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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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College of Nursing and Health Innovation
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Mindfulness Intervention Reduces Substance Cravings and Increases Psychological Flexibility

Description
Objective: Substance use disorder (SUD) is an epidemic in the United States. Current standard of care for SUD continues to produce a 40-60% relapse rate. Treatment for SUD is costly and is not obtainable for many individuals. The purpose of this project is to implement mindfulness as an adjunct treatment…

Objective: Substance use disorder (SUD) is an epidemic in the United States. Current standard of care for SUD continues to produce a 40-60% relapse rate. Treatment for SUD is costly and is not obtainable for many individuals. The purpose of this project is to implement mindfulness as an adjunct treatment for SUD to reduce relapse. Methods: Voluntary program offered at a residential treatment center designed as a team-based project. The combined project includes exercise, wellness, and mindfulness. Adults over the age of 18, male or female with a diagnosis of SUD were eligible. Program consisted of three hourly sessions a week, for a total of three weeks. Sessions included one session of exercise and wellness, one session of mindfulness training, and a combined session. Mindfulness sessions included learning the seven pillars of mindfulness followed by guided meditation. Participants were given a mindfulness journal for daily exercises. Five Facet Mindfulness Questionnaire (FFMQ) was completed before program and on completion. Results: 11 of 22 participants completed the program. FFMQ total scores were analyzed with paired t-test with Wilcoxon signed rank to account for small sample size. Statistical significance was based on an alpha of 0.05, V=10.50, z=2.00 and p=0.45. Conclusion: This project has the potential to decrease relapse rates by increasing mindfulness in individuals with SUD. Mindfulness training reduces cravings and negative thought processes. Implementing mindfulness training with current standard of care can be cost effective and recommended for all individuals with SUD.
ContributorsRouston, K. Courtney (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
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Decreasing Burnout in Psychiatric Nursing

Description
Burnout has become an increasingly popular topic among registered nurses, but unfortunately burnout among psychiatric nursing is less understood than other nursing specialties such as the Intensive Care Unit, Emergency Room, or Oncology. Psychiatry is unique and psychiatric nurses, in particular, are often subjected to physical and verbal violence as…

Burnout has become an increasingly popular topic among registered nurses, but unfortunately burnout among psychiatric nursing is less understood than other nursing specialties such as the Intensive Care Unit, Emergency Room, or Oncology. Psychiatry is unique and psychiatric nurses, in particular, are often subjected to physical and verbal violence as well as exposure to patient’s trauma. The aim of this project was to decrease burnout among psychiatric nurses in a private practice out-patient family psychiatric facility using Rossworm and Larabee’s change model (Appendix D). The MBI-HSS was completed by 1 participant (n=1) at pre-intervention and post-intervention. Between the pre/post MBI-HSS questionnaire the participant was asked to partake in a mindfulness-based intervention utilizing the smartphone application Headspace to complete a 10-session meditation course over one week. The results conclude the participant’s burnout decreased overall from pre-intervention to post-intervention. Internal Review Board (IRB) was granted in September 2021, and the project was completed in November 2021. The impact of the project was projected to have a more thorough statistical influence, but due to the participant size, there is minimal impact of system or polices in the psychiatric facility.
ContributorsSteward, M. Shannon (Author) / Guthrey, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-30
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Patient Portal Utilization Effect on Patient Engagement

Description
Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a…

Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos. Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins. Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
ContributorsHerrera, M. Sara (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
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Sustaining Depression Remission: Integrating Mindfulness-Based Modalities and Ketamine Infusion Therapy

Description
Major depressive disorder contributes to a growing disease burden globally, with limiting or inadequate treatment options available to patients and healthcare providers. Traditional medications to treat the disorder demonstrate modest efficacy while best outcomes are seen when psychotherapy is implemented adjunctively. Barriers to delivering optimal treatment can lead to relapse, diminished psychosocial functioning, and…

Major depressive disorder contributes to a growing disease burden globally, with limiting or inadequate treatment options available to patients and healthcare providers. Traditional medications to treat the disorder demonstrate modest efficacy while best outcomes are seen when psychotherapy is implemented adjunctively. Barriers to delivering optimal treatment can lead to relapse, diminished psychosocial functioning, and suicide, a leading cause of death in the United States. The purpose of this paper is to examine the rapid antidepressant effects of ketamine combined with nurse-delivered mindfulness-based cognitive therapy to help reduce depression severity and support remission. Research differentiating ketamine’s mechanism of action from traditional anti-depressants and the efficacy of mindfulness-based interventions to reduce depression, have led this evidence-based project integrating these modalities.
ContributorsYuhas, John V. (Author) / McIntosh, Wayne (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-20
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Educating Emergency Department Staff on Sex Trafficking Victim Identification: A Quality Improvement Project

Description
Objective: Nearly 90% of sex trafficking victims will come into contact with an emergency department healthcare provider during his or her period of exploitation. Yet, victim identification by healthcare providers remains inadequate. The purpose of this quality improvement project is to improve emergency department healthcare providers’ confidence and ability to…

Objective: Nearly 90% of sex trafficking victims will come into contact with an emergency department healthcare provider during his or her period of exploitation. Yet, victim identification by healthcare providers remains inadequate. The purpose of this quality improvement project is to improve emergency department healthcare providers’ confidence and ability to identify sex trafficking victims through staff education centered around sex trafficking. Method: A quality improvement project, guided by the Social Cognitive Theory, was implemented in an Arizona emergency department. ED staff were provided with a 40-minute education video about sex trafficking, including victim identification and appropriate responses. Participation in this project was open to all current healthcare workers employed at this emergency department. Stakeholders within the facility assisted with recruitment via weekly staff emails over a three-week period. A pre- and post-survey, consisting of a self-evaluation Likert scale, was used to assess confidence in identifying victims. Case studies were included to measure the participants’ ability to identify victims of trafficking. All aspects of this project were approved by Arizona State University’s and the organization’s Institutional Review Board. Results: One hundred percent of staff agreed to feeling confident in their ability to identify sex trafficking victims post intervention. However, there was no improvement in staff’s actual ability to identify victims through case studies post intervention. Conclusions: Education can be a valuable tool to improve confidence in identifying victims of sex trafficking in an emergency setting.
ContributorsKieser, Reynaldo (Author) / Helman, Jonathan (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
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Educating Healthcare Providers on Human Trafficking: A Small Intervention, Large Benefits

Description
Human trafficking affects men, women, and children, of all races, and incomes. Healthcare providers can work directly with those who are trafficked when they come into the emergency room or clinic to seek care. The identification of those who are trafficked is key to assisting those who need hel…

Human trafficking affects men, women, and children, of all races, and incomes. Healthcare providers can work directly with those who are trafficked when they come into the emergency room or clinic to seek care. The identification of those who are trafficked is key to assisting those who need help obtain resources and get the help they need to move forward in their lives. Unfortunately, many healthcare providers do not have the knowledge to identify or the time it takes to pick up on cues that a patient is being trafficked. Currently, there is no set education or curriculum to teach healthcare providers. This has resulted in increased lack of identification of those who are trafficked. An evidence-based quality improvement practice change was implemented. The purpose of this project was to educate healthcare professionals about the red flags that trafficked individuals might exhibit and to implement a screening tool in the emergency department. A brief educational Power Point on human trafficking was provided. A pre-test, post-test and a post-survey was utilized to evaluate awareness and knowledge. After the implementation of the human trafficking screening tool, 1,749 patients were screened, for a screening rate of 71%.
ContributorsRosch, Lisa (Author) / Chifelle, Rochelle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-03
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Stress in Healthcare Professionals: Caring for the Carers

Description
Background: Healthcare Professionals commonly experience elevated stress levels, and this issue has only further intensified by the ongoing COVID-19 pandemic. Mindfulness-based intervention have been shown to improve stress levels in diverse populations. Objective: The purpose of this project was to evaluate if an online, multicomponent MBI can reduce stress levels…

Background: Healthcare Professionals commonly experience elevated stress levels, and this issue has only further intensified by the ongoing COVID-19 pandemic. Mindfulness-based intervention have been shown to improve stress levels in diverse populations. Objective: The purpose of this project was to evaluate if an online, multicomponent MBI can reduce stress levels in healthcare professionals enrolled in a graduate health program. Methods: Recruitment was conducted at two different Southwestern institutions via email announcement from university’s program directors. The brief, 12-day intervention involved (1) self-guided online educational modules, (2) one group course via the platform zoom, and (3) at home practice of guided meditation session. The Perceived Stress Scale-10 (PSS-10) was used to measure stress levels pre- and post-intervention. General feedback of experience was also inquired on Postsurvey. Results: Sample comprised of 17 health professionals enrolled in a graduate health program from two different Southwestern Institutions. Scores from PSS-10 in postsurvey (M=20.94, SD=6.04) were statistically significantly lower than scores in pre survey (M=24.24, SD=5.78), t(16) = 3.35, p = .004. A large effect size was detected with findings (d = .81). Conclusions: Mindfulness Based Interventions may be able to reduce stress levels in healthcare professionals. More literature should focus on mindfulness intervention tailored to the needs of healthcare professionals.
ContributorsAfrin, Farhana (Author) / Uriri-Glover, Johannah (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-03
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An Education for Mental Health Care Providers: Sex Trafficking Victim Identification

Description

Purpose: The purpose of this project was to examine if a relationship existed between the changes in attitude and knowledge of a mental health care provider, before and after an educational intervention was given on how to identify sex trafficking victims.

Background: According to the National Trafficking Hotline (2017), last year…

Purpose: The purpose of this project was to examine if a relationship existed between the changes in attitude and knowledge of a mental health care provider, before and after an educational intervention was given on how to identify sex trafficking victims.

Background: According to the National Trafficking Hotline (2017), last year there were over 5,000 cases of sex trafficking reported. Lederer & Wetzel (2014) discuss that more than 88% of victims interact with a health care provider while being trafficked at least once. A majority of cases, mental health care providers were informed that their patient was a sex trafficking victim through collaboration of other services. Without this collaboration, many providers would have never
known that they had interacted with a victim (Domoney, Howard, Abas, Broadben, & Oram, 2015).

Methods: The participant population consisted of psychiatrists, psychiatric nurse practitioners and psychologists working in acute and out patient settings.
A pre survey was given to identify the participant’s knowledge of sex trafficking and their awareness of available resources and tools to help screen as well as treat victims of sex trafficking. After completion, the participants viewed an educational voice over presentation that educated them on how to identify current sex trafficking victims, what screening tools are available, the mental health risk factors and how to protect both the victim and provider from potential danger from the alleged trafficker. A post survey was then given to assess their knowledge after the presentation intervention, how much they retained and their confidence in being able to assess and treat sex trafficking victims. All surveys and the presentation were available online for participant convenience via a private link.

Results: The knowledge posttest score was higher than the pretest (Z=-2.694, p<0.007).
The confidence score on treating sex trafficking victims was higher posttest (Z=-2.251, p<0.024) No significant change in attitudes for advocating for sex trafficking victim care. All providers agreed that this high-risk vulnerable population needs advocates (Z=4.67, p<0.707).

Conclusion: All providers agreed for the need to advocate for victim care prior to the educational intervention. The results suggest that mental health providers are more knowledgeable posttest about risk factors, have a higher level of confidence in treating sex trafficking victims and have a higher confidence in their ability to protect victims and provide adequate care.
ContributorsChang, Lillian (Author) / Chen, Angela Chia-Chen (Thesis advisor)
Created2018-04-29
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An On-Site Mindfulness-Based Intervention to Promote Wellness in the Workplace

Description

The purpose of this project is to implement an on-site mindfulness-based intervention to reduce stress and burnout among mental health care workers. Healthcare professionals are among the most stressed of any profession, and mental health workers are at an extremely high risk for burnout and compassion fatigue (Christopher & Meris,…

The purpose of this project is to implement an on-site mindfulness-based intervention to reduce stress and burnout among mental health care workers. Healthcare professionals are among the most stressed of any profession, and mental health workers are at an extremely high risk for burnout and compassion fatigue (Christopher & Meris, 2010) with an estimated 21% to 67% of mental health workers reporting that they experience high levels of burnout (Salyers et al., 2011).

After researching the literature, it was evident that practicing mindfulness can lead to less stress and higher job satisfaction. In an effort to combat this problem, an on-site mindfulness intervention was implemented at an outpatient psychiatric setting for eight weeks. Twenty-seven mental health workers gave their consent to be part of the study, and eleven were able to complete the study and self-assessment surveys for three time periods. The Maslach Burnout Inventory (MBI) (the Human Service Version) and a 1-item job satisfaction were used to measure the effect of intervention on employees’ levels of stress and job satisfaction.

A non-parametric Friedman test of differences among repeated measures was conducted and findings were not significant when comparing the average total scores of means between pre-, post-, or 1-month follow-up for Emotional Exhaustion (p = .148), Depersonalization (p = .223), Personal Achievement (p = .784) and job satisfaction (p = .422). The positive outcomes cited by participant support the thesis that the on-site mindfulness-based intervention is better than no intervention though the effect was not statistically significant.
ContributorsUwimana, Aimee (Author)
Created2016-04-29
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Joy in Work: Addressing Nurse Burnout through Mindfulness

Description
Aim: To investigate the feasibility and efficacy of mindfulness as an intervention in reducing burnout and promoting joy in work for progressive care unit (PCU) nurses and nursing aides. Background: The Institute for Healthcare Improvement (IHI) describes a lack of joy in work and the resultant burnout as a serious threat to healthcare…

Aim: To investigate the feasibility and efficacy of mindfulness as an intervention in reducing burnout and promoting joy in work for progressive care unit (PCU) nurses and nursing aides. Background: The Institute for Healthcare Improvement (IHI) describes a lack of joy in work and the resultant burnout as a serious threat to healthcare workers and organizations. Few studies have examined this phenomenon in PCU nurses and aides. Method: Pre- and post-intervention surveys with established instruments on three variables, mindfulness, burnout, and joy in work, were administered to ten PCU nurses and aides (N = 7) at a city hospital. The intervention was the virtual IHI's mindfulness course and was guided by Martin Seligman's PERMA Model and the Iowa Model for Evidenced Based Practice. A paired sample t-test was used to evaluate changes in the pre-post survey responses. Results: Significant increase in joy in work based on an alpha value of 0.05, p = .041. Slight increase in mindfulness practice based on an alpha value of 0.05, p = .398. Burnout remained the same based on an alpha value of 0.05, p = .766. Conclusion: PCU nurses and aides who practiced mindfulness for 12 weeks scored the same on burnout scales and higher on the joy in work scales. Implications for Nursing Management: Nurse managers can incorporate mindfulness exercises at strategic times during the shift to reduce burnout and promote joy in work for nurses and aides. Future EBP projects should assess the effectiveness of different mindfulness activities in promoting nurses' emotional and psychological well-being in various care settings.
ContributorsImanatue, Loveline (Author) / Sanborn Heidi (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-24