DNP-806 PROGRAM DEV. IMPLEM & EVALUATION
Evaluation is an essential aspect of assessing a research project. Program evaluation assesses and provides the overall value of the research to obtain feedback and to improve its program (CDC, 2012). The purpose of this paper is to provide a framework that evaluates and assess the doctorate of nursing research project. The DNP research project will focus on the Administration and Directors of Nursing. The research problem is: For new residents with cognitive impairment living in communities such as 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 routinely every 3-months for possible adjustment related disorders related to depression, anxiety, disturbance of conduct, or mixed symptoms (I) compared to not having any risk assessments and implemented clinical pathways (C) decrease the likelihood of having unidentified or untreated adjustment disorders (O) within six months after moving into new community. In this program evaluation paper, the author will also be discussing evaluation tools, financial considerations, data collections, data analysis, and objectives of the project.
Model for Evaluation
Although there are several distinguished models for evaluation that might apply to this research project, the models may have specific pros and cons in each model that may not be appropriate to the target goal. Different models for evaluations varies in its methodology, philosophy, data collection, analysis and program interpretation, and applicability. Therefore, it is essential to understand that an appropriate model of evaluation is chosen to make sure that it thoroughly applies to answer research project. Thus, it is crucial to identify the appropriate model for dissemination of the outcome of research to its research stakeholders (Boulmetis & Dutwin, 2011).
First, the discrepancy model is an evaluation model that emphasizes process activities, which is an internal focus evaluation model, therefore not needing additional cost of having an external evaluator. However, it has its downside, which is the possibility of questioning biased when utilizing the internal evaluation model (Hill & Hill, 1983). Second, the goal-free model can be a challenging model to follow due to its no specific foci and withheld from the evaluator.
Third, the transaction model initially proposed by R.M. Rippey combines active participants providing constant feedback with evaluators utilizing a variety of observational and interview interventions. Fourth, the goal-based model of evaluation uses qualitative or quantitative methods to measure the degree of the outcome being met (Boulmetis & Dutwin, 2011). Lastly, the decision-making model focuses on interventions about the purpose of the research project for potential improvement in the future.
The DNP research project’s focus is to implement the clinical protocol in assisted and supported living facilities, improves mental health management, and prevents exacerbation of the disease. Therefore, choosing the appropriate evaluation model is essential to make sure improvement in clinical practice and outcome. Evaluating the purpose of this research project based on the outcome will provide the efficacy of clinical preventive measures in clients with increase risks of untreated mental health conditions.
There are several reasons why a specific evaluation model may not work towards the author’s research project, which could hinder effectiveness and not meeting target outcomes. The discrepancy model would not work due to its sole focus on identifying comparison on performance to current standards. Although the goal-free model evaluator’s conduct is the evaluation; however, it does not become beneficial to the author’s research due to its lack of predetermined goals and objectives. The transaction model would not also be beneficial to this research project due to its focus on back and forth interaction between evaluator and target population, which lacks transparency and essential data. The goal-based model may work to a certain extent in the application of guidelines during set timelines; however, the goals do not correlate with the research project, which focuses on applicability and the potential effect of set clinical standards.
The most applicable and appropriate research project model of evaluation would be utilizing a decision-making model. This particular model assesses and utilizing data or information gathered to improve on the future applicability of the project. The goal of this research project is to evaluate the applicability and potential outcome of implemented clinical guidelines in preventing untreated and unmanaged mental health issues in elderly clients new and currently living in assisted and supported living facilities. Evaluating this project using a decision-making model will provide preventive mental healthcare very vulnerable clients unable to express their needs, decrease hospitalization rates, and improved compliance with care.
Objectives to Evaluate
Identifying and evaluating several objectives with the research project will be essential to determine the positive clinical outcome, applicability, and impact within the community. There has been little research, evidence, or clinical pathways being implemented in elderly clients that are living in assisted and supported living facilities. Under federal guidelines, nursing homes are to be inspected at least once every 15 months; however, assisted living communities inspection can be as long as five years from the last survey (ProPublica, 2013). To be able to conceptualized development and evaluation, there are eight characteristics of the professional practice environment. These eight characteristics include leadership and autonomy over the practice, staff relationships with physicians, control over practice, communication about patients, teamwork, handling disagreement and conflict, internal work motivation, and cultural sensitivity (Erickson et al., 2009). As such, these eight characteristics would apply and implemented throughout the research paper.
Evaluation of financial aspects within the project is another critical part of a research proposal to stakeholders to assess for sustainability and limitations of continued implementation. Stakeholders are individuals with a stake in the evaluation as such will be engaged in financial or non-financial limitations or gains from the research. Early identification of evaluation places in place will ensure that program evaluation is feasible and financially viable to program staff and stakeholders (Martin, 2015).
Studies have shown that 8.9 million informal caregivers provide care to someone aged 50+ with dementia (Alzheimer’s Association and National Alliance for Caregiving, 2004). Also, psychiatric and mental health disorders, particularly depression and schizophrenia, are associated with higher risks for late-life dementia (Onyike, 2016). Therefore, multidisciplinary healthcare efforts and preventive risk-assessment measures must be in place in a community setting to care for clients with cognitively impaired mental health issues to decrease the cost of potential hospitalization and added cost in care. The author’s research project may provide additional evidence implementing clinical pathways and guidelines to decrease the likelihood of unmanaged and untreated mental health issues, specifically adjustment disorder with depression, anxiety, mood, and conduct disorder that are often disregarded during the transition phase to a new facility.
Three studies that examined resident characteristics and hospitalizations found that residents with a diagnosis of depression had more hospitalizations (Becker et al., 2012). This is significant in assisted living and supported living communities since facilities are only paid on the number of days the client is staying each month. Therefore, any days the client is out of the facility are money lost to the organization. Concurrently, the cost of resident staying at an inpatient hospital, directly and indirectly, affects insurance cost, client’s assets, or financial capabilities for funding by families supporting care.
The application of the standardized clinical tool is essential for this research project.
Aside from the clinical guidelines/pathways that are going to be the main steps in this research, the author will be utilizing several mental health tools essential in specific points of the guidelines. Screenings should be provided to people of all ages, even the young and the elderly (Substance Abuse and Mental Health Services Administration, n.d.). Routine screenings are essential in mental health as a primary intervention to provide early intervention in clients, especially for a very vulnerable population – elderly.
Montreal Cognitive Assessment (MoCA) test will be implemented within the research project. MoCA is a better tool in early detection and more precise than other cognitive tests such as MMSE in assessment for cognitive impairment (Nasreddine et al., 2005). Geriatric Depression Scale (GDS) will also be utilized to capture current risk for exacerbation of depression and possible intervention. Anxiety is another mental health condition affecting the elderly population and associated with poor outcomes and quality of life (Seignourel, 2009). Geriatric Anxiety Inventory (GAI) is a tool that consists of a 20-items questionnaire that has demonstrated the most significant utility and screening for anxiety in elderly clients. Additional evaluation tools will be implemented as necessary during the development of the research project, which will include within projected cost and benefits.
Data collection for this project will begin with the client’s identification as being newly transitioned resident within the community and residents who have been living in the community for an extended period that has voluntarily agreed and consented to be part of the research project. The nursing manager and nursing staff will provide and follow protocol in implementing clinical guidelines, completing necessary assessment tool/s, and additional referrals to resources necessary. The data will then be analyzed for accuracy and completion. Clinical guidelines and pathways will be conducted on a rolling basis quarterly and provide report analysis.
Administrators and Nursing staff will gather data quarterly to discuss results, limitations, and overall outcomes. Collected data will be analyzed and compare to State and National standards for comparative analysis. Utilizing data and results from the research project allows the use of a decision-making model of evaluation for future applicability and use of the program for clinical improvement processes in vulnerable clients.
There has been a lack of published evidence-based literature discussing clients with cognitive impairment being closely monitored for potential exacerbation of mental health conditions and management. The proposed project could provide additional evidenced-based practice with improved outcomes based on data collected. Evidence suggests that GAO reports have found 26 out of 48 state Medicaid agencies were unable to count the number of severe incidents in assisted living, including physical, emotional, and sexual abuse due to lack of systems to collect reportable data (Schoch, 2019). Mental health assessment and management should be nothing different in assessing and treating young and adult populations. Thus, the purpose of this research project is for the author to provide evidence-based clinical practice guidelines that can assist nursing communities in preventing and early identification of elderly clients for possible mental health conditions that may otherwise overlook without any clinical intervention.
In the conclusion of this paper, the evaluation of the research project is an essential component of any project proposal for stakeholders and financial sustainability. Overall assessment and evaluation of the research project are essential to assess the feasibility and identify goals and possible limitations. Utilizing an appropriate model of evaluation will provide straight to the point focus and necessary identification of goal and applicability of outcome. For this DNP research project, the decision-making model is the framework that seems will better for evaluating data for improvement in process and applicability in its future use.
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.
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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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