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.
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- All Subjects: Prevention
- All Subjects: Guidelines
Falls are prevalent among those aged 65 years and older and may result in minor to debilitating injuries in this vulnerable population. Frailty, unsteady gait, and medication side effects all contribute to fall risk as well as dementia, a type of cognitive impairment that disrupts memory and judgment leading to an underestimation of fall risk. Fall prevention evidence suggests that interventions aimed at decreasing fall rates begin with a fall risk assessment and tailored fall prevention measures that promote safety.
To examine the effectiveness of a fall prevention program in dementia care, an evidence-based pilot was conducted in a long-term care facility focused on dementia care. A convenience sample of 16 nurses received a fall prevention education intervention. A fall prevention knowledge instrument measured pre and post-fall prevention knowledge. There was a significant increase in fall risk knowledge from the pre-test (p < .001). The participants then conducted a fall risk assessment of 50 dementia patients using the Morse Fall Scale.
Of the 50 dementia patients, 28 were identified as high risk for falls. The nurses then instituted tailored fall risk prevention measures for those high risk for falls. As a result of the pilot, 40 fall events were noted within a three-month time period, reflecting a significant reduction in falls (p < .001) from the previous year. The institution of a fall prevention program in dementia care incorporating nursing education, a fall risk scale, and measures to promote safety can reduce fall risk in dementia patients.
Introduction: Pediatric delirium has a 25% prevalence rate in the pediatric intensive care unit (PICU). The project purpose was to implement a nonpharmacological nursing bundle in the PICU to assess the effects on delirium reduction.
Method: A nonpharmacological nursing bundle was implemented for PICU patients, 2-18 years of age, admitted to an Arizona metropolitan, children’s hospital. Data was collected using the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool.
Results: Prebundle CAP-D and postbundle CAP-D scores (M=5.57, SD=5.78; M=7.10, SD=5.61) did not differ among the participants. Prebundle participants required an intervention 26.7% of the time for delirium compared to 31.6% in the postbundle population. No statistical significance was seen between the prebundle and the postbundle CAP-D scores t(59)=7.46; t(205)=18.17 (P=0.08, fisher’s exact test).
Discussion: Nonpharmacological bundles for delirium prevention are needed in the PICU. This project shows that significant barriers exist when implementing them in a complex pediatric environment.
Design: The primary hypothesis was that active participation as defined by contact with a sponsor of an hour or more per week, as measured by the impact on affective characteristics correlated with increased levels of sobriety, when measured by the AWARE questionnaire (Advance Warning of Relapse) within 7 days of entry and prior to discharge (within 30 days). Setting: The project took place in a residential treatment facility in Phoenix, Arizona.
Participants: There were 12 clients from a men’s house and 12 clients from a woman’s house, all of which were going through recovery. Intervention: The educational session explained what a sponsor is and the importance of finding one early as a key role in relapse prevention.
Measurements: Pre and post-test results were compared to see if there was an impact on the predictability of relapse and sponsorship. The paired t-test was performed to compare the two means of AWARE scores. A lower score on the AWARE questionnaire indicates a person is more likely to succeed in sobriety.
Findings: Based on 24 samples collected, the mean scores within the first seven days were 91.17 with a standard deviation of 18.59 and the mean score prior to discharge were 72.78 with a standard deviation (SD) of 20.02. The mean difference between the two scores was 18.39 (SD=2.84). There was a significant effect of the relapse prevention program which included sponsorship, t (22) = 4.79, p < 0.001.
Conclusion: Implications for practice include increased time with sponsors to reduce rates of relapse. Future concerns include good fit matching which may reduce rates of relapse even further.
Background and Significance: Drownings are the leading cause of death in one to four year old children in the United States. Arizona’s drowning rate is nearly double the national average for this age group. Water safety is an important anticipatory guidance topic a primary care provider should be discussing at all well visits. The Health Belief Model is an effective framework to guide family education interventions. It is strongly encouraged that providers incorporate water safety education into the developmental milestone discussions.
Methods: Ten providers recruited from six Arizona pediatric primary care clinics participated in an educational one-hour session. Providers were encouraged to prioritize water safety discussions within the one to four year old age group and deliver education in the context of individual child development. Additionally, providers were updated on water safety recommendations from the Center for Family Health and Safety at Phoenix Children’s Hospital. Supplemental handouts with developmental water safety information were given to each office to aid providers in parent education. A pre-survey was administered to the providers prior to the education session and a post-survey was given at an eight-week follow up. The surveys measured provider perception and current practices of water safety education and utilized a Likert scale to compare data sets. Current and retrospective chart reviews were conducted to evaluate sustainability of the educational intervention.
Outcomes/Results: Sixty percent of provider participants were Medical Doctors (MD) and 40% were Nurse Practitioners (NP) with experience ranging from one year to over 20 years. Following the education session, providers were more likely to discuss keeping a child at arms-reach at all times (p=0.046) during their well visits. There was also an increase in providers incorporating water safety discussions into milestone education (p=0.054).
Conclusion: This educational intervention empowered providers to deliver water safety education in the context of normal developmental milestones at each one to four year old well visit. The anticipatory guidance emphasizes to parents that the behaviors their children exhibit are healthy and normal, but also explains how achieving these milestones put their children at greater risk for drownings. This quality improvement project is part of a larger initiative to decrease the number of drownings in Arizona through education and policy
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.
Purpose: The purpose of the project was to improve physical activity (PA), eating habits (EH) and self-efficacy (SE) by implementing short lifestyle modification education in a rural primary care setting.
Background: Although prediabetes awareness has slightly improved, the nationwide unawareness remains high. General knowledge about the disease and its risk factors and prevention are significant variables to adopt health-promoting behaviors. Lifestyle change intervention has been shown to be effective with the risk reduction behaviors in prediabetic population. However, it can be a daunting task to translate during short office visits.
Methods: Sixteen participants with risk for prediabetes or diagnosed prediabetes enrolled into a 5-minute education session in a rural health clinic. They received follow-up phone calls weekly for 4 weeks. Demographics, PA, EH and SE levels were measured before the education session. During the fourth week, PA, EH and SE were measured again. Frequency, descriptive analysis, and paired t-test were used for data analysis.
Outcomes: The mean age of participants was 56.6 13.0 years. Approximately 81% were female, and 62.5% identified as Caucasian. Over 80% reported married, and 56.3% described their health condition as good. The three quarters (75%) noted they have heard of the term prediabetes. The intervention had a significant effect on PA, EH and SE from the baseline to post intervention, p = .005, p = .008, and p = .003, respectively.
Conclusion: This DNP project illustrated that one time brief lifestyle change education could positively impact PA, EH and SE in people with high risk for prediabetes in a primary care clinic.
Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.
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.