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This is Amy. I have been working on a project to help improve the state of sex education in our country. I think a great use of the tools we have been learning to use would be to track students understanding of the word consent at different ages by region and use that data to determine what areas of our country have done a better job teaching the concept and what areas are lacking. My project uses PhotoVoice, a tool originally developed for and used in research, to help students connect more deeply, thoughtfully, and with lower likelihood of bias or judgement when learning about sex and sexuality. Recognizing where the gaps in understanding are helps us to see where making changes might make the biggest difference, or even just give us a place to start.
I know that this doesn't necessarily apply to improving quality in a practice setting, but I feel that improving the quality of education for our patients regarding topics that apply to their physical health and understanding of their own bodies is a key element in improving healthy outcomes for communities everywhere.
Maybe eventually I can get to a place where I can use PhotoVoice as a teaching tool for providers about consent. We poke, prod, and peer at our patients bodies every day, and I would guess that many of us don't stop to gain consent before jumping in. Most of us make the assumption that if they are there to see us, they must be okay with whatever I need to do. It may seem like a minor thing in settings where we are looking in ears and checking throats all day for URI's (I believe that consent is still a thing in these settings), but in settings where new or expecting moms are having their vulvas, vaginas, and cervix's handled no differently than an ear or throat, consent is something that should be continually obtained and respected. It should never be assumed.

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Greg: Engaging Pediatricians to participate in my research

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Greg: Engaging Pediatricians to participate in my research

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Brief overview of my DNP Project: I'm seeking to establish a screening tool for sibling violence and aggression in pediatric primary care. A good part of my project has been engaging productively with pediatricians and pediatric clinics, asking them to review the screening questions, provide feedback, and pilot the questions in practice.

Reading creative confidence has given me a language and style with which to interact with these pediatric providers that are essential to my project. Months ago, I started approaching pediatricians and attempted to convince them to participate - I quickly hit roadblocks as providers (understandably) are very protective of their time. I found participation in my project increase as I stopped trying to convince providers and started presenting some background information on sibling violence and simply asking "why don't we screen for the most common type of household violence?" Creative Confidence discusses this in chapter 3: "Spark" by starting with asking "why" to accelerate interest, insight, and learning. This helped reframe the project for the provider, and I have to do a lot less convincing to participate in a 15 minute survey.

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As Jeff mentioned, he and I are focusing our DNP project on strategies to improve retention amongst inpatient psych RNs. While reading Creative Confidence, I've been really interested in what they have to say about empathizing with end users, and really focusing on making sure you understand the problem from the perspective of those it affects the most. For our project, if we want to understand why nurses aren't staying in their jobs on psych units, it's best to speak directly to the nurses and get their perspective. Jeff and I recently held focus groups for inpatient RNs to hear both what concerns them about inpatient work, as well as why they enjoy it. Both of us have experience working in inpatient psych, so we understand and empathize with a lot of the issues, but there were also parts that surprised me. A lot of the nurses brought up the concern of continuing education and trainings, which I would not have assumed was a big concern for most. Now it's becoming one of the focal points of our project. Without holding the focus groups and hearing directly from those who are affected, we might have missed such an important piece.

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Anne here. One of the stories from Creative Confidence that appealed to me was the quality vs. quantity pottery professor... the idea of simply throwing as many ideas out there to see which ones might stick, knowing some of them might be silly but not holding back for fear of judgment. Naturally, the 'quantity group' came up with a better finished product. I am not sure exactly sure what my plan is, but the idea I brought up on this week's discussion board, about an app for Image Rehearsal Therapy, is one that I may end up running with. I found out there is only one app currently out there, and it's a Dept of Defense app. For many reasons, this won't appeal to a large number of people who would benefit from its use. I like that there is one out there, so I can evaluate what I think works and doesn't, but I am also excited about the prospect of thinking through my own app and possibly trying to find out how to develop it. 

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Anne here. One of the stories from Creative Confidence that appealed to me was the quality vs. quantity pottery professor... the idea of simply throwing as many ideas out there to see which ones might stick, knowing some of them might be silly but not holding back for fear of judgment. Naturally, the 'quantity group' came up with a better finished product. I am not sure exactly sure what my plan is, but the idea I brought up on this week's discussion board, about an app for Image Rehearsal Therapy, is one that I may end up running with. I found out there is only one app currently out there, and it's a Dept of Defense app. For many reasons, this won't appeal to a large number of people who would benefit from its use. I like that there is one out there, so I can evaluate what I think works and doesn't, but I am also excited about the prospect of thinking through my own app and possibly trying to find out how to develop it. 

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My original DNP project was focused on Compassion fatigue and burn out in ICU nurses.  I have been working with the Compassion Team at Providence for over a year looking to replicate some work they did in the ambulatory setting to enhance compassion satisfaction and resilience to the ICU setting.  I completed my initial writing work in Critical Inquiry 2 last spring and was ready to tackle the IRB when the entire project was put on hold by Prov.  Even before that happened the Compassion Team was experiencing barriers in engaging the ICU's to participate in the proposed project.
The chapter, "Spark From Blank Page to Insight" immediately caught my attention as I was reading the book.  While recognizing that all of my work on compassion, compassion fatigue and burnout didn't necessarily have to be for nought, thinking of a different way to use the work I had done to a different end was a bit daunting.  I didn't have a true blank page, but definitely need a spark.

Reframing the challenge has provided some new inspiration.  Why were we less successful than expected in engaging the units to participate?  What is the real issue? How might we bypass resistance? Recognizing that I still have time to reframe the work that I want to do was helpful. As I am completing this program part time, I likely have another 18 months before I finish. In the meantime I had an unexpected opportunity to work with the Compassion Team implementing the compassion resilience curriculum with a different population. I am not doing this as "my project" but supporting the teams work and gaining internship hours. With the new knowledge and expertise that I gain from this work I am thinking that I will be able to redesign my actual project. Perhaps I can find 1 inpatient unit that I can support in committing to this work, rather than the 7 unit design that we were initially envisioning. I am still "a little out of breath" when I think about this but I am trying to "engage relaxed attention" as I begin to plan for my project's next steps.

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Emma - surveying school nurses. Throwing out your assumptions!

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Emma - surveying school nurses. Throwing out your assumptions!

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My DNP project (now coming to a close- whew!) is a WA state-wide survey of school nurses.  I am assessing their knowledge, attitudes, beliefs, and self efficacy to care for children with Adverse Childhood Experiences and to use a trauma-informed approach.  Many of Kelley and Kelley’s ideas of “Think like a Traveler” really reminded me of my project.  I have needed to throw out my assumptions about school nurses, and learn much more about their day-to-day practices, as they are often juggling so many different tasks and requirements.  Part of my survey looks at the question “what is getting in the way” as Bonnie discussed in her podcast – trying to figure out what makes one nurse feel more confident in using trauma-informed care, or applying the research on ACEs, in practice compared to someone else.   (And using Bandura’s concepts of self-efficacy!) This also reminds me of the Kelly and Kelly’s discussion of reframing techniques (page 101). They discuss the need to “Step back from obvious solutions: Instead of trying to invent a better mousetrap, for example, look at other ways to mouseproof your home.  Maybe the mousetrap isn’t really the problem.”  As an outsider, I have no experience with the school nurse practice,  with some nurses caring for huge caseloads of thousands of children at multiple schools throughout the week.   I ask a series of questions in my survey about “barriers” to using the research in practice- is it time? Education/training? Supervision? Resources? Other priorities? Lack of leadership support?  My interviews with school nurses and school nurse leaders in WA state was also a critical piece of my project, both before and during my “implementation phase”, and many times I was surprised by comments/responses
received in my survey and through talking with school nurses, as my assumptions and ideas about challenges and barriers were not the full picture.

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This Is Jeff Kendall. Sam and I are currently working on our DNP project to identify strategies an area psychiatric hospital can use to improve nurse retention. I am also on the quality improvement committee for the mental health agency I work for. I am in the very early stages of designing a project that might be useful in improving staff retention there. The two projects are very different as one is only related to nurses, while the other includes all staff in an agency that employs hundreds. I am curious to see what the difference and similarities are between the two studies.

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Calista - Empathizing with end users, and experimenting with experiences

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Calista - Empathizing with end users, and experimenting with experiences

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Tom and David Kelley recommend empathizing with end users, and experimenting with experiences.  For a quality improvement project at the workplace (clinic), we are implementing an online patient communication portal where patients can message questions and concerns to the health care provider.  This system decreases communication error from a message left at the front desk and its transcription to the medical assistant and health care provider.  The health care provider can respond directly to the patient as needed.  It could also improve efficiency for the clinic.  In empathizing with end users, we were able to consider the patient’s whole experience and focused on the support a patient needs after leaving our clinic.  The tool “Customer Journey Map” can be utilized to visualize steps and assess patterns that may need improvement.  To experiment with experiences, I hope to reach out to colleagues at other clinics and health systems to learn about efficiencies (and inefficiencies) with patient portals and other patient communication methods such as virtual visits.  It may be worthwhile to pilot new ideas and suggestions from innovative colleagues and health systems to enhance our clinic’s status quo.

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This is Kate. I'm finishing my MSN focusing on CNM/NP burn out and compassion fatigue. My DNP focus will be something to do with the difference in perceived care between the L&D and Postpartum/ Mother Baby unit. There are many layers to this care dynamic and it will take some effort to un-peel it all. I think that similarly to another poster, starting with a "doable piece" will be where this project starts. Perhaps sitting down with L&D/ PP nurses who have worked in both units and have a discussion about the care they have observed and provided themselves to see where to steer this idea next. It could be a sensitive topic to approach so that will be an additional layer of complexity.

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This is Kirsten. I am currently finishing my graduate capstone project for my MSN. I am focusing on the use of health information technology to better support caregivers of medically complex children. I'm finding that there is very little research asking this population what they want or need in an electronic health tool to help them manage the child's care. I plan to extend this research to my DNP studies. My thought is to utilize user (family) interviews to gain their perspectives and ideas, but I also really like the Creative Confidence emphasis on empathizing with the end user. After reading this book, I realize it may be even better to create an innovation team of providers, admin, nurses, and families to better work toward solutions. I know that in the medical profession, it is sometimes difficult to understand what a patient experiences. I'm brainstorming ways to get providers to empathize with the struggles faced by families of medically complex children, especially when it comes to managing multiple conditions, medications and appointments. Although my DNP project is still very much in its infancy...embryonic really...I'd like to somehow incorporate providers/administration into understanding these struggles and partnering to help improve technology systems for these families. 

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This is Kirsten. I am currently finishing my graduate capstone project for my MSN. I am focusing on the use of health information technology to better support caregivers of medically complex children. I'm finding that there is very little research asking this population what they want or need in an electronic health tool to help them manage the child's care. I plan to extend this research to my DNP studies. My thought is to utilize user (family) interviews to gain their perspectives and ideas, but I also really like the Creative Confidence emphasis on empathizing with the end user. After reading this book, I realize it may be even better to create an innovation team of providers, admin, nurses, and families to better work toward solutions. I know that in the medical profession, it is sometimes difficult to understand what a patient experiences. I'm brainstorming ways to get providers to empathize with the struggles faced by families of medically complex children, especially when it comes to managing multiple conditions, medications and appointments. Although my DNP project is still very much in its infancy...embryonic really...I'd like to somehow incorporate providers/administration into understanding these struggles and partnering to help improve technology systems for these families. 

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Padlet doesn't automatically identify users

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Clinical practice problems--leaping into action

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Clinical practice problems--leaping into action

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The hardest thing for me with clinical practice problems is the leaping into action. I'm interested in using the tools suggested in Creative Confidence for this problem. They suggest using constraints to leap into action. One clinical practice problem I've identified that relates to my DNP project is that providers tend to do a good job of ordering Hepatitis C antibody tests, but if that comes up positive, there is a delay, or sometimes a breakdown in the process to get a viral load drawn. This can limit the ability to accurately diagnose patients and to get them into treatment. Previously, labcorp did not have a reflex test from antibody to viral load, but recently I believe they have developed one. The difficulty is making the leap to educate providers about the new lab, get it added to our lab list so that it is easy to order, and finding out costs and coverage for the lab. Creative confidence suggests starting with tackling a "doable" piece of the problem. For me, this might be the first step of ensuring there is a test available, and what the test number is. They also recommend narrowing the goal, and creating a milestone.

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Share your ideas about possible approaches and tools to use for gathering data for your clinical practice process improvement project.  Which tools from Creative Confidence are you thinking about using?
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