Hi, my name is Laura Bonanno, and I'm going to be presenting on scholarly projects for practice doctorate nurse anesthesia programs. Just to tell you a little bit about myself, I am the program director at LSU Health Sciences Center School of Nursing's Nurse Anesthesia Program in New Orleans, Louisiana. I've been in that position since 2007, so quite a long time. I'm also a professor of nursing here at LSU, and I'm a member of the AANA's Faculty Stabilization Task Force, and a member of the COA Scholarly Work Special Interest Group, and co-author of the COA White Paper. I previously served two terms on the COA, two years as president and three years as vice president, and just finished my term in October of 2022. Some of the objectives of this presentation, we're going to discuss the key elements of a scholarly project for practice doctorate nurse anesthesia programs, and also review the COA practice doctorate standards that pertain to scholarly work. We're going to review the COA glossary definitions pertaining to scholarly work, also provide some guidance to nurse anesthesia faculty on how to successfully manage scholarly projects. We'll differentiate between what is and is not considered a key element of scholarly work, and also discuss evaluation of scholarly work, and some of the options that the task force who developed the White Paper decided for dissemination. So the COA White Paper kind of came out of a special interest group that was formed in order to support nurse anesthesia programs, and this group was formed in October of 2018 by the Council on Accreditation to examine the current state of scholarly work, and also to produce a White Paper that could serve as a guide for programs development of criteria for their scholarly work, and this was as it's defined in the standards for accreditation of nurse anesthesia programs, the practice doctorate standards. Nurse anesthesia educators provided input via a survey, and then a focus group was held at the 2019 Assembly of Didactic and Clinical Educators meeting, and then there was also an active discussion and a question and answer session that was held during the assembly, so we got feedback from that survey as well as the focus groups, and that also informed the COA's White Paper. There was also a call for comments sent to stakeholders to review and comment on the draft of the White Paper before it was finally published, and this COA White Paper is available on the COA's website, and there was also an article that was published in the AANA Journal in February of 2021 that you can refer to. So again, the COA White Paper is really meant to provide guidance regarding the titling and the key elements of scholarly work. To satisfy the requirements of practice doctorate training, scholarly work represents an evidence-based inquiry process using scholarship skills that results in an academically sound product to improve clinical practice. So in nurse anesthesia programs, the scholarly work should include the following steps. One, identify a problem. Two, search, analyze, and synthesize the existing evidence. Literature reviews are a requirement for all projects, but a standalone literature review is not considered sufficient to serve as the scholarly project in nurse anesthesia programs. The third step is to develop a strategy to address the identified problem, to plan for implementation of the strategy, evaluation of the scholarly work, and then dissemination of the scholarly work. So the COA White Paper also addresses some other topics, which include use of student teams to complete the scholarly work, literature reviews, academic portfolios, original research, resources and implications of participation on student projects for faculty workload, and also how DNP projects can help faculty meet professional rank and tenure requirements. The COA practice doctorate standards that are relevant to scholarly work include standard D48, which says the graduate must demonstrate the ability to disseminate scholarly work, and then standard E8 states that the curriculum requires the student to complete scholarly work that demonstrates knowledge and scholarship skills within the area of academic focus, which here would be anesthesia-related. And there's a glossary definition for both scholarly work and scholarship skills, so I encourage you to make sure you take a look at those, and I've included them on the slides here as well. And then standard A8 states that the conducting institution provides sufficient time to permit faculty to fulfill their obligations to students, including clinical and classroom teaching, counseling and evaluation, and advising on doctoral-level scholarly activities. And again, there's also a glossary definition that relates specifically to scholarly work oversight. So here are those definitions that are included in this glossary of the practice doctorate standards. So for scholarship skills, this includes but is not limited to the ability to perform extensive literature searches, critically appraise the available research evidence, synthesize information from diverse formats and sources, and cogently express understanding of complex concepts in both verbal and written forms, all while demonstrating high professional, personal, and intellectual integrity. And then scholarly work, the doctoral program culminates with the completion of a scholarly work that demonstrates the ability to translate research findings into practice. And this is an opportunity for the student to prepare a substantial final written work product applicable to nurse anesthesia practice that reflects the breadth of skills and knowledge the student has gained throughout the program of study. And the final written work product may be in the form of a manuscript submitted for publication, a poster presented at a national meeting, it could also be a state or local meeting, design of innovative clinical practice model or other effective means of dissemination. The structure and process of the scholarly work is going to vary according to the requirements of the governing institution and also conform to accepted educational standards at the practice doctoral level. And then finally, the glossary definition for scholarly work oversight states that while CRNA and non-CRNA faculty involvement in the scholarly work development process may vary depending on the institution, college or program, or the project scope, faculty with a CRNA credential must be involved in the process of planning, formation, and evaluation of each scholarly project. An evaluation of scholarly work may include a combination of methods including faculty, expert, and or peer evaluation, and programs may tailor scholarly work evaluation and approval processes for university, departmental, program, or committee requirements. So again, the important thing to take away is that there must be a CRNA, a faculty member with the CRNA credential involved in all projects where for nurse anesthesia programs awarding a doctoral degree and they must participate in the planning, formation, and evaluation of each of those scholarly projects. Now what that means is, I'll just give you an example here at LSU, we have a CRNA on every project, however, we may have another School of Nursing faculty doctorally prepared that may chair the project and the CRNA may be a team member on the project, or it could be switched around. The CRNA faculty may be the lead or the DNP project faculty is the term that we use here, and there may be a School of Nursing faculty member serving as a team member on that project, but you'll meet the criteria as long as there's a CRNA involved in those aspects that we just mentioned. And then I mentioned that we would talk about the title. So when we developed the white paper, we really felt like the title Scholarly Project speaks to the unique application of work required to attain the practice doctorate, and that terminology consistent with the degree focus is recommended. So Scholarly Project is fine, DNP Project is fine for those programs that are in a School of Nursing that kind of aligns with CC&E's white paper that was published in 2015, or for those in a DNAP program, it could be the DNAP Project. And then as far as the term dissertation, that is really conveys research oriented work consistent with a PhD or an EdD degree, so that should not be used. And the term capstone is used in high school, middle school, or at the end of an academic program that's not at the doctoral level. So that term should not be used. So Scholarly Project, DNP Project, DNAP Project are all acceptable terms. So regarding the elements of scholarly work for all projects, we kind of went through these a couple of minutes ago, identify the problems, search, analyze, and synthesize the existing evidence that a literature review is required for all projects, that there has to be a strategy or a method developed to address the problem, and then a plan for implementation. Now, this doesn't mean that implementation has to occur, but there has to be a plan for implementation. And we'll kind of go over some examples of projects that may include a plan for implementation but not implement, and those that may include implementation. Okay, so we'll go, again, just quick review of the elements of the scholarly work for all projects. So we mentioned identify a problem, and this needs to be related to nurse anesthesia practice. It can be a clinical problem, an educational problem, or something professional related. And then search, analyze, and synthesize the existing evidence using literature search skills and critical thinking. And then the literature review, again, is a requirement for all projects but cannot serve as a standalone project. And the review of the literature should be inclusive of an appraisal with implications and or recommendations for practice that offers breadth and depth and scope to a project. For example, a student may complete a literature review and then do an analysis and synthesis focused on CRNA involvement in professional associations. And then we mentioned the possibility of doing team projects, although this may be kind of two students focused on the same issue. Another student could address the same topic and then focus their project on state policy development. Again, standalone literature reviews without analysis serve as a platform for a project but fall short of the other elements of the scholarly work. Pairing, moving on with the elements, the next would be to develop a strategy or a method to address the problem, demonstrating problem solving and critical thinking. And then last, the plan for implementation of the strategy or a method to be used to address the problem has to be there. It's acknowledged that not all projects can be implemented due to the breadth and scope of the project, but there at least, at the very least has to be a plan for implementation. So projects aimed at changing practice, educational strategies or administrative policies may be projects that cannot be implemented because of the wide scope. The student may generate the foundations of change based on evidence and analysis and proposed methods for implementing the change as actually executing the change may require time, resources and committee approvals that would extend past the student's graduation. But again, there just has to be that plan for the implementation. So I said we would provide you with some examples. Here is an example of a project with implementation. Registered nurses may lack knowledge and training regarding malignant hyperthermia protocols throughout a multi-facility hospital system. Administration of a pretest to determine baseline knowledge would precede an in-service education program. And then following the in-service, a post-test to evaluate gains in knowledge would form the foundation of the project. Implementation of new educational requirements would result. And then implementing oral didactic testing in an entry-level neurosanesthesia educational program may be initiated based on a project dedicated to testing comparisons. So those are some examples of projects that would actually include that implementation piece. And an example without implementation. So the issue was improving patient safety by changing current monitoring practices for patients receiving peripheral nerve blocks. To address this issue, a student may search for, analyze and apply evidence to create a hospital policy for patients receiving peripheral nerve blocks. However, implementing the policy requires multiple levels of approvals as well as staff education. So time constraints on the entry-level or completion degree CRNA may preclude the full implementation just because of the time. Sometimes it may take several months or even longer to get those approvals. And then projects with a very large scope may be extended from one cohort to the next. So it may not be feasible to implement the initial project because it may have such a large scope. But narrowing the scope of the project is advisable but not always feasible depending on what that project topic is. And sometimes programs have been successful by having one student, for example, take it to that plan for implementation stage and then maybe another student comes in and carries that project through. And then evaluation and dissemination of scholarly work. Evaluation may include a combination of methods that includes faculty, expert and or peer evaluation. And programs tailor those scholarly work evaluation requirements and approval processes based on the university, department, program or committee requirements. Dissemination again is required by the COA, it is a standard. So dissemination of rigorous scholarly work contributes to the profession. Methods can include a combination depending on the program or the institution's requirements. So dissemination includes a final written product that is presented to stakeholders at the university or at a local, state or national meeting. And other methods for dissemination can include poster presentations, a manuscript submitted for publication in service education, a podcast. You can be creative as to what's gonna meet your institution's requirements, but there has to be dissemination of the project. The other thing that we stated in the white paper is that you may consider avoiding the term defense in the final presentation of the project as that term is commonly applied to approval for research oriented doctorates, like our research-oriented doctorates. Like a dissertation defense. So anyway, it's up to your institution to decide what you wanna call that final presentation of the project. And team projects, this is always something that programs are very interested in knowing. Many programs face an ever increasing number of projects and therefore are opting to incorporate the multifaceted engagement of a team approach to complete scholarly work. The advantages are that students can gain essential teamwork skills. For faculty, it does reduce the number of projects that they have to oversee. And for clinical sites, it helps with project fatigue because sometimes depending on the particular program, you may have several projects being carried out in one particular institution and that can cause project fatigue. If a program is going to do team projects, it's recommended that there is a clear delineation of the requirements for team projects to make sure that each student is, again, meeting the criteria for the scholarship skills and contributing to the project. So it's recommended that the program consider the use of learning contracts that delineate clearly the responsibilities for the project, consider the team composition. This may vary by institutional needs and also consider the AACN guidance regarding teamwork that was in the AACN DNP toolkit from 2019. And I also want to mention about academic portfolios and original research. Academic portfolios chronicle student accomplishments throughout the program, which may include their scholarly work, student papers that they've written, case numbers, reflections, presentations, et cetera. The portfolio should be used as a tool to enhance the presentation and understanding of a project, but should not be considered the sole deliverable product of a project. And every program uses portfolios differently. Here, we use a portfolio. The students are required to complete a portfolio that kind of chronicles the highlights of things that they've submitted or completed during the program. So they may include some of the papers that they've written or presentations that they've given, but we keep that separate from the project, but their project is a component of the portfolio. So just as an example. And then original research. Research to develop new knowledge is viewed as work within the PhD domain and therefore is not viewed as a requirement for the practice doctorate scholarly project. Programs may provide this as an option for exceptionally motivated students, but requiring original research is not necessarily consistent with the aim of the practice doctorate. And then I also wanted to mention about faculty resources and workload. So scholarly projects require faculty input as a source of expert guidance and oversight. And faculty workload inclusive with teaching, clinical practice, community service, and scholarship can pose challenges because of the time element that is involved in mentoring scholarly projects. It's recommended that programs consider the academic workload when planning practice doctorate education to ensure that they have an adequate number of faculty with the appropriate background to meet this need. And programs are required by the COA to demonstrate that they have sufficient faculty resources to support the projects. At this time, the COA does not have a minimum requirement. However, it recently added questions to the annual report to start tracking what programs are doing and how many projects each faculty member is assigned to. But in any case, programs are required to show that they have sufficient faculty resources to support the projects. Some of the benefits for faculty regarding doctoral projects is faculty participation in scholarly projects in many institutions is considered scholarship, teaching, and or service. And it may meet the requirements based on your institution for all three. And the diversity of approaches to awarding promotions, rank, and or tenure to faculty based on their work in scholarly projects can be beneficial to faculty who are seeking advancement. So you can get recognition from the project dissemination, especially if it's something that was submitted for publication or a presentation at a meeting. It also is an opportunity to provide mentorship to students to contribute to your scholarship as based on your work on the project. And also project topics can be matched with faculty interests and expertise. So it may be a venue for faculty to kind of extend or to do some work in an area of their interests and expertise. Just a note about comparison to other practice doctorates. So when we were working on the white paper, the special interest group explored the requirements for scholarly work and other practice doctorates and found that there were a variety of approaches to an interpretation of scholarly work as a culmination of the academic programs. So there is a table in the back of the COA white paper that provides a review of 18 other practice doctorates and the requirements for scholarly work in those particular doctoral programs. In summary, the COA white paper presents the status of scholarly work project requirements in practice doctorate programs of nurse anesthesia. As an integral component of practice doctorate curricula, faculty must guide and mentor students as they engage in scholarly work. And the most desirable outcome of the practice doctorate training will be to produce clinical scholars with the skillsets that enable them to identify practice problems, to explore the relevant scientific literature and to devise and test solutions in a skillful and engaged manner. So programs should strive to assure that this faculty contribution is recognized as a source of support for academic advancement, not as an extra responsibility. So the guidance set forth in the COA white paper in no way supersedes institutional or other accredited requirements. It is meant to provide guidance to nurse anesthesia programs in successfully managing scholarly project in their curriculum. So I just wanna say thank you for the opportunity to present this presentation on the scholarly projects for nurse anesthesia programs. If you have any questions, I believe our contact information is available in the Educator Edge. Feel free to reach out to me and thank you again for participating in this presentation.

scholarly projects

nurse anesthesia

COA standards

evidence-based inquiry

faculty involvement

clinical practice