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: Parents
- All Subjects: Patient Readmission
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.
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.
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.
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.