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.
Filtering by
- All Subjects: Guidelines
- All Subjects: Provider Education
Method: A single group pre-test post-test design was utilized to evaluate nursing staff knowledge before and after an education program on pressure injury prevention. Staff knowledge was evaluated using a modified version of the Pressure Ulcer Knowledge Assessment Tool 2.0. Participants completed pre- and post-education surveys. Rates of hospital acquired pressure injuries were obtained via chart review.
Results: Pre- and post-education scores were analyzed in participants who completed both surveys using a paired t-test. Post-education scores (M = 0.73, SD = 0.07) were significantly higher than pre-education scores (M = 0.59, SD = 0.09); t(7) = -5.39, p = .001. Pre- and post-education median scores of all participants were analyzed using two-tailed Mann-Whitney U test. Post-education scores (Mdn = 0.71) were significantly higher compared to pre-education scores (Mdn = 0.56); U = 102.5, z = -4.05, p = .001. Monthly incidence of pressure injuries on the unit increased following education.
Discussion: Increase in scores from pre- to post-education surveys indicate staff knowledge improved. The increased incidence of pressure injuries is thought to be secondary to staff’s increased ability to detect pressure injuries. Staff education is recommended, but more research is needed regarding the impact on pressure injury rates.
Antibiotics have contributed to the decline in mortality and morbidity caused by infections, but overuse may weaken effectiveness resulting in a worldwide threat. Antibiotic overuse is correlated with adverse events like Clostridium difficile infection, antimicrobial resistance, unnecessary healthcare utilization and poor health outcomes. Long term care facility (LTCF) residents are vulnerable targets for this phenomenon as antibiotics are one of the most commonly prescribed medications in this setting. Consequently, multiple organizations mandate strategies to promote antibiotic stewardship in all healthcare sites particularly LTCFs.
To address this global issue, this doctoral project utilized the Outcomes-Focused Knowledge Translation intervention framework to provide sepsis education, promoted use of an established clinical algorithm, and engaged a communication tool for nurses and the certified nursing assistants (CNAs) thus, improving antibiotic stewardship. The project was conducted in a 5-star Medicare-rated LTCF in Mesa, AZ with a convenience sample of 22 participants. The participants received a knowledge questionnaire and Work Relationship Scale pre- and post- intervention to determine improvement.
The results show that the education provided did not improve their knowledge with a p = 0.317 for nurses while p = 0.863 for CNAs over 8 weeks. Lastly, education provided did not improve the nurses’ Work Relationship p = 0.230 or for the CNAs p = 0.689. Though not statistically significant, the intervention tools are clinically significant. Additional research is needed to identify ways to determine barriers in implementing an antibiotic stewardship program.
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: A multifaceted intervention was utilized that included educational sessions for providers, adjustments to the electronic health record (EHR), access to toolkits, and workflow changes. Pediatric patients aged 5-18 years and diagnosed with asthma (N = 173) were evaluated using a pre-post design. Provider adherence to key components of clinical practice guidelines were assessed prior to implementation, and a three and six months post-implementation. Data was analyzed using descriptive statists and the Friedman’s ANOVA by rank.
Results: Provider education, EHR adjustments, provider toolkits, and changes to office workflow improved provider adherence to key aspects of asthma clinical practice guidelines. A significant difference was found between the pre and post implementation groups (p < .01).
Conclusion: Increased adherence to clinical practice guidelines leads to fewer complications and an overall improved quality of life. Continuing provider education is critical to sustained adherence.
Background and Significance: HF affects over 5.1 million people in the United States, costing $31 billion a year; $1.7 billion spent on Medicare readmissions within 30 days of discharge. Guidelines and care coordination prevent expenses related to hospital readmissions and improve quality of life for adults with HF.
Methods: Healthcare providers (HCPs) at a metropolitan hospital participated in an education session reviewing HF treatment and CMD. Thirty participants completed the single five-point Likert scale pre/post surveys evaluating their opinions of knowledge and behaviors toward implementation of guidelines and CMD. Patient outcome data was abstracted measuring pre/post education compliance for ejection fraction, ACE/ARB, beta-blocker, HF education, follow-up appointments, aldosterone antagonist, anticoagulation, hydralazine nitrate, and CMD 30-45 day’s pre/post education. Analyses included descriptive statistics of participants and pre/post surveys using a paired t-test. Percentage of compliance for quality measures was completed on patients from September through December.
Results: Providers post intervention showed improved knowledge and behaviors toward implementation of guidelines and CMD, including reconciliation of medications to statistical significance. However, the demographics showed the majority of participants were non-cardiac specialties. Improved compliance for outcome data of quality measures was insignificant over time. The non-cardiac demographic may have contributed to this result.
Conclusion: The surveys did not correlate with the patient outcome data. Recommendations would include targeting cardiac focused HCPs for future education sessions.
Background:
Asthma is one of the most common pediatric diseases, affecting 6.3 million U.S. children in 2014, that can result in negative health outcomes if not managed correctly due to it's chronic and complex nature requiring frequent and close management (NHLBI, 2007). The National Heart, Lung, and Blood Institute's (NHLBI) Guidelines for the Diagnosis and Management of Asthma will be implemented into practice to determine the health outcomes of patients before and after guideline implementation.
Methods:
Inclusion criteria includes patients 5-18 years with a history of asthma, recurrent albuterol use, or intermittent symptoms of airflow obstruction. Data will be collected through EHR data reports at pre implementation, 3 months, and 6 months post implementation and will be analyzed using SPSS. Descriptive statistics, paired t-tests, and a Friedman's ANOVA will be conducted to analyze data.
Results:
A Friedman ANOVA was conducted comparing the outcome variables six months priot to the practice change, at three months post implementation, and at six months post implementation. A significant difference was found (x2(15) = 216.62, p<.05). The implementation of the practice change significantly affected the outcome variables.
Conclusions:
In general, the implementation of a practice change to use evidence based NHLBI ERP-3 Asthma Guidelines, along with staff and provider education sessions and creation of standardized assessment and documentation tools resulted in positive changes in the outcomes variables. Findings from this study along with the literature of implementing evidence based asthma guidelines supports similar practice change implementations in other pediatric primary care clinics.
Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions, treatment delays, chemotherapy changes, or discontinuation of treatment. Guidelines exist to better prevent and treat CINV. Evidence supports the use of guidelines to prevent CINV, however patients still suffer from CINV often due to a lack of guideline adherence.
Objectives:
The purpose of this project was to increase CINV guideline adherence by increasing knowledge of antiemetic guidelines utilizing an educational intervention for providers and nurses at an outpatient oncology office.
Methods:
A brief educational intervention on CINV and recommended NCCN guidelines was
conducted with providers and nurse (n=6) at an oncology practice in Southwestern United States. An evaluation to assess change in knowledge was performed using a pre and post test format. Statistical analysis was performed using descriptive statistics, McNemar tests and Wicoxan Signed Rank Test.
Findings:
There was a significant effect on knowledge of NCCN antiemetic guidelines (Z=-1.89, p=0.059, mean 2.5) post intervention. There also was a significant impact on likelihood to use guidelines in practice (Z=-1.89, p=0.059, mean 2.5). Increasing awareness and likelihood to CHEMOTHERAPY INDUCED NAUSEA AND VOMITING 3 follow recommended guidelines may improve CINV symptoms in patients undergoing chemotherapy and improve the treatment outcomes for these patients.
Background and Significance: Evidence shows primary care providers (PCPs) are not adhering to the GOLD Guidelines for COPD screening.
Methods: Guideline education with pre/post-intervention survey and percent of eligible participants screened.
Results: Pre-intervention surveys (n=10) and post-intervention surveys (n=8) completed. Significant increase in knowledge regarding the CAT score (M score = 11.50, U = 24.000, p<.05). Part 2) 24% (n=6) of participants were screened with the CAT questionnaire.
Conclusions: PCPs are aware of the GOLD Guidelines, but do not always adhere to its recommendations. Future research should concentrate on effective ways to implement the GOLD Guidelines screening recommendations in primary care clinics.