INTRODUCING STATISTICS FOR THE DNP Identifying Nursing Problems and Defining Gaps

INTRODUCING STATISTICS FOR THE DNP Identifying Nursing Problems and Defining Gaps

In the nursing research study conducted by Emsden et al. (2020), the identified nursing problem is the lack of an effective pain assessment tool for heterogeneous intensive care unit (ICU) patients, especially those unable to communicate due to sedation, intubation, or altered consciousness. This problem illustrates a gap in knowledge, as current tools may not be valid or reliable for such diverse populations. The study sought to validate the Behavioral Pain Scale (BPS) to support more accurate and evidence-based assessments in critical care.

In contrast, the Doctor of Nursing Practice (DNP) quality improvement (QI) project by Hicks (2024) targeted the issue of central line-associated bloodstream infections (CLABSIs) in hospitalized patients. The nursing problem here stems from non-adherence to evidence-based maintenance protocols, a well-documented but inconsistently applied standard in clinical settings. This demonstrates a gap in practice, not in available evidence but in its implementation. Hicks (2024) addressed this through staff education and adherence monitoring, resulting in improved protocol compliance and reduced infection rates.

These problems—pain underassessment and CLABSI incidence—highlight different but complementary approaches to improving patient outcomes. The research study by Emsden et al. (2020) generates new knowledge to refine clinical tools, whereas the QI project by Hicks (2024) translates established knowledge into actionable practice changes. Similarly, Goldsack et al. (2015) addressed inpatient falls through structured hourly rounding, emphasizing how consistent, evidence-based interventions reduce adverse outcomes. Together, these examples underscore the dynamic interplay between research and practice in advancing nursing care.

Key Measurements and Variables

Each project utilized a primary variable aligned with its purpose and scope:

1. Emsden et al. (2020) measured pain scores using the Behavioral Pain Scale (BPS) to assess its validity and reliability.
    
2. Hicks (2024) tracked CLABSI rates as the main outcome variable to determine the effectiveness of educational and monitoring interventions.
    
3. Goldsack et al. (2015) used the number of patient falls before and after implementing hourly rounding as a key metric of patient safety and QI success.
4. The Johns Hopkins EBP model (Dang et al., 2021) emphasizes selection of clearly measurable outcome variables, such as reduction in medication errors, pressure injuries, or infection rates, depending on the problem under investigation.

These outcome variables provide measurable evidence of the interventions’ impact and are essential to demonstrating the effectiveness of nursing practice changes.

Critique of the Question Development Tool

The Johns Hopkins Question Development Tool (Dang et al., 2021) provides a structured method for identifying clinical problems, formulating practice questions using the PICO(T) format, and aligning them with relevant interventions and outcomes. For instance, Hicks (2024) likely applied a question such as:

In hospitalized patients with central lines (P), how does staff education and adherence monitoring (I), compared to standard practice (C), affect CLABSI rates (O) over three months (T)?

The tool’s strength lies in its clarity and ability to align evidence with actionable outcomes. However, it may overlook contextual variables such as organizational culture, workload pressures, and staff turnover that can influence the sustainability of practice change (Melnyk & Fineout-Overholt, 2019). Moreover, it is less applicable to traditional research designs like validation studies, as seen in Emsden et al. (2020), which do not test interventions but assess tool reliability and accuracy.

Nevertheless, the tool remains a foundational component in evidence-based practice (EBP) and quality improvement, ensuring that questions are rooted in real-world problems, guided by measurable outcomes, and shaped by interdisciplinary collaboration.

Scholarly Examples and External Evidence

1. Emsden et al. (2020) validated a tool for pain assessment in non-verbal ICU patients, thereby addressing a critical knowledge gap and contributing to safer, more accurate pain management practices.
    
2. Hicks (2024) led a DNP QI project to reduce CLABSIs, highlighting how structured education and process monitoring can bridge practice gaps and reduce preventable infections.
    
3. Goldsack et al. (2015) implemented structured hourly rounding to reduce inpatient falls, exemplifying how consistent, simple interventions can produce significant safety improvements.
    
4. Whitby et al. (2008) suppo