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
Displaying 1 - 10 of 23
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- Creators: Rauton, Monica
- Creators: Bay, Sarah
- Creators: Bain, Ilyssa D.
Description
Vicarious exposure to traumatic events is correlated with: mental health problems, a higher prevalence of posttraumatic stress disorder, employee attrition, and higher mortality rates for Law Enforcement Officers when compared to the general population. The purpose of this evidence-based project was to determine if a resiliency training improved resiliency and resiliency knowledge in law enforcement officers in a rural law enforcement agency in the southwestern United States. Six participants completed a demographic survey, Response to Stressful Experience Scale and a resiliency knowledge measure. A Wilcoxon signed-rank test was conducted to compare pre- and post- training resiliency and resiliency knowledge scores.
The post-test overall resiliency scores (Mdn = 59.50) were not significantly higher than pre-test overall resiliency scores (Mdn = 54.50), Z = -1.47, p = .141. Post-test resiliency knowledge scores (Mdn = 9.00) were not significantly higher than pre-test resiliency knowledge scores (Mdn = 8.00), Z = -1.63, p = .102. In this group of law enforcement officers, the resiliency training did not have an effect on resiliency or resiliency knowledge. These outcomes could be potentially explained by the limited sample size (N = 6), and possibly small effect size. Recommendations for improving the current study include conducting the resiliency training with a larger sample size of at least 30, and including additional relevant questions in the resiliency knowledge measure.
ContributorsWolfe, Summer (Author) / Rauton, Monica (Thesis advisor)
Created2020-04-14
Description
There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management is largely to blame for many HF exacerbations. Current evidence supports utilizing both verbal and written education with an emphasis on self-care and education delivered in a group setting or individual setting showed equal impact on self-care and HF knowledge ( Hoover, et. al., 2017; Ross et. al., 2015; Tawalbeh, 2018).
An outpatient VA clinic located in a suburb of the large metropolitan identified there was no consistency on how a HF patient was educated, managed, or tracked and the registered nurses (RNs) lacked knowledge of HF. As a results of these findings this Evidence Based Project (EBP) was implemented. RNs were educated on HF and completed a self-assessment questionnaire evaluating their knowledge pre and post education. The RNs, as part of a multidisciplinary team, educated HF patients on signs and symptoms of HF as well as on how to manage the disease. Patients completed, the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and the Self Care Heart Failure Index (SCHFI) to assess knowledge of HF and self-management skills.
These questionnaires were completed initially and at 30 and 60 day intervals. The RNs self-assessment of their knowledge and ability to educate patients increased in all areas. The patient’s KCCQ and SCHFI score improved at 30 days and 60 days when compared to their initial score. Larger EBPs are needed over a longer period of time to assess the impact on hospital readmissions and same day clinic visits for HF exhibitions.
ContributorsSpano, Emily (Author) / Rauton, Monica (Thesis advisor)
Created2020-05-05
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
Introduction: Most melanoma cases are directly related to harmful ultraviolet exposure (UV). An adolescent athlete spends close to four hours per day outdoors, which equates to over one thousand hours of sun exposure every year. Athletes are typically unaware that extended periods of UV exposure can cause melanoma and therefore an education regarding sun safety is needed. The Social Cognitive Theory depicts the studied behaviors for this project showcasing external factors that may contribute to an adolescent not using proper sun protection.
Methods: Athletes on the swim team at a Phoenix High School (n=6) were surveyed to determine their current sun protection habits. An education intervention about sun safety and melanoma risk/identification was then implemented. The student athletes were then re-surveyed two weeks post intervention to determine if their sun protection habits and melanoma knowledge had changed. Descriptive statistics were run to compare the pre- and post-survey results.
Results: There was no change between baseline and post-intervention sun safety/melanoma knowledge when descriptive statistics were run. Amongst the six athletes, sun safety habits and knowledge identifying melanoma did not change after the education intervention.
Discussion: Adolescents are unaware of the consequences their lack of safe sun habits can cause on their skin. Most adolescents do not have the proper education from schools or sporting teams to teach them about the dangers of poor sun safety practices. Education alone cannot serve as the sole influence as to whether adolescent athletes increase sun protection habits.
ContributorsRyan, Alexandra (Author) / Bay, Sarah (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Purpose: To educate clinic staff on interventions and education materials which are suitable for implementation in a pediatric primary care setting, and to improve delivery and documentation of appropriate asthma interventions and inhaler/spacer education.
Background: Asthma is a chronic illness that impacts 10.9% of the pediatric population in Arizona. Poor asthma understanding and management leads to high-utilization of emergency rooms and urgent care clinics, negatively impacting the healthcare economy. Poor asthma management also leads to decreased health outcomes and impacts on the child’s academic functioning, mental health, and overall quality of life. Current evidence supports use of written asthma action plans (WAAP) and inhaler/spacer instruction to improve asthma management.
Methods: The intervention was an evidence-based educational session provided to the staff of a military, pediatric primary care clinic in southwest Arizona regarding the use of WAAP, the Asthma Control Test (ACT) and integrated inhaler/spacer instruction. Chart reviews were conducted to evaluate the documentation of use of WAAP, ACT, and inhaler/spacer education.
Results: Charts were collected from pre-intervention (n = 33) and post-intervention (n = 18). Data analysis demonstrated a statistically significant higher use of WAAP (U = 0.008, p < 0.05, d = 0.83). Although there was not a statistically significant change in use of ACT tool, Cohen’s value (d = 0.48) suggested a moderate positive effect. A Pearson correlation coefficient was also calculated for the relationship between use of ACT tool and use of WAAP, demonstrating a moderate positive correlation (r (49) = .372, p < .01).
Conclusions: An evidence-based education session for pediatric staff members is a cost-effective and simple method of improving pediatric asthma management practices.
Background: Asthma is a chronic illness that impacts 10.9% of the pediatric population in Arizona. Poor asthma understanding and management leads to high-utilization of emergency rooms and urgent care clinics, negatively impacting the healthcare economy. Poor asthma management also leads to decreased health outcomes and impacts on the child’s academic functioning, mental health, and overall quality of life. Current evidence supports use of written asthma action plans (WAAP) and inhaler/spacer instruction to improve asthma management.
Methods: The intervention was an evidence-based educational session provided to the staff of a military, pediatric primary care clinic in southwest Arizona regarding the use of WAAP, the Asthma Control Test (ACT) and integrated inhaler/spacer instruction. Chart reviews were conducted to evaluate the documentation of use of WAAP, ACT, and inhaler/spacer education.
Results: Charts were collected from pre-intervention (n = 33) and post-intervention (n = 18). Data analysis demonstrated a statistically significant higher use of WAAP (U = 0.008, p < 0.05, d = 0.83). Although there was not a statistically significant change in use of ACT tool, Cohen’s value (d = 0.48) suggested a moderate positive effect. A Pearson correlation coefficient was also calculated for the relationship between use of ACT tool and use of WAAP, demonstrating a moderate positive correlation (r (49) = .372, p < .01).
Conclusions: An evidence-based education session for pediatric staff members is a cost-effective and simple method of improving pediatric asthma management practices.
ContributorsBrown, Jennifer (Author) / Bay, Sarah (Thesis advisor)
Created2019-05-02
Description
Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could receive unwanted treatment. Providers can utilize advance care planning (ACP) to educate patients and support them in forming a medical power of attorney (MPOA) and AD. Evidence suggests that having ACP conversations can engage a patient to form an AD. The purpose of this project was to see if ACP discussions with older patients encouraged them to complete an AD and MPOA.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.
The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
ContributorsKrasowski, Maria (Author) / Rauton, Monica (Thesis advisor)
Created2018-05-01
Description
Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of the leading causes of patients' ability to maintain peritoneal dialysis. Evidence suggests that enhanced patient education on infection control practices beyond standard education effectively reduces peritonitis incidents.
Methods: Enhanced education on infection control practices was delivered to 18 peritoneal dialysis patients in Southern Arizona through the application of determinants of the Health Belief Model utilizing the principles of the ADKAR framework. Data analysis will be available through facility-specific quality metrics of decreased peritonitis and modality loss episodes. Each of these measures is to have data compared to pre/post-intervention.
Results: All participants in the study were able to sustain peritoneal dialysis as their renal replacement therapy. Of the 18 participants, one patient episode of peritonitis occurred three months before the intervention, and zero episodes were reported during the first three months of monthly infection control education. Facility-specific peritonitis and modality loss measures are not available until after project publication.
Conclusion: To decrease peritonitis rates and modality loss, the intervention will continue for eight to 12 months to determine success. More time is needed to determine if patients adhere to monthly infection control practices taught during enhanced education.
ContributorsSchneeweis, A. Danielle (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Introduction: Depression screening in the pediatric setting is a crucial part of the adolescent's examination. A standardized screening tool and protocol streamlines the process of assessing adolescents and minimizes the chances of serious mental health disorders going undetected and untreated. Evaluation of current evidence demonstrates the use of a standardized tool improves detection, diagnosis, and management of depression and other mental health illnesses.
Method: The Patient Health Questionnaire—modified for adolescents (PHQ9-A) was administered to all eligible adolescents, ages 12-18, during an annual well visit for a period of 6 weeks. Lewin's Change Theory guided a system change in the electronic health record, and the questionnaire results were documented and provided to the pediatric provider at the time of the appointment. A chart review was conducted to determine whether all eligible patients were administered the questionnaire and if a depression diagnosis or mental health referral had been made.
Results: Out of 76 eligible well visits, 65 (86%) patients completed the PHQ9-A. The average score was 5.29 (SD = 6.49) with a maximum score of 25. Out of those that completed screening, 11 (17%) had a positive PHQ9-A score resulting in 8 referrals to mental health services and 2 mental health diagnoses in the clinic.
ContributorsCoomer, Meagan (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-27
Description
Breast or formula feeding is a personal and challenging decision for any new parent. Breastfeeding goes beyond the mother-baby dyad, having profound implications across different societal contexts, including financially and medically. Although a natural form of feeding, breastfeeding can be difficult and isolating if it does not come easily. A mother's first contact for help is usually at her newborn's first primary care appointment. However, these appointments are insufficient in allowing the healthcare provider to answer breastfeeding concerns or questions. A quality improvement project was conducted at a pediatric primary care clinic in the southeast valley of Arizona after approval was granted by an Institutional Review Board. Eight participants were recruited, and four completed the project. This project focused on extending the newborn appointment by 15 minutes to provide an educational resource binder and address breastfeeding questions. The Bristol Breastfeeding Assessment Tool (BBAT) was utilized to determine the mother's self-efficacy towards breastfeeding since the Theory of Self-Efficacy was the foundation for this project. Weekly follow-up telephone calls were conducted to address the mother's questions. The project concluded at the one-month appointment, where BBAT was performed again. The BBAT scores demonstrated an increase in breastfeeding self-efficacy. The participants were also evaluated if the project aided their breastfeeding journey. Every participant was breastfeeding by the one-month appointment except one who was not exclusively breastfeeding. In addition, all preferred the extended-length newborn appointments, educational binder, and weekly phone calls. Qualitative theming supported the use and continuation of the project for future mothers.
ContributorsScott, Taryne (Author) / Bay, Sarah (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
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