DNP 750 Week 7 Feasibility, Ethics and Site Approval Example

Can It Be Done, Should It Be Done and Who Must Say Yes: Feasibility, Ethical Safeguards and the Approval Path for a Diabetes Distress Screening Project

[Student Name]

University of Phoenix

DNP/750: DNP Applied Project I

Week 7 Assignment

[Instructor Name]

[Date]

The health center, staff and figures are composites written for a model paper.

The precis for my DNP applied project now has a problem, a practice question, evidence, a framework, a design and methods. Before it can become a proposal, three questions need answers: whether a 12-week diabetes distress screening pilot is feasible at our site, whether it is ethical and how its risks will be managed, and who must approve it. This paper takes each question in turn and ends with a summary of risks and responses.

Feasibility: Staff Time

Medical assistants will spend about one extra minute per eligible visit handing over the tablet and checking completion, and patients who screen positive will spend four to six minutes on the longer scale while waiting for the clinician. With about 200 eligible patients over 12 weeks, the added medical assistant time is roughly 17 minutes a week spread across five assistants. Care managers will absorb an estimated 65 follow-up contacts over the project, about five or six a week between them, which the medical director has approved within their current hours. The behavioral health consultant expects two or three extra handoffs a week and can take up to eight.

Feasibility: Technology and Data

The electronic health record analyst has agreed to build the two structured forms and a weekly report, estimated at six hours of work, scheduled for the second month of DNP 751. The tablets used for depression screening already exist in every exam pod. The quality coordinator will run the report each week and remove names before sending it.

Feasibility: Cost

Direct costs are small. Printing English and Spanish handouts on distress and coping will cost about $200, interpreter review of the Spanish instruments about $150, and refreshments for two training sessions about $80, for a total of $430, covered by the site's quality improvement budget. Staff time is absorbed within existing schedules, valued at about $2,900 in salary if counted.

Feasibility: Time

The project spans three courses. The precis ends this term, the proposal, approvals and form build occur during DNP 751, and implementation, analysis and dissemination take place during DNP 752, whose eight weeks will be preceded by the 12-week pilot scheduled to begin as that course opens.

SWOT Analysis

Strengths include leadership approval, care managers already assigned to the diabetes panel, an on-site behavioral health consultant and tablets in every room. Weaknesses include high medical assistant turnover, a 20-minute visit length and my dual role as clinician and project lead. Opportunities include the health center's grant priority on diabetes control and the replacement of its screening forms this year. Threats include staff vacancies during the pilot and competing projects for the analyst's time.

Ethics: Improvement or Research?

Lynn et al. (2007), reporting a Hastings Center project, argued that quality improvement is an ethical obligation of health care organizations and that most improvement activities should not go through research review designed for experiments, but that improvement still carries duties: it should be well designed, should respect patients' privacy and should involve oversight proportional to its risk. They listed features that raise risk and call for more formal review, among them randomizing patients, delaying the feedback of data to clinicians and adding burdens beyond usual care. This project implements validated tools recommended in national standards, adds minimal burden and aims at improvement at one site, so it fits the definition of quality improvement. The university's DNP project committee and the health center's quality committee will make the formal determination.

Ethics: The Risk of Finding Crisis

The most serious ethical risk in this project is not the screen itself but what it might uncover: a patient asked about the weight of diabetes may disclose hopelessness or thoughts of self-harm, and the project must be ready for that before the first tablet is handed over. The site already uses the PHQ-9 for depression screening, whose ninth item asks about thoughts of being better off dead or of self-harm; Kroenke et al. (2001) validated the PHQ-9 as a brief measure of depression severity in primary care. The pathway will require that any patient with high emotional burden on the distress scale also complete the PHQ-9 if it has not been done that day, and that any positive answer to item 9 triggers the site's existing crisis policy: same-day assessment by the behavioral health consultant or the on-call clinician and a documented safety plan. Young-Hyman et al. (2016) note that distress and depression overlap and call for referral to mental health care when distress is severe or does not respond to education and support.

Ethics: Privacy, Voluntariness and Fairness

Screening will be voluntary; patients may decline without any effect on care, and declines will be counted. Results will be treated like other clinical data in the chart, and project reports will use study numbers and aggregate counts. Because 14% of patients prefer Spanish, validated Spanish versions and interpreter support will be provided so that the pilot does not reach only English speakers.

Site Approval Path

The approvals follow a set sequence. First, the medical director signs a site agreement and letter of support, already drafted. Second, the health center's quality committee reviews the proposal and issues a quality improvement determination. Third, the university's DNP project committee reviews the proposal and the determination during DNP 751. Fourth, the chief operating officer approves the staff time and the analyst's hours. Implementation will not begin until all four are documented.

What the Letter of Support Commits

The medical director's letter does more than grant permission. It names the site as the setting, confirms that care manager time for follow-up is approved within current hours, commits the analyst's six hours, agrees that de-identified aggregate results may be used in the DNP manuscript and poster, and states that the health center, not the student, owns the clinical workflow and will decide on adoption after the pilot. Writing those commitments down now prevents misunderstandings later, especially about data use and publication, which sites often question only when a manuscript is ready.

My Dual Role

As a nurse practitioner at the site and the project lead, I hold two roles that could blur. Colleagues might feel pressure to report good numbers, and patients I treat might feel obliged to complete the screen. The quality coordinator, not I, will run the data reports, the champion will time rooming, and I will not administer the screen to my own patients during the pilot.

Risks and Responses

If medical assistant turnover disrupts screening, the champion will train new staff within their first week. If positive screens exceed care manager capacity, contacts will be prioritized by subscale level. If the analyst's build is delayed, a paper version of both forms will be used, with scores entered by the champion. If a patient in crisis is identified, the safety pathway above applies.

Conclusion

The pilot is feasible with modest time and a direct cost of $430, it fits the ethical definition of quality improvement while carrying real duties to patients, and its most serious risk has a pathway. Approvals are sequenced with named decision makers. Next week these elements come together in the complete precis.

References

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Lynn, J., Baily, M. A., Bottrell, M., Jennings, B., Levine, R. J., Davidoff, F., Casarett, D., Corrigan, J., Fox, E., Wynia, M. K., Agich, G. J., O'Kane, M., Speroff, T., Schyve, P., Batalden, P., Tunis, S., Berlinger, N., Cronenwett, L., Fitzmaurice, J. M., ... James, B. (2007). The ethics of using quality improvement methods in health care. Annals of Internal Medicine, 146(9), 666-673. https://doi.org/10.7326/0003-4819-146-9-200705010-00155

Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., & Peyrot, M. (2016). Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126-2140. https://doi.org/10.2337/dc16-2053