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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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Improving Patient Outcomes through Use of a Stroke Navigator Program

Description
BACKGROUND: Stroke is a serious condition associated with significant morbidity and mortality. Of the 800,000 strokes that occur in the United States annually, one quarter can be described as recurrent events. Timeliness of care and patient education are considered critical tenets of stroke management. These interventions limit neuronal loss and…

BACKGROUND: Stroke is a serious condition associated with significant morbidity and mortality. Of the 800,000 strokes that occur in the United States annually, one quarter can be described as recurrent events. Timeliness of care and patient education are considered critical tenets of stroke management. These interventions limit neuronal loss and prepare the patient to adopt lifestyle changes that prevent recurrent stroke. Several previous studies demonstrate that the use of patient navigator programs can improve clinical outcomes in this patient population. METHODS: A stroke navigator quality improvement program was designed and deployed at a stroke center in the American Southwest. During the 3-month study, patients diagnosed with stroke were enrolled by means of implied consent (n=52). Subjects were followed from emergency department presentation to discharge. Interventions aimed to reduce times from door to computed tomography (CT), door to alteplase, and door to thrombectomy. Patients were also provided education, emotional support, and case management. Positive response was defined as reduction in time taken to achieve core measures when compared with baseline institutional data. RESULTS: Two-tailed Wilcoxon signed rank tests were utilized to compare two large data sets: baseline door to CT, alteplase, and thrombectomy mean times for three months preceding the intervention to the three month period during which the intervention was deployed. No statistical significance was demonstrated. Next, the same test was used to compare baseline CT time data to the smaller group of patients that were treated by the stroke navigator. This showed that the stroke navigator yielded significant reduction in door to CT times when compared to baseline institutional performance (p=0.015). CONCLUSION: In concurrence with previous research, the stroke navigator program was successful in improving the quality of stroke care, notably during the acute phase when expedited computed tomography is needed to prevent neuronal loss. Further research is needed to determine if the intervention could improve door to alteplase and thrombectomy times as well as prevent stroke readmissions.
ContributorsOrganes, Laura & Schoefeld, Nicolas (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-23
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Improving the Identification of Depression in Pediatric Primary Care

Description
Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized…

Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized tool improves detection, diagnosis, and management of depression and other mental health illnesses. Method: The Patient Health Questionnaire—modified for adolescents (PHQ9-A) was administered to all eligible adolescents, ages 12-18, during an annual well visit for a period of 6 weeks. Lewin's Change Theory guided a system change in the electronic health record, and the questionnaire results were documented and provided to the pediatric provider at the time of the appointment. A chart review was conducted to determine whether all eligible patients were administered the questionnaire and if a depression diagnosis or mental health referral had been made. Results: Out of 76 eligible well visits, 65 (86%) patients completed the PHQ9-A. The average score was 5.29 (SD = 6.49) with a maximum score of 25. Out of those that completed screening, 11 (17%) had a positive PHQ9-A score resulting in 8 referrals to mental health services and 2 mental health diagnoses in the clinic.
ContributorsCoomer, Meagan (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27