NURS 8600 Week 9 DNP final report discussion section example

What the Results Can and Cannot Bear: The Discussion Section of a DNP Final Report on Alcohol Screening and Brief Intervention in a Rural Clinic

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College of Nursing, Walden University

NURS 8600: DNP Field Experience

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Month Day, Year

What the Results Can and Cannot Bear: The Discussion Section of a DNP Final Report on Alcohol Screening and Brief Intervention in a Rural Clinic

Summary of Findings

Over six months after launch, documentation of alcohol screening at adult annual visits in the composite rural clinic rose from a sampled baseline of about a quarter of visits to well over four in five and continued to improve slowly, meeting run chart rules for both a shift and a trend. Documentation of brief intervention for patients who screened positive improved at launch, stalled at about half for four months and rose in the two months after the course correction that added provider delivery on phone-coverage days, though too few months have passed to confirm a shift. Referral offers for patients with higher-range scores increased from none at baseline to more than half of eligible visits each month after the first improvement cycle spread, but the monthly numbers are too small for firm conclusions. Rooming time rose by about one minute. The figures behind these statements, reported in the results section, are illustrative values for a composite clinic.

Interpretation: Aim 1, Screening

The screening finding is consistent with the proposal's synthesis, which argued that a standard instrument built into rooming, with clear ownership by medical assistants, would make screening routine. National guidance recommends screening all adults in primary care (US Preventive Services Task Force et al., 2018), and the project shows that a small rural clinic can build this into an ordinary visit with modest added time. The slowing of gains after June suggests that the remaining unscreened visits share features, late starts and patients who decline, that the workflow does not address, and the clinic should not expect documentation to reach every visit.

Interpretation: Aim 2, Brief Intervention

The brief intervention finding is the project's most instructive. The proposal assumed that a flag and a trained nurse would carry each positive screen to an intervention. The stall showed that the chain depended on whether the nurse was free at that moment. The course correction, moving delivery to the provider on phone-coverage days with a note shortcut that prompted the three core elements, addressed the constraint rather than the individuals, and the early months after it suggest improvement. A Cochrane review found that brief interventions in primary care reduce alcohol consumption at one year compared with minimal or no intervention, though effects are modest (Kaner et al., 2018). The project did not measure drinking and cannot claim this effect for its patients; what it can say is that more patients who screened positive received the conversation the evidence supports.

The shift of part of the intervention to providers is an adaptation that deserves discussion in its own right. It was not in the approved plan, it emerged from what some providers were already doing, it was tested before adoption and its effect on fidelity was monitored. Reporting it transparently, rather than presenting the final workflow as if it had been planned, is part of what makes the results interpretable.

Interpretation: Aim 3, Referral

Referral offers improved in count after the telehealth introduction, but the aim remains inconclusive. The proposal's synthesis suggested that offering a warm or scheduled introduction would increase uptake of behavioral health services. A meta-analysis of randomized trials, however, found little evidence that brief alcohol interventions by themselves increase use of specialty substance use treatment (Glass et al., 2015). That finding tempers expectations: even with better offers, the number of patients who connect with the counselor may remain small. The project measured offers, not attendance, and future work should measure whether patients who accept a telehealth introduction attend it.

Limitations

Five limitations affect how far the results can be trusted. First, the baseline came from a sampled chart review, while post-launch data came from a full count through a structured template; part of the improvement in screening may reflect better measurement. Second, the measures capture documentation, not practice; some screening before launch may have gone unrecorded, and some documented interventions may have been brief. Third, only about twenty patients a month screened positive and only four or five needed a referral, so percentages for aims 2 and 3 are unstable from month to month. Fourth, the project took place in one clinic with engaged leadership, and results may not transfer to settings without that support. Fifth, the project did not measure patient outcomes, such as changes in drinking, and so cannot claim clinical benefit.

The balancing measure deserves mention as a finding rather than a limitation. The screen added about a minute to rooming. That is a real cost in a busy clinic, and other practices considering the change should plan for it.

Implications

For the clinic. The workflow can be sustained with the ownership and routines in the handoff plan. The clinic should expect some decline after the project ends and should watch the warning signs the plan names, especially on phone-coverage days.

For similar rural practices. Small clinics can implement alcohol screening and brief intervention without new staff, but they should design for the days when staff are pulled to other duties, and they should plan referral pathways for days when behavioral health staff are not on site. A scheduled video introduction is one practical option.

For nursing practice. The project shows the DNP-prepared nurse's role in leading a practice change through iterative cycles: measuring carefully, noticing where the plan and practice diverge and adapting the workflow while protecting the intervention's core. It also shows the value of reporting a stalled aim honestly, since the stall led to the project's most important learning.

Conclusion

The project achieved its first aim, improved its second after a course correction and made progress on its third that the data cannot yet confirm. Its most useful contribution may be the lesson about designing workflows for the clinic's worst days rather than its best. Future projects at the clinic could build on this work by measuring whether patients who accept a video introduction attend it, by following drinking outcomes for a sample of patients at one year and by testing whether the same workflow can extend to acute visits without adding to delays.

References

Glass, J. E., Hamilton, A. M., Powell, B. J., Perron, B. E., Brown, R. T., & Ilgen, M. A. (2015). Specialty substance use disorder services following brief alcohol intervention: A meta-analysis of randomized controlled trials. Addiction, 110(9), 1404-1415. https://doi.org/10.1111/add.12950

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

US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA, 320(18), 1899-1909. https://doi.org/10.1001/jama.2018.16789