Doctor of Nursing Practice (DNP) Final Projects

The human papillomavirus (HPV) is a sexually transmitted infection (STI) that is associated with several types of cancer and genital warts. No cure exists for those currently infected with HPV, but a vaccine is available that can prevent the virus and development of cancers associated with HPV. Military servicemembers are at a high risk for contracting HPV; it is one of the most common STIs among active duty service members. The health consequences of HPV can impact a servicemember’s military readiness. The HPV vaccine is not required for military servicemembers, but it is offered free of charge. HPV vaccination rates among military service members remain relatively low.

The purpose of this evidence-based project was to increase the level of knowledge about HPV, improve health beliefs regarding HPV, increase HPV vaccine intention, recommendation, and uptake. Using the Health Belief Model as an organizing framework, a population targeted eight-minute education video on HPV and HPV vaccination was developed. It was implemented at an outpatient military treatment facility located in the southwest United States over a 6-week period, to newly reported service members. Participants included 116 military service members aged 18 to 45. A pretest and posttest questionnaire were used to assess the impact of the intervention. HPV level of knowledge increased significantly from pretest to posttest mean scores were 3.00 to 4.39 respectively (p < .001). HPV vaccine intention increased from 62% to 66% (p = .739). HPV vaccine recommendation increased from 62% to 85% (p < .001).

While the COVID-19 pandemic continues to evolve, America’s nursing work force continue to work in the most challenging of circumstances. While expected to hold the fort and continue on, deep inside, they bury an unprecedented level of acute stress, anxiety and depression. Peer support groups have been posed as a possible coping behavior. This cross-sectional designed project was developed to assess the worth and feasibility of a virtual peer support group with a focus on healthcare provider wellness during a period of surge of the COVID-19 pandemic. Overwhelmed staff, technology/documentation changes and challenges, competing clinical demands, short-staffing and Zoom fatigue were identified as the limiting factors for this project’s completion within its given timeframe. These findings informed of current barriers, providing a basis for future program development to mitigate the impact of psychological distress among healthcare providers. Evolving literature on this topic supports recommendations for further study and action by individual health care providers, organizations and at the state and national levels.

New graduate nurse practitioners and physician assistants, also known as advanced practice providers (APPs), face a significant number of challenges when entering professional practice. If the new graduate does not receive sufficient guidance and support during this transition to practice (TTP), they will likely experience significant psychological stress and anxiety. If an organization does not implement measures to address TTP, the new graduate is much more likely to leave the current position within the first two years of practice.

An extensive literature review was conducted investigating the effects, and necessary components of an orientation program which supports the new graduate through TTP. Using Van Maanen & Schein’s (1979) Theory of Organizational Socialization, a comprehensive new graduate orientation program was designed and implemented in large multi-specialty practice. Initial results suggest that this program improves both the perceived organizational support felt by the new graduate, as well as the new graduates’ affective commitment to the organization. Improvements in both these dimensions have been shown to decrease turnover intention and increase retention of the employee.

The human papillomavirus (HPV) is the most commonly spread sexually transmitted infection in the United States. Although the HPV vaccine protects against transmission of the most common strains of HPV that cause genital warts and numerous urogenital cancers, uptake in the United States remains suboptimal. Failure to vaccinate leaves individuals vulnerable to the virus and subsequent complications of transmission. The evidence demonstrates that provider recommendation alone increases rates of vaccine uptake. The literature does not suggest a specific method for provider recommendation delivery; however, best practice alerts (BPAs) were correlated with increased vaccination rates.

These findings have directed a proposed project that includes an electronic health record (EHR) change prompting internal medicine, family practice and women’s health providers to educate and recommend the HPV vaccine at a Federally Qualified Health Center (FQHC) in the Southwest United States. The project demonstrates that after the implementation of a practice change of a HPV BPA in the EHR, HPV vaccination rates increased. Practice settings pre and post were similar, making the increase clinically significant.

The strengths of this project include an increase in HPV vaccination rates, a sustainable intervention, and an intervention that can easily be replicated into other health maintenance tasks. There were some limitations including the BPA alert only catching the HPV 9 vaccine series and the BPA did not always capturing historical data. Despite these technical barriers the HPV BPA delivered an increase in the HPV vaccine to protect more individuals from the HPV virus, increased provider adherence to national guidelines, and provides a platform for BPAs to be utilized for other vaccines.

The mentor role can help support the experienced nurse practitioner (NP) enhance a sense of belonging and commitment to the organization; however, NPs identify barriers of time, dedication, and lack of knowledge about mentoring. Current mentoring programs in Arizona are sporadic and formal training for the mentor is even more limited. In this project, an online training intervention to develop mentorship skills was provided for experienced NPs who viewed three video sessions of 20-25 minutes each. The topics (Open Communication & Accessibility; Mutual Respect & Trust; Independence & Collaboration) focused on developing key mentoring competencies identified from the literature. Participants did not report a significant increase in their mentoring skills after the video sessions, but they identified useful individual outcomes. Participants identified the need to formalize the experience with objectives for both the mentee and mentor and recommended seeking out the novice NP to build a mentoring relationship.

The project outcomes led to several recommendations. To support ongoing mentor relationships, organizations may need to push training out to their experienced NPs on the role of the mentor. Mentors who do not self-identify for remediation or training may need organizations to provide the training and not make it optional. Community and professional organizations like the Arizona Board of Nursing, Arizona Nurses Association and others could create training modules utilizing multiple platforms to reach NPs in rural and urban parts of the state. Finally, further projects are necessary to identify the most effective modalities when delivering training.

Human papillomavirus (HPV) is a prevalent sexually transmitted infection that affects many adolescents and adults worldwide. The consequences of contracting HPV have proven to be devastating, potentially leading to a variety of life-threatening genitourinary and oral cancers. As such, prevention via vaccination is critical. HPV vaccination is recommended for all adolescents beginning at 11 years of age. Although the immunization has proven to be safe and effective, HPV vaccination rates are substantially below target goals worldwide.

A literature review of evidence from the last five years was conducted to examine barriers and facilitators to HPV vaccine uptake. The most commonly cited barriers to vaccination included lack of knowledge about the vaccine and inadequate provider recommendation. Current evidence regarding interventions to increase HPV vaccine uptake reveal that best practices are multi-factorial and should include a combination of provider education and recommendation training. These findings led to the proposal of an evidence-based intervention aimed to increase adolescent HPV vaccination rates.

A one-hour educational program was conducted at a local pediatric primary care facility. Five healthcare providers participated in the program, which consisted of a PowerPoint presentation outlining the benefits of HPV vaccination and use of an interactive application from the CDC. The app taught participants how to offer a strong recommendation for the vaccine through active participation. Pre and posttests were administered to determine the providers’ intent to vaccinate and vaccination rates were monitored. Analysis of the data collected revealed a statistically significant rise in vaccination rates. These results reveal that provider education can improve recommendation techniques and therefore increase vaccine coverage. Further research is needed to see if one-time education is sustainable.

Rural healthcare leaders are increasingly tasked with the responsibility of providing health access to 21% of the national population with only 10% of the provider workforce (Sonenberg, Knepper, & Pulcini, 2015). Provider recruitment strategies offering loan repayment have had some success in the short term, but are less impactful at creating a long-term retention rate, unless the providers have an existing connection to either the community in which they are working or rural healthcare (Renner et al., 2010).

Responding to this data, a demonstration project has been created in Colorado to test a rural focused “grow your own” advanced practice registered nurse (APRN) model. This model is designed to recruit RNs from inside rural communities to return to school and become primary care providers within those communities upon graduation. The project offers stipend support with assistance in the school application process, educational support, clinical and job placement assistance, and monthly coaching. Additionally, communities are asked to provide matching funds to support the APRN students with a goal of creating a self-sustaining model that will build a continuous pipeline of APRN providers. This strategy avoids the costly need to recruit and relocate providers who have no ties to the community.

The initial response from rural nurses and communities around the state has been overwhelmingly successful. This success suggests that this model could serve as a new and sustainable strategy for building a rural APRN provider workforce pipeline while ensuring access to a primary care health provider for all people living in rural areas.