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: Nurse practitioners
- All Subjects: Cognitive Behavioral Therapy
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 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.
requiring readmission the same day as discharge.
Method: The purpose of project was to check the feasibility of the use of cognitive behavioral therapy-based group called Creating Opportunities for Personal Empowerment (COPE) in the treatment of children with depression and suicidality. The study patients participated in up to 7 groups of a 60-minute lesson of COPE each day, combined with interactive activities that helped
them practice problem solving and coping skills. The feasibility of the COPE groups were measured by the consistent decrease of Columbia Suicide Severity Rating Scale at the beginning and conclusion of lessons as well as consistency of engaged participation in the COPE groups on the unit based of staff observation obtained from Staff Survey.
Results: The results analyzed using the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -3.64, p < .001. This indicated that the differences between Pre-CSSR and Post-CSSR were not likely due to random post variation. The median of Pre-CSSR (Mdn = 1.00) was significantly lower than the median of Post-CSSR (Mdn = 2.00).
Discussion: The results proved feasibility of a cognitive behavioral therapy-based group in the treatment of depression and suicidality of children in an inpatient unit.
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.