Quality improvement in the implementation science paradigm in professional programs: scoping review

Corrêa, Bruna Luísa Melo de Aquino Lemos; Santana, Rosimere Ferreira; Rocha, Greiciane da Silva; Bandeira, Tatiany Marques; Carmo, Thalita Gomes do; Carvalho, Ana Carolina Siqueira de

doi:10.1590/1983-1447.2023.20220159.en

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Scoping Review • Rev. Gaúcha Enferm. 44 • 2023 • https://doi.org/10.1590/1983-1447.2023.20220159.en copy

Quality improvement in the implementation science paradigm in professional programs: scoping review

Mejora de la calidad en el paradigma de la ciencia de la implementación en programas profesionales: revisión del alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs.

Method:

This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol.

Results:

18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs.

Conclusion:

Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

Keywords:
Quality improvement; Education; graduate; Implementation science; Nursing

Author	Country	Type of program	Objective	Result
Glanville I, Schirm V, Wineman NM77. Glanville I, Schirm V, Wineman NM. Using evidence-based practice for managing clinical outcomes in advanced practice nursing. J Nurs Care Qual. 2000;15(1):1-11. doi: https://doi.org/10.1097/00001786-200010000-00002 https://doi.org/10.1097/00001786-2000100...	USA	Graduate Nursing program	To describe how a graduate program prepares advanced practice nurses to use the best scientific evidence with clinical experience to influence patient outcomes.	The activities that students contemplate in their program provide examples of evidence-based practices that apply Quality Improvement principles and science-based nursing interventions to create best practices.
Buerhaus PI, Norman L88. Buerhaus PI, Norman L. It’s time to require theory and methods of quality improvement in basic and graduate nursing education. Nurs Outlook. 2001;49(2);67-9. doi: https://doi.org/10.1067/mno.2001.114403 https://doi.org/10.1067/mno.2001.114403...	USA	Graduate Nursing program	To show the importance of considering the requirement that the nursing curriculum explicitly incorporates theories, methods and practices in Quality Improvement.	Research courses should include scientific methods for improvement, such as statistical process control and models for testing changes in daily work. Nurses must develop Quality Improvement skills in their educational programs.
Walrath JM, Muganlinskaya N, Shepherd M, Awad M, Reuland C, Makary MA, et al99. Walrath JM, Muganlinskaya N, Shepherd M, Awad M, Reuland C, Makary MA, et al. Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience. Acad Med. 2006;81(8):744-8. doi: https://doi.org/10.1097/00001888-200608000-00013 https://doi.org/10.1097/00001888-2006080...	USA	Graduate studies	To describe how, in 10 months during 2004 and 2005, the school of medicine, nursing, and an administrative residency program, all at Johns Hopkins University, implemented and evaluated a program, with an interdisciplinary approach to learn QI that was tested in several locations in the United States.	The importance of interdisciplinary participation in planning QI projects, the value of the patient’s perspective on systems problems, and the value of a systems perspective in devising solutions to problems that proved to be a valuable lesson.
Bellflower B, Carter MA1010. Bellflower B, Carter MA. Primer on the practice doctorate for neonatal nurse practitioners. Adv Neonatal Care. 2006;6(6):323-32. doi: https://doi.org/10.1016/j.adnc.2006.08.001 https://doi.org/10.1016/j.adnc.2006.08.0...	USA	DNP	To make a brief review the history of the role and formation of the DNP, define the DNP and propose that the Doctoral practice is the main mechanism to meet this need, it is the future of our profession.	Several topics are exposed, among them the need for advanced education and the future of the evolving practice, which will require increasingly sophisticated skills in Quality Improvement methods from professionals.
Jones CB, Mayer C, Mandelkehr LK1111. Jones CB, Mayer C, Mandelkehr LK. Innovations at the intersection of academia and practice: facilitating graduate nursing students’ learning about quality improvement and patient safety. Qual Manag Health Care. 2009;18(3):158-64. doi: https://doi.org/10.1097/QMH.0b013e3181aea1f0 https://doi.org/10.1097/QMH.0b013e3181ae...	USA	Graduate Nursing program	To describe an academic-practice partnership to educate graduate-level nursing students about quality and safety in health care.	The frameworks-processes-outcomes of our partnership were shared, including course content as well as broader improvements in the education of health care professionals about quality and patient safety.
DeMarco RF1212. DeMarco RF. Palliative care and African American women living with HIV. J Nurs Educ. 2010;49(8):462-5. doi: https://doi.org/10.3928/01484834-20100430-08 https://doi.org/10.3928/01484834-2010043...	USA	Graduate Nursing program	To create strategies to help graduate students of advanced practice nursing, who come from a range of backgrounds and levels of experience, to assess and develop projects to improve the quality of palliative care.	Graduate students were able to successfully complete the task and submit a written analysis of palliative care Quality Improvement suggestions that were also presented in a class seminar.
Nelson JM, Cook PF, Raterink G1313. Nelson JM, Cook PF, Raterink G. The evolution of a doctor of nursing practice capstone process: programmatic revisions to improve the quality of student projects. J Prof Nurs. 2013;29(6):370-80. doi: https://doi.org/10.1016/j.profnurs.2012.05.018 https://doi.org/10.1016/j.profnurs.2012....	USA	PhD and DNP	Describes the processes and experiences to educate and involve faculty in the Capstone DNP process, distinguishing competencies for Doctoral and DNP projects, aligning the Capstone DNP project with methods of Quality Improvement and not with research.	It mentions optimism about progress regarding the challenges faced to support the completion of high-quality QI projects by DNP students. It reports that 2/3 of these projects were published or presented at national conferences, 25% submitted for publication with 2/3 of them accepted, and faculty feedback on student presentations.
Tovar EG, Warshawsky N1414. Tovar EG, Warshawsky N. Use of a problem-based learning exercise to teach the lean 8-step problem-solving method. Nurse Educ. 2015;40(2):101-4. doi: https://doi.org/10.1097/NNE.0000000000000124 https://doi.org/10.1097/NNE.000000000000...	USA	DNP	Describes a practical and successful problem-based learning exercise for students to work through the QI process using the 8-step LEAN problem solving method.	The use of Problem-Based Learning PBL to teach the Lean method in 8 steps was successful. Students pointed out a better understanding of QI principles and strategies, including Lean tools and methods, and DNP undergraduates agree that they should be prepared to apply this method into practice.
Hamrin V, Vick R, Simmons M, Smith L, Vanderhoef D1515. Hamrin V, Vick R, Simmons M, Smith L, Vanderhoef D. Teaching a systems approach: an innovative quality improvement project. J Nurs Educ. 2016;55(4):209-14. doi: https://doi.org/10.3928/01484834-20160316-05 https://doi.org/10.3928/01484834-2016031...	USA	Master’s program in nursing	To describe the objectives of the QI project in a Master's of Psychiatric Nursing and Mental Health curriculum and to address common student challenges faced with implementation of a QI project in the student’s clinical setting.	It was observed a significant difference in performance on the QI project between students in the class of 2014 and 2015, as measured by grades obtained on students’ final papers.
Jeffs L, Scavuzzo L, Lopez AJ1616. Jeffs L, Scavuzzo L, Lopez AJ. Making the case for graduate students and quality improvement. Nurs Manage. 2016;47(7):18-9. doi: https://doi.org/10.1097/01.NUMA.0000484483.37102.90 https://doi.org/10.1097/01.NUMA.00004844...	Canada	Master’s program in nursing	To report the development of the Project of Translation on Performance Data Knowledge for Nurses and Frontline Leaders for graduate students to work with managers and clinical nurses and lead Quality Improvement efforts in their respective endeavors.	The program evaluation identified the manager's key role in supporting Quality Improvement (QI) projects and mentors to keep teams focused and guide them through performing small test changes.
Dols JD, Hernández C, Miles H1717. Dols JD, Hernández C, Miles H. The DNP project: quandaries for nursing scholars. Nurs Outlook. 2017;65(1):84-93. doi: https://doi.org/10.1016/j.outlook.2016.07.009 https://doi.org/10.1016/j.outlook.2016.0...	USA	DNP	To identify and describe faculty practices and challenges related to the DNP program in the United States.	It shows the lack of knowledge of the faculty about evidence-based practice and Quality Improvement, causing dissatisfaction among professors of DNP programs.
Kukla A, Dowling DA, Dolansky MA1818. Kukla A, Dowling DA, Dolansky MA. The history and state of neonatal nursing quality improvement practice and education. Neonatal Netw. 2018;37(2):78-84. doi: https://doi.org/10.1891/0730-0832.37.2.78 https://doi.org/10.1891/0730-0832.37.2.7...	USA	DNP	To trace the history and current state of QI practice and education in neonatal nursing, providing a history of the integration of Quality Improvement methods used to improve outcomes.	The article brings several Quality Improvement (QI) initiatives and their results, obtaining positive results in the proposed improvements and reduction of rates after implementation. Above all, it emphasizes the difficulty faced in sustaining Quality Improvement, mainly by teachers who do not feel competent with QI knowledge and skills.
Trautman DE, Idzik S, Hammersla M, Rosseter R1919. Trautman DE, Idzik S, Hammersla M, Rosseter R. Advancing scholarship through translational research: the role of PhD and DNP prepared nurses. Online J Issues Nurs. 2018;23(2):1-8. doi: https://doi.org/10.3912/OJIN.Vol23No02Man02 https://doi.org/10.3912/OJIN.Vol23No02Ma...	USA	PhD and DNP	To explore the different but complementary roles that PhD and DNP nurses discover and play within the discipline in scholarship.	Nurses prepared for DNP typically focus on scholarship from practice or translating evidence into practice, often using quality improvement methodologies, with the objective of improving and transforming health care delivery and patient outcomes.
Durham ML, Cotler K, Corbridge SJ2020. Durham ML, Cotler K, Corbridge SJ. Facilitating faculty knowledge of DNP quality improvement projects: Key elements to promote strong practice partnerships. J Am AssocNurse Pract. 2019;31(11):665-74. doi: https://doi.org/10.1097/JXX.0000000000000308 https://doi.org/10.1097/JXX.000000000000...	USA	DNP	To review faculty knowledge on DNP Quality Improvement projects that align with practice partners’ objectives, to address gaps and prepare students to lead and transform health care.	Although DNP projects are predominantly related to quality improvement, the absorption of QSEN content by the Faculty of Nursing has been low and there is a lack of professors with experience in Quality Improvement in some academic programs.
Tovar E, Ossege J, Farus-Brown S, Zonsius M, Morrow L2121. Tovar E, Ossege J, Farus-Brown S, Zonsius M, Morrow L. DNP program faculty and graduates’ knowledge and use of QI and safety processes. Nurse Educ. 2020;45(1):11-6. doi: https://doi.org/10.1097/NNE.0000000000000677 https://doi.org/10.1097/NNE.000000000000...	USA	DNP	To examine the characteristics of the DNP project and compare knowledge, skills and attitudes about processes of Quality Improvement (QI) between undergraduates and faculty of the DNP program.	Most projects were QI/practice (85.5%). DNP program faculty and undergraduates showed significant differences in QI knowledge or skills; Faculty members reported less confidence in their QI knowledge and skills than undergraduates.
Buckley KM, Idzik S, Bingham D, Windemuth B, Bindon SL2222. Buckley KM, Idzik S, Bingham D, Windemuth B, Bindon SL. Structuring doctor of nursing practice project courses to facilitate success and ensure rigor. J Prof Nurs. 2020;36(4):206-11. doi: https://doi.org/10.1016/j.profnurs.2019.12.001 https://doi.org/10.1016/j.profnurs.2019....	USA	DNP	To describe the school’s process of developing and modifying DNP project courses to effectively translate changes in evidence-based practice.	One of the results mentioned is the integration of the Quality Improvement models into the DNP. It cites that the DNP student must have the necessary skills to effectively translate research into practice, developing, leading and implementing data-driven QI initiatives.
Idzik S, Buckley K, Bindon S, Gorschboth S, Hammersla M, Windemuth B, et al2323. Idzik S, Buckley K, Bindon S, Gorschboth S, Hammersla M, Windemuth B, et al. Lessons learned using logic models to design and guide DNP projects. Nurse Educ. 2021;46(5):E127-E131. doi: https://doi.org/10.1097/NNE.0000000000001025 https://doi.org/10.1097/NNE.000000000000...	USA	DNP	To identify opportunities for enhancement of DNP curriculum to ensure students to show an adequate level of knowledge and skills necessary to effectively translate research into practice by developing, leading and implementing data-driven QI initiatives.	Many benefits and challenges were identified during the implementation of the Quality Improvement (QI) process. One of which was a logic model, which may benefit other schools looking to increase consistency and rigor. Results included better project conceptualization, clarity, conciseness, and feasibility of achieving goals.
Reynolds SS, Howard V, Uzarski D, Granger BB, Fuchs MA, Mason L, et al2424. Reynolds SS, Howard V, Uzarski D, Granger BB, Fuchs MA, Mason L, et al. An innovative DNP post-doctorate program to improve quality improvement and implementation science skills. J Prof Nurs. 2021;37(1):48-52. doi: https://doi.org/10.1016/j.profnurs.2020.12.005 https://doi.org/10.1016/j.profnurs.2020....	USA	Postdoctoral DNP	To describe the planning, implementation, and evaluation of an innovative Postdoctoral DNP Quality Implementation Scholars program developed through an academic-practical partnership to address this need.	This innovative DNP Postdoctoral program leveraged the skill sets of DNP-prepared nursing leaders to lead system-wide Quality Improvement initiatives tailored specifically for health care organizations.

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[1] Corresponding author:
Bruna Luisa Melo de Aquino Lemos Corrêa E-mail:brunaaluisa@gmail.com