Doctor of Nursing Practice (DNP) Final Projects

Vicarious exposure to traumatic events is correlated with: mental health problems, a higher prevalence of posttraumatic stress disorder, employee attrition, and higher mortality rates for Law Enforcement Officers when compared to the general population. The purpose of this evidence-based project was to determine if a resiliency training improved resiliency and resiliency knowledge in law enforcement officers in a rural law enforcement agency in the southwestern United States. Six participants completed a demographic survey, Response to Stressful Experience Scale and a resiliency knowledge measure. A Wilcoxon signed-rank test was conducted to compare pre- and post- training resiliency and resiliency knowledge scores.

The post-test overall resiliency scores (Mdn = 59.50) were not significantly higher than pre-test overall resiliency scores (Mdn = 54.50), Z = -1.47, p = .141. Post-test resiliency knowledge scores (Mdn = 9.00) were not significantly higher than pre-test resiliency knowledge scores (Mdn = 8.00), Z = -1.63, p = .102. In this group of law enforcement officers, the resiliency training did not have an effect on resiliency or resiliency knowledge. These outcomes could be potentially explained by the limited sample size (N = 6), and possibly small effect size. Recommendations for improving the current study include conducting the resiliency training with a larger sample size of at least 30, and including additional relevant questions in the resiliency knowledge measure.

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma.

Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks.

Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25).

Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Keywords: teacher training, adverse childhood experiences, ACEs, childhood trauma, resilience

Children with congenital heart disease (CHD) are at increased risk for psychosocial issues (PSI), decreased quality of life (QOL), and decreased resilience. The purpose of this project was to implement a screening protocol for PSI, QOL, and resilience, with appropriate psychosocial referral for children with CHD.

A pilot protocol was implemented to screen children with CHD, aged 8-17 years, and parents, for resilience, QOL, and PSI. Referrals for psychosocial services were made for 84.2% of children screened (n = 16) based on scoring outcomes. Statistically significant differences in the parents and children’s resilience mean scores were noted. Higher parental scores may indicate that parents believe their children are more resilient than the children perceive themselves to be.
Early identification of concerns regarding QOL, resilience, and PSI in children with CHD can provide ongoing surveillance, while affording opportunities for improved communication between providers, parents, and children. Routine screening and longitudinal follow-up is recommended.

There is an increasing number of cancer patients outliving their diagnosis and treatment and requiring more support as they transition to cancer survivors. To bridge this gap, survivorship care plans should be provided to all cancer survivors to provide post treatment plans of care, recommendations, and resources (Commission on Cancer, 2016). A quality improvement project was implemented in the urology practice of a National Cancer Institute-designated, academic hospital in Phoenix, Arizona to provide survivorship care plans to prostate cancer patients with surgical intervention as their cancer treatment.

Through interprofessional collaboration, the process change was designed and implemented with the residents and Physician Assistants of the urology practice. There was a 93% adherence rate in delivering the survivorship care plans during the project. The “Confidence in Survivorship Information” questionnaire was used to measure the patients’ confidence in survivorship information prior to and after receiving a survivorship care plan. A paired t-test showed statistical significance in improvement in confidence in the knowledge of long-term physical effects of cancer treatment, strategies for preventing and treating long-term physical effects, and resources available for family members who may be at risk. The project will continue in order to meet requirements for cancer programs established by the Commission on Cancer (Commission on Cancer, 2016).

Cancer survivors meet survivorship with uncertainty due to a lack of uniform information provided post cancer treatment. The implementation of survivorship care plans (SCP) has been recognized by key stakeholders as the solution to transitional uncertainties. In fact, to achieve accreditation by the Commission on Cancer (CoC) cancer centers are required to deliver SCPs to cancer survivors within a year of their treatment completion. Research demonstrates SCP delivery results in significant improvement in patient satisfaction, coordination of care, and survivorship care knowledge.

In order to meet CoC standard 3.3 and bring understanding to SCPs function in cancer survivorship care a quality improvement project was initiated within an Arizona cancer center. SCPs were delivered at a survivorship visit to adult breast cancer patients. SCPs affect on survivors’ confidence in cancer self-care knowledge and care satisfaction was evaluated as well as the organization’s adherence to CoC standard 3.3 requirements. Identified survivors were scheduled for a survivorship visit where a SCP was delivered by a oncology provider.

Survivors perceived confidence in knowledge and satisfaction was measured using the modified 16-item Confidence in Survivorship Information Questionnaire (CSI). Questionnaires were completed pre and post survivorship visit. A paired t-test analysis was used to evaluate SCP effectiveness. There was an increase in the delivery of SCPs from zero to 57 with an 84 percent SCP delivery from August 2017 to January 2018. Survivors and providers verbalize value in SCPs.

No statistical significance was found in the comparison of SCPs affect on survivors’ confidence in cancer self-care knowledge and care satisfaction to that of standard follow-up care; however, when comparing the pre/post questionnaire averages an improvement was noted across the board.The prospect of this project is to unveil the impact SCP delivery at a survivorship visit has on the selected metrics. This project aids as a director for organization wide implementation for CoC standard 3.3 requirement compliance.

Cancer survivorship has been identified as separate stage in cancer treatment posing unique issues that arise from the diagnosis of cancer, as well as late effects associated with treatments. Evidence shows that cancer survivors demonstrate suboptimal follow-up care, and report high levels of unmet needs related to their cancer experience. To improve care for the increasing number of cancer survivors in the United States, survivorship care plans (SCPs) have been proposed as way to strengthen care coordination and improve patient outcomes.

Research suggests that SCPs have favorable impact on patient satisfaction and quality of life, however little research to date investigates the utility of SCPs in improving patient outcomes, adherence to follow-up recommendations, or patients’ confidence in self-care management. To further understand the role of SCPs in survivorship care, a pilot implementation of SCPs in colon cancer patients was implemented to gather data on the identified gaps.

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.