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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- All Subjects: Guidelines
- All Subjects: Health Personnel
- All Subjects: Survivorship
There is an increasing number of cancer patients outliving their diagnosis and treatment and requiring more support as they transition to cancer survivors. To bridge this gap, survivorship care plans should be provided to all cancer survivors to provide post treatment plans of care, recommendations, and resources (Commission on Cancer, 2016). A quality improvement project was implemented in the urology practice of a National Cancer Institute-designated, academic hospital in Phoenix, Arizona to provide survivorship care plans to prostate cancer patients with surgical intervention as their cancer treatment.
Through interprofessional collaboration, the process change was designed and implemented with the residents and Physician Assistants of the urology practice. There was a 93% adherence rate in delivering the survivorship care plans during the project. The “Confidence in Survivorship Information” questionnaire was used to measure the patients’ confidence in survivorship information prior to and after receiving a survivorship care plan. A paired t-test showed statistical significance in improvement in confidence in the knowledge of long-term physical effects of cancer treatment, strategies for preventing and treating long-term physical effects, and resources available for family members who may be at risk. The project will continue in order to meet requirements for cancer programs established by the Commission on Cancer (Commission on Cancer, 2016).
Cancer survivors meet survivorship with uncertainty due to a lack of uniform information provided post cancer treatment. The implementation of survivorship care plans (SCP) has been recognized by key stakeholders as the solution to transitional uncertainties. In fact, to achieve accreditation by the Commission on Cancer (CoC) cancer centers are required to deliver SCPs to cancer survivors within a year of their treatment completion. Research demonstrates SCP delivery results in significant improvement in patient satisfaction, coordination of care, and survivorship care knowledge.
In order to meet CoC standard 3.3 and bring understanding to SCPs function in cancer survivorship care a quality improvement project was initiated within an Arizona cancer center. SCPs were delivered at a survivorship visit to adult breast cancer patients. SCPs affect on survivors’ confidence in cancer self-care knowledge and care satisfaction was evaluated as well as the organization’s adherence to CoC standard 3.3 requirements. Identified survivors were scheduled for a survivorship visit where a SCP was delivered by a oncology provider.
Survivors perceived confidence in knowledge and satisfaction was measured using the modified 16-item Confidence in Survivorship Information Questionnaire (CSI). Questionnaires were completed pre and post survivorship visit. A paired t-test analysis was used to evaluate SCP effectiveness. There was an increase in the delivery of SCPs from zero to 57 with an 84 percent SCP delivery from August 2017 to January 2018. Survivors and providers verbalize value in SCPs.
No statistical significance was found in the comparison of SCPs affect on survivors’ confidence in cancer self-care knowledge and care satisfaction to that of standard follow-up care; however, when comparing the pre/post questionnaire averages an improvement was noted across the board.The prospect of this project is to unveil the impact SCP delivery at a survivorship visit has on the selected metrics. This project aids as a director for organization wide implementation for CoC standard 3.3 requirement compliance.
Cancer survivorship has been identified as separate stage in cancer treatment posing unique issues that arise from the diagnosis of cancer, as well as late effects associated with treatments. Evidence shows that cancer survivors demonstrate suboptimal follow-up care, and report high levels of unmet needs related to their cancer experience. To improve care for the increasing number of cancer survivors in the United States, survivorship care plans (SCPs) have been proposed as way to strengthen care coordination and improve patient outcomes.
Research suggests that SCPs have favorable impact on patient satisfaction and quality of life, however little research to date investigates the utility of SCPs in improving patient outcomes, adherence to follow-up recommendations, or patients’ confidence in self-care management. To further understand the role of SCPs in survivorship care, a pilot implementation of SCPs in colon cancer patients was implemented to gather data on the identified 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: Alarming levels of burnout in mental health care staff is a significant concern not only for the organization but for the individual as well. Identifying and addressing burnout ought to be an essential protocol in a behavioral health organization. Currently, burnout remains an ongoing concern for mental health care organizations as it is associated with negative impacts for staff, patients, families, and the organization.
Method: The purpose of this project is to utilize the Maslach burnout inventory (MBI) survey tool to measure burnout pre and post intervention. The intervention utilized will be mindfulness-based interventions (MBI) to reduce burnout among mental healthcare workers. Implementing mindfulness interventions has evidence that it reduces burnout rates in mental health care staff. Current literature supports mindfulness-based interventions and have showed a decrease in burnout, stress, and depersonalization.
Results: The pre-intervention results were as followed: emotional exhaustion; 40, depersonalization; 20.4 and personal accomplishment 32. The post-intervention results emotional Exhaustion; 28, depersonalization; 14.90 and personal accomplishment 30. It was found that the category for emotional exhaustion was statistically significant as it had a P value .040, whereas depersonalization was not statistically significant as the P value was .171 and personal accomplishment was not statistically significant as the P value was .577.
Discussion: The use of MBI as an intervention has robust literature supporting the effectiveness in decreasing burnout and stress in mental health care staff.
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.