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 20
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- All Subjects: Quality Improvement
- All Subjects: Peer Group
- All Subjects: Survivorship
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: Advance Care Planning (ACP) conversations are discussions between patients, providers, and loved ones addressing key care decisions in the event of incapacity. Nearly twothirds of US adults have not completed an Advance Directive (AD), yet ACP conversations rarely occur in practice. The objective of this quality improvement project was to implement workflow changes with a reminder system to facilitate ACP conversations during Medicare Wellness Visits (MWV).
Method: Social Cognitive Theory describes the complex relationship between variables that can influence an individual’s decision to address ACP. Providers in a primary care office in the Southwestern United States participated in an ACP education session and confidence survey. Patients presenting for the MWV were screened for ACP, and visual reminders were attached outside the exam room for provider review. Aggregate data were used to evaluate provider surveys. Descriptive statistics were used to evaluate patient characteristics and the Chi-square Test of Independence, and Fisher’s test was used to compare the pre-and post-intervention advance directive documentation.
Results: Qualitative feedback from the survey indicates reminders and easily accessible resources may help facilitate ACP conversations. Of the 251 MWVs, 21 (8%) had an AD documented, significantly less than the nationally reported rate of 37.7% (p < 0.05, z = -2.39).
Conclusions: Healthcare providers face multiple barriers preventing or delaying ACP conversations in practice. System-level changes and provider education can improve the rate of ACP conversations and impact patients’ care at the end of life.
ContributorsSmith, E. Elizabeth (Author) / Reifsnider, Elizabeth (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: Breastmilk is the optimal source of nutrition for infants as recommended by the American Academy of Pediatrics and the World Health Organization (WHO). Despite proven benefits, rates of breastfeeding have shown to decrease drastically at six months of age.
Purpose: The purpose of this project is to assess the effectiveness of virtual peer support and infant education in increasing/improving a mother’s wellbeing and breastfeeding relationship. This project was guided by the theory of self-efficacy.
Methods: Participants were recruited utilizing flyers that were posted to social media and distributed at a breastfeeding center in Southwestern United States. Six breastfeeding mothers were recruited, and each participated in four, one-hour peer support sessions that were held weekly via Zoom. Participants completed the WHO Well Being Index and the Breastfeeding Relationship scale before and after the intervention. Pre- and post-implementation scores were compared.
Ethical Considerations: The research was approved by the IRB board at Arizona State University and was in compliance with ethical considerations and standards of the institution.
Results: Descriptive analysis conducted on the WHO Well-Being Index showed the same results or improvement for 80% of the questionnaire. Descriptive analysis conducted on the Breastfeeding Relationship Scale showed improvement on 81% of questions.
Conclusions/Discussion: Breastfeeding can be taxing and overwhelming for mothers leading them to discontinue earlier than planned. Peer support has been identified to be substantial to women going through this process in helping them initiate and continue to breastfeed their infant.
ContributorsLopez, Danielle (Author) / Reifsnider, Elizabeth (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Medicare implemented a yearly Annual Wellness Visit (AWV) to improve quality patient care through early detection of declining health. However, there has been only partial provider participation since its inception, which potentially delays treatment and negatively impacts patient outcomes. The aim of this quality improvement project was to assess the feasibility of implementing a standardized electronic AWV template into private primary care practices to improve the consistency of delivery and documentation. The project designer utilized the theory of transitions (TOT) to facilitate the project execution. An electronic Excel-based template was designed to capture and calculate all aspects of the AWV, including billing codes, to allow for ease and consistency of use within a small primary care practice over two weeks. A provider performed the AWVs using the electronic template after completing a hands-on tutorial and reviewing an educational handout. Data were retrieved from a 7-question, 5-point Likert scale questionnaire given to the provider to assess the effectiveness of the electronic template versus a paper assessment. The results of this study indicated overall satisfaction with using leveraged technology to provide consistency of AWVs to improve patient outcomes, provider satisfaction, and increase revenue through uniform charting and billing. The outcomes of this project provide a basis of existing evidence for using standardized methods to perform and track Medicare AWVs.
ContributorsHill, L. Michelle (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project.
Objectives: To improve advanced care planning processes in a healthcare organization.
Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event.
Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center.
Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training.
Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning.
Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.
ContributorsPate, A. Shurine (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background: This quality improvement project examined the effect an educational intervention focused on the psychosocial needs of cancer patients had on knowledge, attitudes, and behaviors (KAB) of a group of nurses. While nurses understand the physical toll of cancer, they may forget the impact cancer has on mental health. The project was guided by the Health Belief Model.
Methods: Consent was obtained from 15 participants working as nurse advocates for a large insurance company. Nurse advocates are tasked with improving the health of patients and connecting them to additional resources. A twenty-minute educational intervention focused on the impact cancer has on mental health and the benefit of multiple psychosocial supportive resources was delivered to the participants. Education included a comprehensive review of the resources available for cancer patients at the project site. Participants were then given 10 minutes to complete a retrospective post-then-pre survey, based on a Likert Scale.
Results: Statistically significant improvements in survey scores were observed in each of the three KAB domains. Statistical analysis confirmed improvements in survey scores were significant and not likely due to random variation. Participants also referred more patients into a cancer support program following the intervention.
Conclusion: A brief educational intervention was able to improve KAB scores among nurses. There was also an increase in the number of patients these nurses referred into a psychosocial supportive program. Nurses that better understand the mental health needs of cancer patients are more likely to connect them with psychosocial resources. This intervention will become part of standard training for new nurse advocates at the project site.
ContributorsLeyba, S. Edward (Author) / Harrell, Liz (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-02
Description
Falls in hospitalized patients are a widespread occurrence in the United States, resulting in unfavorable outcomes amongst patients, healthcare providers, and hospital organizations. Current fall prevention efforts have failed to adequately reduce patient fall rates. Nursing peer review (NPR) seeks to refine the quality and safety of patient care, making its use applicable in post-fall reviews. This evidenced-based quality improvement project implements a post-fall NPR program to examine patient falls in an inpatient setting, in addition to the facilitation of patient safety culture education. The Hospital Survey on Patient Safety Culture was used to assess nurses’ perceptions of their units’ patient safety culture. The pre- and post-survey results were analyzed using a two-tailed Mann-Whitney U test, determining significant differences in event (U=2033, z=-2.81, p=.005) and learning (U=1196, z=-2.52, p=.012). No significant differences were noted in support (U=1587, z=-0.05, p=.959), prevent (U=1369, z=-0.70, p=.485), and rate (U=1355.5, z=-0.34, p=.737). Post-fall NPR participation survey results were analyzed using descriptive statistics, showing that it improved patient safety culture (n=10, 91%), reduced “blame & shame” culture (n=9, 82%), and was a non-punitive learning method (n=10, 91%). Reviewing falls through NPR and educating nurses on patient safety culture can create a positive environment to learn from falls. Additional research is needed to determine the impact on patient fall rates.
ContributorsBlythe, M. Lindsay (Author) / Morgan, Michelle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-28
Description
Introduction: Drowning is the leading cause of death in children between 1 and 4 years of age; in Arizona drownings are double the national average for this age group. The goal of this Doctor of Nursing project was to educate and empower pediatric providers to give quality drowning prevention (DP) anticipatory guidance (AG) to caregivers of children between 1 and 4 years of age at every well exam.
Method: This quality improvement (QI) project included 32 providers from six pediatric clinics in Arizona. A one-hour education session focused on drowning prevention followed one month later by a a thirty-minute follow-up feedback session were conducted. Pre- and post- education surveys were administered at the first session to measure perceived previous and future intended DP AG practice. An additional follow-up survey was administered at the second session to evaluate perceived change. In addition, caregivers were contacted and surveyed one to three months post initial education to assess provider delivery of AG. Likert-scales and descriptive statistics were used to evaluate data sets.
Results: Post-educational intervention, providers reported increased intention (p = 0.027) to provide water safety AG, and increased intention (p < 0.001) to connect water AG to developmental milestones. Post-intervention follow-up indicated an increased provision of developmentally specific water safety AG to caregivers (p < 0.001) and increased connection of developmental milestones in AG (p = 0.016). Barriers that prevent water safety AG were reported as time constraints and other perceived AG of higher priority.
Implications: This QI project adds to the literature and demonstrates the benefit of education to invigorate and empower increased provision of quality DP AG from providers.
ContributorsDiMiceli, Carolyn (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22
Description
Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated, triage-based CS administration and determine the effect on overall length of stay (LOS). Methods: For this quality improvement initiative, ED nurses at a large, freestanding, children’s emergency department in the southwestern United States were given education on inclusion and exclusion criteria for nurse-initiated CS in ED triage. Time to CS administration, LOS, and whether the ED nurse or provider ordered the CS were evaluated through chart reviews of patients presenting with a chief complaint of difficulty breathing. These metrics were compared to charts from the previous year during the same timeframe to evaluate for improved timeliness of CS delivery. Results: Time to CS administration decreased from a mean of 98.6 minutes to 57.6 minutes. LOS decreased from an average of 259.3 minutes to 169.6 minutes. The effect of timely CS on LOS was significant for December p =.003, January p =.002, and February p = <.001. Conclusion: A streamlined process for CS delivery to pediatric patients experiencing an asthma exacerbation can enable providers to achieve efficient and effective care in the ED and decrease a patient’s overall LOS.
ContributorsBain, Ilyssa D. (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-23
Description
Purpose: Understanding the factors impacting communication between residents and peer staff in peer-run residential substance abuse treatment programs. The purpose of this paper is to explore male survival behaviors and cultural norms such as no snitching that impede communication to prevent relapse. Methods: The sample was male residents accepted into a residential treatment facility in the southwestern United States. Stories of peer-staff’s personal struggles with the no snitching code videotaped and shown in group followed with a guided discussion of relapse triggers, communication, and behavior norms that impede treatment. An online confidential pre-post retrospective survey designed using the Drug Abstinence Self-Efficacy Scale. Results: Descriptive statistics run show Cronbach's alpha of 0.96. A two-tailed paired samples t-test was conducted to examine the Overall Confidence Pre-test and Post-test mean difference. The overall confidence post-test was not statistically significant, but it was clinically significant. Clinical significance evidenced by residents 3-point lower confidence post-intervention. Conclusions: How-to elicit behavior change is unique to every individual. The goal is behavior change to sustain recovery and better communication between clients and peer staff to prevent relapse.
ContributorsKoreny, Danielle M. (Author) / Harrell, Liz (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26