In 2011, registered nurses Anne Kiraithe, Afsaneh Lomax, Shaun L’Esperance and Hanna Roy were admitted to the first class of the Graduate School of Nursing’s new, accelerated Bachelor of Science to Doctor of Nursing Practice program. Now possessing unique qualifications that make them pioneers in today’s dynamic health care landscape, members of the Class of 2014 are poised to achieve many more firsts in their careers upon receiving their diplomas at Commencement on Sunday, June 1.
“As a new commodity on the job market, the career path will be unique for each of us,” said L’Esperance.
Wishing to expand their nursing knowledge and professional roles by becoming nurse practitioners, L’Esperance, Kiraithe, Lomax and Roy all considered the traditional Master of Science in Nursing program, but chose the new BSN to DNP program in order to attain the highest level of advanced practice nursing training available. Equipped with their practice doctorates, they now look forward to providing primary care to patients and communities as family nurse practitioners, as well as assuming leadership and policymaking roles in primary care and urgent care settings.
“We are trained to identify practice problems and review the research literature for the best evidence to address them in order to improve quality of care and patient outcomes,” L’Esperance continued. “With the DNP, what we bring in addition to the advanced practice clinical role is leadership in advanced concepts of health policy, population-based care, epidemiology, biomedical informatics and clinical research-based methodologies.”
An alternative to research-focused doctoral programs such as the PhD in nursing, theDNP is a practice-focused doctorate. DNPcurricula build on traditional master's programs with additional education in evidence-based practice, quality improvement and health systems leadership. A capstone project that synthesizes these skills to measurably improve the quality of care and outcomes for patients in a particular setting is a requirement for the degree.
The Class of 2014’s capstones exemplify the Doctor of Nursing Practice in action, and demonstrate the added value each will bring to health care and, most importantly, to their patients.
Coming from a background where medical professionals are in limited supply, Kenya native Kiraithe decided to engage with community health workers— lay people who volunteer to educate members of their own underserved communities about health issues. She did this at Central Massachusetts Area Health Education Center where community health workers serve many African-American and Hispanic women—who experience higher death rates from breast cancer than white women—to gain a better understanding of why patients don’t get mammography screenings. “Lessons learned included what resources are needed to increase knowledge, awareness, and participation in breast cancer screening, including talking about myths and fears of discomfort that often prevent underserved women from getting a mammogram,” said Kiraithe.
For her capstone, Lomax conducted a performance improvement project at a community health center to improve hypertension control using a collaborative team approach. She did this by engaging and elevating the role of the clinic’s nursing staff. “I put together an algorithm for hypertension management which allowed patients access to weekly nurse-visits and frequent blood pressure checks,” said Lomax. She also developed a protocol on proper techniques to accurately measure blood pressure. The protocol includes simple but easily overlooked steps like using the right size cuff in the correct placement.
“When you have a protocol, everyone can be educated to obtain accurate blood pressure measures,” she explained. “Enabling the nursing staff to work to the full scope of their practice improved results and proved the value of the team approach.”
Interested in the use of telemedicine applications in diabetes care management, L’Esperance focused his capstone on assessing advantages and barriers to an online diabetes management system among patients and staff of the UMass Memorial Diabetes Center of Excellence’s adult diabetes clinic. His survey identified lack of awareness as a significant barrier among patients who weren’t using the system, along with technical difficulties. Recommendations include outreach to enhance patient knowledge and awareness, and initiating creative technical support strategies. ”Being a part of a quality and performance improvement team would ideally be a portion of my future job description in addition to direct patient care,” L’Esperance said.
Roy’s capstone advances the collaborative model of health care in which DNPs are members of an interdisciplinary team: she worked with family medicine residents to help them better address adolescent sexual health. Her needs assessment asked the residents how frequently they performed adolescent sexual health assessment, and asked them to identify topics related to adolescent sexual health that cause them the most trouble and which they needed to learn or review. “I found that physicians don’t spend much time assessing the sexual health of adolescents,” said Roy. “I then created a didactic presentation to explain to them how important it is, using data about STDs, pregnancy rates and so on.” With a follow-up survey and interviews conducted several weeks after the training, Roy was pleased to learn that residents were now addressing sexual health more often than before her training.
Equally encouraging, a majority of the residents also agreed that the project enhanced their interest in working with nurse practitioners in the future—proof that the new BSN to DNP graduates will advance nursing practice, science and leadership to improve patient care.