on parents of leukemic parents. Studies have moved a step further in investigating the impacts of childhood leukemia among surviving adults (Zannini, Cattaneo, Jankovic, & Masera, 2014). The results of the study indicate that most adults have kept dark memories of their experiences with leukemia at an early age. The aspect of pain is very much in the domain of surviving patients, with most recounting that they had never experienced such pain in their lifetimes. However, results of studies indicate that some surviving adults hold positive lessons from their experiences (Phillips, & Jones, 2014). These researches show the success of interventions of leukemia in childhood. Administration of leukemia on children has effects on the Neurocognitive abilities of children (Darling, De Luca, Anderson, McCarthy, Hearps, & Seal, 2018). Studies carried out indicate that survivors of leukemia at an early age have problems with their processing powers. The results of the studies suggest that survivors had decreased fractional anisotropy. These results are attributed to the influence of white matter microstructure interactions. White matter microstructures affect the processing speed of individuals. Further research attributed low processing power to poor parenting styles (Sheikh, Joanisse, Mackrell, Kryski, Smith, Singh, & Hayden, 2014). Poor parenting styles, coupled with the derailed mobility issues, make it even more difficult for kids to handle. A review is done to find out how medication prescribed on children can affect their well-being. It is also essential to counter check possible errors that may occur while a doctor is administering drugs to children between 3 and 4 years of age. Most of the children who are within this age gap cannot be able to spot any mistakes made during the process of drug administration for the kids. A study to look at the mistakes made during administration, including chemotherapy doses and how the children are giving the drugs together with how parents administer the medications to the children. It is essential to check at the health of the children before applying remedies to them especially if the child is allergic to the drug or is not of the required weight. A common mistake done during drug administration is giving similar drugs rather than the exact medicine. Parents are advised to take precautions when giving medications to avoid an overdose or underdose of drugs. The advice goes further to say that medicine should be taken out of the reach of children to prevent mishandling by children. The role of some drugs has been misunderstood over the years, and that is the first issue of concern that should be addressed by the physicians. Some medications like Antibacterial Prophylaxis are used to harness recovery in children as they undergo chemotherapy, but the dispensation of the drug is also essential to maintain the efficiency of the process. Proper allocation of drugs plays a critical role in the management of diseases such as leukemia. Errors that occur due to wrong prescription of drugs are of concern and need to be looked into while looking at medical safety. Parents who have children who have leukemia should make sure that the children do not live in stressful conditions for faster recovery. Medication Administration Errors Summary of research questions Research articles analyzed cover several subthemes of medical errors in the treatment of Leukemia in children. Research questions explored acknowledge that medical procedures are prone to mistakes. Subsequently, research questions aim at investigating the sophistication of medical procedures and drug administration in young children who have Leukemia. Among the critical areas tackled through research, items include prescription of drugs. Research questions delve into identifying the effects caused by wrong prescriptions of drugs on pediatric leukemia patients. Studies further post research questions that seek to investigate the impact of dispensation errors on children who have Leukemia. Some studies also focus on the mistakes and effects created by those errors in the administration of drugs. The scope of error covered by studies include both physician errors and parental errors. Summary of the Sample Populations Used Overview of the sample populations used various research papers used in this analysis; most of them used Pretest and posttest methods of getting data. These methods, therefore, required sample populations for study. Depending on the objective of the research, different research papers used different sample sizes. Research papers aiming at looking at the impacts of medical errors in children used a sample population of children below the age of five. However, some studies were interested in the identification of the impact medical errors had on grown-ups during their childhood. These studies subsequently required adults as sample populations. Most of the research papers analyzed used a sample size of at least fifty to three hundred people. All the studies analyzed followed the ethical requirement of performing research in obtaining sample populations. All adult participants in the sample populations were aware of them being involved in the study. For children, consent was obtained through parents. Summary of Limitation of Studies Different researches experienced different limitations. First, the reaction of children to a medical error was observed to be different for different children. For prescription errors, for example, children reacted differently to the wrong medication. As a result, this led to researchers generalizing observations. Most researches were also restricted to remarks and testimonials. These cases are because most of the data in treatment were considered private, and therefore, researchers were not allowed to access it. Small samples also made it difficult for researchers to obtain more substantiated research. Short periods of the study also acted as a limitation towards collecting and performing an in-depth analysis of research. Additional health problems apart from Leukemia made it difficult for researchers to identify the impacts of medication errors. Summary of the conclusion and recommendations for further research Studies used in this research used an approach of providing findings based on the analysis of data obtained from research. However, the data used by various researchers in the study were recorded differently. Besides, the analysis of data was carried out in different methods. Moreover, qualitative and quantitative methods of research were used. These methods made various examinations have different ways of concluding on their results. On recommendations, the majority of research articles made recommendations based on the conclusions obtained from results. Some studies did not make any recommendations. Researchers also provided insights into what further studies could explore. These insights were derived from limitations and elements of research deemed out of the scope of research. Prescription Errors Summary of research questions A majority of the studies assessed in this research used research questions as a guide to the goals and objectives of the investigation. Most of the studies have research questions wired to enable researchers to keep track of their systematic approach to research. Articles covering the impacts of medical errors on children who have Leukemia aimed at making several substantiated inferences. Among the most common research questions in many studies aimed at investigating the role of physicians in errors of prescription. Some studies went further to assess the factors in clinical settings that lead to prescription errors. The research was specific at identifying the impact of how errors made an impact on the overall treatment of Leukemia. Summary of the Sample Populations Used Studies used to identify prescription errors in leukemia patients used different samples. Among the most common samples used were obtained through medical records obtained from various health facilities. Some studies were used as a method contrary to having a fixed sample size. These studies analyzed prescriptions offered to patients over some time. This way, the sample population varied with time. However, the overall sample population was determined at the end of the research. Moreover, some research papers used random sampling techniques where sample populations were collected without following a particular order. However, studies that used specific sample populations used samples of about 100 to 300 children. In all the studies, due processes of obtaining consent from sample populations were carried out. With the sample sizes uses, the data from the researches is deemed sufficient to provide reliable results. Summary of Limitation of Studies Researches investigating prescription errors indicated several limitations. The field of prescription of drugs is broad, and therefore, researchers aimed at reducing the scope to a manageable range. Access to resources of research was among the most common limitation cited by many studies. Considering the sensitivity of private data, many researchers indicated to have been denied access to sensitive information of patients. Besides, some researchers cited rebellion by physicians to the approaches of research. Many physicians felt that the study would be detrimental to them. Physicians indicated that the results of the research would put their jobs on the line. These limitations are cited by researchers to be the greatest hindrance to efficient data collection. Summary of the conclusion and recommendations for further research Findings of research were observed to be helpful as they provided reviews of the data collected through research. All studies provided outcomes. These conclusions provided the researchers’ opinions about the survey. Besides, findings gave a brief indication of the success of research carried out. From the results, researchers drew recommendations of the study. The recommendations made revolved around the alternate opinions that the researchers thought would have helped in promoting further research. As observed from the recommendations made, it was evident that researchers aimed to support new research by using the concluded inquiries as a base. Dispensation of drugs Summary of research questions Virtually all the studies reviewed incorporated used research questions to guide their researches. In the allocation of drugs, there were consistent patterns observed for research questions. A fair share of researches made inquiries on the role of the patient or the accompanying caregiver in ensuring the correct dispensation of drugs. Another percentage of research question aimed at investigating the methods of dispensing drugs that were more prone to errors. Other research papers talked about different topics in drug dispensation, such as the role of technology in distributing medicine. Other research papers sought to identify the relationship between dispensing errors and prescription errors. These research questions guided the direction of research. The inquiries of research questions were reflected in the entire process of research. Summary of the Sample Populations Used The studies within which this research inquired had sample populations of research. The target population of research for these studies was pediatric patients who have Leukemia. However, the target population was not entirely accessible. Different studies used different sample sizes. The difference in sample sizes can be attributed to the research constraints, such as the location of study that affect the accessibility of samples. However, most of the reviewed articles used sample sizes of between one hundred and five hundred the general scenario of the topic of research. This sample size is deemed sufficient. From the analysis of the descriptive studies, it is observed that most research articles used ethical considerations of research. The consent of children used in the study was obtained from their parents. Permission was obtained from various health facilities covered in the study. Summary of Limitation of Studies Studies in this research indicated various limitations of research. Limitations of the research are the hindrances that researchers encountered in the course of their research. The most common shortcomings of research are the inaccessibility of materials. Identifying errors of drug dispensation lie on the records in place. Researchers indicated that some health facilities denied them access to records of drug dispensation. Some stated that they were allowed to access the files of research but were not given access to patient’s records. This denial made it difficult for them to match singles with individual patients. Besides, a fair share of parents of children who have Leukemia did not have the documentation of drugs prescribed at the hospital. This phenomenon made it difficult for researchers to collect data from either the parents or the health facilities. This aspect exemplifies the impact of the inaccessibility of research materials on research. Summary of the conclusion and recommendations for further research A majority of the studies analyzed provided outcomes to their findings. Conclusions from results indicated that there is a strong relationship between dispensation errors and prescription errors. A significant proportion of errors are attributed to prescription errors. Besides, the inference drawn from research indicates that dispensation errors have adverse effects on pediatric patients who have Leukemia. However, a vast majority of studies make sentiments on the inaccessibility of data for research. The researchers recommend that regulations are put in place to support research. Upon identification that dispensation errors have negative impacts on the outcomes and health conditions for pediatric patients, researchers recommend more research is done on methods of alleviating dispensation errors. Administration of Drugs Summary of research questions The studies analyzed in this research uphold the use of research questions. In this regard, research questions explored explore various topics of drug administration for pediatric patients. A majority of studies focus on the role of parents on drug administration. Leukemic children are identified as a vulnerable group who cannot administer drugs on themselves. Therefore, parents play a critical role. A fair share of researches delves into checking the role of physicians in educating parents on the administration of drugs on leukemic children. Previous inferences of research motivate these research questions that it is the fundamental role of physicians to inform patients and families on patient care and patient families. These research questions help drive the objectives and keep the researcher focused on the goal of research. The majority of research questions fulfilled their purpose in their respective studies. Summary of the Sample Populations Used According to the majority of studies reviewed, the target population of the research was pediatric children under the age of five who were suffering from Leukemia. However, several inquiries targeted adults. Inquiries that focused on adults aimed at identifying the influence of drug administration had on adults who had survived Leukemia during childhood. However, the target population could not be covered through researches, and therefore, an accessible population had to be assessed. It is paramount to note that the bigger the accessible population is concerning the target population, the better the outcomes of the research. Most researches used about fifty to two hundred. This sample was deemed sufficient in consideration of the prevalence of pediatric Leukemia. Summary of Limitation of Studies The various studies assessed indicated to have limitations in accessing data for research. Among the limitations noted circled the accessibility of homes with leukemic patients. Most researchers reported that leukemia patients live far part and from each other, and therefore, it was hard to cover a significant sample population. Some researchers showed problems with language barriers. Some parents were not fluent in the English language, which was commonly used by many researchers. Some researchers suggested that some resource persons could not converse in English at all. These limitations had an overall effect on the collection of data. Summary of the conclusion and recommendations for further research Conclusions drawn from the study indicated that there were many cases of drug administration errors. Administrative errors were attributed to poor family advises by the doctors. Besides, there were many cases of physicians’ recklessness in their job that caused a fair share of drug errors. In many conclusions, many connections between prescription, the dispensation of drugs as well as the administration of medications. Researchers go further to recommend solutions. Many researchers indicate that patient and family education could effectively reduce the administration of drug errors. Besides, most findings suggest further research should be done for sufficient causes of actions to be taken. Peer reviewed Journals Popular Trade Online libraries Government resources and reports Examples International Journal of Cancer Research and Prevention Journal of psychosocial oncology Nursing professional materials Nursing scholarly materials Various options Not recommended Audience Scholars General public Practitioners Professional in the industry Various options General Public Content Empirical research Critical analysis of pediatric leukemia Limited book reviews Common news on pediatric leukemia Nursing related content. Various options Laws, regulations and professional ethics Format Scholarly Journal With plain appearance Articles, graphs and data. Academic vocabulary General language suitable for general audience. General scholarly language Journal format General industry- specific language Language level may vary from publication to another. PDF formats Html formats Information compile for consumption of general consumption. Various reporting formats in print. 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(2018). Effectiveness of antibacterial prophylaxis during induction chemotherapy in children with acute lymphoblastic leukemia. Pediatric blood & cancer, 65(5), e26952. Taverna, L., Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2016). Adaptive functioning of preschooler children with leukemia post one year of therapies compared with sane peers. Br. J. Educ. Soc. Behav. Sci, 18, 1-15. Taverna, L., Tremolada, M., Bonichini, S., Tosetto, B., Basso, G., Messina, C., & Pillon, M. (2017). Motor skill delays in pre-school children with leukemia one year after treatment: Hematopoietic stem cell transplantation therapy as a significant risk factor. PloS one, 12(10), e0186787. Taylor, J. A., Winter, L., Geyer, L. J., & Hawkins, D. S. (2016). Oral outpatient chemotherapy medication errors in children with acute lymphoblastic leukemia. Cancer, 107(6), 1400-1406. Toft, N., Bergen, H., Abrahamsson, J., Griškevičius, L., Hallböök, H., Heyman, M., … & Quist-Paulsen, P. (2018). Results of NOPHO ALL2008 treatment for patients aged 1–45 years with acute lymphoblastic leukemia. Leukemia, 32(3), 606. Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2015). Coping with pain in children with leukemia. International Journal of Cancer Research and Prevention, 8(4), 451. Tremolada, M., Bonichini, S., Basso, G., & Pillon, M. (2016). Post-traumatic stress in parents of children with leukemia: Methodological and clinical considerations. Comprehensive Guide to Post-Traumatic Stress Disorders, 579-597. Wang, Y., Liu, Q., Yu, J. N., Wang, H. X., Gao, L. L., Dai, Y. L., … & Mu, G. X. (2017). Perceptions of parents and pediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukemia: a qualitative study in China. BMJ Open, 7(9), e015727. Whitlow, P. G., Saboda, K., Roe, D. J., Bazzell, S., & Wilson, C. (2015). Topical analgesia treats pain and decreases propofol use during lumbar punctures in a randomized pediatric leukemia trial. Pediatric blood & cancer, 62(1), 85-90. Yeh, T. C., Liu, H. C., Hou, J. Y., Chen, K. H., Huang, T. H., Chang, C. Y., & Liang, D. C. (2014). Severe infections in children with acute leukemia undergoing intensive chemotherapy can successfully be prevented by ciprofloxacin, voriconazole, or micafungin prophylaxis. Cancer, 120(8), 1255-1262. Zannini, L., Cattaneo, C., Jankovic, M., & Masera, G. (2014). Surviving childhood Leukemia in a Latin culture: An explorative study based on young adults’ written narratives. Journal of psychosocial oncology, 32(5), 576-601. Zhang, F. F., Rodday, A. M., Kelly, M. J., Must, A., MacPherson, C., Roberts, S. B., … & Parsons, S. K. (2014). Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL). Pediatric blood & cancer, 61(7), 1263-1269.
Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesi
Research Article Chart Criteria and Defining Characteristics Article 1: Article 2: Article 3: Abstract After reading the abstract what do you expect to learn from the article? Introduction: Summarize the following in paragraph form. What is the purpose of the study? What is the scope of the study? What is the rational for the study? What is the hypothesis or research question? What key concepts and terms are noted? Is a review of the literature provided? Methods: Summarize the following in paragraph form. What is the population being sampled? What data collection procedure is presented? What other procedures are described? Results: Summarize the following in paragraph form. What are the given findings? How was data collected? Are the findings supported by graphs and charts? What does the analysis of data state? Conclusion: Summarize in paragraph form. What is the summary of the study? What is the conclusion of the hypothesis? What are the questions for future research? References What are the total number of references used in the study? List two of the references used. © 2014. Grand Canyon University. All Rights Reserved.
Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesi
80 The Direct Practice Improvement Project Title Appears in Title Case and Is Centered Submitted by Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Equal Spacing ~2.0” – 2.5” Direct Practice Improvement Project Proposal Doctor of Nursing Practice Equal Spacing ~2.0” – 2.5” Grand Canyon University Phoenix, Arizona [Insert Current Date] GRAND CANYON UNIVERSITY The Manuscript Title Appears in Title Case and Is Centered by Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Proposed [Insert Current Date] DPI PROJECT COMMITTEE: Full Legal Name, EdD, DBA, or PhD, Manuscript Chair Full Legal Name, EdD, DBA, or PhD, Committee Member Full Legal Name, EdD, DBA, or PhD, Committee Member Abstract Rationale/Background: Provide one to two statements describing the nature of the project topic and introducing the problem. Purpose: State the purpose of the project. Please make sure your purpose statement is the same throughout the manuscript. Theoretical Framework: Include approximately one to two statements summarizing the theoretical framework. Project Method and Design: Include approximately two to four statements summarizing the methodology and design. Data Results: Identify the population and the sample size. Briefly describe the approach for data analysis and results of statistical tests. State whether the results were statistically significant and include numeric values. Implications: Conclude the abstract with one to two statements describing how the results of your project directly impacted practice at your site, and recommendations for what should be done in the future based on the findings of the project. Keywords: Abstract, assist future investigators, 150 to 250 words, vital information Table of Contents Problem Statement 10 Purpose of the Project 12 Advancing Scientific Knowledge 16 Significance of the Project 17 Rationale for Methodology 19 Nature of the Project Design 21 Definition of Terms 22 Assumptions, Limitations, Delimitations 26 Summary and Organization of the Remainder of the Project 29 Theoretical Foundations 34 Review of the Literature 36 Summary 43 Chapter 3: Methodology 47 Statement of the Problem 48 Clinical Question 49 Project Methodology 52 Project Design 54 Population and Sample Selection 56 Instrumentation or Sources of Data 59 Validity 60 Reliability 61 Data Collection Procedures 62 Data Analysis Procedures 64 Potential Bias and Mitigation 67 Ethical Considerations 71 Limitations 73 Summary 74 References 76 Appendix A 78 Appendix B 81 Appendix C 85 Chapter 1 : Introduction to the Project 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. (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. 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 Thinking stormTM (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: 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 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 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). 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. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 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) 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) impacts __________________ (what) when compared to _____________ among _____________ (population) patients in a ______ (setting) in _______ (state) over four-weeks? Then, include a leading phrase to introduce the questions such as: The following clinical questions guide this quantitative project: Q1: Q2: Q3: Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 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. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 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 Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) 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. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 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. Criterion Learner Score (0, 1, 2, or 3) Chairperson Score (0, 1, 2, or 3) Comments or Feedback 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. 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: 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. 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: Lack of funding limited the scope of this project. Provide an explanation to support this limitation. 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 research 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 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 citations. Present strong evidence for the intervention. Background: Discusses how the problem has evolved historically into its current form. Criterion 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 theories or 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 theory or model. The seminal source for each theory or 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 includes a discussion of how the clinical question(s) align with the respective theories or models and illustrates how the project fits within other evidence based on the theories or models. 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 theories or models 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 and describes the theories or models to be used as 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 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. 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 articles, a limited number of practice improvement projects, peer-reviewed or scholarly journal articles, and books that are cutting-edge views on a topic, evidence-based research, or seminal works. The 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 . You may want to organize this section by themes and subthemes. To do so, use the pattern below. Subtheme 1 . Grouped findings related to Theme 1. Project 1. Describe the clinical question(s), sample, methodology, and findings of this project. Project 2. Describe the clinical question(s), sample, methodology, and findings of this project. Project 3. Describe the clinical question(s), sample, methodology, and findings of this project. In a concluding paragraph, provide a synthesis of the evidence studies presented in Subtheme 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 subtheme. Subtheme 2. Grouped findings related to Theme 1. Project 1 . Describe the Clinical question[s], sample, methodology, findings Project 2. Describe the clinical question[s], sample, methodology, findings) Project 3. Describe the clinical question[s], sample, methodology, findings Provide a synthesis of the evidence in the subtheme as suggested above. Continue repeating this pattern with other evidence findings that fit with Theme 1 and then provide an overall synthesis of the evidence for Theme 1. Repeat this pattern for the next major theme in your literature review and continue repeating as needed. Theme 2. 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 articles, a limited number of practice improvement projects, peer-reviewed or scholarly journal articles, and books that present cutting-edge views on a topic, evidence-based, or seminal works. 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: 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 . 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 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: Q3: 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 Variable Variable Type Level of Measurement Project Groups (Pre-Intervention & Post Intervention) Independent Nominal Rates or events Dependent Nominal Socio-economic status or categories in order Dependent Ordinal Time, Temperature Dependent Interval Age, height, Scores of tests Dependent Ratio Note: Add notes here = (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 . 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. 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 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 an 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 (Creswell & Creswell, 2018) The independent variable within a quasi-experimental design will be most 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 (Creswell & Creswell, 2018) 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). 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 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. 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, site authorization letter(s), 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. 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). References American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author. 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. 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.  doi:  10.1016/j.bjpt.2018.02.001 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 APA (6th ed.). 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 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 Your Ten Strategic Points table will be Appendix A for the proposal. Possible Appendices Include a copy of your instruments/tools. Include a copy of the permission to use the tools. Include your site authorization letter (proposal only). Include any project materials. 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 Appendix C Enter the Title here