DNP 850A Module 1 Selecting and Testing a DNP Project Topic Example

From a Worry at the Front Desk to a DNP Project: Selecting a Topic in Hypertension Control

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP 850A: Project Planning

Instructor Name

Month Day, Year

From a Worry at the Front Desk to a DNP Project: Selecting a Topic in Hypertension Control

The DNP project begins with a choice that shapes every later course. A good topic starts from a real problem in practice, is supported by evidence that something can be done about it, falls within the scope of nursing, and can be carried out with the time and access a doctoral student actually has. This paper describes how I selected my topic, a nurse-led program of home blood pressure monitoring for adults with uncontrolled hypertension at the federally qualified health center where I work as a registered nurse care manager, and tests that choice against five criteria.

Where the Topic Came From

The idea did not begin as a project. It began with a pattern I kept seeing: patients who arrived for visits with blood pressure readings well above target, who said their pressure was fine at home, and who left with instructions to return in three months. Many returned with the same readings. Some had been told their medication would be adjusted at the next visit, and the next visit was months away.

When I asked our quality coordinator for data, the pattern turned out to be large. The health center's registry lists 2,860 adults with a diagnosis of hypertension across its three sites, and 1,173 of them, 41%, had a blood pressure of 140/90 mm Hg or higher at their most recent visit. The clinic where I work, which serves the largest share of patients who prefer Spanish, had the lowest control rate of the three. The problem was large, it weighed most on patients whom language, cost or transport already kept at a distance, and it was one that nurses at the clinic were in a position to change.

Narrowing the Topic

My first ideas were too broad: improving hypertension care, or reducing cardiovascular risk in our patients. Neither pointed to something I could change and measure in a few months. I narrowed the topic by asking what, specifically, stood between patients and control. Three answers came up repeatedly in conversations with clinicians and patients: office readings were infrequent and sometimes inaccurate, medication changes waited for visits, and patients had little way to see whether their efforts were working. Home blood pressure monitoring addresses all three, because it produces frequent readings between visits, gives the care team data to act on, and lets patients see their own numbers.

The topic therefore became a nurse-led program in which patients measure their blood pressure at home with validated devices, readings are transmitted to the care team, and registered nurses review them weekly and adjust medication under a standing protocol approved by the medical director.

Testing the Topic: Significance

Uncontrolled hypertension is one of the most important and most fixable problems in primary care. National survey data show that blood pressure control among American adults with hypertension climbed from 31.8% in 1999 to 2000 to 48.5% in 2007 to 2008, did not change significantly through 2013 to 2014, and then declined (Muntner et al., 2020). The national guideline for adults defines hypertension at a lower threshold than before and recommends out-of-office readings to confirm the diagnosis and guide treatment (Whelton et al., 2018). At my health center, whose patients are mostly low-income and many uninsured, the gap between current control and what is achievable is wide.

Testing the Topic: Evidence

A topic is only a good DNP project if evidence shows an intervention can help. Pooling the individual records of patients from randomized trials, one meta-analysis found that self-monitoring alone produced little or no reduction in blood pressure, but when self-monitoring was combined with co-interventions such as medication titration, education or counseling, systolic pressure fell by about 6.1 mm Hg more than usual care at 12 months with the most intensive support (Tucker et al., 2017). This finding shaped the topic directly: the project could not simply hand out cuffs. It had to pair monitoring with a nurse who acts on the readings.

Testing the Topic: Nursing Scope, Feasibility and Fit

Nursing scope was clear. Registered nurses at the health center already provide education and care management, and state law and the organization's policies permit nurses to adjust medications under a protocol signed by a physician. The project would extend a role nurses already hold rather than borrow one from another profession.

Feasibility required more checking. I confirmed that the electronic record can receive readings from a patient portal, that the health center had a small grant for cuffs, and that the medical director agreed to sign off on a titration protocol and to act as my practice mentor. The clinic manager agreed that two nurse care managers, including me, could spend part of each week on the project. The main feasibility risk was reaching patients who prefer Spanish, which the clinic's community health worker offered to help address.

Personal fit matters because the project will last more than a year. I care about this problem, I see its effects every week, and I have the clinical background and relationships to lead it. That combination makes it more likely I will finish well.

What the Topic Is Not

Defining the boundaries helps as much as defining the topic. The project will not address the diagnosis of hypertension in people who do not yet have it, lifestyle programs as a separate intervention, or hypertension in pregnancy or in children. It will not test different cuffs or transmission technologies against each other. Each of these questions deserves study, but together they would overwhelm a single project; leaving them out keeps the work small enough to do well within the DNP sequence.

Conclusion

My DNP project topic grew from a repeated pattern in practice, was narrowed by asking what stood between patients and control, and was reshaped by evidence showing that home monitoring works only when someone acts on the readings. Tested against significance, evidence, nursing scope, feasibility and personal fit, a nurse-led home blood pressure monitoring program with protocol-based titration holds up. The next steps are to state the problem and purpose precisely and to form the PICOT question that will guide the project.

References

Muntner, P., Hardy, S. T., Fine, L. J., Jaeger, B. C., Wozniak, G., Levitan, E. B., & Colantonio, L. D. (2020). Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA, 324(12), 1190-1200. https://doi.org/10.1001/jama.2020.14545

Tucker, K. L., Sheppard, J. P., Stevens, R., Bosworth, H. B., Bove, A., Bray, E. P., Earle, K., George, J., Godwin, M., Green, B. B., Hebert, P., Hobbs, F. D. R., Kantola, I., Kerry, S. M., Leiva, A., Magid, D. J., Mant, J., Margolis, K. L., McKinstry, B., . . . McManus, R. J. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLOS Medicine, 14(9), Article e1002389. https://doi.org/10.1371/journal.pmed.1002389

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Jr., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Jr., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., Sr., . . . Wright, J. T., Jr. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065