Module Components

• Overview
• Assignments

Topics

• Results
• Discussion
• Conclusion
• Abstract
• Tables & Figures
• Squire Guidelines
• From Proposal to Manuscript
• Published DNP Project Manuscripts

NDNP 813 - DNP Project Evaluation and Dissemination

Module 4: DNP Project Manuscript

Discussion

The purpose of the discussion is to describe and interpret the meaning of your findings in view of what is already known about the practice problem being evaluated, and to explain any new understanding of the problem after you have taken the findings into consideration.

The discussion section is where you:

1. Interpret the results of the project, and explain the meaning of the findings in relation to the goals of the project.
2. Think critically about a problem, and develop solutions to problems based on an analysis and synthesis of the findings.
3. Engage the reader in thinking critically about issues based upon an evidence-based interpretation of findings.

Relation of Findings to Goals

You might begin by making a clear statement on the support or lack of support for the short- and long-term goals of the project.

Example:

This quality improvement project provides initial support regarding the feasibility of implementing a screen for antepartum and postpartum depression in a women’s health clinic."

Compare Findings to the Literature

The discussion section is also where you compare your findings to those of previous studies, some of which you may have cited in your literature review. While you may only want to cite studies that support your findings, it is just as essential to include studies with different findings. Discuss why these findings may be different. Could it be differences in sample sizes, settings, instruments or measures used, data analysis statistical methods?

It is your responsibility to evaluate possible reasons why your findings are different from those in the literature. This information may help others who are interested in translating the same evidence into practice.

Unexpected Findings or Variation in Processes and Measurement Data

A good discussion section includes analysis of any unexpected findings. Provide a brief interpretation as to why you believe they occurred, and their possible significance in relation to the overall project. If more than one unexpected finding emerged during the project study, describe each of them in the order they appeared in the results. The exception to discussing findings in the same order you described them in the results section would be to begin by highlighting the implications of a particularly unexpected or significant finding that emerged from the study, followed by a discussion of the remaining findings.

A discussion of data variation is also useful for identifying areas that need improvement.  The identification of variation in structures, processes, and outcomes is one way a QI leader identifies opportunities for action. For example, if the central line infection rate in units A, B, and C are much lower than they are in unit D then the QI leader further analyzes the situation to determine the reasons why. Are there best practices in units A, B, and C that can help guide improvements in clinical practices in unit D? Are there differences in the population of patients being cared for in unit D versus units A, B, and C? A QI leader can also use variation in data to explore the differences among clinical practices between the night and day shifts or among different clinicians. Variation is the first clue that improvements may be needed.

Data variation often occurs during a QI initiative, so evaluating trends is needed. How data were collected, tracked, recorded, and interpreted throughout the project phases affects the QI project leader’s decisions about what implementation strategies and tactics worked well and what needs to be modified in the future. QI leaders also need to be cautious about over-reacting to individual data points that can vary widely. Instead they need to evaluate data over time and identify averages and trends. The Institute for Health Improvement (IHI) has an excellent discussion and illustration of how to interpret and track data variation and the use of overall data trends to identify whether improvements occurred or not. Click here to read more on IHI’s explanation of data variation.

General Application of Results

The discussion section also may be used to discuss application of results to practice changes. For example, you may want to use the results to provide general recommendations for other who wish to implement a similar practice change, describe lessons learned, or highlight what you feel were the best practices.

Limitations

All DNP projects have limitations in terms of the sample, measurement, and procedures for data collection. In this section, focus on the limitations that resulted from your plan for implementation. How might the participants be more representative of target population? How were the measures or instruments inadequate? Were there any problems with procedures used to implement the practice change? What unexpected problems arose in collecting data to evaluate the practice change. Although your project may have been limited by time, money or other resources, these are limitations that common to most DNP projects. Since these factors are external to the project, avoid focusing on them.

Common Errors

Common errors made by students in the discussion are:

• Repeating what has already been stated in the overview or literature review.

In comparing findings with what has been reported in the literature, students sometimes end up repeating what was already stated earlier in the manuscript. Rather than repeat, reflect on previous work in light of the new findings of the current project and how understanding of the problem is refined with new information. Another option is to save what you included in the literature review, so that you can cite it in the discussion, if you feel it is more important to compare them with your results rather than be part of your literature review. This decision can be made as you begin writing the discussion.

• Introducing new findings to explain other findings reported in the results section.

For example, a student might report information in the discussion section learned from conversations with the staff to help explain findings based on data collected from the medical record, which was placed in the results sections. Whether the findings are based on formal or informal data collection methods, they are still findings and should be only included under the results section.

• Repeating information that was already described in the results section.

Example:

Results

Overall 7% of the women screened positive for depression. After being triaged to a social worker, 75% of the women went on to receive a mental health evaluation by a psychiatrist or licensed psychologist. The evaluations were significantly more common for antepartum versus postpartum women (83% vs 72%; p<0.04).

Discussion

The women who screened positive for depression prior to delivery were more likely to receive a mental health evaluation. This may have been due to the framework of more frequent prenatal visits prior to delivery as compared to those postpartum. " />Students sometimes feel that the reader may need a reminder of a previously stated finding presented in the results section before discussing it. The best approach is to provide a reference to the results for context, but not repeat it. Generally, the discussion section does not include any numbers, repeat statistics from the results, or refer to tables or figures. See example below of results may compare to a discussion.

Tips on Format

• Be concise and avoid repetition
• Be clear and write for a broader audience
• Discuss your findings in the same sequence you described them in your results section
• Use the present verb tense for discussion with the exception of using past tense when refer to prior studies