Date of Conferral



Doctor of Nursing Practice (DNP)




Barbara Niedz


The practice problem for this quality improvement project was the lack of engagement of chronic back pain patients at a Midwest clinic in evidence-based risk/benefit discussions regarding treatment options. The project was designed to explore whether practice guidelines increase patient engagement as measured by the Patient Activation Measure (PAM). Practice guidelines for interactive patient/nurse practitioner discussions regarding treatment options were developed, implemented, and evaluated. The concepts of chronic pain, chronic pain treatment options, and patient engagement were researched, and the evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation system. The clinical practice guideline was developed following the domains of Agree II. The project was based on the Chronic Care Model and Roy's Adaptation Model. Sources of evidence included literature on the PAM survey and development and implementation of a clinical guideline. To evaluate the project, PAM data were analyzed using a paired t test to compare means before and after implementation of the practice guidelines. The PAM mean score was 45.86 prior to guideline implementation and 76.62 post implementation. Paired t testing (p < .000) showed statistically significant increase in scores. Implications for the patient might be a decreased level of chronic back pain by patients' full engagement in treatment options. Contributions to positive social change include increased patient engagement because patients will experience control over treatment options and experience less pain as a result.

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Nursing Commons