NR 707- Week 2 The Role of the DNP-Prepared Nurse Ensuring Intervention Fidelity
Part 1
Definition of Intervention Fidelity
Intervention fidelity is the extent to which an intervention is delivered consistently and accurately according to the research design, ensuring that the outcomes are reliable and reflect the intervention’s actual effect. To stakeholders, this concept is crucial because it protects against the confounding effects of variations when championing the project’s implementation (Hoffacker et al., 2022). High intervention fidelity reduces variability in the findings to prevent implementing an intervention in practice, only to discover that it differs from the research findings in terms of the benefit it accrues. It entails compliance with identified procedures, constant supervision, and effective feedback mechanisms to correct any discrepancies. Using such high fidelity, it will be possible to have accurate information regarding the efficiency of the intervention and the changes that it brings out for replication of the intervention in other settings (Akiba et al., 2021).
Intervention Fidelity in Practice Change Project
In my practice change project, which involves implementing Cognitive Behavioral Therapy (CBT) to improve medication adherence in adult psychiatric patients with schizophrenia, intervention fidelity is vital. Adhering to the protocols means that CBT implemented by the participants of the treatment is identical to that established during the development of the evidence-based research. This consistency is important because even the slightest changes to the planned intervention may have a rather drastic impact on the outcomes of the process and lead not only to a lack of regularity in the results but also to a reduction in the efficiency of the therapy (Guerbaai et al., 2023). In order to ensure high fidelity, I have developed a structured checklist and provided formative assessments to check therapists’ compliance with the outlined CBT procedure. This way, the intervention will augment the likelihood of achieving the intended changes based on the original design of the intervention to influence medication adherence.
Part 2: Implementation Update
Practice Question: In adult psychiatric patients diagnosed with schizophrenia, does the implementation of Cognitive Behavioral Therapy (CBT), compared to current practice, improve medication adherence within ten weeks?
Intervention Start Date and Current Week: The intervention began on August 5, 2024. Currently, we are in Week 4 of the implementation phase.
Current Number of Participants: The current number of participants involved in the intervention is 22.
Challenges in Participant Recruitment: A challenge in participant recruitment is scheduling conflicts, particularly with participants who have other commitments that interfere with the fixed CBT session times. To address this, we offer flexible session times, which have helped mitigate the issue and increase participation.
Formative Evaluation Plan to Check Intervention Fidelity
- Method and Frequency: The formative evaluation is done every two weeks by filling out the form checklist specially designed to establish the level of treatment integrity of the delivered CBT. These are made through general monitoring and evaluation during the sessions, participants’ feedback forms, and daily team meetings to reflect on the various sessions and evaluate if the team was able to follow through with the outlined interventional strategies.
- Person Responsible: As a project manager, the DNP-prepared nurse is expected to carry out these evaluations and report back to the implementation team.
- Type of Feedback Provided: All the formative evaluations are followed by instant feedback to identify any divergence from the intended intervention. The input is aversive and meant to reorient and maintain quality in the subsequent iterations of the process.
- Frequency of Stakeholder Communication: Communication with stakeholders takes place on a weekly basis with the organizational leadership, other department managers, and the CBT implementation team. This makes the process clear and continuously helps, and should problems arise, take care of them immediately.
Implementation Successes, Challenges, and Barriers
The implementation received a good response from the participants, who demonstrated good interest in the CBT sessions. The participants’ first response to the therapy is positive, and some have confessed to adjusting to their medication schedules much earlier. Other than recruitment difficulties, lack of consistency in the sessions causes others to drop out because of work and family engagements. One issue that could become a barrier is the fluctuation of staff available to run the sessions, which happens at certain times. To counter this, more training sessions for backup facilitators will be conducted to ensure continuity in case of any eventuality.
References
Akiba, C. F., Powell, B. J., Pence, B. W., Nguyen, M. X. B., Golin, C., & Go, V. (2021). The case for prioritizing implementation strategy fidelity measurement: Benefits and challenges. Translational Behavioral Medicine, 12(2), 335–342. https://doi.org/10.1093/tbm/ibab138
Guerbaai, R. A., DeGeest, S., Popejoy, L. L., Simon, M., Nathalie, Denhaerynck, K., & Franziska Zúñiga. (2023). Evaluating the implementation fidelity to a successful nurse-led model (INTERCARE), which reduced nursing home unplanned hospitalizations. Evaluating the Implementation Fidelity to a Successful Nurse-Led Model (INTERCARE) Which Reduced Nursing Home Unplanned Hospitalisations, 23(1). https://doi.org/10.1186/s12913-023-09146-8
Hoffacker, C., Klein, M. R., Becker‐Haimes, E. M., Fishman, J., Schoenwald, S. K., Fugo, P. B., McLeod, B. D., Dorsey, S., Litke, S., Shider, L., Lieberman, A., Mandell, D. S., & Beidas, R. S. (2022). Stakeholder intention to engage in fidelity measurement methods in community mental health settings: A mixed methods study. Implementation Research and Practice, 3, 263348952211146-263348952211146. https://doi.org/10.1177/26334895221114664
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Week 2 The Role of the DNP-Prepared Nurse Ensuring Intervention Fidelity
Discussion
Purpose
This discussion aims to explore the role of the DNP-prepared nurse ensuring intervention fidelity for DNP practice change project success. The intervention implementation is the focus, and the DNP student is checking the process to ensure the intervention is implemented exactly as planned to provide maximum impact on the project outcome. Variations in intervention compliance can negatively affect the outcomes and project.
Lesson
Role of the DNP-Prepared Nurse Ensuring Intervention Fidelity
Intervention Fidelity
This week’s focus is on the role of the DNP-prepared nurse ensuring intervention fidelity. One very important aspect of implementing an evidence-based intervention is fidelity. Intervention fidelity is the degree to which the intervention is implemented as described in the research, which is essential because the research-based intervention affects the outcomes. If the intervention is implemented as described in the research, the outcomes for the practice change project are more likely to be similar to the outcomes reported in the research. Conversely, if the intervention is not implemented as described in the research, the practice change project outcomes will be different from those in the research. Therefore, standardizing the intervention implementation across team members for the implementation duration is a crucial factor in obtaining the desired outcomes.
During a practice change project implementation, it is necessary to check the intervention fidelity often to ensure high intervention fidelity. There are many ways to assess the intervention fidelity. One prevalent way to assess intervention fidelity is using a checklist. The checklist contains the main parts of the intervention that must be implemented as described in the research. When the intervention implementation slips and some of the checklist elements are missing, it is necessary to offer feedback to the implementation team to ensure the intervention includes all elements uniformly and in the right order. The frequency of checking intervention fidelity in a practice change project depends on the intervention and the recommendations from the research. Assessing fidelity can be done as often as after every participant receives the intervention twice weekly. The DNP-prepared nurse leader determines the frequency of the fidelity assessment, and this frequency can change during the implementation as needed.
Formative and Summative Evaluation (3:47)
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