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: Correctional Facilities
The birth of a new baby is known to be a joyful time for families. However, such a treasured experience can quickly reroute in a matter of moments which leaves the family feeling helpless, frightened, and guilty. The innate process of bonding and attachment is interrupted by the resuscitative course following a traumatic birth. Separation, grief, anger, and fear promote what’s being deemed more and more frequently as parental posttraumatic stress disorder (PTSD). Rates of parental PTSD associated with separation at birth are equivalating those of post-partum depression and post-partum psychosis. Emotionally unstable parents are unable to adequately care for their newborn for both short and long term needs.
Facilitation and support of the parental role in an altered environment, such as a neonatal intensive care unit (NICU), is thought to create opportunities for relationship security. Establishment of an emotionally invested caregiver has been proven to minimize sequelae of the NICU patient, reduce length of stay, cut readmission rates, and lower the incidence of failure to thrive post-discharge. A parental psychosocial program was instituted in a 32-bed NICU within a southwest children’s hospital. The program efficacy was analyzed several months after implementation. Results are concurrent with the thought that individual counseling for NICU families reduces stress scores and improves patient satisfaction at discharge.
Background and Significance: NIRS data can be used in conjunction with standard vital sign monitoring to help clinicians understand blood flow and metabolic demands of organ systems, particularly cerebral, renal, and mesenteric blood flow patterns. A NICU unit in the northwestern US adopted NIRS use on their patients in 2008, however, NIRS monitoring usage decreased over the past 5 years, citing a lack of continued education and comfort interpreting and managing NIRS monitored patients. One patient was monitored with NIRS in the year prior to the QI project.
Methods: A 5 point Likert-Type survey was designed to examine provider comfort and confidence using and interpreting NIRS on NICU patients. No Croanbach’s alpha value exists for the survey as it was purposefully designed for the QI project. An educational presentation on the use and interpretation of NIRS on NICU patients was created and delivered during a formal provider staff meeting. Pre and Post education surveys were distributed electronically to participants and were presented 1 week prior to educational session and 1 month after educational session. IBM SPSS version 23 was used for descriptive statistics, paired t tests, and Wilcoxon test. Significance set to p<0.05.
Results: In total, 18 providers (N=18) were surveyed, and 13 paired survey results (n=13) were received (8 MD and 5 NNP). Paired-samples t tests were calculated to compare the mean total score (TS) for pre/post comfort and pre/post confidence. This was a significant improvement for both comfort (t(11) = -3.13, p=0.010) and confidence (t(11) = -3.37, p=0.006). Wilcoxon test showed a significant increase in the times a provider managed a patient with NIRS (z=-2.762, p=0.006). The number NIRS monitored patients increased from one in the previous year to 15 patients in the 5 months of data tracking, a clinically significant increase.
Conclusions: Providing educational session on previously utilized clinical applications can improve providers comfort and confidence and influence their usage in clinical practice. Future continuing education sessions could be designed for different clinical applications in order to keep clinicians abreast of the current evidenced based applications of advanced clinical monitors.
Skin and soft tissue infections (SSTI’s) are a significant health concern with serious potential implications. Evidence suggests the importance of implementing a severity stratification tool to improve early identification of SSTI’s. The aim of this evidence based project is to examine if educating healthcare staff on the use of a severity stratification tool would increase staff knowledge of SSTI's. The sample consisted of 18 participants, 12 healthcare providers and 6 healthcare staff at a correctional facility in the Southwestern United States. A pre-and posttest design, including an educational session was implemented.
A 14-item multiple choice self-developed questionnaire was used to evaluate participants’ knowledge of identifying and ranking SSTI’s using the CREST tool. A one tail paired t-test was performed to compare the pre-and post-test case study scores for the healthcare provider group. A significant increase from pre-test to post-test case study scores was found (t(13)= -6.19, p < 0.00). Of the healthcare providers, 57% found the tool “moderately helpful.” Of the non-provider sample, 50% found the tool “extremely helpful” and plan to use the tool “all of the time.” The findings of this study suggest that implementing an educational session on a wound severity stratification tool improves staff knowledge and increases the likelihood of the tool being used in practice. Recommendations for future research include larger sample sizes across a variety of regional correctional facilities to further explore the use and knowledge of the tool in practice.