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A Quantitative Cross-Sectional Descriptive Study on the Comparison between DNP and MSN Prepared Nurses Concerning Influencing Patient Outcome

Abstract

The contribution of nurses to the healthcare system, particularly primary care, is immense since nurses form the largest part of the healthcare system. The Institute of Medicine (IOM) recommends nurses to get more education. The purpose of this study is to examine the relationship between the Doctor of Nursing Practice(DNP) and the Master of Science in Nursing (MSN) regarding following up the scheduled appointments and helping patients obtain preventive care. A quantitative cross-sectional descriptive design will be done where 400 patients are examined, 200 of them are being under the care of DNP, and 200 ones fall under the care of MSN. The data will be collected from the hospital records and analyzed using the statistical package for social sciences. Then they will be tabulated for comparison. Descriptive statistics will also interpret the data. The t-test will be done to compare the two cadres. It is predicted that DNP nurses will be efficient in the follow-up of patients. However, all healthcare consumers will show improvement under the care of all nurses. The implications of the study devoted to the nursing profession will be discussed.

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Nurses are charged with the responsibility of providing quality health care and advocating for the needs of patients. Additionally, nurses are essential in a clinical area when it comes to the collaboration of allied health professionals in meeting the needs of a patient. Therefore, these medical practitioners need to be prepared academically to handle any challenges they encounter when caring about patients and when collaborating with the healthcare team. The Master of Science in Nursing (MSN) and the Doctor of Nursing Practice (DNP) are two degrees that prepare nurses to handle various challenges related to patient care effectively. However, there is a slight difference between the MSN and DNP degrees. However, both degrees are considered to be the advanced programs. This paper uses various sections of the research proposal, proposing to study the relationship between the MSN and the DNP regarding influencing the patient outcome (concerning following up scheduled appointments and obtaining preventive health care) within the next five years.

Background and Significance of the Problem

Many researchers have considerably promoted the need to advance in nursing education. The Institute of Medicine (IOM) recommends that nurses need to make a significant progress in education due to the impact that learning has on the improved patient outcome (as cited in Blegen, Goode, Park, Vaughn, & Spetz, 2013). Blegen et al. have examined the results of patients in hospitals with Registered Nurses (RNs) who possess baccalaureate degrees. They report that there is a reduced mortality rate in such medical institutions. Conversely, Weinberg, Cooney-Miner, and Perloff (2012) argue that improving the nursing profession should not only focus on the education aspect of nurses but also consider the factors such as the contribution to work, work environment, and collaboration with other healthcare workers. Regarding DNPs and MSNs, Lathrop and Hodnicki (2014) contend that nursing practitioners with a DNP degree are well prepared to handle healthcare as opposed to other cadres. However, a MSN degree is equally an advanced program that prepares these employees to offer leadership and manage healthcare matters efficiently. Therefore, there is conflicting literature on whether some cadres indeed contribute immensely to the patient outcome as opposed to others. In this regard, it is paramount to examine the relationship between MSN and DNP prepared nurses and compare these two degrees concerning the influence that each one has on the outcome of patients. Specifically, the study will analyze these two programs about follow-up with scheduled appointments and obtaining preventive care.

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Statement of the Problem and Purpose of the Study

The study intends to examine the relationship between nurses who hold an MSN degree and those who have a DNP level. The research is regarding influencing the outcome of patients (concerning following up scheduled appointments and obtaining preventive care) in the next five years. From the literature search, as documented in the next section, it is evident that more research needs to be done regarding the impact that nursing education has on the outcome healthcare consumers. In as much as many studies examine the effects of improved education on patient outcome, there is limited literature comparing the connection between MSN and DNP prepared nurses about the response to treatment.

The research problem above leads to this question: “For Nurse Practitioners, how does a Nurse Practitioner with a DNP degree compare to a Nurse Practitioner with a MSN degree, in terms of influencing patient outcomes (in terms of: following up with scheduled appointments, and obtaining preventive health care), during the next five years.” Therefore, this study will make necessary suggestions that will form a baseline for the further research on the two cadres for the next five years.

Literature Review

In coming up with this literature review, no research has been found comparing the two degrees, MSN and DNP. Similarly, there is a limited study specifically on the importance of acquiring the MSN degree to the clinical setting. Conversely, more research has been done regarding the importance of DNP in spite of it being less common than MSN. Finally, there is more literature associating higher educational achievements in nursing with improved patient outcome.

Wolf, Budd, and Bhattacharya (2011) have conducted a prospective, descriptive cross-sectional study to investigate the clinical hours required to study DNP and the types of clinical experiences that students will get. The DNP program directors, forty-three in number, have completed an electronic survey in the research. The results have showed that the DNP and the PhD programs required more hours of study as compared to other nursing training programs. Additionally, the DNP nurses concentrated more on learning about leadership and improving the outcome of patients. Therefore, DNP nurses have been expected all along to contribute to the knowledge of nursing through evidence-based practice and carry out practice interventions improving patient outcomes in healthcare systems (Broome, Riner, & Allam, 2013).

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Broome, Riner, and Allam (2013) have analyzed 175 articles. They have used a codebook to extract the relevant information about DNP nurses. They have found out that DNP nurses were publishing more articles on practice in the healthcare setting and administration with increasing frequency. Consequently, Broome, Riner, and Allam have recommended that DNP nurses should actively participate in improving the outcome of patients in a clinical setting.

In another literature search concerning MSN, Rosseter (2014) has asserted that there were 692 BSN (Bachelor of Science in Nursing) programs for the upgrade by Registered Nurses (RN) and 159 masters programs for RNs. Rosseter ascertains that these programs build on the education of RNs to prepare them for a broader base of practice. Therefore, MSN prepares nurses to play a similar role in improving the outcome of patients through evidence-based practice. The two articles by Rosseter (2014) and Broome, Riner, and Allam (2013) show a need to examine the relationship between the MSN and the DNP concerning patient outcome, specifically on following up scheduled appointments and obtaining preventive health care.

Research Questions, Hypothesis, and Variables

This study is set to answer four questions

1. How effectively does a DNP nurse implement follow-up to patients compared to a MSN nurse?

2. How effectively does a MSN nurse implement follow-up to patients compared to a DNP nurse?

3. Do patients under the care of a DNP nurse obtain preventive care more than the patients under the care of a MSN nurse?

4. Do patients under the care of a MSN nurse obtain preventive care more than the patients under the care of a DNP nurse?

Hypothesis

1. Patients under the care of the DNP prepared nurse show more improvement in going for care as compared with the patients under the care of the MSN nurse.

2. The DNP nurse carries out an adequate follow-up as opposed to the MSN nurse.

3. Patients under the care of the DNP nurse seek preventive care more as opposed to the patients under the care of the MSN nurse.

Variables

Variables are things, persons, situations or properties that change and can be measured, manipulated, and controlled in the research study (Flannelly, Flannelly, & Jankowski, 2014). They are classified into two categories, i.e. dependent and independent variables. Significantly, changes in dependent variables are caused by independent variables. In this study, there will be two dependent variables, i.e. the patients under the care of MSNs and the patients under the care of DNPs. Similarly, there will be two independent variables, the MSN prepared nurses and the DNP prepared nurses.

Theoretical Framework

Overview and Guiding Propositions

This research compares the MSN and DNP nurses in improving patient care concerning following up scheduled appointments and obtaining preventive care. Therefore, there are two dependent variables to be examined independently. That is, following up scheduled appointments by nurses and getting preventive care services by patients. Similarly, there are two independent variables, the MSN prepared nurses and DNP prepared nurses. Each group will be examined against two dependent data. From the literature, the research advocates for the DNP when it comes to improving patient outcome. Additionally, the MSN has been associated with improved practice in the healthcare setting. Therefore, this theory proposes that those patients under the care of DNP and MSN prepared nurses will have a positive attitude seeking health care services but in varying extents.

This theory uses a health belief model. This template demonstrates and foretells health behaviors and reasons for not complying with recommended health actions (Julinawati, Cawley, Domegan, Brenner, & Rowan, 2013). Therefore, it is applied in this theoretical framework to observe scheduling up appointments and obtaining preventive care among nurses and patients respectively in the next five years. The chart concerning this theoretical framework is on the appendix page.

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Application of Theory to Study Focus

This theory will be helpful in this research to examine the relationship between the response of patients to the care delivered by MSN and DNP prepared nurses. The study will then compare the effectiveness of two cadres. Since the data will be descriptive, the results will show the efficiency of each degree in patient outcome regarding following up scheduled appointments and obtaining preventive health care. Most importantly, both programs are necessary for improving patient outcome. However, the effectiveness of each cadre will be examined, and various comparisons will be made. Methodology

Sample/Setting

The population for this study will be all patients seeking care in a hospital setting, and specifically under the supervision of MSN and DNP prepared nurses. Considering that this research study has two independent variables, one type of healthcare consumers must be under the care of MSN prepared nurses. The other kind of healthcare consumers should be cared by DNP prepared nurses. The investigator will examine only patients who receive care by the two cadres separately without the involvement of another staff to avoid a sample bias. Most importantly, the study will be carried out in an outpatient setting where nurses view healthcare consumers, schedule appointments, and do a follow-up.

Sampling Strategy

First, the sample size needs to be determined before a sampling strategy is used. For a quantitative study like this one, a larger sample will be required to come up with appropriate results. Significantly, this template is proposed to be a representative of the target population. Therefore, the sample of 400 patients is recommended. Two hundred healthcare consumers under the care of MSN prepared nurses will be analyzed, They will be compared to two hundred patients under the care of DNP prepared nursing practitioners.

Secondly, the investigator will make a sampling frame. The one will obtain a list of all patients under the care of the each cadre and select 2000 patients over the age of 25 years. The adults (older than 25) will be included in the study due to their ability to make decisions regarding their health. The sample will include the patients who are not acutely ill.

Finally, the type of probability sampling and systematic sampling will be used to select the selection of 200 patients for each cadre to be included in the study. Using this sampling strategy, the investigator will select every tenth healthcare consumer from the sampling frame of 2000 of them to come up with a sample of 200 patients. This procedure is suggested because all of them will have an equal probability to be included in the study for a possible analysis of the two cadres, MSN and DNP prepared nurses. This method has been selected for its efficiency and inexpensiveness in choosing samples.

Research Design

The proposed approach to meet the objectives of this study is a quantitative cross-sectional descriptive design. It is a suggested method and recommended for its effectiveness in carrying out the studies for a short time to examine the relationship between variables (Williams, 2011). It is proposed that this research will collect the details of the current appointments that nurses have been carrying out to patients and the follow-up regarding those appointments. Additionally, the study will examine the response of the same healthcare consumers concerning obtaining preventive health care.

Extraneous Variables

The quantitative cross-sectional descriptive design chosen is aimed at decreasing the extraneous variables that might be experienced in this study. Such data are undesirable factors that influence the outcome of the research. In this study, it is thought that some factors such as a change in the location of residence of patients and the difference in the type of a healthcare setting will affect the work. Therefore, the researcher has aimed to control the extraneous variables by carrying out the research in one healthcare setting, but in different departments over a period of two months.

Instruments

Since this study will examine the turnover of patients based on the scheduled appointments and then observe their return-seeking preventive care, the hospital records with tally sheets will be used to collect data. These records are chosen for this research because they are inexpensive to access. They are unbiased and cover an extended period that will ensure an access to the registers and files of over 2,000 patients. Additionally, the completeness of the records will guarantee the accuracy of data to avoid bias.

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Description of the Intervention

The tools will be pretested to ascertain their validity and reliability in this study. Before the research, the records will be accessed. Moreover, the number of samples required for the relevant data (200 patients from each department) will be identified in each department (MSN and DNP) separately to find out the extent to which the instruments can go concerning the collection of appropriate data.

Data Collection Procedures

The investigator will collect quantitative data on scheduled appointments and their follow-up by both MSN and DNP prepared nurses. Similarly, the one will collect data about obtaining preventive healthcare by patients. The hospital records will be accessed; and then the appropriate samples as explained will be chosen. Then, the tally sheet will be used for easier collection of data. The information will be counted in three parts. First, the number of healthcare consumers seeking care will be counted. Then, the number of these patients based on scheduled appointments will be calculated. Lastly, the amount consumers looking for preventative health care based on the advice given will be evaluated. Most importantly, the data collection will be carried out separately in two departments for comparison.

Data Analysis Plans

The descriptive analysis will be done on the data using frequent and standard deviation. The results will then be tabulated for a proper explanation and comparison of patient outcomes in the care of MSN and DNP prepared nurses separately. The statistical evaluation will be done by the statistical package for social sciences.

The t-test will be used for inferential statistics since this study is aimed at comparing two independent variables. The difference between the means will be evaluated. Most importantly, an independent sample test will be used to compare the nonrelated data.

Ethical Issues

Before the study is carried out, some ethical issues will be considered. Before accessing hospital records, the approval of the hospital will be sought concerning both the research process and the dissemination of study findings. Additionally, the data collected will remain confidential and not be shared with the public. Most importantly, the dignity of MSN and DNP nurses will be observed throughout the research process.

Limitations of Proposed Study

The study will have the limitations because it will be conducted in one hospital setting. Similarly, it will target nurses in the same healthcare circumstances with the same qualifications. Therefore, it will be difficult to generalize the results to nurses in other medical institutions. The researcher recommends that both quantitative and qualitative researches should be carried out on the same subject in other settings in future so that a general picture can be established.

Conclusion and Implications for Practice

Delivering evidence-based practice is essential to the nursing profession. Both MSN and DNP prepared nurses are equipped with the knowledge sufficient enough to practice effectively on improving patient outcome. The results of this research will contribute to the growing body of notion on the need to enhance nursing care delivery and follow-up of healthcare consumers. Furthermore, the research will give a rational recommendation on the appropriate cadre for improving healthcare delivery concerning following up with scheduled appointments and in obtaining preventive health care.