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.
Filtering by
- All Subjects: Guidelines
- All Subjects: Self Care
There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management is largely to blame for many HF exacerbations. Current evidence supports utilizing both verbal and written education with an emphasis on self-care and education delivered in a group setting or individual setting showed equal impact on self-care and HF knowledge ( Hoover, et. al., 2017; Ross et. al., 2015; Tawalbeh, 2018).
An outpatient VA clinic located in a suburb of the large metropolitan identified there was no consistency on how a HF patient was educated, managed, or tracked and the registered nurses (RNs) lacked knowledge of HF. As a results of these findings this Evidence Based Project (EBP) was implemented. RNs were educated on HF and completed a self-assessment questionnaire evaluating their knowledge pre and post education. The RNs, as part of a multidisciplinary team, educated HF patients on signs and symptoms of HF as well as on how to manage the disease. Patients completed, the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and the Self Care Heart Failure Index (SCHFI) to assess knowledge of HF and self-management skills.
These questionnaires were completed initially and at 30 and 60 day intervals. The RNs self-assessment of their knowledge and ability to educate patients increased in all areas. The patient’s KCCQ and SCHFI score improved at 30 days and 60 days when compared to their initial score. Larger EBPs are needed over a longer period of time to assess the impact on hospital readmissions and same day clinic visits for HF exhibitions.
Purpose:
The purpose was to implement a self-management program to decrease pain and disability and improve self-efficacy among low-income, Latino individuals diagnosed with arthritis.
Background:
All arthritis pain has the potential to impair mobility. Arthritis is the leading cause of disability among American adults, with over 50 million individuals affected. The Latino population experiences a disproportionate incidence of disability attributable to arthritis compared to other populations. Evidence supports self-management education incorporating physical activity as a promising intervention for arthritis.
Methods:
The intervention included a curriculum developed by the Arthritis Association, three teaching sessions, and a pre/post-test. Anticipated outcomes included decreased pain measured by the Pain Visual Numeric, decreased report of disability measured by the Stanford HAQ, and increased self-efficacy measured by the Arthritis Self-Efficacy Scale. The setting was a faith-based medical clinic that services the uninsured population located within Southwest Arizona. Participants included Spanish and English speaking adults diagnosed with arthritis.
Results:
Twelve participants were consented however, only eight participants completed the entire project. Although the mean pain score decreased, indicating reduced pain, it was not statistically significant (pretest- M=5.75 SD=3.19; posttest- M=5.25 SD=2.82; z (7)=-.11, p= .92). However, there was a statistically significant increase in reports of exercise after the intervention (pretest M=.83, SD=.39; posttest- M=.43, SD=.53; z (6)=-2.0, p =.046). This was in response to an non validated question developed by the primary investigator and co-investigator of, “Do you currently exercise?”.
Conclusions:
Results include increases in reports of exercise post-intervention and decreased pain. The use of non-pharmacological interventions such as self-management to reduce pain and increase mobility in arthritic patients can help lessen the socioeconomic health disparity gaps.
Methods: A multifaceted intervention was utilized that included educational sessions for providers, adjustments to the electronic health record (EHR), access to toolkits, and workflow changes. Pediatric patients aged 5-18 years and diagnosed with asthma (N = 173) were evaluated using a pre-post design. Provider adherence to key components of clinical practice guidelines were assessed prior to implementation, and a three and six months post-implementation. Data was analyzed using descriptive statists and the Friedman’s ANOVA by rank.
Results: Provider education, EHR adjustments, provider toolkits, and changes to office workflow improved provider adherence to key aspects of asthma clinical practice guidelines. A significant difference was found between the pre and post implementation groups (p < .01).
Conclusion: Increased adherence to clinical practice guidelines leads to fewer complications and an overall improved quality of life. Continuing provider education is critical to sustained adherence.
Background and Significance: HF affects over 5.1 million people in the United States, costing $31 billion a year; $1.7 billion spent on Medicare readmissions within 30 days of discharge. Guidelines and care coordination prevent expenses related to hospital readmissions and improve quality of life for adults with HF.
Methods: Healthcare providers (HCPs) at a metropolitan hospital participated in an education session reviewing HF treatment and CMD. Thirty participants completed the single five-point Likert scale pre/post surveys evaluating their opinions of knowledge and behaviors toward implementation of guidelines and CMD. Patient outcome data was abstracted measuring pre/post education compliance for ejection fraction, ACE/ARB, beta-blocker, HF education, follow-up appointments, aldosterone antagonist, anticoagulation, hydralazine nitrate, and CMD 30-45 day’s pre/post education. Analyses included descriptive statistics of participants and pre/post surveys using a paired t-test. Percentage of compliance for quality measures was completed on patients from September through December.
Results: Providers post intervention showed improved knowledge and behaviors toward implementation of guidelines and CMD, including reconciliation of medications to statistical significance. However, the demographics showed the majority of participants were non-cardiac specialties. Improved compliance for outcome data of quality measures was insignificant over time. The non-cardiac demographic may have contributed to this result.
Conclusion: The surveys did not correlate with the patient outcome data. Recommendations would include targeting cardiac focused HCPs for future education sessions.
Background:
Asthma is one of the most common pediatric diseases, affecting 6.3 million U.S. children in 2014, that can result in negative health outcomes if not managed correctly due to it's chronic and complex nature requiring frequent and close management (NHLBI, 2007). The National Heart, Lung, and Blood Institute's (NHLBI) Guidelines for the Diagnosis and Management of Asthma will be implemented into practice to determine the health outcomes of patients before and after guideline implementation.
Methods:
Inclusion criteria includes patients 5-18 years with a history of asthma, recurrent albuterol use, or intermittent symptoms of airflow obstruction. Data will be collected through EHR data reports at pre implementation, 3 months, and 6 months post implementation and will be analyzed using SPSS. Descriptive statistics, paired t-tests, and a Friedman's ANOVA will be conducted to analyze data.
Results:
A Friedman ANOVA was conducted comparing the outcome variables six months priot to the practice change, at three months post implementation, and at six months post implementation. A significant difference was found (x2(15) = 216.62, p<.05). The implementation of the practice change significantly affected the outcome variables.
Conclusions:
In general, the implementation of a practice change to use evidence based NHLBI ERP-3 Asthma Guidelines, along with staff and provider education sessions and creation of standardized assessment and documentation tools resulted in positive changes in the outcomes variables. Findings from this study along with the literature of implementing evidence based asthma guidelines supports similar practice change implementations in other pediatric primary care clinics.
As the incidence of acute and chronic wound conditions rises and wound dressing protocols become more complex, uninsured patients lacking access to specialty wound care are challenged to manage their own wounds. Understanding multistep dressing change protocols may be inhibited by low health literacy. Low health literacy is associated with reduced disease knowledge and self-care. Little evidence of health literacy effects on wound patients is available nor are literacy-sensitive educational interventions that address wound knowledge and self-care. Improved outcomes occur in all health literacy levels in other diseases with the use of literacy-sensitive educational interventions that incorporate more than one literacy strategy over multiple sessions. To examine the effectiveness of a literacy-sensitive wound education intervention on wound knowledge and self-care, an evidence-based pilot project was conducted in an urban wound clinic.
A convenience sample of 21 patients received a literacy-sensitive wound education intervention consisting of spoken and written communication over several sessions. Instruments measured health literacy level, wound knowledge, dressing performance, and wound healing status. There was a significant increase in wound knowledge scores in all literacy groups from baseline to visit two (p < .01) and four (p < .01). Dressing performance scores remained consistently high through visit four in all literacy levels. All participant’s wounds progressed toward wound healing significantly from baseline to visit two (p < .01) and four (p < .01). Incorporation of a literacy-sensitive education intervention with supportive literacy aids over several sessions supports improved wound knowledge and dressing self-care and can affect healing in patients of all health literacy levels.
Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions, treatment delays, chemotherapy changes, or discontinuation of treatment. Guidelines exist to better prevent and treat CINV. Evidence supports the use of guidelines to prevent CINV, however patients still suffer from CINV often due to a lack of guideline adherence.
Objectives:
The purpose of this project was to increase CINV guideline adherence by increasing knowledge of antiemetic guidelines utilizing an educational intervention for providers and nurses at an outpatient oncology office.
Methods:
A brief educational intervention on CINV and recommended NCCN guidelines was
conducted with providers and nurse (n=6) at an oncology practice in Southwestern United States. An evaluation to assess change in knowledge was performed using a pre and post test format. Statistical analysis was performed using descriptive statistics, McNemar tests and Wicoxan Signed Rank Test.
Findings:
There was a significant effect on knowledge of NCCN antiemetic guidelines (Z=-1.89, p=0.059, mean 2.5) post intervention. There also was a significant impact on likelihood to use guidelines in practice (Z=-1.89, p=0.059, mean 2.5). Increasing awareness and likelihood to CHEMOTHERAPY INDUCED NAUSEA AND VOMITING 3 follow recommended guidelines may improve CINV symptoms in patients undergoing chemotherapy and improve the treatment outcomes for these patients.
Background and Significance: Evidence shows primary care providers (PCPs) are not adhering to the GOLD Guidelines for COPD screening.
Methods: Guideline education with pre/post-intervention survey and percent of eligible participants screened.
Results: Pre-intervention surveys (n=10) and post-intervention surveys (n=8) completed. Significant increase in knowledge regarding the CAT score (M score = 11.50, U = 24.000, p<.05). Part 2) 24% (n=6) of participants were screened with the CAT questionnaire.
Conclusions: PCPs are aware of the GOLD Guidelines, but do not always adhere to its recommendations. Future research should concentrate on effective ways to implement the GOLD Guidelines screening recommendations in primary care clinics.