Part I: 
     What is the impact of the DNP-prepared healthcare systems leader on healthcare systems of today?
DNP-prepared healthcare systems leader has shown to positively impact the healthcare systems of today. DNP-prepared scholars has proven to affect health outcomes by improved patient quality of care, innovation, and influence (Boswell & Batcheller, 2021). DNP-prepared scholars have the competencies for communication, leadership, and ability to promote change in multiple areas (Boswell & Batcheller, 2021). The DNP scholars were prepared for the faster transition of evidence-based findings into actual clinical practice, which improves overall provision of updated scientific findings for better patient outcomes and staff processes.

     How do you anticipate integrating this role into your current or future career?
I am a newly graduated Family Nurse Practitioner in California. As a DNP-prepared scholar, I am planning to utilized my knowledge and skills to update patients’ treatment plans and clinic processes based on the best evidence-based findings related to outpatient services. I can use such knowledge and skills to advocate for the patients in the clinic and community that hopefully provide quality care at affordable healthcare costs. 

      In your opinion, what is needed for successful professional identity formation in DNP students to achieve healthcare systems leadership roles after graduation?
In my opinion, DNP students will need further support to achieve healthcare system leadership roles after graduation. One step to achieve such exposure is to apply for DNP residency programs that support further exposure to situations and resources thus promoting healthcare leadership competencies. Another step is to finder a mentor that provides support and guidance for both personal and professional growth.

Part II: For Case Study 

     Please state your practice question in PICOT format
For patients 18 years of age and above in an acute care unit, will the 4AT rapid clinical screening tool to detect delirium, as compared to current practice, impact the use of restraints within 8-10 weeks. 

     Discuss best practices for implementing evidence-based practice guidelines with citations and matching references sufficient to support your discussion.
It is essential to utilized best practices for the implementation of evidence-based practice guidelines. The first step is identifying current issue at the identified site and creating an answerable and clinically relevant questions based on the clinical practice (Esteban-Sepulveda et al., 2021). Additional processes involves: the search for and retrieval of the best available evidence to answer the clinical questions;  appraisal of the evidence for relevance and validity; application of the appraised evidence in clinical practice; implementation and integration of evidence with clinical experience; and evaluation of the impacts of the intervention on individuals (Esteban-Sepulveda et al., 2021). These steps are necessary to support best practices and effectiveness in implementing evidence-based practice guidelines. 

     Discuss strategies for overcoming barriers in implementing evidence-based practice with citations and references to support strategies.
There are various strategies that the DNP student can utilized for overcoming barriers in implementing evidence-based practice. Strategies can include effective training and support systems, clear allocation of roles to implementation team, provision of evidence to stakeholders related to its cost-effectiveness, and ease of use, and providing a transparency and flexibility to all individuals involved in the implementation process (Mathieson, Grande, & Luker, 2018). Effective planning, communication, and collaboration are additional strategies that can aid the implementation process of evidence-based practice.

     Discuss your formative evaluation plan to check intervention fidelity.
It is essential to create a formative evaluation plan to check for intervention fidelity. The DNP student can utilize the manager’s checklist to monitor the progression of the intervention, while the nursing champions can utilize the nursing champion checklist to check if the nurses are utilizing appropriate interventions per patient daily. Improvement in intervention fidelity should focus on utilization of frameworks, clarification on defined interventions, and clear definition on the various formative evaluation for involved individuals (Hardeman et al., 2020). In addition, the DNP student can use one-to-one discussions and weekly follow-ups in the formative evaluation plan.

     In Week 2, your formative evaluation plan reveals a few staff did not implement the evidence-based intervention as intended. What is your next step?
The formative evaluation plan revealed that a few staff did not implement the interventions. As a project lead, it is essential to investigate the varying reasons related to the staff not able to implement the interventions. The first step is to identify the next scheduled work of the staff and perform a one-to-one discussion on the revelation of the evaluation plan. Provide additional support and resources for staff that are unable to perform interventions due to lack of time or unclear on the required steps.

     In your simulated Case Study, some staff state, I am too busy or I do not see a need for change since the way we have always done it works fine. How will you address this?
There will always be a resistance to change and it is essential to provide information on the reasons and benefits of changing current processes. For the staff that were too busy, the DNP student or the nursing champions can assist in filling out the 4AT forms per patient daily or report the intervention to the next shift. For the staff the are resistant to change, it is important to emphasized that the facility has a growing concern for increased physical restraint usage, thus promoting the creation of an initiative to help decrease restraint use. It is also important to detect patients that are at risk or positive for delirium so that we can provide early interventions that can prevent worse outcomes, thus leading to more work for the staff.

     You identify that stakeholders were not included in the project planning meetings and are resisting change.  How will you work with these stakeholders to turn their resistance into support?
The DNP student had identified that some stakeholders are resistant to change. Additional resources and support are necessary to start the process of changing the resistant behaviors of some stakeholders. It is essential to include stakeholders in every step of the implementation process to increase involvement, rapport, and lower resistance to change. In addition, it is essential to follow-up on the stakeholders that are resistant to change and provide additional information on the importance of the project and how it will impact staff and patient care.

     Thinking about a live implementation, are there additional resources that may be necessary for a successful implementation?   If so, what are those resources?
Additional resources are required to have a successful implementation. The project implementation will require a weekly meeting room, laminated cards for nursing staff, printers and office supplies, and gift cards for staff involvement. In addition, a budget for provision of snacks during meetings and educational sessions is another resource during the planning to implementation transition. 

References

Boswell, C., & Batcheller, J. (2021). Capturing the impact of the Doctor of Nursing Practice degree on West Texas health care.

Esteban-Sepulvedam, S., Sese-abad, A., Lacueva-Perez, L., Domingo-Pozo, M., Alosno-Fernandez, S., Aquilue-Ballarin, M., Barcelo-Martinez, A., Cristobal-Dominguez, E., & Fernandez-Dominguez, J. (2021). Impact of the implementation of best practice guidelines on nurse’s evidence-based practice and on nurses’ work environment: Research protocol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756465/
Hardeman, E., Hankonen, N., Byrne, M., McSharry, J., Matvienko-Sikar, K., & Lorencatto, F. (2020). Focusing on fidelity: narrative review and recommendations for improving itnervention fidelity within trials of health behaviour change interventions.

Mathieson, A., Grande, G., & Luker, K. (2018). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/strategies-facilitators-and-barriers-to-implementation-of-evidencebased-practice-in-community-nursing-a-systematic-mixedstudies-review-and-qualitative-synthesis/74D8FB3E7561129C8CBBF01207837BCC

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