Date of Award

Summer 8-4-2023

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Sandra Swearingen

Second Advisor

Lee Petrarca


Practice Problem: Within a 12-month period, high incidences of severe post-spinal surgical complications resulted in a host of concerns in this clinical site when patients either returned to the operating room for spine revision or increased the length of stay.

PICOT: The PICOT question that guided this project was: "In Medical Surgical (Med-Surg) nurses (P), how would a Competency-Based Orientation (CBO) protocol with the inclusions of four critical elements of postoperative spinal care [POSC] (I) compared to the usual postoperative practice (C) enhance competency level in Med-Surg nurses when delivering postoperative practice at an inpatient setting (O) over 10 weeks (T)?”

Evidence: An extensive evidence literature review supported organizational reform in competence management and improves patient outcome with the development and implementation of a CBO assessment tool highlighting critical components on POSC.

Intervention: The intervention was the implementation of POSC CBO assessment tool in an inpatient hospital setting. National Association of Orthopaedic Nurses guided the CBO assessment tool to focus on four crucial elements on POSC.

Outcome: Statistical significance reflected the positive impact demonstrated in improved patient recovery in clinical practice after the implementation of a POSC CBO assessment tool compared to previous standard of post-surgical care in the Med-Surg Unit. The clinically significant findings were a reduction of post-spinal complication and improvement in patient outcomes.

Conclusion: CBO assessment tool was designed to restructure the clinical site’s previous standardized nursing care in POSC. With a CBO assessment tool to clearly outline the nurses’ functional role to safely and competently deliver POSC, the rate of post-spinal complications significantly reduced and patient outcome improved nearly 90%.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice

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