Posted: February 7th, 2022

The statistical test for this DNP project will be the Wilcoxon sign-rank test.

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Data Management Plan
The data management plan is a vitally important component of the DNP project implementation and allows for the dissemination of accurate project outcomes. The DNP student consulted a statistician for the following practice question that will serve as the basis for the proposed “For adolescents diagnosed with depression in a primary care clinic, will the implementation of AAP Computerized Cognitive Behavioral Therapy, compared to current practice, impact depression scores on the PHQ-A over 8-10 weeks?”
For this DNP project, the Doctor of Nursing Practice (DNP) student will collect PHQ-A scores from each participating adolescent before and after implementing the computerized cognitive behavioral therapy intervention. The PHQ-A is a Likert scale tool and scored on an ordinal level of data for depression in adolescents.

Participants’ PHQ-A scores will be matched on pre and post-data analysis, making them dependent groups. With dependent groups and an ordinal variable, a non-parametric test can be used to determine whether there is a statistically significant difference between paired or matched observations based on median scores.
The statistical test for this DNP project will be the Wilcoxon sign-rank test. The Wilcoxon sign-rank test will evaluate the median difference in matched PHQ-A scores pre and post-intervention (Hollander & Wolfe, 1999; Wilcoxon, 1945). The median difference between the related groups will be tested using a z-test. Data analysis will be presented using tables and graphs to illustrate the median differences. The significant level for the DNP project is α=0.05.
The planned analysis of the evaluation data begins with the DNP project student comparing the PHQ-A score from the participants that were collected in week one to the data collected post-project in week nine. The PHQ-A will be collected by the advanced practice registered nurse at the practicum site. The data will be entered into an Excel spreadsheet for analysis and comparison.
Project Management Plan and Gantt Chart
The DNP project intervention plan will be conducted over a ten-week period. The detailed project proposal, planning, data management and analysis, and dissemination plan can be found in the 32-week Gantt chart in Appendix B. The formative and summative evaluations will occur within ten weeks.
Pre-Implementation Phase
During the pre-implementation phase, the DNP student will assess and review the intake screening process and treatment delivery process at the practicum site. The DNP student will meet with the primary care clinic stakeholders and clinic staff to ensure buy-in for implementing CCBT. During the pre-implementation phase, the DNP student will prepare content and material for CCBT educational offering and the implementation phase.
Week one of Implementation
Educational offerings (Appendix D) will be held with staff and include instruction on access and instruction of use for the Computerized Cognitive Behavioral Therapy (CCBT) program and mechanisms for re-education each week will be planned. Support for the educational offering will be provided by a child psychiatrist from the behavioral health outpatient clinic where CCBT is currently utilized. Additional training will be provided to the APRN CCBT champions.
Week Two to Eight of implementation
In week two, pre-implementation data collection will consist of PHQ-A scores for adolescents at their initial visit. At the initial visit, adolescents will be screened by the APRN for inclusion criteria, including PHQ-A score. Those meeting inclusion criteria will be recruited, consent and assent will be completed, and CCBT instruction will be provided. Enrolled patients and inclusion criteria information will be documented on the inclusion criteria compliance checklist (Appendix E) by the CCBT champions and completed by the end of week two. Pre-intervention data will be documented on the Excel data worksheet by the DNP student. In the clinic, observations will be conducted, and initiation of CCBT compliance will be monitored. Real-time feedback, 1:1 conversations, and huddles/team meetings will be conducted. Weekly meetings will be held with clinic leadership, stakeholders, and multidisciplinary team members to ensure there is open communication between the DNP student and the implementation team.
The implementation phase of CCBT will be held from weeks two to eight. Patients will follow the CCBT program in their homes during weeks two to eight. Scheduled virtual visits with the APRN to answer questions and provide support will be scheduled for week three and at the conclusion at week nine. Phone calls will be made to patients by the CCBT champions during weeks two to seven to ascertain compliance and provide support. Phone calls will be documented on the compliance checklist (Appendix E). Noncompliance with CCBT will be reported to the APRN, and a virtual appointment will be scheduled during the week. The APRN will provide re-education, support, and encouragement for the use of CCBT. The DNP student will be physically present during the CCBT implementation to ensure compliance with the procedures of the project. The DNP student will meet with the CCBT champions bi-weekly on Monday and Friday for feedback sessions about the implementation.
Formative evaluations will facilitate by weekly discussions with the clinic leadership, stakeholders, and staff to assess the implementation of CCBT and provide project updates.
Week Nine through Ten
In week nine, post-implementation data PHQ-A scores will be obtained by the APRN during their scheduled patient visit. In week ten, post-intervention PHQ-A scores will be obtained from the DNP student’s chart review of all enrolled patients and input into the excel database. A statistical analysis of the PHQ-A data will be performed with a statistician’s aid in week ten. The DNP student will contact the course instructor weekly during the implementation phase.
Proposed Budget
The DNP project expenses, revenue source, and the total value of revenue to expenses are $0, as shown in the following table 1.
Table 1
Budget
EXPENSES
$$
REVENUE
$$
Grant
$2000
Direct
Salary and benefits:
DNP student: Initial education/training and weekly review of compliance data with real-time education as necessary.
120 hours x $60 per hour
$7,200
In-Kind Donation
(DNP Student)
$7200
Education/training provided to nurse practitioners (NPs) instructions on use of CCBT for patients.10 NP’s for 2 hours x $60 per hour
$1,200.00
Institutional Budget Support
$1,200.00
Weekly follow-up calls to check CCBT compliance and provide support. 1 nurse for 10 hours x $50 per hour
$500.00
Institutional Budget Support
$500.00
Supplies:
CCBT material
50 patients x $40 per material
$2,000.00
Grant
$2,000.00
Services
Marketing/Advertising Printed promotional materials to recruit participants
$100.00
Institutional Budget Support
$100.00
Statistician
4 hours x $40 per hour
$160.00
Institutional Budget Support
$160.00
Indirect
Overhead: None: All activities during open clinic hours
Total Expenses
$11,160.00
Total Revenue
$11,160.00
Net Balance
0
Ethical Issues and Considerations
The Institutional Review Board (IRB) pre-determination review team for Chamberlain University will review the project, and implementation will begin after receiving an approval letter from IRB. Additional IRB approval by the practicum site is not required. Patient protection and the protection of health information will be at the forefront of this project. Any patient with severe depression symptoms or at risk for self-harm behavior as demonstrated on PHQ-A will be excluded and referred to urgent care services. All patient identifiers will be removed from collection data, and each patient will provide a corresponding number for identification. PHQ-A scores for each patient will be communicated using the corresponding number. Data will be stored in a password-protected computer in an encrypted electronic file and kept for seven years. Informed consent for parents and assent for an adolescent will be provided prior to the project’s onset (Appendix F & G). One anticipated risk for participants is an escalation of the participant’s depressive symptoms and a need for further resources from the clinic. The parents and participants are informed of the resources in the informed consent and offered the phone number with confidential access if they require further counseling or referral to urgent care related to exacerbation of depressive symptoms.
References
Hollander, M., & Wolfe, D. A. (1999). Nonparametric statistical methods (2nd ed.). Wiley.
Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics Bulletin, 1(6), 80–83.
Sharon Goodman Gantt Chart 702.docx Reply

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