Doctor of Nursing Practice (DNP) Final Projects

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.

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma.

Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks.

Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25).

Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Keywords: teacher training, adverse childhood experiences, ACEs, childhood trauma, resilience

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.

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.

Oral health in the pediatric population is an overlooked topic in primary care, yet it is vital to their overall health. Dental caries, otherwise known as cavities, are a significant problem among the pediatric population. Dental caries is the most common non-transmittable disease across the globe. Dental caries can have painful effects that can lead to serious health implications and reduce the quality of life. Prevention is key when addressing dental caries and oral health care. Oral health prevention and education should begin early on in life and continue throughout the lifetime.

Pediatricians and primary care practitioners play a vital role in the prevention identification, and treatment of dental caries. Individuals in these care roles must become familiar with dental caries and the best evidence-based practices. Furthermore, these health care providers can have an active role in policy creation and change within the community to address the issue. A project was conducted to help improve oral health in the pediatric population. The project consisted of a well-child template modification at the 9-month well-child visit that would prompt providers to encourage a dental visit by the 12-month appointment. The results were limited, and the outcomes were not statistically significant. A recommendation for future studies will be to verbalize the recommendation and provide a handout or recommend a specific pediatric dentist.