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: Patient education
- All Subjects: Exercise
Background and Purpose: Over 30 million people in the United States (U.S.) have diabetes mellitus, which comprises about 9% of the population, and about 90% of individuals with diabetes have type 2 diabetes (Centers for Disease Control and Prevention [CDC], 2017). Adults with type 2 diabetes at a local internal medicine clinic were consistently having high glycated hemoglobin (HbA1C) levels, demonstrated by data collected from the electronic health record (EHR), and there was no ordering process for referring patients to diabetes management education and support (DSMES) services. The purpose of this project was to improve glycemic control, demonstrated by lower HbA1C levels, and reach a diabetes education attendance rate of 62.5% at an internal medicine clinic in Chandler, Arizona.
Methods: An electronic health record (EHR) template was created and brief staff training was completed to connect patients with diabetes in the community to a local formal diabetes education program. HbA1C levels were measured before and three months after adults with education program. HbA1C levels were measured before and three months after adults with type 2 diabetes mellitus (T2DM) received physicians’ orders for a DSMES program, and rates of attendance to the program were calculated. Data was collected through the EHR and through feedback from the DSMES program. Descriptive statistics were used in data analysis.
Outcomes: The participants’ results did not demonstrate significant differences in pre-referral and post-referral HbA1C results after they were ordered DSMES services (p = .506). The proportion of education attendance (30%) was lower than the project goal of 62.5%, but increased from the clinic baseline.
Conclusions: EHR template implementation for referral to DSMES may increase rates of formal diabetes education and improve glycemic control. Larger sample sizes, longer project periods, alternative methods of communication, and increased follow-up of participants may be required to produce significant results.
Recommended first-line treatment with atypical antipsychotic medication for management of schizophrenia and other psychotic disorders is contributory to weight gain and associated comorbidities. Beyond comorbid conditions – weight gain can lead to poor self-image, poor compliance and treatment outcomes in an already stigmatized population. Caregivers were selected as participants as they are a primary support in this population. In alignment with the Health Belief Model the purpose of this evidence-based intervention was to increase risk awareness, increase knowledge of strategies to offset risk, increase confidence and self-efficacy and empower health related behaviors among caregivers.
Participants were identified by providers in an outpatient mental health clinic as caregivers of patients prescribed atypical anti-psychotic medications adults aged 18 and above, able to read and understand English, and agree to provide consent. They were asked to:
1. Complete a demographic and knowledge pre-test, gauge perceived knowledge/confidence.
2. View an educational PowerPoint focused on atypical anti-psychotic medications, benefits, risks and strategies to mitigate weight-gain.
3. Complete a knowledge post-test and gauge perceived knowledge/confidence.
Descriptive statistics were used to examine distribution of variables, due to small sample size, Wilcoxon Signed Ranks test was used to compare outcomes. Qualitative data was also gathered to further develop interventions and inform practice. Comparison between pre- and post-test analysis demonstrated improvement in all areas of knowledge, perceived knowledge, and perceived confidence. Statistical analysis demonstrated statistical significance and high practical significance. One-hundred percent of participants recommended the intervention and provided qualitive feedback, and suggestions that may be used to inform practice.
Stress of transitioning to parenthood, hormonal fluctuations as well as physical changes, and complications during postpartum could be addressed at the routine postpartum follow-up visit to avoid long-term adverse effects. While emphasis on preconception and prenatal care has increased nationwide, attendance at this important visit is on the decline. The purpose of this project was to investigate how enhanced prenatal education and concurrent scheduling of a well-baby visit at four weeks, instead of the traditional six weeks, could increase adherence to recommended follow-up care at a federally qualified health clinic in the Southwestern United States.
The Theory of Reasoned Action guided the intervention while Rosswurum and Larrabee’s evidence-based practice model was used to develop the project. The pre-existing weekly prenatal education program was enhanced with information regarding the importance of a four-week postpartum follow-up visit. Front desk schedulers were educated to offer same day appointments for the postpartum care visit and one-month well-baby appointment. Data collection took place for three months after implementation of the project and was compared to adherence rates during the three months prior to the intervention. Providers and scheduling staff members participated in a short post-intervention interview. Prenatal education and convenience of concurrent scheduling increased the percentage of adherence to follow-up visits over a three-month period. Providers and clinic staff recommend continuing with the process changes to increase patient’s access to family centered care.
Purpose/Aims: The purpose of this project was to evaluate how patient education can improve medication adherence.
Background and Significance: An exhaustive literature search was conducted with critical appraisal and evidence synthesis to evaluate the effectiveness of patient education on medication adherence. The search concluded that adherence is crucial to chronic disease processes. However, there was no one intervention that emerged as being superior for improving medication
adherence. Working with patients individually to address needs through a variety of methods appeared was the best way to improve medication non-adherence.
Methods: A project to improve medication adherence in an outpatient mental health clinic incorporated electronic medical record (EMR) technology with patient education materials. The project evaluated provider satisfaction with the EMR handout system and evaluated providers’ perceptions of improved medication adherence. Providers (n=9) were followed for eight weeks once system was live. Appraisal was conducted on the providers and pre-test, mid project test, and an eight week post-test were administered. The instrument used was the Technology Acceptance Model-2 (TAM-2).
Outcomes: Friedman Test was conducted. Results obtained showed no significant difference between the three tests (χ2 (2) =2.889, p>0.05). The pretest had a standard deviation of 14.24. The posttest standard deviation was 23.75.
Conclusion: Providers educate patients about a variety of topics such as chronic conditions and wellness. It is beneficial to focus on education more broadly, instead of only medication adherence.
Keywords: patient education, medication adherence, physician perceptions
Diabetes is a leading cause of morbidity in the world. About 42 million people worldwide have
diabetes. Poorly managed diabetes leads to long term complications and mortality. Diabetes self-management education (DSME) has been effective in preventing or delaying complications.The purpose of this project is to implement a diabetes self-management education (DSME)
program in primary care and to evaluate its impact on glycemic control and diabetes knowledge in a selected group of adults 18 years or older in a community-based practice.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
Purpose:
The purpose was to implement a self-management program to decrease pain and disability and improve self-efficacy among low-income, Latino individuals diagnosed with arthritis.
Background:
All arthritis pain has the potential to impair mobility. Arthritis is the leading cause of disability among American adults, with over 50 million individuals affected. The Latino population experiences a disproportionate incidence of disability attributable to arthritis compared to other populations. Evidence supports self-management education incorporating physical activity as a promising intervention for arthritis.
Methods:
The intervention included a curriculum developed by the Arthritis Association, three teaching sessions, and a pre/post-test. Anticipated outcomes included decreased pain measured by the Pain Visual Numeric, decreased report of disability measured by the Stanford HAQ, and increased self-efficacy measured by the Arthritis Self-Efficacy Scale. The setting was a faith-based medical clinic that services the uninsured population located within Southwest Arizona. Participants included Spanish and English speaking adults diagnosed with arthritis.
Results:
Twelve participants were consented however, only eight participants completed the entire project. Although the mean pain score decreased, indicating reduced pain, it was not statistically significant (pretest- M=5.75 SD=3.19; posttest- M=5.25 SD=2.82; z (7)=-.11, p= .92). However, there was a statistically significant increase in reports of exercise after the intervention (pretest M=.83, SD=.39; posttest- M=.43, SD=.53; z (6)=-2.0, p =.046). This was in response to an non validated question developed by the primary investigator and co-investigator of, “Do you currently exercise?”.
Conclusions:
Results include increases in reports of exercise post-intervention and decreased pain. The use of non-pharmacological interventions such as self-management to reduce pain and increase mobility in arthritic patients can help lessen the socioeconomic health disparity gaps.