Doctor of Nursing Practice (DNP) Final Projects

The human papillomavirus (HPV) is the most commonly spread sexually transmitted infection in the United States. Although the HPV vaccine protects against transmission of the most common strains of HPV that cause genital warts and numerous urogenital cancers, uptake in the United States remains suboptimal. Failure to vaccinate leaves individuals vulnerable to the virus and subsequent complications of transmission. The evidence demonstrates that provider recommendation alone increases rates of vaccine uptake. The literature does not suggest a specific method for provider recommendation delivery; however, best practice alerts (BPAs) were correlated with increased vaccination rates.

These findings have directed a proposed project that includes an electronic health record (EHR) change prompting internal medicine, family practice and women’s health providers to educate and recommend the HPV vaccine at a Federally Qualified Health Center (FQHC) in the Southwest United States. The project demonstrates that after the implementation of a practice change of a HPV BPA in the EHR, HPV vaccination rates increased. Practice settings pre and post were similar, making the increase clinically significant.

The strengths of this project include an increase in HPV vaccination rates, a sustainable intervention, and an intervention that can easily be replicated into other health maintenance tasks. There were some limitations including the BPA alert only catching the HPV 9 vaccine series and the BPA did not always capturing historical data. Despite these technical barriers the HPV BPA delivered an increase in the HPV vaccine to protect more individuals from the HPV virus, increased provider adherence to national guidelines, and provides a platform for BPAs to be utilized for other vaccines.

Gestational diabetes mellitus (GDM), diabetes diagnosed in the second or third trimester of
pregnancy that is not clearly overt diabetes, has become more common as the rates of obesity in women of childbearing age have increased. Undiagnosed, uncontrolled diabetes in pregnancy can lead to maternal and infant health comorbidities as well as have adverse long-term effects for mother or baby. Although routine screening for gestational diabetes mellitus (GDM) occurs between 24 and 28 weeks gestation, the American Congress of Obstetricians and Gynecologists (ACOG) recommends screening earlier in pregnancy for women at risk for undiagnosed type 2 diabetes. Risk factors include previous history of GDM, known impaired glucose metabolism, or obesity (BMI > 30).

The purpose of this project is to implement the clinical practice guideline for early maternal glucose screening during pregnancy in women with risk factors through the integration of a clinical decision support (CDS) tool in an electronic health record (EHR). CDS tools can be utilized as a point of care strategy to remind providers of the clinical practice guidelines and to assist providers in decision-making related to screening. Participating providers (n=18) utilized the CDS tool during the initial obstetrical visit for at risk women without a pre-pregnancy diabetes diagnosis and entering prenatal care prior to 24 weeks. The impact of
implantation of the CDS tool shows that an increase in screening was statistically significant (p<.001).

Background: Alarming levels of burnout in mental health care staff is a significant concern not only for the organization but for the individual as well. Identifying and addressing burnout ought to be an essential protocol in a behavioral health organization. Currently, burnout remains an ongoing concern for mental health care organizations as it is associated with negative impacts for staff, patients, families, and the organization.

Method: The purpose of this project is to utilize the Maslach burnout inventory (MBI) survey tool to measure burnout pre and post intervention. The intervention utilized will be mindfulness-based interventions (MBI) to reduce burnout among mental healthcare workers. Implementing mindfulness interventions has evidence that it reduces burnout rates in mental health care staff. Current literature supports mindfulness-based interventions and have showed a decrease in burnout, stress, and depersonalization.

Results: The pre-intervention results were as followed: emotional exhaustion; 40, depersonalization; 20.4 and personal accomplishment 32. The post-intervention results emotional Exhaustion; 28, depersonalization; 14.90 and personal accomplishment 30. It was found that the category for emotional exhaustion was statistically significant as it had a P value .040, whereas depersonalization was not statistically significant as the P value was .171 and personal accomplishment was not statistically significant as the P value was .577.

Discussion: The use of MBI as an intervention has robust literature supporting the effectiveness in decreasing burnout and stress in mental health care staff.