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: Provider Education
- All Subjects: Social Determinants of Health
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.
Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.
The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).
The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.
The reactionary nature of the current healthcare delivery system in the United States has led to increased healthcare spending from acute exacerbations of chronic disease and unnecessary hospitalizations. Those who suffer from chronic diseases are particularly at risk. The dynamics of health care must include grappling with the complexities of where and how people live and attempt to manage their health and disease. Team-based care may offer a solution due to its interdisciplinary focus on proactive, preventative care delivered in outpatient primary care.
Studies examining the effects of team-based care have shown improvement in; HbA1c, blood pressure, lipids, healthcare team morale, patient satisfaction rates, quality of care, and patient empowerment. In an effort to improve type 2 diabetes health outcomes and patient satisfaction a team based care project was implemented. The setting was an outpatient primary care clinic where the patients are known to have limited social resources. The healthcare team was comprised of a DNP Student, Master of Social Work Student, Clinical Pharmacist, and Primary Care Physician, who discussed patient specifics during informal meetings and referral processes.
Adult patients whose HbA1c level was greater than 6.5% were eligible to participate, 183 were identified and invited. Fourteen (14) agreed to participate and seven (7) completed the initial screening with a mean HbA1c of 9.7%. Significant social needs were identified using the Health Leads Questionnaire. The diabetes and social needs were addressed by members of the team who met individually with patients monthly over the course of three months. Of those who completed the initial evaluation only two (2) returned for a follow-up and had a repeat HbA1c. Both participants had important improvements in their A1C with a decrease of 2.3%, and 3.4%. The others were lost to follow up for unknown reasons. Despite the small numbers of participants this project suggests that patients can benefit when an interdisciplinary team addresses their needs and this could improve health outcomes.