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.
Collaborating Institutions:
College of Nursing and Health Innovation
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Description
Hospital visitation policies have continued to evolve throughout the pandemic resulting in
visitation restrictions for COVID patients. To positively shape the experience for patients,
families, and care providers a new communication plan utilizing virtual visiting emerged. The
purpose of this quality improvement project, developed based on the caring theory, is to
explore if implementing iPads with virtual visiting capabilities is effective in increasing patient
and family satisfaction. IPads were deployed throughout a large, emergency department
located in the southwest United States to enable virtual communication among patients,
families, and healthcare workers to measure the patient and family’s satisfaction. After the
virtual visit the patient and family member had the option to complete a satisfaction survey.
The anonymous post-visit Likert-scale surveys measured (1) ease of iPad use, (2) staff
engagement, and (3) mental health - coping and stress. Participants were recruited via the
electronic medical record that displayed patients being ruled out for COVID. Data was
analyzed using descriptive analysis and the results showed high levels of satisfaction among
the patients and families in all areas. There is sufficient evidence to suggest that the
availability of virtual visits is beneficial for patients and families. The implementation of video
communication via iPad showed high levels of patient and family satisfaction, mental health
outcomes and increased family involvement.
ContributorsZirkus, Cloe (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-30
Description
Background: An evidence-based project was performed to train and increase skills among healthcare providers to perform advance care planning. Training decreases barriers and improves attitudes and confidence to perform advance care planning. Advance care planning can include the Physician Order for Life-sustaining Treatment, an out-of-hospital order that directs emergency medical services of a patient’s wishes. Internal evidence found that many providers are unfamiliar with the Physician Order for Life-Sustaining Treatment form. The Theory of Planned Behavior was used to guide the project.
Objectives: To improve advanced care planning processes in a healthcare organization.
Design: A quality improvement project was performed at a medical center with outpatient provider groups. Virtual training was provided by the Arizona Hospital and Healthcare Association on the Physician Order for Life-Sustaining Treatment. Participants completed a three-part survey to measure skills for advance care planning after a training event.
Setting/Subjects: Five (n=5) American palliative and primary care providers at a medical center.
Measurements: The East Midlands Evaluation Toolkit is a validated survey tool that measures confidence and competence in advance care planning after training.
Results: Descriptive statistics, Friedman’s test, and the Kruskal-Wallis test were used for data analysis. Results provided evidence to the healthcare facility that there is a significant need to train their healthcare professionals on advance care planning.
Conclusions: Recommendations are made to focus research on larger studies looking at the types of advance care planning, and differences in disciplines and specialties.
ContributorsPate, A. Shurine (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Medicare implemented a yearly Annual Wellness Visit (AWV) to improve quality patient care through early detection of declining health. However, there has been only partial provider participation since its inception, which potentially delays treatment and negatively impacts patient outcomes. The aim of this quality improvement project was to assess the feasibility of implementing a standardized electronic AWV template into private primary care practices to improve the consistency of delivery and documentation. The project designer utilized the theory of transitions (TOT) to facilitate the project execution. An electronic Excel-based template was designed to capture and calculate all aspects of the AWV, including billing codes, to allow for ease and consistency of use within a small primary care practice over two weeks. A provider performed the AWVs using the electronic template after completing a hands-on tutorial and reviewing an educational handout. Data were retrieved from a 7-question, 5-point Likert scale questionnaire given to the provider to assess the effectiveness of the electronic template versus a paper assessment. The results of this study indicated overall satisfaction with using leveraged technology to provide consistency of AWVs to improve patient outcomes, provider satisfaction, and increase revenue through uniform charting and billing. The outcomes of this project provide a basis of existing evidence for using standardized methods to perform and track Medicare AWVs.
ContributorsHill, L. Michelle (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
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 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
Description
Background: Type II diabetes mellitus (T2DM) is a growing issue globally. Social determinants of health (SDH) play a crucial role on patients’ outcomes and complications from the disease. Hispanics are twice as likely to suffer from T2DM when compared to non-Hispanic whites, and they often rely on federally qualified community health centers (FQCHC) for their medical needs. These centers are then faced with high volume of patients with high acuity, which leads to limited time and resources to provide diabetic education.
Methods: The Purnell model of cultural competence will be used as a framework to provide unbiased, culturally tailored (CT) education to improve patients’ outcomes. The advancing research and clinical practice through close collaboration (ARCC) model will be used as it focuses on evidence-based practice (EPB) implementation that is sustainable across the system.
Purpose: The purpose of this EBP project is to promote culturally tailored (CT) DSME at a low-income FQCHC in greater Phoenix to improve diabetes outcomes and decrease complications from the disease. Consequently, decreasing the costly effects of diabetes complications to patients, FQCHC, and the state of Arizona.
Conclusion: Evidence suggest that diabetes self-care management education (DSME) is successful, independent of the format of delivery, in improving diabetes outcomes and patients’ self-care. However, it is underutilized in the United States even though it is a covered Medicare service.
ContributorsDavis, Maria Regiane (Author) / Rauton, Monica (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
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 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