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Methodology and Project Design
Brandi J Parker
Jacksonville State University
FNP 797: FNP Residency I
Dr. Lori S. McGrath
November 5, 2023
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Methodology and Project Design
Moving toward evidence-based quality improvement projects and away from more
traditional research-based projects as part of DNP education demands an improvement approach
to engage students in the change (Durham et al., 2019). The methodology of the DNP project is a
guide that helps plan the DNP project (Bradshaw & Vitale, 2020). I plan to use the Plan-Do-
Study-Act (PDSA) model for the proposed DNP project. The Plan-Do-Study-Act (PDSA) cycle
is a commonly used improvement process in healthcare settings (Coury et al., 2017). The Plan-
Do-Study-Act (PDSA) method is a way to test a change that is implemented (Agency for
Healthcare Research and Quality [AHRQ], 2020).
First, the planning phase of the PDSA cycle includes identifying the population,
timeframe, and process in which the DNP project is implemented (AHRQ, 2020). During the
planning phase, the who, what, when, and where portions of the DNP project are identified
(Institute for Healthcare Improvement [IHI], 2023). Additionally, high-risk revocation patients,
patients with a prognosis of two weeks or fewer, and patients with a diagnosis of cancer will be
identified and tracked for comfort medication implementation. I will work to record and track
those who receive a comfort medication kit and those who do not receive a comfort medication
kit over an eight-week period. I will also work with the administration and QA teams to track
hospice revocations over eight weeks. Prior to the initiation of the proposed DNP project, it is
essential that I will complete staff education sessions. I will convey the importance of the DNP
project during the educational sessions; it is essential the team understands the purpose of the
project. Education is part of the planning process for the proposed DNP project.
Next, the “do” part of the PDSA cycle includes the actual implementation of the DNP
project and the carrying out of the interventions (IHI, 2023). DNP project-specific interventions
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include implementing comfort medication kits in hospice patients’ homes and tracking
revocations over an eight-week period. During this time, I will record patient data. The patient
data include active daily census reports, medication lists, care plans, advanced directive status,
and discharge reports. All data will be stored in the secure electronic health record (EHR)
system. “Do” includes running the test or intervention on a small scale, carrying out the test,
documenting problems, and unexpected outcomes, and collecting data (IHI, 2023).
Finally, the “study” step of the PDSA cycle includes analyzing the results and comparing
them to the predictions established during the planning process (IHI, 2023). I will work with the
administrator, clinical supervisors, and QA team to analyze and process the recorded data
collected during the eight-week time frame. We will analyze patients with comfort medication
kits and those without. We will compare those patients who revoked their benefits to those
patients who did not. We will observe if patients with comfort medication kits have reduced
revocation rates as compared to those patients who did not have comfort medication kits.
The “act” phase of the process is where a plan can be made for the next step in the
organization. We will plan for the future based on what we will learn from the project. Adapting
and making necessary modifications, adopting the project concepts, or deciding to abandon the
project is part of the act phase (IHI, 2023). Preparing a plan for the next PDSA cycle is done
during the “act” phase (IHI, 2023). If the results show that implementing comfort medication kits
reduces hospice revocation rates, we might implement a system to increase the overall quality of
life and reduce unnecessary hospice revocations. The QA team will continue to analyze record
data in an ongoing performance improvement project (PIP) using the PDSA cycle.
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References
Agency for Healthcare Research and Quality(AHRQ). (2020). Plan-Do-Study-Act (PDSA)
Directions and Examples. Agency for Healthcare Research and Quality.
https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html
Bradshaw, M., & Vitale, T. (2020). The DNP Project WorkbookA Step-by-Step Process for
Success (1st ed.). Springer Publishing. https://doi.org/10.1891/9780826174338
Coury, J., Schneider1, J., Rivelli, J., Petrik, A., Seibel, E., D’Agostini, B., Taplin, S., Green, B.,
& Coronado, D. (2017). Applying the Plan-Do-Study-Act (PDSA) approach to a large
pragmatic study involving safety net clinics. BMC Health Services Research, 17(411), 1–
10. https://doi.org/10.1186/s12913-017-2364-3
Durham, M., Yingling, C., & Hershberger, P. E. (2019). Accelerating improvement of a doctor
of nursing practice project proposal course using quality improvement methods. Journal
of Nursing Education, 58(5), 306–311. https://doi.org/10.3928/01484834-20190422-11
Institute for Healthcare Improvement (IHI). (2023). QI Essentials Toolkit: PDSA Worksheet.
https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx?
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