Healthcare facilities that seek high standards of care involve their employees in decision-making and management processes. The observation at Hampton VA Medical Center, Community Living Center (CLC), showed a lack of nursing shared governance in the care for dementia patients, which justified the need in the Doctor of Nursing Practice (DNP) project. The insufficient engagement of bedside nurses in decision-making impairs their performance (Olender et al., 2020). Studies addressing this problem compared institutions with and without shared governance and found that shared governance brings advantages to nurses’ perception of the working environment, quality of care, workplace engagement, and workplace empowerment (Ayaad et al., 2018; El Shal et al., 2018; Olender et al., 2020). Although implementing shared governance can be very beneficial, it will take much effort and time, as well as involving key stakeholders – the chief nurse manager, the chief geriatrics, the nurse manager, and the nurses.
The implementation of the DNP project requires the use and study of substantial data volume regarding the problem. It is crucial to highlight that data collection for problem statements differs from the data gathering process for project implementation control (Sylvia, 2018). At the same time, the choice of benchmarks by which the DNP project’s impact will be assessed depends on data that has become the basis for the problem statement (Sylvia, 2018). Recommendations for choosing metrics also suggest including structure, process, and outcome measurements whenever possible (Sylvia, 2018). These aspects guide selecting benchmarks and determining the data required for project monitoring and assessment.
Considering the problem of the lack of shared governance, one can choose special tools for measuring it. The data must be collected and analyzed to formulate a problem statement before the project begins. The instrument used to measure shared governance is the Index of Professional Nursing Governance (IPNG) (Weaver et al., 2018). It measures governance in the spectrum depending on the employees who make decisions – administration, staff, or shared process (Weaver et al., 2018). The tool includes subscales determining who controls staff and resources, has access to governance information, participates in governance activity, monitors practice, and sets goals (Weaver et al., 2018). These subscales allow measuring both the structure and process in the department.
After the project is complete, the measurement must be repeated. IPNG is available for use in its latest version, 3.0. To fully interpret the results, permission to use the tool and subscale key must be obtained from the Forum for Shared Governance (“IPNG/IPG/Council Health Guidelines,” 2021). However, for this version of the questionnaire, the desired benchmark is a score of >100 in total governance (“Measurement & accreditation,” 2021). This indicator will testify to a sufficient level of shared governance to improve the quality of services.
Shared governance should also affect the outcome in the department. Weaver et al. (2018) note that IPNG can provide evidence that shared governance is associated with best practice, professional, and patient outcomes. Nevertheless, it is also critical to pay attention to the assessment of data on caring behaviors within the project’s framework to understand whether the intervention affects the care of patients with dementia. Caring Nurse-Patient Interactions Scale is an appropriate tool for collecting data on care and its perception by nurses. The tool assesses humanism, hope, sensitivity, helping relationships, emotional expression, learning, environment, problem-solving, needs, and spirituality (Cossette et al., 2019). Shared governance should increase the ability of nurses to help the patient and provide for their needs, and the questionnaire should show the progress.
Measuring caring behavior is also necessary at the beginning of the project for the problem statement and at the end to assess progress. Each question in the questionnaire is scored on a scale of one to five and counted, creating an average subscale score (Cossette et al., 2019). Benchmarks in this measurement of care are a minimum of four points for each subscale. The questionnaire will show nurses’ perception of the quality of their services provided to patients.
Thus, clinical data management is essential to the DNP project implementation. It is used for problem statements and to assess progress after changes, comparing results with the established benchmarks. The considered problem, lack of nursing shared governance, also needs such data management. Required information can be obtained through the use of a few questionnaire tools. Shared governance can be measured using the IPNG instrument in its latest version, 3.0. It is also necessary to understand whether patient care has improved after the project. Caring Nurse-Patient Interactions Scale can reflect the nurses’ perception of care and show progress.
References
Ayaad, O., Alloubani, A., Thiab, F., Yousef, D., & Banat, B. (2018). Adopting a shared governance model to improve nurses’ working environments.British Journal of Healthcare Management, 24(12), 594-602. Web.
Cossette, S., Pepin, J., & Fontaine, G. (2019). Caring Nurse–Patient Interactions Scale. In K. Sitzman & J. Watson (Eds.), Assessing and measuring caring in nursing and health sciences (3rd ed., pp. 251-270). Springer. Web.
El Shal, S. M., Eid, N. M., & Ebrahim, R. M. (2018). Nursing personnel’ perception toward shared governance and its relation to their job empowerment.Menoufia Nursing Journal, 3(2), 97-106. Web.
IPNG/IPG/Council Health guidelines. (2021). Shared Governance. Web.
Measurement & accreditation.(2021). Shared Governance. Web.
Olender, L., Capitulo, K., & Nelson, J. (2020). The impact of interprofessional shared governance and a caring professional practice model on staff’s self-report of caring, workplace engagement, and workplace empowerment over time.JONA: The Journal of Nursing Administration, 50(1), 52-58. Web.
Sylvia, M. L. (2018). Clinical analytics and data management for the DNP. Springer Publishing Company.
Weaver, S. H., Hess, R. G., Williams, B., Guinta, L., & Paliwal, M. (2018). Measuring shared governance: One healthcare system’s experience.Nursing Management, 49(10), 11-14. Web.