Doctor of Nursing Practice (DNP) Final Projects

Health statistics for physical activity, nutrition, and psychological wellbeing demonstrate the tenuous status of youth in the United States (US). These factors significantly affect growth and development during this critical period and indelibly influence adult health. Consequently, the successful utilization of multicomponent pediatric health promotion programs could improve current and future health, saving billions in health-care costs. The analysis of a literature review on this topic led to the development and completion of an evidence-based project. The project was guided by two conceptual frameworks, Pender’s Health Promotion Model and the Stetler Model for Evidence-based Practice. The project was completed in partnership with a local after-school youth program.

Methodology included a project intervention comprised of a single specialized training session. Data was collected using a pretest-posttest format with repeated measures from a survey adapted from the Organization Readiness to Change Assessment (ORCA) tool. Survey questions focused on participant’s knowledge, skills, attitudes, and use of the selected health promotion program. Descriptive Statistics, the Wilcoxon-Signed Rank Test, and the Friedman Test were completed for data analysis using IBM SPSS v25. Using a critical value p < .1, results from the data indicated improvement in median scores for participant’s knowledge and skills (p-value’s range = .05 - .082). Other changes were not statistically significant (p-value’s range = .135 - .317). The results indicate the project intervention’s efficacy. Future research may focus on optimal training formats, a comparison of repeat sessions versus supplemental web-accessible resources, and program sustainability via refresher sessions and/or designated management.

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

Local Problem: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

Methods: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

Results: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

Conclusion: MI can be an effective part of a strategy to increase vaccination rates.

Purpose: The purpose of this project was to implement health promotion education for overweight and obese adults with endocrine disorders. The overarching goal was to change dietary intake and improve exercise to reduce the incidence, prevalence, and impact of comorbidities associated with obesity.

Background/Synthesis: Obesity is a significant epidemic facing the nation today with multiple impacts on the national healthcare system. There is often an association between obesity and endocrine disorders such as type 2 diabetes and prediabetes. Both obesity and diabetes cost the nation billions of dollars annually in healthcare costs. Evidence shows that lifestyle modifications related to nutrition and physical activity are effective in weight reduction and prevention of chronic disease, especially when given by a healthcare provider.

Methods: Fifteen adult patients at an endocrinology office in Arizona received individual counseling using the teach-back method focusing on health promotion behaviors through nutrition and exercise with a two-week follow-up phone call. Short-term outcomes measured in this project included changes in dietary intake and exercise behaviors through a pre- and post-test adapted from an obesity-screening tool developed by Greenwood et al. (2008).

Outcomes/Results: Participants were primarily Caucasian and Hispanic, married, female, average age of 50 years, average BMI of 34.5, and some college education. There was a statistically significant increase in health promoting behavior on posttest scores (M=66, SD=6.23, range=58-76) compared to pretest scores (M=61, SD=4.72, range=50-66), t(14)=-2.55, p=0.023.

Conclusions and Implications: Overall, patient health promotion behaviors increased with this educational intervention. Clinical implications include a potential decrease in patient comorbidities related to overweight and obesity. Implications for the greater healthcare system include decreased comorbidities, utilization of healthcare resources, and costs associated with overweight and obesity. Future recommendations would include determining weight and BMI changes over a longer period of time for even better outcome measures.

Keywords: obesity, obese, overweight, health promotion, health education, diet, exercise, nutrition