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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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Addressing Low Vaccination in a Free Clinic

Description
Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each…

Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each year in the United States (US) from vaccine-preventable diseases, and nine billion dollars are spent on associated healthcare costs and lost productivity (ADHS, 2015; Wilson et al., 2019). To improve adult vaccination rates, the National Vaccine Advisory Committee recommends the Standards for Adult Immunization Practices, including regular assessment, recommendation, delivery or referral, and documentation during follow-up on vaccination (Orenstein et al., 2014; CDC, 2016). Local problem: A free clinic in Arizona serving uninsured, undocumented Latin American immigrants had low vaccination rates and a deficiency in vaccination documentation in electronic medical records. Methods: An evidence-based quality improvement project was conducted to address low vaccination rates and provider practices using a multi-component intervention. The effect and usage were evaluated through chart audits and pre- post-intervention surveys. Interventions: A vaccination questionnaire was administered at all in-person primary care visits. Brief educational videos were provided to providers and office staff before the intervention addressing the questionnaire's use, purpose, and goals. Adult immunization schedule printouts were made available in all patient rooms and provider charting areas. Additionally, a resource sheet on local free immunization programs was created for providers and patients. Results: The intervention's effect was unable to be determined due to a breakdown in the protocol after the second week of implementation. However, 92% of completed questionnaires reviewed indicated the patient needed one or more vaccination. Sixty-five percent of electronic medical records reviewed had no vaccination documentation historically for assessment, recommendation, referral, follow-up, or scanned vaccination records. No charts reviewed had these areas documented regularly. Conclusion: Vaccination rates and the Standards of Adult Immunization Practices are low at the free clinic. Further quality improvement measures are indicated addressing barriers present.
ContributorsDukes, Alyssa (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-27
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Addressing Vaccine Hesitancy in the Prenatal Population

Description
False accusations concerning the development of autism and other hazardous side effects have triggered parental vaccine hesitancy, leading to outbreaks of vaccine-preventable diseases. This opposition to vaccination risks the health of both individuals and entire communities. The purpose of this project was to determine the effectiveness of prenatal education on…

False accusations concerning the development of autism and other hazardous side effects have triggered parental vaccine hesitancy, leading to outbreaks of vaccine-preventable diseases. This opposition to vaccination risks the health of both individuals and entire communities. The purpose of this project was to determine the effectiveness of prenatal education on maternal vaccine hesitancy and infant immunization rates. In a pretest posttest design, pregnant mothers greater than or equal to 30 weeks gestation were recruited by The Arizona Partnership for Immunization (TAPI) and virtually educated about infant immunization. A voice-over PowerPoint presentation was delivered to the participants virtually and focused on vaccine knowledge, intention to vaccinate, and vaccine hesitancy. These outcomes were evaluated virtually pre- and post-intervention with the Parent Attitudes about Childhood Vaccines (PACV) survey (⍺ = 0.84), and the infants’ vaccination records were compared against the recommended immunization schedule at two months of age. Using the Wilcoxon Signed-Ranks test, data analysis revealed vaccine hesitancy was significantly reduced between pre- and post-intervention (Z = 27.70, p = .000), and 100% of the 2-month-old infants were fully immunized with the recommended vaccines. The effect size (d = 12.807) also indicated a strong relationship between pre- and post-intervention vaccine hesitancy. Vaccine hesitancy remains a threat to public health. With prenatal education, pregnant mothers will likely become more knowledgeable of vaccine benefits and better prepared to make informed decisions. Confident vaccination will decrease vaccine hesitancy and improve immunization rates, while promoting individual and societal health.
ContributorsWolsey, Carly M. (Author) / Chen, Angela (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-27
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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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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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Health Care Provider Use of Motivational Interviewing to Address Vaccine Hesitancy in College Students

Description

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for…

Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

Local Problem: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

Methods: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

Results: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

Conclusion: MI can be an effective part of a strategy to increase vaccination rates.
ContributorsWermers, Rita (Author) / Ostroski, Tammy (Author, Thesis advisor) / Hagler, Debra (Author, Thesis advisor)
Created2019-04-26