DNP-806 PROGRAM DEV. IMPLEM & EVALUATION

The evaluation of a research project is a crucial component of its evaluation. Program assessment determines the total value of the research and rates it in order to get feedback and enhance the program (CDC, 2012). This essay’s goal is to offer a framework for analyzing and evaluating the doctoral nursing research project. The Administration and Directors of Nursing will be the main subjects of the DNP study project. The research issue is: For new residents with cognitive impairment living in communities like Assisted Living and Supported Living Facilities (P), does having mental health risk assessment screening and implementation of clinical guidelines within 30 days of move-in and regularly every three months for possible adjustment-related disorders related to depression, anxiety, disturbance of conduct, or mixed symptoms (I) compare to not having any risk assessments and implementation of guidelines compared to not having any risk assessments and implementation of guidelines? The author of this program assessment paper will also go into evaluation techniques, budgetary issues, data collection, data analysis, and project goals.

The evaluation model

Although this research project may benefit from applying a number of notable assessment models, each model may have unique advantages and disadvantages that are inappropriate for the intended purpose. The technique, philosophy, data collection, analysis, program interpretation, and applicability of various assessment models differ. Hence, it is crucial to comprehend that a suitable model of assessment is chosen in order to ensure that it fully applies to the research project’s questions. Therefore, it is essential to choose the right methodology for disseminating research results to its research stakeholders (Boulmetis & Dutwin, 2011).

First off, the discrepancy model is an assessment model that places a focus on process activities. Because it has an internal focus, it does not require the added expense of an external evaluator. However, it has a drawback in that using the internal evaluation model may lead to questions about bias (Hill & Hill, 1983). Second, because there are no clear foci and the evaluator is kept in the dark, the goal-free paradigm might be difficult to implement.

Finally, R.M. Rippey’s original transaction model mixes active participants who continuously provide feedback with evaluators who use a variety of observational and interview interventions. Fourth, the goal-based model of evaluation measures the extent to which the outcome is met using qualitative or quantitative approaches (Boulmetis & Dutwin, 2011). Last but not least, the decision-making model emphasizes interventions about the goal of the study project for potential future improvement.

The goal of the DNP research project is to improve mental health management, avoid disease exacerbation, and implement the clinical protocol in aided and supported living facilities. Thus, it is crucial to select the right evaluation model to ensure improvement in clinical practice and outcomes. Based on the findings, the goal of this research project will be evaluated, and the effectiveness of therapeutic, preventive interventions in clients who have a higher risk of going untreated for mental health disorders will be revealed.

There are a number of reasons why a particular assessment model might not be useful for the author’s research project, which could impede efficacy and fail to produce the desired results. The discrepancy model would not operate due to its only focus on identifying a comparison of performance to existing norms. Although the goal-free model’s evaluator’s actions are the evaluation, their absence of predetermined aims and objectives prevents them from being helpful to the author’s research. The transaction model’s emphasis on back-and-forth communication between the evaluator and the target population, which lacks openness and important data, would not also be helpful for this study endeavor. The goal-based methodology may be effective in implementing regulations within predetermined time frames, but the goals do not align with the study project’s focus on applicability and the possible impact of established clinical standards.

Using a decision-making model is the most suitable and acceptable approach to evaluation for research projects. This specific model evaluates and makes use of the data or information acquired to enhance the project’s potential future applicability. In order to avoid older clients living in assisted and supported living facilities from having their mental health concerns go untreated and unmanaged, the aim of this research study is to assess the applicability and prospective outcomes of applied clinical recommendations. The provision of preventative mental healthcare to extremely vulnerable clients who are unable to voice their needs will lower hospitalization rates and enhance compliance with treatment if this initiative is evaluated using a decision-making model.

Goals for Evaluation

For the research study to have a positive clinical outcome, applicability, and community influence, it is crucial to identify and assess multiple objectives. Few clinical pathways, research, or evidence, have been applied to older clients residing in assisted and supported living institutions. According to federal regulations, nursing homes must be examined at least once every 15 months; however, the inspection period for assisted living facilities can be up to five years from the date of the previous examination (ProPublica, 2013). The professional practice environment has eight qualities that can be understood as development and evaluation. These eight traits include practice management and autonomy, connections between staff and doctors, practice control, patient communication, teamwork, resolving disagreement and conflict, internal work motivation, and cultural sensitivity (Erickson et al., 2009). As a result, the research article will use and implement these eight features.

Financial Dimension

Another crucial component of a research proposal to stakeholders is the evaluation of the financial aspects of the project in order to determine its viability and its potential constraints. Stakeholders are those having a stake in the evaluation as such, will be engaged in financial or non-financial constraints or gains from the research. Early implementation of evaluation strategies will guarantee that program personnel and stakeholders can carry out the evaluation in a practical and financially sustainable manner (Martin, 2015).

According to studies, 8.9 million unpaid informal carers (Alzheimer’s Association and National Alliance for Caregiving, 2004) support people with dementia who are 50 or older. Moreover, psychological and mental health issues, in particular depression and schizophrenia, are linked to increased risks of developing dementia in old age (Onyike, 2016). Hence, to reduce the cost of potential hospitalization and additional costs in care, multidisciplinary healthcare efforts and preventative risk-assessment methods must be in place in a community setting to care for clients with cognitively impaired mental health disorders. With regard to adjustment disorder with depression, anxiety, mood, and conduct disorder—which is frequently ignored during the transition phase to a new facility—the author’s study endeavor may offer additional evidence for the implementation of clinical paths and guidelines.

Residents with a diagnosis of depression experienced greater hospitalizations, according to three studies that looked at resident characteristics and admissions (Becker et al., 2012). In assisted living and supported living homes, this is important because facilities are only compensated based on how many days a client stays each month. Hence, the organization loses money every day the client is not using the service. The price of a hospital stay for a resident influences insurance costs, the assets of the client, and the ability of the client’s family to pay for the patient’s care in a direct and indirect manner.

Assessment Tools

For this study effort, using the standardized clinical tool is crucial.

A number of mental health tools that are crucial in particular parts of the clinical guidelines will be used by the author in addition to the clinical guidelines/pathways that will be the major steps in this research. Everyone should receive screenings, including children and the elderly (Substance Abuse and Mental Health Services Administration, n.d.). In order to provide early intervention for clients in the field of mental health, routine screenings are crucial, especially for the elderly, a group that is particularly vulnerable.

The research effort will use the Montreal Cognitive Assessment (MoCA) test. When assessing for cognitive impairment, MoCA is a superior tool for early identification and more accurate than other cognitive tests like the MMSE (Nasreddine et al., 2005). The Geriatric Depression Scale (GDS) will also be used to monitor present depression risk and potential treatments. Another mental health disorder that is prevalent in the elderly and is linked to poor outcomes and low quality of life is anxiety (Seignourel, 2009). A 20-item questionnaire called the Geriatric Anxiety Inventory (GAI) is a measure that has proven to be quite useful for identifying anxiety in senior people. As the research project is developed, further evaluation instruments will be added as needed, taking predicted costs and benefits into account.

Data

The first step in gathering data for this project is identifying the client as a recently relocated member of the neighborhood and inhabitants who have lived there for a significant amount of time and has willingly accepted and approved to participate in the research project. In order to execute clinical guidelines, complete appropriate evaluation tools, and make additional referrals to resources as needed, the nurse manager and nursing staff will give and follow protocol. After that, the data will be checked for accuracy and completeness. A rolling quarterly report analysis will be done using clinical guidelines and pathways.

Data will be gathered every three months so that administrators and nursing staff can review the results, constraints, and overall outcomes. For comparative analysis, the collected data will be examined and compared to national and state norms. A decision-making model of evaluation for future applicability and application of the program for clinical improvement processes in vulnerable clients is made possible by utilizing data and outcomes from the study project.

Practices Based on Evidence

A lack of published evidence-based research on the subject of closely monitoring clients with cognitive impairment for possible deterioration of mental health disorders and management. Based on the data gathered, the proposed study might offer a more evidence-based approach with better results. Due to a lack of procedures to gather reportable data, evidence reveals that 26 out of 48 state Medicaid agencies were unable to tally the number of serious occurrences in assisted living, including physical, emotional, and sexual abuse (Schoch, 2019). The evaluation and treatment of young and adult populations with regard to mental health should be identical. Accordingly, the aim of this research project is for the author to offer evidence-based clinical practice recommendations that can help nursing communities prevent and early identify elderly clients for potential mental health conditions that may otherwise go unnoticed without any clinical intervention.

Conclusion

The evaluation of the research project is a crucial part of any project proposal for stakeholders and financial sustainability, as this article concludes. To determine goals and potential restrictions, evaluate the research project overall, determine its viability, and determine its feasibility. Using the right assessment model will give you a laser-like focus, the ability to clearly identify your objectives, and the capacity to use the results. The decision-making model is the framework that will function best for this DNP research project when reviewing data for process improvement and applicability in its future application.

References

Alzheimer’s Association and National Alliance for Caregiving. Families care: Alzheimer’s caregiving in the United States 2004. Washington, DC: Author, 2004

Becker, M., Boaz, T., Andel, R., & DeMuth, A. (2012). Predictors of avoidable hospitalizations among assisted living residents. Retrieved April 19, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/21450253

Boulmetis, J., & Dutwin, P. (2011). The ABCs of evaluation: Timeless techniques for program and project managers (3rd ed.). Retrieved from https://ebrary.net/8291/management/choosing_evaluation_model#443

Erickson, J. I., Duffy, M. E., Ditomassi, M., & Jones, D. (2009, May). Psychometric evaluation of the revised professional practice environment (RPPE) scale. The Journal of Nursing Administration, 39(5), 236-243.

Hill, E. W., & Hill, M.-M. (1983). The use of the Discrepancy Evaluation Model in evaluating educational programs for visually handicapped persons. Education of the Visually Handicapped, 15(1), 2–11.

Martin, A. B. (2015). Plan for Program Evaluation from the Start. Retrieved April 19, 2020, from https://nij.ojp.gov/topics/articles/plan-program-evaluation-start

Nasreddine Z.S, Phillips N.A, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JLC, Chertkow H. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc 53:695–699, 2005

Onyike C. U. (2016). Psychiatric Aspects of Dementia. Continuum (Minneapolis, Minn.), 22(2 Dementia), 600–614. https://doi.org/10.1212/CON.0000000000000302

ProPublica. (2013). Elderly, At Risk, and Haphazardly Protected. Retrieved April 19, 2020, from https://www.propublica.org/article/elderly-at-risk-and-haphazardly-protected

Schoch, D. (2019). Protections Against Abuse in Assisted Living Are Lacking. Retrieved April 19, 2020, from https://www.aarp.org/caregiving/financial-legal/info-2019/assisted-living-elder-abuse-protections.html

Seignourel, P. J., Kunik, M. E., Snow, L., Wilson, N., & Stanley, M. (2008). Anxiety in dementia: a critical review. Clinical psychology review, 28(7), 1071–1082. https://doi.org/10.1016/j.cpr.2008.02.008

Substance Abuse and Mental Health Services Administration. (n.d.). Screening Tools. Retrieved April 19, 2020, from https://www.integration.samhsa.gov/clinical-practice/screening-tools

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Differentiate between quality improvement projects and quality improvement research. How can you use quality improvement in your scholarly project. My project is based on the PICOT question below. Please table this response based on the PICOT.

Please use ONLY the articles attached and NO other resources. Please make sure that you provide in-text citation for all the references.

I need this in 600 words with references and in-text citations.

PICOT

Among patients requiring health care visits (P), how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)? The target population is home-based patients. The independent variable is the Ask Suicide Screening Question toolkit, while the dependent variables are self-harm behavior and suicide within 3 months of the visit.

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