Learners in the DNP program are required to develop a Direct Practice Improvement (DPI) Project.
Describe your proposed practice site and a potential patient practice problem that you are interested in
exploring for your project. Explain why this is a valid topic for your practice site. How do you believe this
project will contribute to the body of knowledge in your field?

To ensure that the proposed practice problem is viable, refer to the “DNP Direct Practice Improvement
Project Recommendations,” located in the DC Network, and answer these questions: Why is this a valid
issue at my practice site? Why is this a patient practice problem? Will there be enough current research
on this topic, or is it still being investigated by researchers?

I propose to conduct my Direct Practice Improvement (DPI) project in an emergency department, building upon the research initiated during my MSN capstone. My focus centers on adult behavioral health patients seeking inpatient care within the Cleveland Clinic Health System (CCHS) and facing extended waiting times exceeding 6 hours.

In emergency departments, patients undergo a mandatory medical screening, after which they await a mental health evaluation to determine appropriate disposition. This process is crucial for deciding between inpatient admission or follow-up care at an outpatient mental health center. Notably, psychiatric patients face higher boarding rates, with studies indicating a 4.78 times greater likelihood compared to non-psychiatric cases (Nolan et al., 2015).

The decreasing availability of inpatient psychiatric beds intensifies the challenge for ED staff to find timely placements. For behavioral health patients, prolonged ED stays exacerbate distress, impacting their mental state. While some may be isolated in private rooms, those in hallways endure the constant noise, lights, and chaos, often requiring restraint for safety.

Extended boarding of psychiatric patients disrupts the ED’s flow, compromising the well-being of patients and staff. Emergency departments aren’t designed for prolonged behavioral health care, posing safety risks like suicidality, aggression, and elopement. Purposeful rounding offers a valuable opportunity for nursing professionals to engage, assess, and provide individualized care.

My interest lies in evaluating the impact of incorporating basic personal care during purposeful rounding to enhance patient comfort. This involves addressing nutritional needs, assisting with personal hygiene and oral care, and ensuring restroom access (Curtis & Wiseman, 2008). Addressing these fundamental needs contributes to patients’ comfort, safety, well-being, and dignity. Preserving dignity is particularly vital in emergency care settings, where patients often feel a loss of control. Offering choices, no matter how small, fosters trust and respect, potentially reducing aggression.

Through my DPI project, I aim to introduce practices that not only alleviate the challenges faced by behavioral health patients but also enhance the overall efficiency and compassionate care delivery within the emergency department.

Also Read: DNP Capstone Project Help


Curtis, K., & Wiseman, T. (2008). Back to basics—Essential nursing care in the ED, Part

2. Australasian Emergency Nursing Journal, 11(2), 95–99. https://doi.org/10.1016/j.aenj.2007.11.005

Nolan, J. M., Fee, C., Cooper, B. A., Rankin, S. H., & Blegen, M. A. (2015). Psychiatric boarding incidence, duration, and associated factors in United States emergency departments. Journal of emergency nursing, 41(1), 57–64. https://doi.org/10.1016/j.jen.2014.05.004

Response to Student: Hello Benson,

Even before the onset of the pandemic, nurses were grappling with a significant burnout rate. The advent of the COVID-19 virus has further exacerbated the psychological strain on nursing professionals, who find themselves at an increased risk of exposure. The challenges faced by nurses during the pandemic include delivering complex care to acute patients with limited resources, extended work hours, and a decrease in nursing staff, resulting in moral distress and burnout. Empowering nurses to participate in decision-making and contribute innovative solutions to address burnout-related barriers could foster increased engagement and potentially enhance nurse retention.

I eagerly await your insights into the strategies you plan to employ to tackle this pressing issue.

Hello Sljl,

I concur that achieving glucose control remains a formidable challenge for diabetic patients. Adhering to lifestyle modifications and adhering to daily prescribed medications often imposes a significant self-management burden on patients. Diabetes self-management education and support have demonstrated substantial benefits in reducing hospital admissions and readmissions. Research indicates that smartphone apps designed for diabetes management, incorporating features such as reminder alarms, carb counting, community support, glucose tracking, and diabetic-friendly recipes, have effectively improved self-management (Huang et al., 2018).

Another valuable resource for patients managing diabetes is a certified diabetes coach. These coaches are trained to assist individuals in navigating the day-to-day challenges of diabetes. They can help patients cope with emotional burdens related to diabetes, identify barriers to self-management, establish achievable goals, and promote self-esteem.

Lastly, diabetes-related social support groups offer long-term support and contribute to glycemic control maintenance. These groups can be either in-person or online and play a crucial role in supporting diabetes self-management interventions. By sharing coping strategies, reducing feelings of isolation, inspiring healthy lifestyles, providing encouragement, motivation, and fostering accountability, diabetes social support groups contribute significantly to long-term glycemic control (Ing et al., 2016; van Dam et al., 2005).


Huang, Z., Soljak, M., Boehm, B. O., & Car, J. (2018). Clinical relevance of smartphone apps for diabetes management: A global overview. Diabetes/metabolism research and reviews, 34(4), e2990. https://doi.org/10.1002/dmrr.2990

Ing, C. T., Zhang, G., Dillard, A., Yoshimura, S. R., Hughes, C., Palakiko, D. M., Kehauoha, B. P., Sinclair, K. A., & Kaholokula, J. K. (2016). Social Support Groups in the Maintenance of Glycemic Control after Community-Based Intervention. Journal of diabetes research, 2016, 7913258. https://doi.org/10.1155/2016/7913258 van Dam, H. A., van der Horst, F. G., Knoops, L., Ryckman, R. M., Crebolder, H. F., & van den Borne, B. H. (2005). Social support in diabetes: a systematic review of controlled intervention studies. Patient education and counseling, 59(1), 1–12. https://doi.org/10.1016/j.pec.2004.11.001

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