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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Pregnancy is a specific time in a woman’s life filled with complex changes in health, including the oral cavity. During this time, dental and perinatal care teams can be influential in helping women initiate and maintain essential habits to improve health and prevent adverse outcomes. There is research evidence that dental providers are reluctant to treat dental problems during pregnancy. Barriers to practice identified by dentists include lack of education, time, financial constraints, and concern for the safety treating pregnant women. Factors that facilitate dental care for pregnant women include purposeful assessment, referrals from prenatal providers, and continuing education for dental team members.
Multiple organizations recommend the treatment of oral health conditions during pregnancy to promote health and prevent pregnancy complications. In order to promote community-based partnerships in a healthcare system, dentists are encouraged to develop an intentional plan to increase collaboration with other members of the women’s healthcare team. Prior to developing a system wide intervention to improve access to dental care during pregnancy, dental team members were surveyed to identify barriers and facilitators which promote or hinder care in their practice. The data acquired will be used to inform the design and implementation of an intervention to specifically meet the needs of patients and providers in that system.
Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.
The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.
Maintaining good oral health during pregnancy is a significant contributor to healthy pregnancy outcomes. The physiological changes that happen during pregnancy can adversely affect women’s oral health and place her at risk for pregnancy outcomes such as miscarriage and preeclampsia. The unborn child’s health can also be affected by premature birth and low birth weight. Although professional organizations have evidence-based practice guidelines for both prenatal and dental providers, the evidence shows a gap between recommendations and practice. An oral health promotion project for pregnant women was implemented in a federally qualified community health center where there was a lack of adherence to the guidelines.
The purpose of this project was to implement established oral health screening guidelines for pregnant women and to increase dental visits among pregnant women. For this project, a two-item maternal oral health-screening tool (MOS) for the prenatal providers was added into the electronic health record to standardize and document oral health screening for pregnant women at their first prenatal visit. After three months of implementation, there was a significant increase in maternal oral health screening and referral. This project may be replicated at any prenatal setting to improve oral health during pregnancy.
Gestational diabetes mellitus (GDM), diabetes diagnosed in the second or third trimester of
pregnancy that is not clearly overt diabetes, has become more common as the rates of obesity in women of childbearing age have increased. Undiagnosed, uncontrolled diabetes in pregnancy can lead to maternal and infant health comorbidities as well as have adverse long-term effects for mother or baby. Although routine screening for gestational diabetes mellitus (GDM) occurs between 24 and 28 weeks gestation, the American Congress of Obstetricians and Gynecologists (ACOG) recommends screening earlier in pregnancy for women at risk for undiagnosed type 2 diabetes. Risk factors include previous history of GDM, known impaired glucose metabolism, or obesity (BMI > 30).
The purpose of this project is to implement the clinical practice guideline for early maternal glucose screening during pregnancy in women with risk factors through the integration of a clinical decision support (CDS) tool in an electronic health record (EHR). CDS tools can be utilized as a point of care strategy to remind providers of the clinical practice guidelines and to assist providers in decision-making related to screening. Participating providers (n=18) utilized the CDS tool during the initial obstetrical visit for at risk women without a pre-pregnancy diabetes diagnosis and entering prenatal care prior to 24 weeks. The impact of
implantation of the CDS tool shows that an increase in screening was statistically significant (p<.001).
Adverse childhood experiences (ACEs) are traumatic events experienced during childhood that have negative effects starting as a child and extending into adulthood. The presence of multiple ACEs increases negative mental, physical, and behavioral health outcomes. Children of parents who have experienced ACEs are at a higher risk of experiencing ACEs themselves, creating an intergenerational cycle of trauma between parents and their children. Evidence suggests that parenting education can reduce the impact of ACEs and potentially eliminate poor health outcomes. The literature revealed that parenting education was found to increase parenting competency, which will in turn reduce the impact of ACEs on children.
The purpose of this evidence-based project is to evaluate parenting competency and parenting self-efficacy after implementing six parenting workshops. The workshop topics consist of: (a) stress management, (b) understanding trauma, (c) positive parenting, (d) positive discipline, (e) play, and (f) learning development and support. The workshops were delivered at a community residential facility for women seeking recovery from abuse, incarceration, chemical dependency and other life-controlling problems. Participants included 10 female residents.
Demographics, ACE scores, pre and post Parenting Sense of Competency Scale, and a post intervention satisfaction questionnaire and discussion were used to collect data from the participants. Mothers’ ACE scores ranged from 2-9. The parenting self-efficacy score increased in the subgroup that attended all six workshops. All of the mothers agreed that the workshops would help with parenting their children. The findings suggest that parenting education increases parenting knowledge and self-efficacy, and may reduce the impact of ACEs on children.
Design: Using an established program for health literacy education, a Doctor of Nursing Practice project was implemented. The effect the program had on increasing the health literacy of participants over a period of 4 weeks was examined. The predominately, Latina participants received three hours of instruction based upon the health literacy book “What to do When Your Child Gets Sick”.
Setting and Subjects: The educational program took place in a large, urban county in the Southwestern United States with 24 parents of preschool age children in Head Start.
Intervention: The educational program contained three hours of classroom instruction utilizing PowerPoint® presentation, demonstration, and teach-back techniques on how to care for a child’s healthcare needs.
Measures and Analysis: Pre-, post- and telephone surveys were used to assess the impact of the health literacy educational program. Wilcoxon and Freidman tests were used to interpret the results.
Results: Despite no significant increases in health literacy post implementation, participants’ remarked that they felt the class was helpful and wanted to share the information with friends and family. They appreciated the program and wanted more educational opportunities.
Conclusion: Advanced practice nurses must acquire understanding, cultural sensitivity, and assess the needs of the community when implementing health literacy educational projects.
Background: Cyberbullying and cyber-victimization are rising problems and are associated with increased risk for mental health problems in children. Methods for addressing cyberbullying are limited, however, interventions focused on promoting appropriate parental mediation strategies are a promising solution supported by evidence and by guided by the Theory of Parenting Styles.
Objective: To provide an educational session to parents of middle school students that promotes effective methods of preventing and addressing cyberbullying incidents. Design: The educational sessions were provided to eight parents middle school student. Surveys to assess parent perception of and planned response to cyberbullying incidents and Parent Adolescent Communication Scale (PACS) scores were collected pre-presentation, post-presentation, and at one-month follow up.
Results: Data analysis of pre- and post-presentation PACS using a Wilcoxon test found no significant difference (Z = -.405, p >.05). There was not enough response to the 1-month follow-up to perform a data analysis on follow-up data.
Conclusions: Due to low attendance and participation in the follow-up survey the results of this project are limited. However, parents did appear to benefit from communicating concerns about cyberbullying with school officials. Future studies should examine if a school-wide anti-cyberbullying program that actively involves parents effects parental response to cyberbullying.