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: Psychiatry
Background: The consequences of poor communication or non-therapeutic communication cannot be overemphasized; these can include non-adherence to treatment plan, reduced treatment compliance, higher psychological morbidity, dissatisfaction with care and poor patient-caregiver relationship. Patients’ perception of how they are being treated affects how they respond to treatment plans and medication regimens
Method: The project consisted of providing education on the principles of therapeutic communication to healthcare workers in an outpatient psychiatric clinic. Follow up materials on therapeutic communication principles were provided on a weekly basis for one month. A pre-survey questionnaire was given to patients before intervention and a post-survey questionnaire after intervention to determine patient satisfaction with care and degree of communication with healthcare workers. The Short Assessment of Patient Satisfaction (SAPS) and the Communication Assessment Tool-Team (CAT-T) were the instruments utilized in this project.
Finding: Patient satisfaction and communication with staff were statistically and significantly improved after education on therapeutic communication was given to staff.
Conclusion: Education on therapeutic communication is an effective intervention tool in improving patient’s satisfaction and communication with staff and health care team members in a psychiatric outpatient clinic.
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.
Mental health issues are a growing concern for individuals and the public. When patients do not attend their mental health appointments they place themselves at risk for poor health outcomes including worsening of symptoms, relapse, hospitalization, or danger to self and other behaviors. The breadth, background, and significance of this issue were investigated to determine a clinically relevant PICOT question. These elements of the PICOT question were investigated and high-quality evidence was gathered, analyzed, and synthesized in order to develop recommendations for an evidence-based project to help with no-shows at a non-profit integrated healthcare organization that is experiencing a high incidence of no-shows. The Quality Health Outcomes Model and Ottawa Model of Research Use guide the implementation and monitoring of the project.
A chart review was completed in order to understand the impact of a novel automated reminder system on the no-show rate for all psychiatric appointments for 18 months. Additionally, demographic and appointment information was gathered to identify trends in the data and factors related to appointment status. The no-show rate significantly increased in 2019 with the new reminder system. No-shows occurred significantly more in males, tele-medicine appointments, and hospital discharge appointments. There were significant differences in no-show rates observed between reported races, with different providers, and at different practice locations. This gap analysis has provided insight into further projects and work to be completed in order to decrease no-shows, improve treatment compliance, produce better health outcomes, and increase revenue for this organization.
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.
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.
Findings suggest that stigma associated with mental health may be as strong in healthcare providers as it is in the general public. Research involving non-behavioral health nurses, and medical and nursing students, sought to identify bias and negative attitudes directed towards psychiatric patients in a non-psychiatric setting. Studies were reviewed to determine the effects of educational interventions to teach empathy and increase knowledge related to the pathology of, and treatment modalities for, psychiatric patients. Several scales were used to measure bias and rate interventions to minimize it.
Studies found that healthcare personnel, including nurses, are considered by mental health consumers to be primary contributors to stigma and discrimination against those with mental illness. The studies also discovered that participation in an educational intervention to learn empathy and acquire knowledge about psychiatric patients directly decreased bias. The project utilized the evidence-based practice PRECEDE-PROCEED model (PPM) supported by Bandura’s Social Cognitive Theory (SCT). Combining the PPM with the SCT is supported in the literature as they both rely on learned behavior.
Moving forward, the presentation was completed and participation sought. It was at this point the project shifted its perspective. Out of 80 nurses asked to attend 1 of the 2 presentations, a total of 3 nurses participated. The search for statistical significance was not possible. We were left to formulate descriptive statistics to interpret the outcomes and reflect on their meaning.
Aim: To determine the change in provider’s compassion fatigue after implementing an education-based intervention in behavioral health.
Materials and Methods: A four-part education-based intervention for compassion fatigue was implemented over the course of 16 weeks. The Professional Quality of Life instrument was used to measure compassion fatigue and compassion satisfaction.
Results: Although not statistically significant, mean compassion fatigue scores decreased in the sample.
Conclusion: Based on these results, further exploration into the causative factors of compassion fatigue in behavioral health are recommended.