Among patients requiring health care visits (P), how does use of the ‘Ask Suicide Screening Question’ toolkit (I) as compared to not using the ‘Ask Suicide Screening Question’ too

PICOT Question: Among patients requiring health care visits (P), how does use of the “Ask Suicide Screening Question” toolkit (I) as compared to not using the “Ask Suicide Screening Question” toolkit (C) affect self-harm behavior and suicide (O) within 3 months of the visit (T)? The target population is home-based patients. The independent variable is the Ask Suicide Screening Question toolkit, while the dependent variables are self-harm behavior and suicide within 3 months of the visit.  







[Title here-bolded]

[Student Name here]

DNP 896

[Date here]

Author Note

[conflict of interest statement here-see page 35 of your APA maual]


Should be approximately 250 words – introduces the paper.

Keywords: [enter the key words you may have used to perform a literature search]

(Students, please remove instructions before submitting).

Title of the Paper Here

Introduce the reader to the content that will be covered in this paper. First discuss the topic, gap in practice, and state the PICOT as a question.

Next, describe your search process. What databases were used? How many articles populated? How did you narrow your search? Remember do not use first person. The articles presented must be current and published within the last five years.

First Heading

Provide an introduction and background information that offers what the reader should expect to read related to themes that emerged from the literature review.

Theme 1

In this section you will want to discuss a theme that emerged. Provide as many sections with independent themes/topics as you deem appropriate. Consider how each theme/topic provides evidence to support the need for your intervention and the pervasiveness of the problem.

Theme 2

In this section you will want to discuss a theme/topic that emerged. Provide as many sections with independent themes as you deem appropriate. Consider how each theme/topic provides evidence to support the need for your intervention and the pervasiveness of the problem.

Implications Related to the Topic

Describe how the evidence will inform your project.

Implementation Plan

Describe a written plan to implement the interventions for your project and include a bullet list


Devise a preliminary budget for the project via table.See Moran Text Appendix D, page 348 for a sample budget.

Expected Outcomes

Describe the expected outcomes-bullet list

Evaluation Plan

Describe how you plan to evaluate the results in one paragraph.


Please include an expected timeline of your project. This should include planning, implementeation, evaluation, and dissemination. A written description with a project timeline visual chart. Moran Text pages 213-214 and 230-232 has some information that is helpful.

Dissemination Plan

How you plan to disseminate your project after implementation and evaluation?



**Here are a couple of samples of 7th edition APA format. Please also view the videos I posted in the announcements.

Author Last Name, F. I. (Year). Name of the book (7th ed.). Publisher name here.

Author, A. A. (Year). Title of article. Publication Title, volume number(issue), pp–pp.…

Author, A. (Year). Title of article. Publication Title, volume number(issue), pp–pp. URL



Running head: TIMELINE AND ROL



Timeline and Review of Literature –

Supporting Perioperative Nurse Interns through Mentorship: A Pilot Study

DNP Student- used with permission

Northern Kentucky University

Timeline and Review of Literature

Supporting Perioperative Nurse Interns through Mentorship: A Pilot Study

As perioperative nursing is highly specialized, it can take years to develop into a highly skilled perioperative nurse particularly when working in large academic medical centers caring for high-acuity patients with multiple surgical specialties. Training programs for perioperative nurses involve a six-month perioperative nurse internship before entry-level competency is achieved. Training occurs in both the classroom and clinical environment under the guidance of nurse educators and nurse preceptors (Fitzgerald, 2009). Despite this level of training, there remains a high turnover rate among new perioperative staff worldwide, and research has connected the low retention rate to the competency and confidence of new perioperative nurses (Whelan et al., 2016). Consistent with trends, the nurse intern program at a midwestern facility currently experiences a high amount of turnover during the first year of employment with 40% of nurse news choosing to leave the department within the first year of employment. The majority of these nurses are new graduates (T. Thomas, personal communication, August 26, 2019). According to Ball et al. (2015), the cost to orient a nurse to the operating starts at $59,000 not including the recruiting, interviewing, and hiring process.

Factors influencing nursing turnover have been studied extensively. As Zhang et al. (2016) relates, new nurses often experience high levels of stress during the first year of nursing practice which can result in high rates of turnover. New nurses report feeling overwhelmed, are unprepared for the clinical responsibilities faced in today’s healthcare environment and are frequently met with inhospitable workplace cultures. Research has shown an effective strategy to support the transition to practice for new nurses is implementation of a nurse mentorship program (Zhang et al., 2016). At the midwestern facility, the nurse interns train with nurse preceptors throughout the six-month training program. However, perioperative services lack a formal mentorship program to support the interns’ transition to practice within the department to become a fully, socialized member of the perioperative team.


For newly hired perioperative nurses (P), how will implementation of a nursing mentorship program (I) compared with the traditional onboarding process (C) impact self-efficacy (O) and employee retention (O) during the first six months of hire (T)? The target population is the nurse interns. The independent variable is the mentorship program and dependent variables are self-efficacy and employee retention.


The project plan is to introduce a mentorship program into the perioperative intern program at a Midwest healthcare facility. The key participants will be the perioperative interns, perioperative nurse mentors, DNP student, perioperative leadership and educators to support integration of mentors into the perioperative intern program. The pilot study will be 12 months, but the intention is the pilot study will develop into a full-time mentorship program for the department.

Review of Literature

The Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest, Medline/PubMed, Scopus/Elsevier, SciTech Premium Collection, Wiley Online Library, Sage Journals, and Social Sciences databases were searched to gather relevant publications from the last five years

(2015-2020) with the following search terms: “mentorship programs”, “new nurses”, “mentoring new nurses”, “perioperative services”, “outcomes”, “retention or attrition or turnover”, “self-efficacy”, and “nursing”. The initial search obtained 5,161 articles. The search was reduced to peer-reviewed, full-text only, English-only, nursing-focused articles. By excluding all articles related to experienced nurses, nursing management, and student mentorship, and opinion-based articles and editorials, the search was reduced to 698 abstracts to review. Upon review of the abstracts, 26 articles were selected for full review. Eleven articles were selected relevant to mentorship programs tailored to support new nurses transitioning to practice with varying levels of evidence ranging from four level I systematic reviews, three level III quasi-experimental studies, one level IV case-control study, one level V integrative review of mixed method studies with majority qualitative data, and two level VI cross sectional descriptive surveys.

Despite the number of systematic reviews included in this review of literature (ROL) which provides the highest level of evidence according to Melnyk and Fineout-Overholt (2019), Brook et al. (2019) offers the most comprehensive and compelling compilation of research to demonstrate the effectiveness of mentorship programs on supporting the transitions of new nurses. Multiple studies exist providing quasi-experimental and lower level research studies with small sample sizes boasting similar results on a lesser scale (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016). While mentorship has been shown to provide multiple benefits to include enhanced job satisfaction, enhanced clinical competence, and reduced anxiety, the focus of the DNP project is to impact new nurses’ self-efficacy and reduce employee turnover (Ajorpaz et al., 2016; Jones, 2017; Van Patten & Bartone, 2019; Zhang, et al., 2019). The Ajorpaz et al. (2016) randomized control study is the only perioperative specific to perioperative new hires that is part of the literature review.

Nursing Turnover and Retention

Overwhelmingly, the evidence demonstrates pairing mentors with new nurses positively supports the transition to nursing practice and reduces turnover within the first year of practice (Brook et al., 2019; Edwards et al., 2015; Jones, 2017; Pennington & Driscoll, 2019; Zhang et al., 2016; Zhang et al., 2019). However, the longitudinal study completed by Zhang et al. (2019) with new graduates and the Pennington and Driscoll (2019) mentorship program for new home health nurses both illustrated drops in nurse retention rates in subsequent years. However, both studies maintained retention rates far superior to pre-mentorship retention numbers. Evidence has shown pairing a mentorship and preceptor component improves turnover metrics resulting in an average decrease in turnover by 20% with three studies indicating 15% improved nurse retention (Brook et al., 20).


Experienced nurses who are fully socialized within a unit often possess the resilience and self-efficacy which in turn makes them more committed to the organization and more engaged as employees. According to Innes and Calleja (2018), new graduates often experience lower self-confidence related to the stresses of being a novice nurse particularly in a specialty setting like perioperative services hindering their ability to develop the skills needed to meet the clinical competencies of the department. Self-efficacy is important for nurses as it allows one to face challenges head-on despite the obstacles, have increased levels of resilience, and experience lower levels of stress and anxiety (Wang et al., 2018). Nurse mentorship programs can serve to build new nurses’ confidence, moderate stress levels, enhance unit socialization, increase resilience, and positively impact self-efficacy (Brook et al., 2019; Edwards et al., 2015; Innes & Calleja, 2018; Van Patten & Bartone, 2019: Wang et al., 2018; Zhang et al., 2016).

Characteristics of a Successful Mentorship Program

Factors to influence successful mentorship programs include:

· Thoughtful mentor selection (Zhang et al., 2016)

· Mentor training (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016)

· Mentor/mentee matching (Brook et al., 2019; Tiew et al., 2017; Zhang et al., 2016)

· Mentor and mentee relationship (Lin et al., 2018; Zhang et al., 2016)

· Preceptor/Mentorship paired programs (Brook et al., 2019; Edwards et al., 2015; Van Patten & Bartone, 2019)

Gaps in the Literature

Gaps remain in the literature. Few studies have been conducted exclusively in the United States within the last five years and little research on mentorship programs has been focused in perioperative services, particularly in the operative room. The research studies conducted have been on the lower end of the evidence hierarchy with smaller sample sizes or based on expert opinion limiting the number of studies in the ROL. No clear guideline exists to provide best practice for design of a nurse mentorship program to support the transition of new graduate nurses during the first year of practice.

Implementation Plan

February 2020

· Complete review of the literature and project timeline

· Obtain faculty advisor and project mentor project approval

· Meet with Burkardt Consulting Center regarding statistical support for project and will submit data throughout project based on direction received during meeting

· Complete project proposal

March 2020

· Present project plan to facility Nursing Research Committee. Obtain approval for IRB submission

· Submit IRB application to facility to introduce a 12-month pilot mentorship program for the perioperative nurse interns utilizing a mixed methods approach

· Focus Groups and Pre-and Post-Test Measurement Tool utilizing the General Self-Efficacy Scale (GSE) developed by Schwarzer and Jerusalem (1995).

April 2020

· Develop Mentorship Committee to serve as mentors and help to select mentors for pilot study

· Application process with explanation of commitment

· Assist with mentor matching

· Utilize personality testing to pair mentor/interns

· Shape project with input from staff by conducting Focus Groups (approximately 10 participants per group). Conduct focus groups in March 2020.

· Recent Nurse Interns: < 2 years in department

· Nurse Preceptors: 2-5 years’ experience in department

· Nurse Preceptors: 5+ years’ experience in department

May 2020

· DNP student will conduct mentor training to educate mentors on roles and obtain commitment. Considering training on following:

· Personality type training – considering Myers-Briggs Type Indicator (MBTI) – utilize the free tool on

· Resilience training

· Conflict Management

· Administer the General Self-Efficacy Scale (GSE) Test for the four nurse interns (pre-test) prior to introducing the interns to the mentors. The GSE does not require special permission for utilization, consists of ten questions on using a Likert-scale, and is a highly reliable, valid study with a Cronbach alpha between .76-.90 (Schwarzer & Jerusalem, 1995).

· Introduce mentors to interns. Will need four mentors to connect with four interns for the winter 2020 intern group.

June 2020

· The second group of nurse interns should start in June 2020. Expect 10-12 interns in the June 2020 intern group. Will need to recruit an additional 10-12 new mentors with the help of the mentorship committee via application process.

· Meet with mentorship committee

July 2020

· Conduct mentorship training for the mentors selected by the mentorship committee.

· Administer the GSE pre-test to summer intern class

August 2020

· Meet with mentorship committee. Focus on pairing new mentors with interns.

· Pair mentors with summer interns

· Administer the GSE post-test to the Winter interns (stagger start but half the winter intern group started in Feb. 2020)

· Trace retention of the Winter intern group

October 2020

· Meet with mentorship committee to support mentorship program

December 2020

· Meet with the mentorship committee to support the mentorship program

· Administer the GSE post-test to the Summer interns

· Track retention of the Summer intern group

January 2021

· Submit data to the Bukardt Consulting Center

February 2021 – March 2021

· Data analysis and review project outcomes

· Meet with Burkardt Consulting Center to review data

· Meet with faculty advisor and project mentor to review project findings

· Preparation for DNP project presentation and dissemination of DNP project

April 2021

· Present DNP Project in April 2021 for graduation requirements


· Improved employee retention in the perioperative nurse intern program with implementation of a mentorship program

· Increased self-efficacy of perioperative interns after introduction of mentorship to support transition of new nurses into practice


After six months, the interns will transition from the perioperative internship to independent practice as a new nurse in the operating room. During this transition period and throughout the first year of hire, the novice perioperative nurse is vulnerable and turnover rates are high. The formal mentorship relationship will last for 12 months, but the evaluation period for tracking outcomes related to the pilot study will be completed at six months based on the length of the intern program and general orientation to the operating room when historically turnover has been the highest for the facility.

It is estimated during the pilot study, there will be approximately 15 perioperative nurse interns participate in the pilot study which could impact the ability to obtain statistically significant results based on low volume. However, based on the pre- and post-test design a paired t-test would allow measurement of the impact of the mentorship intervention on self-efficacy. A meeting with the Burkardt Consulting Center will further build out statistical analysis plan to possibly add ANOVA and other data analytics options based on projected numbers in pilot study. Tracking nurse intern retention rates will also be part of the analysis. Further, focus groups will allow for the DNP student to pick up on themes to shape the mentorship program and provide qualitative research for the pilot study (Polit & Beck, 2017). The pilot study could be extended until statistically significant results are obtained demonstrating a possible relationship between mentorship program support and the perioperative nurse interns’ self-efficacy and nurse retention rates.

Project Budget

Program Expenses

Salaries/Wages Monthly Total

· DNP Student $0 $0

· Focus Group Staff Time $227.50 $2,730

· Focus Group Observer $13 $156

· Mentor Committee Meetings $257.83 $3,094

· Mentor Training (staff time) $242.66 $2,912

· Intern Testing (staff time) $61.75 $741

Total Salary Costs $9,633

Startup Costs Monthly Total

· Supplies $4.16 $50

Total Startup Costs $50

Capital Costs $0

Operational Costs $0

Total Project Expenses $9,683

Most of the cost of the mentorship program is related to the expense of paying staff for their time to participate in the committee work, training sessions, and focus groups. No additional capital costs will be incurred as the mentorship will utilize a free tool for mentor and intern matching. If the mentorship program could retain one perioperative intern, the return on investment in the mentorship program would be significant. As the cost of the program is $9,683 for one year, and the cost to recruit and train one perioperative intern exceeds $59,000 (Ball et al., 2015). Retaining only one employee annually nets a return on investment in excess of $49,317.

Dissemination Plan

Based on the perioperative mentorship focus, the Association of periOperative Registered Nurses (AORN) is the ideal audience for dissemination of project findings. AORN is the leader for perioperative nursing professional practice and provides the most up-to-date evidence-based practice information related to clinical, research, education, and management for perioperative nursing professional Either a poster presentation at an AORN conference or pursuing publication in the AORN Journal is the goal for dissemination of the evidence.


The evidence clearly shows there is a need to support new nurses during the first year of practice and establishing programs to ease entry into practice is important to ensure delivery of safe nursing care while retaining nursing talent according to the Institute of Medicine (Van Patten and Bartone, 2019). Organizations owe it to nurses and the profession to invest in programs to support new nurses. Mentorship is a tool consistently recognized in the literature to be effective at positively building the self-efficacy of new nurses and impacting nurse retention rates, thereby easing the transition into practice (Brook et al., 2019; Edwards et al., 2015; Zhang et al., 2016).


Ajorpaz, N., Tafreshi, M., Mohtashami, J., Zayeri, F., & Rahemi, Z. (2016). The effect of

mentoring on clinical perioperative competence in operating room nursing students. Journal of Clinical Nursing, 25, 1319-1325. doi: 10.111/jocn.13205

Ball, K., Doyle, D., & Oocumma, N. (2015). Nursing shortages in the OR: Solutions for new

models of education. Association of periOperative Registered Nurses (AORN) Journal, 101(1), 115-136. doi: 10.1016/j.aorn.2014.03.015

Brook, J., Aitken, L., Webb, R., Maclaren, J., & Salmon, D. (2019). Characteristics of successful

interventions to reduce turnover and increase retention of early career nurses: A systematic review. International Journal of Nursing Studies, 91, 47-59. doi: 10.1016/j.ijnurstu.2018.11.003

Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness

of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies, 52, 1254-1268. doi: 10.1016/j.ijnurstu.2015.03.007

Fitzgerald. B. (2009). Educating novice perioperative nurses. Perioperative Nursing Clinics,

4(2), 141-155. doi:10.1016/j.cpen.2009.01.006

Innes, T., & Calleja, P. (2018). Transition support for new graduate and novice nurses in critical

care settings: An integrative review of the literature. Nurse education in Practice, 30, 62-72. doi: 10.1016/j.nepr.2018.03.001

Jones, S.J. (2017). Establishing a nurse mentor program to improve nurse satisfaction and intent

to stay. Journal for Nurses in Professional Development, 33(2), 76-78. doi: 10.1097.NND.0000000000000335

Lin, J., Chew, Y.R., Toh, Y.P., Krishna, L.K.R. (2018). Mentoring in nursing: An integrative review

of commentaries, editorials and perspective papers. Nurse Educator, 43(1), E1-E5. doi: 10.1097/NNE.0000000000000389

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing &

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Pennington, G., & Driscoll, A. (2019). Improving retention of home health nurses: Fostering

sustainability through an innovation orientation and mentorship program. Home Healthcare Now, 37(5), 256-264. doi: 10.1097/NHH.0000000000000782

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Health. 

Schwarzer, R. & Jerusalem, M. (1995). Generalized self-efficacy scale. Retrieved from

Tiew, L.H., Koh, C,S., Creedy, D.K., & Tam, W.S.W. (2017). Graduate nurses’ evaluation of

mentorship: Development of a new tool. Nurse education today, 54, 77-82. doi: 10.1016/j.nedt.2017.04.016

Van Patten, R., Bartone, A.S. (2019). The impact of mentorship, preceptors, and debriefing on

the quality of program experiences. Nurse Education in Practice, 35, 63-68.

Wang, L., Tao, H., Bowers, B.J., Brown, R., & Zhang, Y. (2018). Influence of social support and

self-efficacy on resilience of early career registered nurses. Western Journal of Nursing Research, 40(5), 648-664. doi: 10.1177/0193945916685712

Whelan, T., Shi, X., Yarke, S., Andony, K., & McKenzie, M.L. (2016). Knowledge and skills

enhancement through perioperative nursing simulation lab training. Operating Room Nurses Association Journal of Canada, 34(2), 13-30.

Zhang, Y., Huang, X., Xu, S., Xu, C., Feng, X., & Jing-fen, J. (2019). Can a one-on-one

mentorship program reduce the turnover rate of new graduate nurses in China? A longitudinal study. Nurse Education in Practice,40. doi:10.1016/j.nepr.2019.08.010

Zhang, Z. Qian, Y., Wu.J., Wen, F., & Zhan, Y. (2016). The effectiveness and implementation of

mentoring program for newly graduate nurses: A systematic review. Nurse Education Today, 37, 137-144. doi:10.1016/j.nedt.2016.11.027




Submit an outline of your project plan in a Word Document and include the PICO question, a two-page summary of the review of literature, a list of possible interventions (implementation plan), a bullet list of expected outcomes, one paragraph of an evaluation plan and a preliminary budget proposa l. Please create a project time line for the entire DNP project. Also, include your plans for dissemination, for example, a poster presentation or podium presentation at a conference. This assignment should be no more than five pages excluding reference page and title page and provides a foundation for your project proposal paper which is due during DNP 896 II. 


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