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.
Collaborating Institutions:
College of Nursing and Health Innovation
Displaying 1 - 10 of 56
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- All Subjects: Pediatrics
- All Subjects: Screening
- All Subjects: Adolescent
Description
The purpose of this Doctor of Nursing Practice (DNP) project is to develop and implement a culturally tailored educational program into a community clinic in a northern border community in Mexico to prevent and combat childhood obesity. In Mexico, 33.2% of children are overweight or obese and numbers are continuing to rise, which has a significant impact on physical and psychological health and can lead to diabetes, fatty liver disease, thyroid disease, cardiovascular disease, cancer, depression, and other chronic diseases. Guided by Bandura’s theory of self-efficacy, weekly education sessions were delivered to members of the community clinic for two weeks. Content included both a nutrition component and an exercise component. An emphasis was made on increasing physical activity, increasing water consumption, decreasing sugar sweetened beverages, and increasing fruit and vegetable consumption. Videos were developed for each education session. Worksheets and handouts were developed to enhance learning and give participants a tangible reference for individual learning. Content was taken from the CDC and adapted to fit the needs of the community. All content was culturally tailored for low literacy levels and translated to Spanish. Knowledge, behavior change, and self-efficacy were measured by pre and post surveys. Self-efficacy showed statistically significant change from pre and post intervention. These findings suggest that healthy eating and exercise education can potentially increase knowledge, promote behavior change, and enhance self-efficacy, which can, in turn, prevent and combat childhood obesity and related disease states.
ContributorsBahena, Sara (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Background: Existing practice standards for discharge education are insufficient to support parents of children with new enteral feeding devices in the outpatient setting which has led to increased clinic and emergency department visits, hospital stays, and preventable complications. The purpose of this Doctor of Nursing Practice (DNP) project was to design and deliver a comprehensive evidence-based enteral feeding tube hospital-based discharge education intervention for parents after their child’s gastrostomy tube placement surgery. Guided by Transition’s theory, the project aims to bridge the gap in education by providing the parent with ongoing support and education about their child’s gastrostomy tube. Methods: This project measured the impact of inpatient discharge education with ongoing support and outpatient education on parent knowledge and confidence. All English-speaking parents of pediatric patients ages 0-17 years with new gastrostomy tubes at a large, urban, freestanding pediatric hospital in the southwest United States were eligible for participation. Institutional Review Board approval was obtained. Informed consent was obtained from all participants. The education intervention was delivered at hospital discharge then reinforced at the first follow-up visit in the surgery clinic. Data analysis included demographic items, a Paired Samples T-Test, and a Two-tailed Wilcoxon Signed Rank Test analyses. Results: Results indicated a statistically significant difference in parent knowledge after the educational intervention. Results also indicated a clinically significant increase in parent confidence. Conclusion: Providing ongoing support and education positively impacts parent knowledge and confidence related to the care of their child’s new gastrostomy tube. Future impacts of this educational intervention may demonstrate a decrease in clinic and emergency department (ED) visits, hospital expenditure, and preventable complications.
ContributorsFriedl, Anne (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Purpose/Background: Children exposed to adverse childhood experiences (ACEs) and toxic stress have an increased risk of developing chronic illness and early death in the absence of protective factors. Many providers feel inadequately prepared to screen for and treat ACEs. This quality improvement project, based on the Health Belief Model, investigated if providing ACEs education before a screening program is effective in improving attitudes, knowledge, and the number of completed screenings. Method: The project was conducted at a pediatric primary care practice in the southwestern United States. All providers voluntarily consented to attend four education sessions: 1) Trauma overview, 2) Trauma physiology, 3) Trauma-informed care, 4) Screening tool/referral process. An anonymous pre/post-education Likert-Scale survey was completed to assess knowledge and attitudes about ACEs and screening. The number of completed ACEs screening tools and referrals made were collected four- and eight-weeks post-implementation. Results: Data were analyzed using Intellectus Statistics SoftwareTM. There was a significant increase in ACEs knowledge from the pre-test (p= .011, ?=.05). There was not a significant change in attitudes from the pre-test (p=.066, ?=.05). However, the mean pre- to post-survey scores increased for both categories, indicating improved attitudes. Over the first four weeks, 75% of eligible children were screened and 6% were referred to an ACEs resource program. In the second four weeks, 56% of children were screened and 8.6% were referred. Discussion: A comprehensive education program for providers can improve knowledge about ACEs screening, leading to improved screening practices, early identification, and the introduction of protective resources.
ContributorsChaisson, Charlotte (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Background and Objectives: Electronic cigarette use, known as vaping, among adolescents was declared a public health epidemic in 2018 and has acute and chronic health consequences. Healthcare providers (HCP) play a pivotal role as health-related educators, including counseling against vaping. Primary HCPs report a lack of adequate knowledge, confidence, and screening for adolescent vaping. Increasing HCP’s vaping awareness and knowledge may increase rates of adolescent vaping prevention screening and counseling. Rosswurm & Larrabee Model and Health Belief Model were utilized in project design and implementation.
Methods: Primary HCPs (n = 8) that provide care to adolescents at a pediatric clinic in Phoenix, Arizona completed online pre- and post- education surveys measuring vaping knowledge before and after viewing an evidence based online educational video. Participation was voluntary, open to all clinic HCPs, and informed consent was provided before the intervention. Data analysis was completed with Intellectus Statistics using descriptive and inferential statistics.
Results: Results of the paired samples t-test was significant based on "?=.05" , t(7) = -3.56, p = .009. The mean of the post-education survey (12.38) was significantly higher than the mean of the pre-education survey (9.62). Descriptive statistics found 85.71% of HCPs reported increased intent to counsel for vaping and 57.14% of HCPs reported increased implemented vaping counseling with their adolescent patients four-weeks post intervention.
Conclusions: HCP vaping knowledge rates and vaping-related counseling and surveillance significantly increased after viewing the educational video. Implementing mandatory HCP vaping education training could increase adolescent vaping prevention interventions and counseling within primary care settings.
ContributorsMarks, Brianna (Author) / Bay, Sarah (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Substance use among adolescents is incessantly problematic, but its recent collision with a rising opioid epidemic has exponentiated deaths in this age group. Despite opioids being a major contributor, indications remain that adolescent prevention efforts should focus on total substance abstinence. Evidence consistently highlights adverse childhood experiences and mental dysfunction as the strongest predictors of youth substance use initiation, and parent-focused interventions as the most significant prevention model. Participants in this project included five parents, with a teen between 11 and 16 years of age, who had recently experienced homelessness or where currently living in a transitional shelter. Guided by the Transtheoretical Model, this project assessed the impact of an evidence-based parenting program among high-risk families. Participants completed the Teen Triple P Online program from home while receiving weekly text message support. Each parent completed a pre-and post- Conflict Behavior Questionnaire (r=.86) and Depression, Anxiety, and Stress Scale (r =.71–.81), and a Client Satisfaction Questionnaire. A two-tailed Wilcoxon signed rank test was performed on the matched pairs of pre- and post- measures with the mean scores compared. Though statistically insignificant results were yielded, this quality improvement project found a clinically significant decrease in conflict behavior and parental anxiety, depression, and stress after completing the Teen Triple P Online program. Participant satisfaction with the program and subsequent family improvements was also found. These results suggest that interventions that decrease family conflict and improve a parent’s mental health, directly impact major family factors that contribute to adolescent substance use and adverse childhood experiences. This project contributes to the evidence that positive parenting programs have an impact at the individual, family, and societal levels.
ContributorsAllen, L. Amber (Author) / Helman, Jonathan (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-01
Description
Introduction: Electronic cigarettes (e-cigarettes) among youth has increased drastically in recent years. E-cigarettes are being used with nicotine which can lead to dependency. Healthcare providers (HPs) are in a unique position to advise against the use of e-cigarettes. Recent studies report a lack of formal education among HPs about e-cigarettes. The purpose of this quality improvement project is to examine how increasing e-cigarette awareness among HPs can change their behavior on patient counseling against e-cigarette use. Methods: A modified E-cigarette Knowledge, Beliefs and Attitude Questionnaire was proctored before and after a virtual educational training about e-cigarettes. All advanced HPs employed, in a Southwestern state, at the organization were invited to participate by email. Results: 29 participants completed the pre-survey, and 4 participants completed the post-survey. While 90% of the participants reported that they first learned about e-cigarettes through informal sources, 72% of the participants reported interest in learning more about e-cigarettes to enhance their practice. Further, a two-tailed Mann-Whitney U test was significant on the “e-cigarettes are helpful aid for smoking cessation” statement based on an alpha value of 0.05, U = 12, z = -2.69, p = .007. Conclusions: Increasing the knowledge about e-cigarettes among HPs is critical in decreasing nicotine use among the public. This project will help in the fight against the use of tobacco products, and adds to the literature on how formal education about e-cigarettes among HPs can increase their intention to screen and counsel patients.
ContributorsWelch, Analuisa (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
Description
Objective: Delirium frequently occurs in Pediatric Cardiac intensive Care Units (PCICU) of hospitals with critically ill patients. An inflammatory process of the brain causes neurotransmitters imbalances and neuronal alterations, leading to increased days on mechanical ventilation, length of stay in the ICU, and possible self -harm. Delirium can be reduced and controlled if detected early through frequent patient monitoring and screening. The purpose of this project is to evaluate the implementation of a delirium screening tool along with education on delirium
Study Selection: An education module on delirium and the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool along with a non-pharmacological bundle was implemented on a pediatric cardiac intensive care unit for patients 2 to 18 years of age, admitted to an Arizona metropolitan children’s hospital. All nurses were required to attend the education session. Data was collected by using pre- and post-survey questions on delirium for those nurses who chose to participate in the study.
Data Synthesis: The results from the pre- and post-tests suggest there was an increase in education. The average score for the 15 nurses on the pre-test was 87.1% while the same nurses scored 100% on the post-test. Chart reviews of the CAP-D screening tool from November 2000 – February 2021 had 71 patients on the unit and had 8 patients scored on the CAP-D screening tool. Chart reviews after implementation of the education module from November 2021 – February 2022, were conducted and 118 patients were on the unit while only 23 patients were scored on the CAP-D screening tool.
Conclusion: So far, the use of an education module and implementation of a non-pharmacological bundle has proven some promising results in helping with delirium and its reduction in the PCICU.
ContributorsHernandez, Ricardo (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Objective: To understand and prevent adverse discharge events, the project assesses the needs and gaps of discharge care coordination for child(ren) with medical complexities (CMC). The National Survey of Children’s Health show 87.4% of CMC does not receive care in a well-functioning system, and 47.4% did not receive adequate care coordination 1. Therefore, does initiating measurement tools and communication before and after discharge identify and prevent discharge related adverse events?
Methods: After IRB approval, a mixed-methods approach project occurred at southwestern pediatric free-standing hospital. Through eight weeks of convenience sampling, CMC caregivers were recruited in the inpatient setting (n=5). Qualitative and quantitative data were obtained through: [Pediatric] Care Transitions Measurement Tool – 15 (CTM- 15), with a Cronbach’s alpha of .932; a demographics survey; a post-discharge survey; and electronic health records.
Results: The CTM-15 post-discharge score was 83.3 (N = 4, SD = 9.83, SE¬M = 4.92). CTM-15 qualitative data included: communication issues; rushed discharge; poor discharge anticipatory guidance; hospital policy concerns; follow-up appointment issues; and prescription errors. LOS average for all participants was 137.8 days (SD = 102.75, SEM = 45.95) with 40 unintended hospital days (SD = 41.55, SEM = 18.51). Issues encountered 30 days post-discharge included: prescription errors, follow-up issues, and home health issues.
Conclusion: Hospitalized CMC have an increased risk to encounter a discharge adverse event because of a complex intertwining of disciplines, services, medications, and needs. Communication, tools, and surveys did not capture all the problems encountered by families with CMC; however, it did identify areas of notable concern.
ContributorsChalla, Hannah (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-02
Description
The number of adolescents who are overweight are suffering from diseases once thought to only occur in adults, such as diabetes mellitus type 2, coronary heart disease, and liver disease with cases increasing exponentially. This may be correlated with adolescents making unhealthy choices in life resulting in depression in obese adolescents. Healthcare providers must continuously explore novel ways to empower teens to make healthy lifestyle changes. The Creating Opportunities for Personal Empowerment (COPE) Thinking, Emotions, Exercise, and Nutrition (TEEN) program was delivered to three adolescent participants in a primary care pediatric clinic in Southwest Arizona. The 15 sessions were provided weekly in the pediatrician’s office using the COPE TEEN manual. The participants completed the HABITS questionnaire and the Patient Health Questionnaire-9 (PHQ-9) before starting the program and after program cessation and kept confidential. The survey results were compared using descriptive analysis and paired t-tests to analyze the data collected. Due to a small sample size (n=3), statistical significance could not be calculated. However, clinical significance was found as evidenced by lower depression scores and improvement in healthy habits. A cognitive behavior skills-building program such as the COPE TEEN program has the potential to empower adolescents to make healthy decisions in life. These healthy choices lead to a long, happy life free from diseases caused by unhealthy choices. This program positively impacts the clinical care of adolescents who are overweight or obese by offering providers an alternative manner of educating adolescents.
ContributorsCortes, Holly (Author) / Esperas, Amanda (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Problem Statement & Purpose: Cervical cancer screening rates for a Federally Qualified Health Center (FQHC) in rural Northern Arizona is 78%, which is below the Healthy People 2030 goal of 84.3%. Identification of socioeconomic barriers unique to rural women through the use of an intake survey can improve cervical cancer screening rates. This project was guided by the Social Cognitive Theory (SCT). SCT proposes that behavioral change is determined by environmental, social, personal, and behavioral elements.
Methods: At a one-day well-woman event called, “See, Test, and Treat” hosted by the FQHC, an anonymous intake survey was implemented that identified participant demographics, basic cervical cancer knowledge, and perceived socioeconomic barriers to routine cervical cancer screening. Participants were recruited through the FQHC. Participant inclusion criteria: Arizona resident, uninsured, underinsured, 21-65 years old, English or Spanish speaking.
Results: Descriptive statistics were utilized to evaluate the survey responses, reliability, and validity of responses unknown due to self-reported responses. A total of 18 surveys were completed with a final yield of (n = 10). Surveys didn’t identify barriers to routine cervical cancer screening; however, an unawareness of cervical cancer risk factors including multiple sexual partners (n = 5, 50.00%), sex at an early age (n = 4, 40.00%), and misperception that cervical cancer is genetic (n = 7, 70.00%) was identified.
Implications for Practice: A need for cervical cancer education exists within the surveyed community. Providing rural women with knowledge regarding cervical cancer can improve screening rates.
ContributorsParkman, T. Lacey (Author) / Janicek, Patricia (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29