Doctor of Nursing Practice (DNP) Final Projects
The Doctor of Nursing Practice Final Projects collection contains the completed works of students from the DNP Program at Arizona State University's College of Nursing and Health Innovation. These projects are the culminating product of the curricula and demonstrate clinical scholarship.
Collaborating Institutions:
College of Nursing and Health Innovation
Displaying 1 - 10 of 20
Filtering by
- All Subjects: Mindfulness
- All Subjects: Patient Portals
Description
Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and improve patient outcomes overall utilization in the United States (US) remains low.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
ContributorsProsev, Brittany (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
Description
Objective: Substance use disorder (SUD) is an epidemic in the United States. Current standard of care for SUD continues to produce a 40-60% relapse rate. Treatment for SUD is costly and is not obtainable for many individuals. The purpose of this project is to implement mindfulness as an adjunct treatment for SUD to reduce relapse.
Methods: Voluntary program offered at a residential treatment center designed as a team-based project. The combined project includes exercise, wellness, and mindfulness. Adults over the age of 18, male or female with a diagnosis of SUD were eligible. Program consisted of three hourly sessions a week, for a total of three weeks. Sessions included one session of exercise and wellness, one session of mindfulness training, and a combined session. Mindfulness sessions included learning the seven pillars of mindfulness followed by guided meditation. Participants were given a mindfulness journal for daily exercises. Five Facet Mindfulness Questionnaire (FFMQ) was completed before program and on completion. Results: 11 of 22 participants completed the program. FFMQ total scores were analyzed with paired t-test with Wilcoxon signed rank to account for small sample size. Statistical significance was based on an alpha of 0.05, V=10.50, z=2.00 and p=0.45.
Conclusion: This project has the potential to decrease relapse rates by increasing mindfulness in individuals with SUD. Mindfulness training reduces cravings and negative thought processes. Implementing mindfulness training with current standard of care can be cost effective and recommended for all individuals with SUD.
ContributorsRouston, K. Courtney (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
Description
Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos.
Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins.
Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
ContributorsHerrera, M. Sara (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Burnout has become an increasingly popular topic among registered nurses, but unfortunately burnout among psychiatric nursing is less understood than other nursing specialties such as the Intensive Care Unit, Emergency Room, or Oncology. Psychiatry is unique and psychiatric nurses, in particular, are often subjected to physical and verbal violence as well as exposure to patient’s trauma. The aim of this project was to decrease burnout among psychiatric nurses in a private practice out-patient family psychiatric facility using Rossworm and Larabee’s change model (Appendix D). The MBI-HSS was completed by 1 participant (n=1) at pre-intervention and post-intervention. Between the pre/post MBI-HSS questionnaire the participant was asked to partake in a mindfulness-based intervention utilizing the smartphone application Headspace to complete a 10-session meditation course over one week. The results conclude the participant’s burnout decreased overall from pre-intervention to post-intervention. Internal Review Board (IRB) was granted in September 2021, and the project was completed in November 2021. The impact of the project was projected to have a more thorough statistical influence, but due to the participant size, there is minimal impact of system or polices in the psychiatric facility.
ContributorsSteward, M. Shannon (Author) / Guthrey, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-30
Description
Background: With the adoption of the Health Information Technology for Economical and Clinical Health (HITECH) Act of 2009, came the implementation of the electronic health record (EHR) and incentivized provider programs called Meaningful Use (MU). A goal of MU is to utilize patient portals to improve access to care. Current evidence supports patient portal use however providers are concerned about increased work load and lost revenue because of the time spent managing the portals rather than providing direct, billable patient care.
Purpose: The purpose of this project was to assess provider readiness for patient portals and provide an educational intervention to address perceived barriers.
Method: Ten providers at a large family practice clinic in the southwest United States were surveyed using The Provider Readiness Questionnaire prior to and after an educational intervention addressing common concerns.
Results: Improved response to patient portal use after the provider viewed the learning module. A paired-samples t-test was conducted to compare pre-and post-intervention responses. There was a statistically significant difference in the scores for the question “increase my workload” Pretest (M= 3.78, SD=1.201) and; Posttest (M=2.67, SD=1.225) ;(t (8) =5.547, p = .001). There was also a statistically significant difference for the question “increased provider professional satisfaction” Pretest (M=3.89, SD= .333) and Posttest (M= 4.44, SD=.527); t (8) = -2.294, p=.051).
Implications: Providing education addressing perceived barriers to portal use can assist the provider in understanding the value of the portals to improve patient outcomes and address common concerns about the impact of portal use on provider productivity.
Purpose: The purpose of this project was to assess provider readiness for patient portals and provide an educational intervention to address perceived barriers.
Method: Ten providers at a large family practice clinic in the southwest United States were surveyed using The Provider Readiness Questionnaire prior to and after an educational intervention addressing common concerns.
Results: Improved response to patient portal use after the provider viewed the learning module. A paired-samples t-test was conducted to compare pre-and post-intervention responses. There was a statistically significant difference in the scores for the question “increase my workload” Pretest (M= 3.78, SD=1.201) and; Posttest (M=2.67, SD=1.225) ;(t (8) =5.547, p = .001). There was also a statistically significant difference for the question “increased provider professional satisfaction” Pretest (M=3.89, SD= .333) and Posttest (M= 4.44, SD=.527); t (8) = -2.294, p=.051).
Implications: Providing education addressing perceived barriers to portal use can assist the provider in understanding the value of the portals to improve patient outcomes and address common concerns about the impact of portal use on provider productivity.
ContributorsLeal, Lauren (Author) / Velasquez, Donna (Thesis advisor)
Created2017-05-02
Description
Purpose: The purpose of this evidence-based practice project was to improve participation by increasing registration on to a medical patient portal to an uninsured population. Medical patient portals have the potential to provide patients with timely, transparent access to health care information and engage them in their health care process and management. This may result in improved disease management outcomes.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
ContributorsAlvarado, Cecilia I. (Author) / Thrall, Charlotte (Thesis advisor)
Created2019-05-03
Description
Stress is the direct source of some health issues and the precursors to many illnesses. The effects of stress are felt by the majority of the population and is usually undertreated or overlooked as a norm of life rather than a potential source of illness. Though everyone has different thresholds of stress, chronic or constant stress is debilitating for some and can manifest itself in limitless ways. For adults with substance use disorders (SUDs), research supports that mindfulness based interventions (MBIs) could be beneficial for stress management. The techniques incorporated in mindfulness based practices can decrease the baseline stress of its practitioners by increasing their awareness and mindfulness within daily life and during stressful situations.
This increase in awareness and mindfulness has shown numerous benefits that may be crucial in increasing the likelihood of sobriety for those with SUDs. Some of these benefits may include, improved stress management, improved mitigation of craving symptoms, reduced incidences of relapse, and a better quality of life. A 4-week self-help mindfulness pilot program was conducted twice within two separate residential substance recovery settings. The participant’s satisfaction and the internalization of mindfulness concepts were measured within the pre and post implementation of a self-help mindfulness class. In the pilot program, participants rated high satisfaction of the mindfulness class and showed increased levels of mindfulness through the use of the client satisfaction questionnaire (CSQ-8) and the five facets of mindfulness questionnaire (FFMQ-39).
ContributorsKwon, Min (Leo) (Author) / Harrell, Liz (Thesis advisor)
Created2018-05-01
Description
Depression and anxiety are common and debilitating illnesses that negatively impact personal well-being and functioning. The effects of depression and anxiety not only affect the individual, but also peers, family, the community, economy, and even the health care system. Pharmacological therapy is a first line treatment for depression and anxiety, but the risk for relapse remains. Cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are treatments that have demonstrated effectiveness in treating depression. The evidence suggests that both therapies are successful in terms of reducing depressive symptoms, but most effective when combined. Further, evidence shows that the combination of MBCT and traditional pharmacological therapy provides relief from depressive symptoms and lengthens the amount of time between recurrent episodes and improves the quality of life. A project was implemented at an integrated health clinic to evaluate the effectiveness of a mindfulness-based intervention to reduce the symptoms of depression and anxiety. The results revealed that practicing mindfulness was statistically and clinically significant in reducing depression and anxiety. In addition, mindfulness scores increased over 30 day application of the intervention. The results demonstrated the value of utilizing mindfulness as a cost-effective therapy in addition to pharmacological treatment to decrease symptoms of depression and anxiety, as well as improve mindfulness. The ease of use demonstrated the value of mindfulness and self-directed skills aimed at improving wellness, reducing depression and anxiety which will result in the improvement of individual, economic, healthcare system, and community health.
ContributorsFong, Luis (Author) / Guthrey, Ann (Thesis advisor)
Created2018-04-28
Description
The purpose of this project is to implement an on-site mindfulness-based intervention to reduce stress and burnout among mental health care workers. Healthcare professionals are among the most stressed of any profession, and mental health workers are at an extremely high risk for burnout and compassion fatigue (Christopher & Meris, 2010) with an estimated 21% to 67% of mental health workers reporting that they experience high levels of burnout (Salyers et al., 2011).
After researching the literature, it was evident that practicing mindfulness can lead to less stress and higher job satisfaction. In an effort to combat this problem, an on-site mindfulness intervention was implemented at an outpatient psychiatric setting for eight weeks. Twenty-seven mental health workers gave their consent to be part of the study, and eleven were able to complete the study and self-assessment surveys for three time periods. The Maslach Burnout Inventory (MBI) (the Human Service Version) and a 1-item job satisfaction were used to measure the effect of intervention on employees’ levels of stress and job satisfaction.
A non-parametric Friedman test of differences among repeated measures was conducted and findings were not significant when comparing the average total scores of means between pre-, post-, or 1-month follow-up for Emotional Exhaustion (p = .148), Depersonalization (p = .223), Personal Achievement (p = .784) and job satisfaction (p = .422). The positive outcomes cited by participant support the thesis that the on-site mindfulness-based intervention is better than no intervention though the effect was not statistically significant.
ContributorsUwimana, Aimee (Author)
Created2016-04-29
Description
Loneliness and depression in older adults are under-recognized public health concerns that increase risks for all-cause mortality, medical morbidity, and rising healthcare costs. This quality improvement project assessed whether smartphone Mindfulness software mitigated self-reported feelings of loneliness and depression among community-dwelling older adults. Nine participants aged 65 and older, living at home, experiencing loneliness or depression, and owning a smartphone were recruited using newsletters and fliers. A short demographics questionnaire and two valid and reliable instruments, namely the University of California Los Angeles Loneliness Scale (UCLA V3) and Geriatric Depression Scale (GDS), were used in pre-intervention and four weeks post-intervention. Participants downloaded the UCLA Mindful app on their smartphones after attending a 20-minute Mindfulness education at a local church banquet room. Participants used the UCLA Mindful software twice weekly for ten minutes for four weeks. Of the nine participants, three completed the study. A two-tailed paired sample t-test and descriptive analysis were used to evaluate the efficacy of the UCLA Mindful smartphone software. The results of the two-tailed paired sample t-test were not statistically significant for the UCLA V3 Loneliness scale (p=.220) and GDS (p=.208) due to the small sample size. Although the results were negligible, participants nevertheless reported favorable impacts. Future research with a larger sample size is encouraged.
ContributorsMurdock, J. Kristine (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26