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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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Advanced Directives in Rural Primary Care

Description
Abstract: Abstract Completion of advance directives (AD) prevent unwanted care. It is clear that systematic integration of AD documentation in primary care practices can lead to less intrusion of patient autonomy, and remove a source or moral injury and ethical ambiguity for providers, family and caregivers. The purpose of this…

Abstract: Abstract Completion of advance directives (AD) prevent unwanted care. It is clear that systematic integration of AD documentation in primary care practices can lead to less intrusion of patient autonomy, and remove a source or moral injury and ethical ambiguity for providers, family and caregivers. The purpose of this project was to examine the effect of an evidence-based AD completion activity on AD completion rates in a rural, primary-care clinic. The theory of self-determination (SDT) guided the project as SDT describes why and how persons are motivated to engage in acts of self-determination. Recruitment was self-selective as all clients aged 18 years or older had access and opportunity to available PREPARE.org materials to complete a state specific AD in English or Spanish on site. Each patient of the clinic signed the site-specific consent form authorizing release of information for study use. Project data was collected via chart audits using a pre/post intervention design. Results indicate that passively providing AD materials, even in a multiple languages and formats is not enough to engage self-motivation to complete an AD. This attempt to improve AD completion in primary care reflects the larger body of knowledge; interpersonal communication is needed to stimulate relatedness and improved competence, the two precursors of acts of self-determination, as outlined by SDT.
ContributorsSipe, Erica (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
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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