NURS 8600 Week 10 DNP SQUIRE manuscript outline example

Shaping the Manuscript Before Writing It: A SQUIRE 2.0 Outline for Reporting a Rural Clinic's Alcohol Screening Project

Student Name

College of Nursing, Walden University

NURS 8600: DNP Field Experience

Instructor Name

Month Day, Year

Shaping the Manuscript Before Writing It: A SQUIRE 2.0 Outline for Reporting a Rural Clinic's Alcohol Screening Project

Cover Page Information

Working title: "Designing for the Busy Day: Asking About Alcohol, and Acting on the Answer, in One Rural Family Medicine Practice." Target journal type: a nursing quality improvement journal or a rural health journal that accepts quality improvement reports; the specific journal will be chosen with the project faculty after comparing scope and article types. Word limit: to be confirmed against the chosen journal's author guidelines; the outline assumes a typical limit of about 3,500 words, with the run charts as figures. Reporting guideline: SQUIRE 2.0, the Standards for Quality Improvement Reporting Excellence (Ogrinc et al., 2016).

Why SQUIRE

SQUIRE was developed for reports of systematic efforts to improve the quality, safety and value of health care, and it asks authors to describe the context, the intervention, how it changed over time and the methods used to study it, elements a general research format does not require (Ogrinc et al., 2016). This project's most important findings, such as the stall in brief intervention and the course correction that followed, are exactly the kind of iterative change SQUIRE asks authors to report. An explanation and elaboration document gives examples of each SQUIRE element from published improvement reports, which will guide the writing (Goodman et al., 2016).

Title and Abstract

Title. State that the work is a quality improvement project, name the setting as rural primary care and name the change. Abstract. Structured, following the journal's headings; include the problem, the intervention, the measures, the main results with numbers and the key limitation that measures reflect documentation, not drinking outcomes.

Introduction

Problem description. Unhealthy alcohol use is common and often undetected in primary care; the clinic had no standard process, and baseline documentation of screening was about one in four annual visits.

Available knowledge. Summarize the recommendation to screen adults in primary care, the Cochrane evidence that brief interventions reduce drinking modestly and the meta-analytic evidence that brief intervention alone rarely increases specialty treatment use (Kaner et al., 2018). Keep this to one paragraph.

Rationale. Explain the Model for Improvement and why iterative testing suited a small clinic with limited staff.

Specific aims. Three process aims and one balancing measure, stated as in the approved plan.

Methods

Context. Describe the clinic without identifying it: rural, three providers, two nurses, four medical assistants, a counselor on site two days a week and a nurse who covers the phone line on some days. SQUIRE asks for the context features that might affect results, so the phone coverage duty must be described here.

Interventions. Describe the original workflow, then each change in order: the declined option, the telehealth introduction with held slots and the provider delivery on phone-coverage days with the note shortcut. A table of adaptations with dates will be included.

Study of the interventions. Describe fidelity reviews against the three core elements and the observations of two conversations.

Measures. Define each process measure with numerator and denominator, the balancing measure and the change from sampled baseline to full count.

Analysis. Run charts with the baseline median and the four annotated events, interpreted with the standard rules (Perla et al., 2011).

Ethical considerations. Clinic leadership approved the project as quality improvement; data were de-identified; the institutional review board's determination will be stated.

Results

Report the course of the project in time order: launch, the April workflow map, the first cycle, the midpoint findings, the second cycle and the course correction. Present the three run charts as figures, each with its annotations. Report brief intervention separately before and after the course correction. Report referral offers as counts. Report the one-minute rise in rooming time as a result, not a footnote. Include the fidelity findings, particularly that the readiness question was the element most often missing before the shortcut.

Discussion

Summary. Screening changed and held; brief intervention improved after a change to who delivers it; referral offers improved in count but remain inconclusive.

Interpretation. Compare the results with the evidence summarized in the introduction and explain the delivery finding as the main contribution.

Limitations. The five limitations from the final report, in brief: change in data source, documentation rather than practice, small numbers, single site and no patient outcomes.

Conclusions. Workflows for brief intervention should be designed around staff availability on the clinic's busiest days.

Other Information

Funding. None. Acknowledgments. Clinic staff by role, with permission. Conflicts of interest. None. Author contributions. The DNP student as first author; faculty and practice mentor listed according to the journal's authorship criteria and the program's policy.

Figures and Tables Planned

Most journals limit the number of figures and tables, so the outline fixes them now. Figure 1 will show the workflow as finally implemented, drawn as a simple swimlane with the provider lane added. Figures 2 to 4 will be the three run charts, each with the baseline median and the four annotated events. Table 1 will define each measure with its numerator, denominator and data source. Table 2 will list the adaptations with dates, who made them and whether the core of the intervention was preserved. If the journal allows only four display items, the referral chart will move to supplementary material, since its small numbers make it the least informative figure.

Timeline to Submission

The draft will be written in two stages. Methods and results, which describe what was done and found, will be drafted first, within four weeks of the final report, while details are fresh. Introduction and discussion will follow, since they depend on how the results are framed. Faculty and the practice mentor will review the full draft, and the clinic's medical director will confirm that the description of the setting cannot identify the clinic. Submission is planned within four months of the project's end, and the outline will be revised if the chosen journal's structure differs from SQUIRE's headings.

Poster Abstract From the Same Outline

The same outline will produce a poster abstract for a regional nursing conference. The abstract will use four headings, background, methods, results and conclusions, and will lead with the delivery finding. The poster itself will center the brief intervention run chart, since it tells the project's story in one image: a stall, an annotated change and the months that followed.

References

Goodman, D., Ogrinc, G., Davies, L., Baker, G. R., Barnsteiner, J., Foster, T. C., Gali, K., Hilden, J., Horwitz, L., Kaplan, H. C., Leis, J., Matulis, J. C., Michie, S., Miltner, R., Neily, J., Nelson, W. A., Niedner, M., Oliver, B., Rutman, L., ... Thor, J. (2016). Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines, V.2.0: Examples of SQUIRE elements in the healthcare improvement literature. BMJ Quality and Safety, 25(12), Article e7. https://doi.org/10.1136/bmjqs-2015-004480

Kaner, E. F. S., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., Daeppen, J. B., Saunders, J. B., & Burnand, B. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2018(2), Article CD004148. https://doi.org/10.1002/14651858.CD004148.pub4

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality and Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality and Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895