By Deborah Small, DNP, MSN, RN, NE-BC
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The executive nurse leadership team at Cleveland Clinic feels strongly that well-rounded, clinical practice-oriented leadership training is key to successful leadership. Thus, many of the health system’s associate chief nursing officers and chief nursing officers have earned their doctor of nursing practice (DNP) degree, are currently working to earn it, or will soon begin their DNP education journey.
Deborah Small, DNP, MSN, RN, NE-BC
As with most advanced education programs, one of the most daunting components of the DNP education process is completion of the culminating capstone project.
Depending on project complexity, it can take a significant amount of time to complete a project of this magnitude. Coupled with the fact that most nurses are in full-time nursing roles, working to earn a DNP degree means there is much to consider when selecting an area of focus for a capstone project.
To begin, the topic chosen should be something the DNP student is passionate about – not only for the student’s enjoyment, but also to help avoid potential burnout if the project takes an extended amount of time to complete. Beyond that, consider the following three “Rs” when selecting a project topic:
- Really impactful
Make sure the project is relevant
Relevance is key when selecting a capstone topic. To make a project successful, the topic chosen should be something that accomplishes a goal or meets a need.
A good starting point is for the student to conduct a situation analysis. This means evaluating potential problems or challenges associated with area(s) of expertise by reviewing issues with nursing staff and gathering feedback on problems they identify. Down the road, staff members may be involved in the data gathering process or project action planning so it is ideal to engage them and get their input as early as possible.
When completing my DNP capstone project, I chose ‘bedside handoff’ as my topic. Even though bedside handoffs were recognized as a best practice at Cleveland Clinic Fairview Hospital, I knew it was a practice area my staff struggled to sustain.
Observation audits had revealed migration away from the bedside and back to the nursing station for report. Nurse communication scores on several acute care units were stagnant or trending downward. And interviews with staff nurses revealed discomfort with bedside handoff processes, as well as a lack of adequate training.
Select a topic that is researchable
Another key recommendation is to choose a topic that is fully researchable. First, reach out to research experts for added guidance. They can offer valuable insight when it comes to idea review as well as how to narrow project focus.
Additionally, a thorough literature review of a proposed topic idea can offer a better understanding of how to build or enhance a project’s relevant knowledge and practice. For example, when conducting my literature review, I found more than 300 articles on my chosen topic, but only 27 had scientific evidence using experimental, qualitative, quantitative and descriptive design. Thanks to this review, it was clear there was a need for more practice validation.
However, I then needed to narrow my topic and state the problem and hypothesis. Narrowing a topic can be harder than one may think. In my case, ‘bedside handoff’ was very broad, but as I began to delve into my identified problem areas through staff interviews, I found nurses’ attitudes played an important role in the bedside handoff practice.
From this research, I was able to hypothesize that a standardized toolkit with educational and demonstrated instruction would improve the attitudes of nurses in performing the bedside handoff. As I continued with my project, I measured nurse attitudes before and after implementing a standardized bedside handoff process to ensure proper evidence-based evaluation.
Focus on results that will really impact nursing practice
Finally, a chosen DNP capstone topic should be something that can make a positive impact on nursing practice.
Spend careful time determining the appropriate methodology – qualitative, quantitative, descriptive, quality study, or quality improvement – as all can move practice forward, but not all are equally impactful, which affects how best to proceed.
To measure the impact the work will have on nursing practice, tool selection and/or development is important. However, it is worth noting that newly developed tools may require validity studies and could affect proposed timelines so using an existing tool may move project work more quickly. Existing research tools are fairly easy to come across through simple online research. For example, I was able to identify a tool in my literature review, called ‘nurses assessment of bedside shift report.’
Other tips for success
In addition to following the three “Rs – relevant, researchable, and really impactful – when selecting a DNP capstone project topic, other tips for success during a DNP capstone course, include:
- Know the course expectations and the breakdown of work.
- Set and stick to timelines as these can make or break success. Definitive completion dates for interventions and education are imperative.
- Try to use every course prior to the capstone course as a building block for the project to avoid repeating work at the end.
- Upon identification of the chosen topic and completion of literature review, get chair approval early.
- If convening a team is necessary, be able to clearly state intent, goals and possible outcomes.
- Keep comprehensive notes.
- Review examples of prior DNP projects from colleagues. This is especially helpful for narrowing topic selection and improving understanding of formatting, process outlining, etc.
- Don’t be afraid to ask questions (to both professors and colleagues) or request proofreading assistance.
- Stay positive.
- Thank those who have offered their help and assistance.
In summary, a capstone project should offer new findings or validate best practices or interventions. It should be relevant, researchable and really impact nursing practice. A capstone project should allow a nursing student to apply what he or she has learned from the didactic portion of the DNP program in a way that showcases mastery of the research essentials.
Deborah Small is the Vice President of Patient Care Services and Chief Nursing Officer of Cleveland Clinic Fairview Hospital.