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.
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Identifying Opportunities for Process Improvement in Innovative Healthcare Technology Implementation
SolarSPELL is a digital learning library created at Arizona State University for
educational environments in the Pacific and East Africa. The library is curated to deliver information to resource-challenged communities around the world, providing culturally relevant materials in a solar-powered data repository. A new SolarSPELL health library was deployed in a border-adjacent community in Sonora, Mexico to enhance health education resources. The Sonoran SolarSPELL (SSS) library is a community-driven model established through Doctor of Nursing Practice (DNP) leadership and reflects the innovative focus of SolarSPELL.
The purpose of this report is to contextualize the Sonoran SolarSPELL experience, identify opportunities for process improvement and innovative leadership, and identify an evidence-based framework to guide implementation in new communities. Implementation framework utilization is especially important in the integration of technology into healthcare settings, where barriers can be novel and complex. Key focal points included the development of strong partnerships with the community members, collaborative design, and leadership roles of DNPs in project development and implementation. This study provides a paradigm for both DNP leadership and the application of innovative healthcare technologies in under-served communities throughout the world.
The birth of a new baby is known to be a joyful time for families. However, such a treasured experience can quickly reroute in a matter of moments which leaves the family feeling helpless, frightened, and guilty. The innate process of bonding and attachment is interrupted by the resuscitative course following a traumatic birth. Separation, grief, anger, and fear promote what’s being deemed more and more frequently as parental posttraumatic stress disorder (PTSD). Rates of parental PTSD associated with separation at birth are equivalating those of post-partum depression and post-partum psychosis. Emotionally unstable parents are unable to adequately care for their newborn for both short and long term needs.
Facilitation and support of the parental role in an altered environment, such as a neonatal intensive care unit (NICU), is thought to create opportunities for relationship security. Establishment of an emotionally invested caregiver has been proven to minimize sequelae of the NICU patient, reduce length of stay, cut readmission rates, and lower the incidence of failure to thrive post-discharge. A parental psychosocial program was instituted in a 32-bed NICU within a southwest children’s hospital. The program efficacy was analyzed several months after implementation. Results are concurrent with the thought that individual counseling for NICU families reduces stress scores and improves patient satisfaction at discharge.
The World Health Organization (2010) reports the nursing shortage is a global issue. With the impact of the shortage causing concern for nurse leaders, retaining Registered Nurses (RNs) is an effective strategy. The emergency department (ED) work environment provides an additional challenge to keep nurses as the ED is a fast-paced, critical care setting where RNs are providing care to multiple patients with a wide range of needs every shift. This paper will examine current literature addressing factors impacting and strategies for improving ED RN retention.
A systematic review of the literature showed relationship-focused/transformational leadership practices have a positive influence on job satisfaction and organizational commitment which translates to higher RN retention. The literature also indicated complexity leadership is needed in today’s changing health care environment. An evidence-based practice project was designed to assist the ED leaders evaluate and improve their leadership behaviors. A combination of education and coaching was provided, utilizing the Multifactor Leadership Questionnaire to assess the participants’ self- and rater evaluations before and after the intervention.
Although the results were not statically significant, feedback from participants and observations by the coach identified the education and coaching did have an impact on individuals that actively participated in the project. Those that embraced the concepts and followed through on their action plans have continued to practice, further developing innovative leadership behaviors after the project timeframe was completed
Background and Significance: NIRS data can be used in conjunction with standard vital sign monitoring to help clinicians understand blood flow and metabolic demands of organ systems, particularly cerebral, renal, and mesenteric blood flow patterns. A NICU unit in the northwestern US adopted NIRS use on their patients in 2008, however, NIRS monitoring usage decreased over the past 5 years, citing a lack of continued education and comfort interpreting and managing NIRS monitored patients. One patient was monitored with NIRS in the year prior to the QI project.
Methods: A 5 point Likert-Type survey was designed to examine provider comfort and confidence using and interpreting NIRS on NICU patients. No Croanbach’s alpha value exists for the survey as it was purposefully designed for the QI project. An educational presentation on the use and interpretation of NIRS on NICU patients was created and delivered during a formal provider staff meeting. Pre and Post education surveys were distributed electronically to participants and were presented 1 week prior to educational session and 1 month after educational session. IBM SPSS version 23 was used for descriptive statistics, paired t tests, and Wilcoxon test. Significance set to p<0.05.
Results: In total, 18 providers (N=18) were surveyed, and 13 paired survey results (n=13) were received (8 MD and 5 NNP). Paired-samples t tests were calculated to compare the mean total score (TS) for pre/post comfort and pre/post confidence. This was a significant improvement for both comfort (t(11) = -3.13, p=0.010) and confidence (t(11) = -3.37, p=0.006). Wilcoxon test showed a significant increase in the times a provider managed a patient with NIRS (z=-2.762, p=0.006). The number NIRS monitored patients increased from one in the previous year to 15 patients in the 5 months of data tracking, a clinically significant increase.
Conclusions: Providing educational session on previously utilized clinical applications can improve providers comfort and confidence and influence their usage in clinical practice. Future continuing education sessions could be designed for different clinical applications in order to keep clinicians abreast of the current evidenced based applications of advanced clinical monitors.
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.