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: Self Efficacy
- All Subjects: Patient Readmission
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.
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.
According to the National Institute on Drug Abuse (NIDA), tobacco, alcohol, and illicit drugs accounted for 820 billion dollars in costs related to crime, lost work productivity, and health care services. Nearly 20 million Americans suffer from substance misuse, but only 3.7 million received treatment. Of those who receive treatment, the risk of relapse is high, ranging from 40-60% within a year of treatment. Improvement in the treatment of substance use disorders (SUD) is necessary to improve the health of our society.
Current literature demonstrates that individualized recovery plans and follow-up care are effective in reducing relapse and readmission. Costs to the individual, institution, and healthcare system can be reduced. This project aimed to decrease the risk for relapse and readmission with recovery plan reviews at 72hrs, and two-weeks, post-discharge. The risk of relapse was measured by the Time-To-Relapse questionnaire and the UCLA loneliness scale. The project took place in a residential treatment facility in Phoenix, Arizona. There were five participants initially; two were lost at the two-week follow-up. Pre and post-test results were compared to measure potential predictability of relapse. The two-tailed paired samples t-test was performed to compare the means of the scores but yielded insignificant results.
All participants maintained sobriety. Qualitative data via interview showed positive results demonstrated by statements from the participants. Recovery plan review with follow-up care is a promising evidence-based practice that can be implemented to help individuals maintain sobriety. Additional research is recommended to examine further the impact on the maintenance of sobriety over time.
Advanced Practice Registered Nurse Led Transitional Care Program in an Accountable Care Organization
Background: Hospital readmissions place a heavy financial burden on patients, families, and health care systems. Readmissions can be reduced or prevented by providing a safe transition through care coordination and enhanced communication. Research demonstrates implementation of APRN led home visits (HV) along with telephonic follow-up are cost effective and can be utilized for reducing readmissions among HF patients.
Methods: A program was designed with an ACO and carried out in a family practice clinic with a group of seven HF patients older than 50 years who were at risk of readmission. Interventions included weekly HV with supplemental telephonic calls by the APRN student along with a physician assistant for 12 weeks. Readmission data was collected. QOL and SCB were measured using “Minnesota Living with Heart Failure Questionnaire” (MLHFQ) and “European Heart Failure Self-Care Behavior Scale” respectively. Data was analyzed using descriptive statistics and the Friedman Test.
Outcomes: There were no hospital readmissions at 30 days and the interventions demonstrated a positive effect on QOL, self-care management and satisfaction (χ2 = 30.35, p=.000). The intervention had a large effect on the outcome variables resulting in an increase in QOL and SCB scores post-intervention (ES= -1.4 and -2 respectively).
Conclusions: TCP designed with an ACO, carried out in a primary care setting has a positive effect on reducing hospital readmissions and improving QOL, SCBs, and patient satisfaction among HF patients. TCPs are not revenue generating at outset due to reimbursement issues, however future considerations of a multidisciplinary team approach with convenient workflow may be explored for long-term feasibility and sustainability.
Funding Source: American Association of Colleges of Nursing and the Centers for Disease Control and Prevention with support of the Academic Partners to Improve Health.
Heart failure (HF) is one of the most common and costly conditions for hospital readmissions in the United States (Conway, 2015). Cardiac rehabilitation (CR) programs are effective in decreasing hospital readmission rates (Koukoui, Desmoulin, Lairy, Bleinc, Boursiquot, Galinier, & Koukoui, 2015). Medicare has established new requirements for qualification into a CR program; thus, patients are at risk for readmission in the six-weeks post discharge. To reduce HF hospital readmissions and to increase enrollment into the HF program, an infrastructure was implemented beginning in January 2016. This quality improvement project employed a patient chart audit reviewing overall hospital readmission rates for HF at a large hospital in Arizona.
A comparison of readmission rates was made between the 6 months prior to, and the 6-months after the expanded utilization of the HF program. An independent-samples t test was calculated comparing the mean score of the readmission rates before and after a HF CR intervention. No significant difference was found (t(358) = .721, p > .05). The mean of the group before the intervention (m =.15, sd = .36) was not significantly different from mean in the intervention group (m = .13, sd = .33). Implications for practice cannot completely be concluded from this project findings. Continued studies focusing on the enrollment, attendance, and completion of the HF CR program could assist in determining the benefits of referring all patients with the diagnosis of HF to the HF CR program.
Hospital readmissions for palliative care patients are costly for patients, families, insurance providers, and palliative care organizations. The evidence shows that integrating virtual visits into palliative care is an innovative way to reduce hospital readmissions, preserve costs, and reduce geographical barriers. The purpose of this article is to evaluate how well transitional care virtual visits reduce future hospital readmissions for palliative care patients when compared to usual care of in-home nurse visits. Palliative care patients from a large palliative company in Arizona, who received a transitional care, post hospital discharge, virtual visit with traditional model care (intervention) were compared to randomly selected traditional model care patients (control).
Data was collected through a retrospective chart review at 30 and 60 days post hospital discharge to evaluate for hospital readmissions and avoided readmissions. The Fishers Exact test was used to compare the results of the two groups to each other. There was no significant difference between the two groups. Virtual visits have an added cost to the agency without decreasing the risk of readmission. Implications for practice are to continue offering transitional care in-home nurse visits. Future research should evaluate if using virtual visits justify the increased costs of use.
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.