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.
Collaborating Institutions:
College of Nursing and Health Innovation
Displaying 1 - 10 of 22
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- All Subjects: Mental Health
- All Subjects: Patient Portals
Description
Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and improve patient outcomes overall utilization in the United States (US) remains low.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
ContributorsProsev, Brittany (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
Description
There is an increase in the prevalence of mental health problems in the United States. Healthy People 2020’s leading mental health indicator is to increase the delivery of care to those with mental health issues and lower the number of youth who experience a major depressive disorder. Teachers and non-teaching staff are well placed in the community to identify youth undergoing emotional distress and facilitate early interventions, yet do not receive adequate training in mental health.
A project was undertaken to determine if a mental health training intervention affected the community youth mentors knowledge, attitude and self-efficacy towards helping youth with mental health issues. Three instruments with good validity and reliability namely Mental Health Literacy Scale (MHLS), Attitudes to Severe Mental Illness (ASMI) scale, and Gatekeeper Behavior Scale were used in pre intervention, immediately post intervention and two weeks post intervention questionnaires. The Wilcoxon Signed Ranks test indicated changes in the pre and post intervention scores as significant in knowledge, and attitude between pre intervention and immediately post intervention time periods. Cohen’s effect size value suggested large, medium, small, and minimum clinical significance in the variables over period of time.
Mental health literacy narrows the gap between symptom onset and intervention. Numerous mental health trainings are currently available worldwide. Schools and after school clubs in collaboration with hospital mental health and other community agencies are better equipped to bridge the gap. School staff report better confidence in addressing mental health and behavioral health issues among youth when equipped with additional resources within the school in the form of psychologists, social workers, and counselors.
ContributorsMazhuvencherry, Elizabeth (Author) / Chen, Angela (Thesis advisor)
Created2020-05-03
Description
Background: Non-Veteran Affair (VA) mental health care facilities are admitting increased numbers of military affiliated members due to recent changes, allowing veterans to outsource healthcare at civilian treatment centers. The VA reports less than 9 million veterans enrolled in VA services, leaving over 50% seeking treatment from civilian providers. Given the high prevalence of Posttraumatic Stress Disorder (PTSD) in the military population, it is imperative to implement a valid and reliable screening tool at primary care facilities to ensure timely and accurate diagnosis and treatment.
Method: This project aimed to provide an evidence-based education for intake nurses to understand prevalence of PTSD and to use a screening tool Primary Care PTSD for DSM-5 (PC-PTSD-5) in a non-VA behavioral health facility.
Setting: The project site was a civilian behavioral health facility located in West Phoenix Metropolitan area. The behavioral health facility serves mental health and substance abuse needs. Project implementation focused on the intake department.
Measures: Sociodemographic data, PTSD diagnosis criteria, prevalence and PC-PTDSD-5 screening tool knowledge collected from pre and posttest evaluation. Patients’ charts for those admitted 6-week before and 6-week after the education to calculate numbers of screening tools completed by nurses at intake assessment.
Data analysis: Descriptive statistics was used to describe the sample and key measures; the Wilcoxon Signed Rank Test was used to examine differences between pre-test and post-test scores. Cohen’s effect size was used to estimate clinical significance.
Results: A total of 23 intake nurses (87.0% female, 65.2% 20-39 years old, 52.2% Caucasian, 95.6% reported having 0-10 years of experience, 56.5% completed Associate’s degree) received the education. For PTSD-related knowledge, the pre-test score (Mdn = 6.00) was significantly lower than the post-test score (Mdn = 10.00; Z= -4.23, p < .001), suggesting an increase of PTSD knowledge among nurses after the education. Regarding the diagnosis, the percentage of patients who were diagnosed with PTSD increased from (0.02% to 20% after the education).
Discussion: An evidence-based education aimed at enhancing intake nurses’ knowledge, confidence and skills implementing a brief and no-cost PTSD screening tool showed positive results, including an increase of PTSD diagnosis. The implementation of this screening tool in a civilian primary mental health care facility was feasible and helped patients connect to PTSD treatment in a timely fashion. Continued use of paper version of screening tool will be maintained at facility as an intermediary solution until final approval through parent company is received to implement into electronic medical records.
Method: This project aimed to provide an evidence-based education for intake nurses to understand prevalence of PTSD and to use a screening tool Primary Care PTSD for DSM-5 (PC-PTSD-5) in a non-VA behavioral health facility.
Setting: The project site was a civilian behavioral health facility located in West Phoenix Metropolitan area. The behavioral health facility serves mental health and substance abuse needs. Project implementation focused on the intake department.
Measures: Sociodemographic data, PTSD diagnosis criteria, prevalence and PC-PTDSD-5 screening tool knowledge collected from pre and posttest evaluation. Patients’ charts for those admitted 6-week before and 6-week after the education to calculate numbers of screening tools completed by nurses at intake assessment.
Data analysis: Descriptive statistics was used to describe the sample and key measures; the Wilcoxon Signed Rank Test was used to examine differences between pre-test and post-test scores. Cohen’s effect size was used to estimate clinical significance.
Results: A total of 23 intake nurses (87.0% female, 65.2% 20-39 years old, 52.2% Caucasian, 95.6% reported having 0-10 years of experience, 56.5% completed Associate’s degree) received the education. For PTSD-related knowledge, the pre-test score (Mdn = 6.00) was significantly lower than the post-test score (Mdn = 10.00; Z= -4.23, p < .001), suggesting an increase of PTSD knowledge among nurses after the education. Regarding the diagnosis, the percentage of patients who were diagnosed with PTSD increased from (0.02% to 20% after the education).
Discussion: An evidence-based education aimed at enhancing intake nurses’ knowledge, confidence and skills implementing a brief and no-cost PTSD screening tool showed positive results, including an increase of PTSD diagnosis. The implementation of this screening tool in a civilian primary mental health care facility was feasible and helped patients connect to PTSD treatment in a timely fashion. Continued use of paper version of screening tool will be maintained at facility as an intermediary solution until final approval through parent company is received to implement into electronic medical records.
ContributorsCowart, Amanda (Author) / Chen, Angela (Thesis advisor)
Created2020-05-06
Description
Background: The shortage of providers, therapists, and long waiting times for appointments in the United States is growing. Mental health technology applications (apps) expand the strategies available to people with mental health conditions to achieve their goals for well being through self-management of symptoms.
Methods: A project was undertaken at an outpatient behavioral setting in urban Arizona to determine the use and effectiveness of a mental health app called insight timer to reduce anxiety symptoms. Adult clients with anxiety symptoms were provided with the insight timer app to use over a period of eight weeks. Anxiety was evaluated with the GAD-7 scale initially and after the eight weeks of app use. Usability and the quality of the app were assessed with an app rating scale at the end of the eight weeks.
Results: Findings of the Wilcoxon Signed Ranks test indicated changes in pre and posttest assessment scores as significant (p = .028), which is a significant reduction in anxiety among seven clients who completed the 8-week intervention. the mean TI score was 15.57 (SD = 4.9), and the mean T2 score was 7.71 (SD = 5.7). Besides, Cohen's effect size value (d = 1.465) suggested large clinical significance for GAD7 in pre and posttest.
Discussion: Evidence suggests that the use of an evidence-based app can effectively reduce anxiety symptoms and improve the quality of life. The use of mental health apps like insight timer could reduce health care costs associated with unnecessary hospital admissions as well as re-hospitalizations. The routine use of apps such as the insight timer may also be beneficial to all the clients who have anxiety symptoms in outpatient as well as inpatient settings.
Methods: A project was undertaken at an outpatient behavioral setting in urban Arizona to determine the use and effectiveness of a mental health app called insight timer to reduce anxiety symptoms. Adult clients with anxiety symptoms were provided with the insight timer app to use over a period of eight weeks. Anxiety was evaluated with the GAD-7 scale initially and after the eight weeks of app use. Usability and the quality of the app were assessed with an app rating scale at the end of the eight weeks.
Results: Findings of the Wilcoxon Signed Ranks test indicated changes in pre and posttest assessment scores as significant (p = .028), which is a significant reduction in anxiety among seven clients who completed the 8-week intervention. the mean TI score was 15.57 (SD = 4.9), and the mean T2 score was 7.71 (SD = 5.7). Besides, Cohen's effect size value (d = 1.465) suggested large clinical significance for GAD7 in pre and posttest.
Discussion: Evidence suggests that the use of an evidence-based app can effectively reduce anxiety symptoms and improve the quality of life. The use of mental health apps like insight timer could reduce health care costs associated with unnecessary hospital admissions as well as re-hospitalizations. The routine use of apps such as the insight timer may also be beneficial to all the clients who have anxiety symptoms in outpatient as well as inpatient settings.
ContributorsJacob, Annie (Author) / Chen, Angela (Thesis advisor)
Created2020-05-06
Description
Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos.
Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins.
Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
ContributorsHerrera, M. Sara (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Healthcare workers may have poor attitudes, bias or feel unprepared when caring for patients with mental illness in the pediatric intensive care unit (PICU) setting. The aim of this project was to resolve these biases using education to increase quality of care for pediatric mental health patients using Rossworm and Larabee’s change model. The Questionnaire on Stigmatizing Attitudes Towards Children with Emotional and Behavioral Disorders (EBD) was completed by voluntary participants at pretest, posttest and at a one month follow up. Between pretest and posttest, participants engaged in three educational modules regarding mental health. Participants were voluntary, anonymous staff members at a pediatric hospital currently employed in the PICU. Results of the questionnaires pre M= 23 post M=11 and follow up M=9.5 indicates education improves attitudes, and decreases bias in PICU staff. Recommendation to obtain larger population of study with trial implementation. Recommend adding educational modules to annual education or to new hire orientation.
ContributorsMoore, W. Alexandra (Author) / Guthrey, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-28
Description
Burnout has become an increasingly popular topic among registered nurses, but unfortunately burnout among psychiatric nursing is less understood than other nursing specialties such as the Intensive Care Unit, Emergency Room, or Oncology. Psychiatry is unique and psychiatric nurses, in particular, are often subjected to physical and verbal violence as well as exposure to patient’s trauma. The aim of this project was to decrease burnout among psychiatric nurses in a private practice out-patient family psychiatric facility using Rossworm and Larabee’s change model (Appendix D). The MBI-HSS was completed by 1 participant (n=1) at pre-intervention and post-intervention. Between the pre/post MBI-HSS questionnaire the participant was asked to partake in a mindfulness-based intervention utilizing the smartphone application Headspace to complete a 10-session meditation course over one week. The results conclude the participant’s burnout decreased overall from pre-intervention to post-intervention. Internal Review Board (IRB) was granted in September 2021, and the project was completed in November 2021. The impact of the project was projected to have a more thorough statistical influence, but due to the participant size, there is minimal impact of system or polices in the psychiatric facility.
ContributorsSteward, M. Shannon (Author) / Guthrey, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-30
Description
Purpose & Background: Serious mental illness among incarcerated people continues to rise within the United States. Correctional officers only receive an average of 13.54 hours of training in special populations, including the mentally ill (Kois et al., 2020). This lack of training leaves new correctional officers inadequately prepared to manage this population in prison. Education is a cost-effective modality to provide a long-term change of practice. Mental health education was provided to New Correctional Officers (NCOs) at a 2,000-bed facility in Southwestern United States during their initial correctional officer training. Internal permissions were granted by the prison internal review board (IRB) and the Arizona State University IRB.
Methods:NCOs (n = 7) were recruited and consented to participate in psychoeducation specific to mentally ill prisoners. Using an evidence-based curriculum developed by Dr. Dana Dehart at the University of South Carolina, NCOs participated in four (4) 1-hour long mental health trainings that were instructor led. Pre/Post assessment tools were completed using a 10-item trauma quiz and a 12- item Mental Health Knowledge Schedule (MAKS) scale assessing participant attitudes towards mental illness.
Results: Participants were primarily male (57 %), White (42%), with an average age range between 31-40 years old, and with a high school degree. Post intervention quiz and MAKS show improved knowledge for all subjects using both tools.
Discussion/Conclusion: This project highlights cost-effective training with significant preliminary results in reducing stigma towards the mentally ill in prison. Furthermore, this information justifies the support, development, and funding for increasing mental health training for correctional staff nationwide.
ContributorsVargas, Ramses (Author) / Baker, Laurie (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-07
Description
Police officers have more mental health issues than the general population and face barriers to seeking help, such as stigma, organizational masculinity, and concerns about confidentiality. This project took place in an urban police department in Arizona and aimed to increase the frequency of officers seeking peer support or counseling and reduce mental health stigma. Peer support volunteers increased officer contact following exposure to traumatic incidents. Officers viewed an educational video on mental health and available resources, and sergeants were provided with a quick reference guide on mental health warning signs. Rates of
counselor fund utilization by officers pre-and post-intervention were monitored, and all officers were emailed a Likert-scale peer support satisfaction survey. Survey results (n=39) showed officers were moderately satisfied with peer support and knowledge, but many were not comfortable contacting peer support for personal issues. Of officers surveyed, 74.4% (n=29) did not seek counselor services after contact with peer support. Counselor fund utilization slightly increased post-intervention, but further study is needed to determine the correlation to interventions. This project was unable to definitively demonstrate that peer support and education for officers and leadership increases help-seeking behaviors. Future projects should focus on improving peer support volunteer training and education.
ContributorsManchak, Nicole (Author) / Helman, Jonathan (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-03
Description
Background: With the adoption of the Health Information Technology for Economical and Clinical Health (HITECH) Act of 2009, came the implementation of the electronic health record (EHR) and incentivized provider programs called Meaningful Use (MU). A goal of MU is to utilize patient portals to improve access to care. Current evidence supports patient portal use however providers are concerned about increased work load and lost revenue because of the time spent managing the portals rather than providing direct, billable patient care.
Purpose: The purpose of this project was to assess provider readiness for patient portals and provide an educational intervention to address perceived barriers.
Method: Ten providers at a large family practice clinic in the southwest United States were surveyed using The Provider Readiness Questionnaire prior to and after an educational intervention addressing common concerns.
Results: Improved response to patient portal use after the provider viewed the learning module. A paired-samples t-test was conducted to compare pre-and post-intervention responses. There was a statistically significant difference in the scores for the question “increase my workload” Pretest (M= 3.78, SD=1.201) and; Posttest (M=2.67, SD=1.225) ;(t (8) =5.547, p = .001). There was also a statistically significant difference for the question “increased provider professional satisfaction” Pretest (M=3.89, SD= .333) and Posttest (M= 4.44, SD=.527); t (8) = -2.294, p=.051).
Implications: Providing education addressing perceived barriers to portal use can assist the provider in understanding the value of the portals to improve patient outcomes and address common concerns about the impact of portal use on provider productivity.
Purpose: The purpose of this project was to assess provider readiness for patient portals and provide an educational intervention to address perceived barriers.
Method: Ten providers at a large family practice clinic in the southwest United States were surveyed using The Provider Readiness Questionnaire prior to and after an educational intervention addressing common concerns.
Results: Improved response to patient portal use after the provider viewed the learning module. A paired-samples t-test was conducted to compare pre-and post-intervention responses. There was a statistically significant difference in the scores for the question “increase my workload” Pretest (M= 3.78, SD=1.201) and; Posttest (M=2.67, SD=1.225) ;(t (8) =5.547, p = .001). There was also a statistically significant difference for the question “increased provider professional satisfaction” Pretest (M=3.89, SD= .333) and Posttest (M= 4.44, SD=.527); t (8) = -2.294, p=.051).
Implications: Providing education addressing perceived barriers to portal use can assist the provider in understanding the value of the portals to improve patient outcomes and address common concerns about the impact of portal use on provider productivity.
ContributorsLeal, Lauren (Author) / Velasquez, Donna (Thesis advisor)
Created2017-05-02