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: Pediatrics
- All Subjects: Depression
Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).
Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.
Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.
Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.
Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Purpose: To examine the implementation of a web-based depression care management training program to increase home health nurses’ knowledge and attitudes regarding depression.
Background and Significance: The Centers for Disease Control and Prevention reported in 2015 that the incidence of major depression in elderly receiving home health service rose to 13.5% compared to less than 5% with those not receiving care in the community.
Materials and Methods: An intervention program was offered to a convenience sample of home health nurses caring for elderly in the community. The Depression CARE for Patients AT Home (depression CAREPATH), which is an evidenced-based online training program consisting of didactic resources about depression screening and depression care management and e-learning modules. Participants were given a pre and post survey to assess their knowledge of the material. Additionally demographic information was obtained via self-report.
Results: A total of 8 out of 18 home health nurses participated in the study. All were females; 13% Caucasian and 88% were Asian. There’s an average of 37 years old (SD 14.7, range 23-58) and had 3 years of experience (SD 2.07, range <1-6). The mean depression CAREPATH knowledge total pre-test score was 15 (SD 1.85, range 13-18), while the mean total post-test score was 18.13 (SD 0.99, range 17-19). There was a difference in the depression knowledge test scores at baseline. All the participants obtained a passing score for the post-test (80%). The mean R-DAQ total pre-test score was 71 (SD 13.37, range 53-71) and mean total post-test score was 68, (SD 3.48, range 62-70). The professional confidence in depression attitude indicated agreement post intervention, except with the feeling comfortable in working with physical illness than mental illness (pre intervention 62.5%, post intervention 100%). Participants agreed that home health nurses are well placed and more confident in assisting patients with depression (pre Depression Care Management 3 3 intervention 75%, post intervention 100%). In addition, participants felt more confident in assessing suicide risk post intervention in patient s presenting with depression. Based from Wilcoxon Signed-ranks test, there was a statistical difference, z = -2.536, p= .01, between the depression knowledge pre and post-test scores, which indicates that there is an increase in depression knowledge after the intervention. However, there was no significant difference, z = -.846, p = .397 between the depression attitude, which indicate that there is no change in depression attitude after the intervention.
Conclusion: For this sample, depression knowledge was increased post intervention, however, increase in knowledge did not significantly alter the depression attitude. Further study in a larger more diverse sample is needed for this intervention.