The setting for the DNP project is a healthcare setting, where primary, secondary and tertiary levels of care are provided. Kings County Hospital Center (KCHC) is a teaching hospital, which has 639 certified beds and the everyday client demographic includes Fifty-six percent (56%) of females and 44% of males. The hospital serves culturally diverse clients. According to 2016 Community Health Needs Assessment (CHNA), the typical clients served are 82% of Black Non-Hispanic; 8% Hispanic or Latino; 5% White Non-Hispanic; 3% Multi-Race/Other; and 2% declined to identify. Among the total recipients of care (ROC), 15% are under age 21; 29% are ages 21-44; 39% are ages 45-64, and 16% aged 65 and older. The most commonly seen diagnosis are Hypertension, Heart disease, cancer, Asthma, etc. (2016 CHNA).
The vision of KCHC is ” to be the hospital of choice for the residents of Brooklyn and for the employees. KCHC strive to provide the highest quality healthcare services with an emphasis on patient safety in a customer-centered environment”. The mission of the hospital is to “provide quality healthcare services to a culturally and linguistically diverse population, regardless of their ability to pay. KCHC recognize that every patient and every employee has great value and therefore the highest organizational priority must be respect for the patients, visitors and one another” (KCHC – Vision & Mission statement). The mission and the vision align with the DNP project since the purpose of the project is to train the staff to be culturally competent and sensitive in order to deliver the highest quality care in a client-centered environment.
KCHC adopted shared governance practice model as part of its journey towards Magnet status and to empower nurses, improve job satisfaction and retention. Since the adoption of shared governance practice model, nurses feel more “at the table” and being part of decision-making. According to Kutney-Lee, et al. (2016), organizations that foster shared governance promote a culture of engagement among nurses in the organizational decision-making. It is not always easy to have a welcoming attitude towards culture change among staff. In order to overcome staff resistance, multiple strategies will be incorporated including creating focus groups, educational workshops/journal clubs, supporting and mentoring staff by superusers/champions, engaging leaders, providing resources such as educational materials, etc. KCHC has a history of being under Department of Justice (DOJ) monitoring after some unfortunate events and had made a significant culture change. DOJ found KCHC to be in substantial compliance with their recommendations and ended their five-year oversight in 2016.
The need assessment conducted within the practicum site includes dialogues with clients, who had complaints regarding their cultural beliefs are not being respected or incorporated in their plan of care and staff, who felt not being culturally competent about caring for culturally diverse clients. The discussion with leadership regarding the patients’ unsatisfactory HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), the patient satisfaction survey results also impacted the project. According to Jones and Roussel (2017), recognizing stakeholders’ opinion of the issue is imperative for its successful resolution. The Iowa model supports the identified problem and can be used to implement a practice change to train staff to be culturally competent to provide quality of patient care and improve health outcomes.
The stakeholders for the project include clients, who felt their cultural needs are not met and the staff, who felt not as knowledgeable as they need to in order to provide the quality care. Organizational leaders are also considered as a key stakeholder since the DNP project will impact the delivery of care, which improves patient experience and staff satisfaction. Communicating effectively with all stakeholders is vital to the success of the project (Burson, 2016).
Organizational support is critical for the implementation, the organizational change and the success of the project. The sustainability of the DNP project also determined by the support of the organizational leaders
Please see attached letter of organizational support.
The practice change associated with the DNP project is expected to sustain after the completion of the project. The practice change will be sustained by continuing to train the new nurses during orientation and yearly annual mandatory training online as part of their competency. In order to promote sustainability, a questionnaire will be incorporated into their annual mandatory exam online as part of their performance evaluation. All managers will be held accountable for ascertaining that the staff on their units attends the online training and completing the questionnaire, which will be updated as needed by the education department. The implementation and the sustainability of the DNP project will be determined by the support of the organizational leaders
Internal Forces (project)
External Forces (Organization or
· Motivated staff
· History of successful practice change
· Sustainability of DOJ recommended practice change
· Managers offering to help in any way they can to implement the project
· Lack of support from some leadership
· Resistance from some staff
· Not enough staff attending the training due to shortage of staff
· Withdrawal of funding for overtimes
Shortage of staff is a possible threat that could be encountered with this project. The processes to overcome this risk would include communicating with the leadership, educators, unit managers and nursing staff regarding the project and working with unit managers to schedule an appropriate number of staff for the training. Another way to overcome the potential risk is to have flyers posted in advance in all units informing staff about the upcoming training (with refreshments served) to motivate staff and to avoid any unintentional absences. According to Burson (2016), it is essential to collaborate efficiently with all stakeholders to ensure that the goals of the project are met.