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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Purpose: Implementation of a postpartum depression (PPD) screening while using evidence-based interventions to improve depressive symptoms, enhance breastfeeding (BF) self-efficacy, and strengthen the mother-infant dyad (MID).
Background and Significance: PPD is highly prevalent among women living in the United States and threatens the physical and psychological health of MIDs. Many of these women go undiagnosed and without treatment, further worsening symptoms and outcomes. This has inspired world healthcare leaders and organizations to address maternal mental health among postpartum women.
Methods: A 12-week evidenced-based project consisted of two-sets of participants including mothers and staff. A comprehensive maternal support program guided by an informational pamphlet (IP) and implementation of PPD screening using the Edinburgh Postnatal Depression Scale served as the two-part intervention for this project. Goals were to decrease PPD, enhance BF satisfaction, and strengthen the MID. Comprehensive maternal support encompasses interventions proven to meet the project goals and includes tailored BF education and care to maternal needs, social support by peer/family involvement, skin-to-skin contact during BF, emotion-regulation strategies, and availability of community resources.
Outcomes: The BSES-SF scores did result in statistical significance based on an alpha value of 0.10, t(3) = -2.98, p = .059, proving a positive effect was seen in breastfeeding self-efficacy post intervention. The results did not show statistical significance (t(3) = 0.60, p = .591) in regard to pre and post-depression scores. However, the mean pre-score (M =3.50, SD 3.11) did decrease post-intervention (M =2.75, SD 1.26) and exemplifies clinical significance.
Conclusion: The outcomes of this Quality-Improvement project showed improved scores for depression and BF self-efficacy post-intervention. This demonstrates the value in screening for PPD using a validated screening tool and instituting comprehensive maternal support guided by evidence-based practice in a community setting.
The birth of a new baby is known to be a joyful time for families. However, such a treasured experience can quickly reroute in a matter of moments which leaves the family feeling helpless, frightened, and guilty. The innate process of bonding and attachment is interrupted by the resuscitative course following a traumatic birth. Separation, grief, anger, and fear promote what’s being deemed more and more frequently as parental posttraumatic stress disorder (PTSD). Rates of parental PTSD associated with separation at birth are equivalating those of post-partum depression and post-partum psychosis. Emotionally unstable parents are unable to adequately care for their newborn for both short and long term needs.
Facilitation and support of the parental role in an altered environment, such as a neonatal intensive care unit (NICU), is thought to create opportunities for relationship security. Establishment of an emotionally invested caregiver has been proven to minimize sequelae of the NICU patient, reduce length of stay, cut readmission rates, and lower the incidence of failure to thrive post-discharge. A parental psychosocial program was instituted in a 32-bed NICU within a southwest children’s hospital. The program efficacy was analyzed several months after implementation. Results are concurrent with the thought that individual counseling for NICU families reduces stress scores and improves patient satisfaction at discharge.
Background and Significance: NIRS data can be used in conjunction with standard vital sign monitoring to help clinicians understand blood flow and metabolic demands of organ systems, particularly cerebral, renal, and mesenteric blood flow patterns. A NICU unit in the northwestern US adopted NIRS use on their patients in 2008, however, NIRS monitoring usage decreased over the past 5 years, citing a lack of continued education and comfort interpreting and managing NIRS monitored patients. One patient was monitored with NIRS in the year prior to the QI project.
Methods: A 5 point Likert-Type survey was designed to examine provider comfort and confidence using and interpreting NIRS on NICU patients. No Croanbach’s alpha value exists for the survey as it was purposefully designed for the QI project. An educational presentation on the use and interpretation of NIRS on NICU patients was created and delivered during a formal provider staff meeting. Pre and Post education surveys were distributed electronically to participants and were presented 1 week prior to educational session and 1 month after educational session. IBM SPSS version 23 was used for descriptive statistics, paired t tests, and Wilcoxon test. Significance set to p<0.05.
Results: In total, 18 providers (N=18) were surveyed, and 13 paired survey results (n=13) were received (8 MD and 5 NNP). Paired-samples t tests were calculated to compare the mean total score (TS) for pre/post comfort and pre/post confidence. This was a significant improvement for both comfort (t(11) = -3.13, p=0.010) and confidence (t(11) = -3.37, p=0.006). Wilcoxon test showed a significant increase in the times a provider managed a patient with NIRS (z=-2.762, p=0.006). The number NIRS monitored patients increased from one in the previous year to 15 patients in the 5 months of data tracking, a clinically significant increase.
Conclusions: Providing educational session on previously utilized clinical applications can improve providers comfort and confidence and influence their usage in clinical practice. Future continuing education sessions could be designed for different clinical applications in order to keep clinicians abreast of the current evidenced based applications of advanced clinical monitors.
Obtaining a comprehensive sexual health history is an important part of the patient history taking process and is essential to providing high-quality, patient-centered, and accessible healthcare. Information gathered from the sexual health history guides delivery of appropriate education about prevention, counseling, treatment, and care. A federally qualified health center (FQHC) reported that they did not have a standardized comprehensive sexual health history taking process. To address this concern, a literature review was conducted to survey current evidence regarding both patient and healthcare provider perspective on sexual health history taking. While it is recommended for a sexual health history to be performed routinely, both healthcare providers and patients have reported sexual health is not discussed at most visits.
The findings led to the initiation of an evidence-based project implementing a comprehensive sexual health history taking tool at the FQHC. The tool assists in obtaining a comprehensive sexual history and provides an understanding of the sexual practices of the patients. If healthcare providers become aware of the sexual practices of their patients, they are better able to provide evidence-based education that could lead to better health outcomes. The participants reported they liked being asked about their sexual health, did not find the questions too personal, and reported the questionnaire addressed their sexual health concerns, and was worth their time. Taking a comprehensive sexual health history is a fundamental skill that all healthcare providers must strive to improve for the general health of their patients and the community.
