Doctor of Nursing Practice (DNP) Final Projects

Women in recovery from substance use disorders (SUD) face significant barriers to achieving reproductive well-being (RWB) and disproportionately experience unintended pregnancy. Unintended pregnancy can have serious consequences in this population. Equity-informed approaches promote the integration of reproductive health care (RHC) with recovery programs to improve both access to and quality of RHC. Arizona’s largest SUD recovery program, Crossroads, Inc. recently opened an on-site, integrated primary clinic offering RHC. A one-month pilot demonstration of One Key Question (OKQ), a pregnancy desire screening tool, was implemented with fidelity at Crossroads to identify clients with RHC needs and offer care.

IRB exempt status was obtained through Arizona State University. All female-bodied clients aged 18-49 were screened following routine admission assessments. The Institute for Healthcare Improvement Triple Aim model based on Self-Determination Theory and Motivational Interviewing was used to prioritize client autonomy. The client experience of care was measured using an adapted Interpersonal Quality of Family Planning scale. The magnitude of needs and desires were summarized with descriptive statistics. Sixty-three clients were screened with OKQ. Needs were identified in 97% of clients. Of those clients, 98% accepted referrals. Ninety percent of items measuring the client experience of care were rated as “excellent.” OKQ provided an efficient structure for person-centered screening and referral conversations to integrate RHC in a large SUD recovery program with excellent care experiences reported by clients.

Purpose: This project examined the effectiveness of an online educational module on basic Motivational Interviewing (MI) techniques for Nurse Practitioners (NPs) providing obesity management to middle-aged women.

Background: Middle-aged women experience distinct physiological and psychosocial factors that contribute to weight gain and make obesity management especially challenging. The evidence supports the use of motivational interviewing (MI) interventions as a highly effective approach to obesity management in combination with standard medical weight loss programs. Educating NPs that provide medical weight loss on basic MI counseling techniques is necessary to facilitate the use of this intervention.

Methods: NP providers at a group of seven medical weight loss clinics in the southwestern United States completed an online MI educational module that was developed for this project. The module content covered basic MI counseling techniques. MI knowledge was assessed using a 6-item pre/post-test. Participants completed an 8-item course evaluation to provide additional feedback.

Results: Ten of the 13 NPs eligible participated in the project. The overall response to the project was positive as demonstrated by high scores on the course evaluation. The average post-test knowledge scores increased after completion of the module, however no statistical significance was noted.

Conclusions: The basic MI education module was beneficial for NPs providing obesity management and future research should focus on developing standardized MI weight loss interventions.

Purpose: Assess provider perceptions on care coordination, collaboration, teamwork, and shared decision-making practices pre and post a brief educational intervention on interprofessional collaboration (IPC).

Background and significance: A lack of care coordination and active follow up in the outpatient setting of individuals living with mental illness places this population at high risk for developing various comorbidities. Care coordination across care providers and patients in a IPC, patient-centered treatment model of care is an intervention that can reduce this barrier to care.

Methods: At a behavioral health clinic in the southwestern United States (U.S.) twenty-two participants were assessed via the Collaborative Practice Assessment Tool (CPAT), before and after an educational presentation on IPC care. The CPAT is a tool that was developed to assess collaborative practice within teams and help identify needs for professional development.

Results: Statistical significance was found from pretest to posttest scores (t(21) = -1.936, p = .066). Statistical significance was found in two of the eight domains; mission, meaningful purpose, and goals (p = .009) and decision-making and conflict management (p = .058). Increases in posttest scores were seen in all eight domains.

Conclusions: Training behavioral health professionals in IPC practice and teambuilding may facilitate improved clinical team experiences and communication. Behavioral health professionals treating individuals living with serious mental illness (SMI), IPC training could prepare providers to work more effectively and efficiently in the delivery of patient-centered care in this population with complex health care needs.

One in every three deaths in the United States results from cardiovascular disease (CDC, 2013). Cardiovascular Rehabilitation (CR) is a medically supervised program designed to help improve cardiovascular health for patients who have experienced heart attack, heart failure, angioplasty, or heart surgery (AHA, 2016). A hospital in the southwestern region of the United States of America reports their 2016 CR attendance rate of 79 %, which is much lower than the national average of 94% (AACVPR, 2016). Motivational interviewing (MI) is a proven method used to promote a positive behavior change for cardiac rehab patients. MI includes quality improvement activities such as peer support and cardiac rehab educational classes that have shown to increase health related quality of life measures and decreased depression symptoms (Pietrabessa et al., 2017; Pack et al., 2013).

Despite all the knowledge about CR and its benefits for health nationally, there are low attendance rates, therefore the purpose of this evidence-based project is to improve CR attendance rates using MI. Patients enrolled into CR participated in the motivational interviewing for eight classes. At the end of the class, they were given notecards to create Specific Measurable Achievable Realistic and Timely (SMART) Goals for themselves for that week. The measurement tools, the PHQ-9 and Dartmouth COOP is a simple, reliable, and valid tool for assessing functional status of cardiac patients and the current CR program utilizes this tool and is familiar with explaining this tool (Eaton, Young, Fergussion, Garrett, & Kolbe, 2005).

A Pearson correlation coefficient was calculated for the relationship between the MI classes and the CR attendance, depression scores, and quality of life. A strong positive correlation was found (r (82)= .456, p< .001) indicating a significant linear relationship between motivational interviewing and cardiac rehab attendance. A weak correlation that was not significant for depression symptoms and quality of life. The impact of this evidence-based project is to give cardiac rehab programs further evidence that the implementation of motivational interviewing can positively influence cardiac rehab attendance rates.

Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014).

If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems.

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.

The health care industry increasingly recognizes interprofessional collaboration (IPC) as the key to optimizing delivery of care, and interprofessional education (IPE) has been the foundational method for building IPC. When IPC is examined, leadership skills of the practitioners are often seen as a positive force for optimizing team performance. This project aimed to deliver an education session sharing interprofessional leadership (IPL) competencies and the effect they may have on attitudes toward IPC. A pilot was designed for a single site, a student run clinic in a large city in the Southwest United States, which serves as a learning laboratory to help future health practitioners grow IPC skills through effective and innovative IPE. A search of the available evidence supporting this project revealed that educational activities delivered to practitioners can build the leadership skills seen in effective IPC.

During the Fall 2017 semester, the education sessions were delivered to student practitioners at the clinic during their semester-long rotation. The University of the West of England Interprofessional Questionnaire, designed to measure self-assessment of attitudes toward collaborative learning and collaborative working, was deployed at the beginning and end of a semester-long rotation to all students working at the clinic to look for changes. A low sample size limited results to assessment of clinical significance, but showed some changes that could be significant if the project continues. Clinically significant changes show an increase in students’ rating of their own skills and preferences toward interprofessional practice. In keeping with the learning laboratory model at the clinic, these outcomes support continued delivery and examination of the education model with subsequent clinic rotations to strengthen the conclusions being drawn from the results.