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: Rural Health Services
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.
Background: The global prevalence of all types of diabetes increased from 108 million in 1980 to 422 million in 2014 (Nazir et al., 2018). The Centers for Disease Control and Prevention (2017) ranks diabetes as the 7th leading cause of death in the United States with an estimated annual expense of $327 billion. Within the rural setting, patients typically have less resources available for the treatment and self-management of their diseases. It is important to explore self-management techniques that can be utilized by patients with type 2 diabetes living in rural areas. Research demonstrating the importance of education, exercise, diet, glucose monitoring, medications, and supportive measures is prominent throughout the literature.
Objective: The purpose of this Doctor of Nursing Practice (DNP) applied project is to investigate the effects of delivering biweekly text messages containing diabetes self-management education (DSME) materials to patients in an effort to support successful self-care.
Methods: During an 8 week period, DSME was provided via text messaging, bi-weekly (Sunday and Wednesday), to 23 rural participants with type 2 diabetes, in a family clinic in Payson, Arizona. Participants were asked to complete the Skills, Confidence, and Preparedness Index both pre- and post-intervention to evaluate their knowledge of diabetes self-management.
Results: Twenty-three adults aged 52 to 78 years (M = 64.91) participated in the project. Of the participants, 57% (13/23) were female. The majority of participants had T2DM diagnosis less than 10 years (M=13.8 years). There was a statistical difference between the pre- and post-Skills, Confidence and Preparedness Index questionnaire (p < .001) indicating an improvement in self-efficacy scores post- intervention.
Conclusion: DSME delivered via text message is a cost-effective way to increase patients' self-efficacy and potentially improve their ability to successfully self-manage their disease.
Pediatric oral health disparities are one of the leading global chronic problems that affect children of all socioeconomic backgrounds. Poor oral health leads to the development of dental caries, which can cascade into an innumerable number of comorbidities, including pain, infection, malnutrition, and decreased self-esteem. Oral health education from the medical and dental home in conjunction with regular cleanings and biannual fluoride varnish has been shown to decrease the risk of caries by at least one third.
Implications for Health Care Providers
Oral health, dental caries, and the resulting comorbid conditions affect the overall health of the child who follows up with their primary care provider. Pediatric health care providers can play a major role in the prevention of these dental caries through the promotion of oral health education and fluoride varnish application during well-child visits
Results
In comparison to pre-data, providers felt more confident and comfortable discussing oral health hygiene and offering fluoride varnish after the educational intervention. There was no significant change in the fluoride varnish applications pre and post in the chart audit; however, there was inconsistent data between the chart audit and the fluoride varnish questionnaire data filled out by providers during the well visit. Lastly, a significant number of parents declined the application of fluoride varnish implying that further intervention should be focused on parent education.
