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 11
Filtering by
- All Subjects: Self Efficacy
- 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
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
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
Description
Purpose: The purpose of this evidence-based practice project was to improve participation by increasing registration on to a medical patient portal to an uninsured population. Medical patient portals have the potential to provide patients with timely, transparent access to health care information and engage them in their health care process and management. This may result in improved disease management outcomes.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
ContributorsAlvarado, Cecilia I. (Author) / Thrall, Charlotte (Thesis advisor)
Created2019-05-03
Description
Background: There is a great need to provide people with Parkinson disease (PD) not only quality medical care, but social support and disease-related resources. Nurses have the training and interpersonal relationship skills to make a tremendous difference in the lives of people living with PD. Objective: This quality improvement project evaluated the effect of a nurse navigation program on self-efficacy among people living with PD.
Methods: Twenty-four members of a PD specific wellness center in the United States were recruited to participate in a nurse navigation program for a 12-week period. The intervention period included an initial needs assessment, ten individual 45-minute sessions focused on specific aspects of PD wellness, and a concluding visit. Results: There was a significant decline in quality of life based on average PDQ-39 scores for the participants in January 2019 (M =24.44, SD=16.66) compared to January 2018 (M=20.11, SD =12.78) where higher scores signify worse quality of life; t(23)-4.329 p=0.025. Average self-efficacy for managing chronic disease pre-intervention scores (M=6.58, SD=1.70) verses post-intervention scores (M=7.44, SD=1.48) showed a significant increase in self-efficacy with a medium effect size; t(23)-0.854 p=0.016, d=0.54. Additionally, unique satisfaction surveys showed high satisfaction with nurse navigation throughout the participant sample and wellness center staff members.
Conclusions: A nurse navigation program focusing on specific aspects of PD management can help improve participant’s confidence in self-management of PD despite disease progression. Additionally, nurse navigation for people with PD was associated with high satisfaction among participants and staff members of a PD wellness center.
Methods: Twenty-four members of a PD specific wellness center in the United States were recruited to participate in a nurse navigation program for a 12-week period. The intervention period included an initial needs assessment, ten individual 45-minute sessions focused on specific aspects of PD wellness, and a concluding visit. Results: There was a significant decline in quality of life based on average PDQ-39 scores for the participants in January 2019 (M =24.44, SD=16.66) compared to January 2018 (M=20.11, SD =12.78) where higher scores signify worse quality of life; t(23)-4.329 p=0.025. Average self-efficacy for managing chronic disease pre-intervention scores (M=6.58, SD=1.70) verses post-intervention scores (M=7.44, SD=1.48) showed a significant increase in self-efficacy with a medium effect size; t(23)-0.854 p=0.016, d=0.54. Additionally, unique satisfaction surveys showed high satisfaction with nurse navigation throughout the participant sample and wellness center staff members.
Conclusions: A nurse navigation program focusing on specific aspects of PD management can help improve participant’s confidence in self-management of PD despite disease progression. Additionally, nurse navigation for people with PD was associated with high satisfaction among participants and staff members of a PD wellness center.
ContributorsDe Santiago, Stephanie (Author) / Nunez, Diane (Author, Thesis advisor)
Created2019-04-15
Description
Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight and health. Primary care providers (PCP) have limited knowledge of current evidence in obesity treatment. The project guides the form of tools to help identify the patients' self-efficacy, change readiness, and insurance reimbursement.
Methods: Expedited IRB approval was obtained, allowing for data analysis from completed de-identified screenings, surveys, and medical records gathered between September 2022 and April 2023. Screenings including Weight Efficacy, Lifestyle long-form (WEL-LF), and Stages Of Change Readiness And Treatment Eagerness Scale In Overweight And Obesity (SOCRATES-OO) were used to assess the effectiveness of the treatment plan. Russwurm and Larrabee's model for evidence-based practice change was chosen for the project's framework. The provider was given a guide for obesity management with tips for billing insurance. A convenience sample of eight patients met with the providers over three months as part of their obesity management treatment plan.
Results: The pre and post-screenings collected from the remaining participants (n=8) showed no statistical differences. However, the satisfaction and feedback survey from patients (n=8), provider (n=1), and office staff (n=4) showed improved quality of care and greater confidence in the provider's part in initiating and managing their patient's chronic obesity.
Conclusion: Improving PCPs' knowledge of Obesity treatment improves patient care. Expanding this project to a larger scale and disseminating the information can impact patients' lives positively.
Keywords: Obesity; self-efficacy; readiness for change; stages of change; primary care, Weight Efficacy Lifestyle questionnaires
ContributorsBrock-Andersen, Marian (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Breastfeeding provides significant health benefits for mothers and infants, but many women fall short of the breastfeeding goals set by the Healthy People initiative. National guidelines such as the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the Academy of Breastfeeding Medicine, and the American Academy of Family Physicians recommend exclusive breastfeeding through six months of age. Peer support and education are key components in helping women achieve their breastfeeding goals and improve breastfeeding self-efficacy. A private obstetrics and gynecology office in the Southwestern United States did not routinely provide breastfeeding support. As the number of people using online peer support groups has grown in popularity and with the project site having an existing active Facebook© page, a project was created utilizing a private Facebook© group for breastfeeding mothers to receive peer support and evidence-based education. Over 12 weeks, evidence-based education postings and discussion prompts were created to encourage conversation upon participants. Sixteen participants made 30 discussion posts. After 11 weeks, three completed the confidential survey and the Breastfeeding Self-Efficacy Scale Short Form, which showed significant levels of breastfeeding self-efficacy. One hundred percent (n=3) of participants accessed the education handouts and found them helpful. Education and peer support results in high breastfeeding self-efficacy which in turn increases breastfeeding duration and exclusivity.
ContributorsSchwartz, Jennifer (Author) / Santerre, Jennifer (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
Description
Sickle cell disease is a genetic hemoglobinopathy resulting in chronic and daily pain, risk of serious sequelae, and altered activities of daily living. Resources dedicated to helping individuals with sickle cell disease are lacking, especially compared to other chronic diseases. Children with sickle cell disease experience school absence, fractured peer relationships, frequent healthcare visits, stigma, and feelings of isolation. Additionally, chronic pain decreases developmentally important play and physical activity in these children. The purpose of this Doctor of Nursing Practice (DNP) project is to conduct a needs assessment to inform sickle cell disease family camp programming in southern Arizona. Once a camp experience can be safely implemented, the effects of a camp experience on knowledge, empowerment, and disease management in children with sickle cell disease will be investigated. Research specific to camps for children suffering from sickle cell disease is lacking, however ample evidence suggests the benefit of disease specific camps. Medical specialty camps provide an opportunity for children and families to normalize their condition, participate in activities, and form peer relationships in an environment that safely accommodates their unique needs. This has led to the initiation of an evidence-based project to develop a needs assessment for families affected by sickle cell disease and community partners to inform camp activity development guided by Bandura’s theory of self-efficacy and the Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation.
ContributorsCessna-Vargas, Carolyn (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-23
Description
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.
ContributorsHealy, Heather (Author) / Hagler, Dr. Debra (Thesis advisor)
Created2020-04-30
Description
The health benefits of breastfeeding are well documented and exclusive breastfeeding for at least the first six months of life is the target of national and global health care organizations. Although initial breastfeeding is on the rise, the percentage of infants still breastfeeding at six months drops significantly. In the population of newly delivered mothers of an obstetric practice, there is no readily accessible breastfeeding support offered following hospital discharge. A review of relevant literature revealed that lack of support is often cited as a key factor in the discontinuation of breastfeeding, whereas the evidence shows that participation in peer support has a positive effect on breastfeeding self-efficacy, which can have a positive effect on breastfeeding duration.
To address this problem, the initiation of a breastfeeding closed social network Facebook group for this practice setting population was developed and implemented to provide readily accessible peer support and have a positive effect on the outcome of breastfeeding self-efficacy. Three months after initiation of the Facebook group, an anonymous voluntary survey was offered to group members, and 25 members participated in the survey. Responses demonstrated that peer support is helpful with breastfeeding confidence and that, following participation in the group, the respondents wanted to continue breastfeeding.
ContributorsStorto, Pamela (Author) / Mangold, Kara (Thesis advisor)
Created2018-05-03