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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Purpose & Background: Family Nurse Practitioner (FNP) residency programs are meant to ease providers' transition into practice, but there is limited evidence about their overall effectiveness and impact on provider satisfaction. When a FNP residency program in the Southwestern United States found they had high resident provider attrition rates, it

Purpose & Background: Family Nurse Practitioner (FNP) residency programs are meant to ease providers' transition into practice, but there is limited evidence about their overall effectiveness and impact on provider satisfaction. When a FNP residency program in the Southwestern United States found they had high resident provider attrition rates, it prompted an investigation into current and past residents’ satisfaction levels. Methods: Arizona State University’s (ASU’s) Institutional Review Board (IRB) and the project site’s review committee approved the project design for human subject protection. After approval, all current and past residents employed at the practice were e-mailed a link to SurveySparrow with the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and a demographic questionnaire in December 2021 and February 2022. Results: Mean satisfaction scores indicated “minimally satisfied” overall. When satisfaction was compared over time using a two-tailed independent t-test for an alpha value of 0.05, p = 0.731, indicating no significant change in satisfaction over two months. Total satisfaction and subscales of satisfaction were divided by cohort, averaged, and compared on a Likert scale from “1” (Very Dissatisfied) to “6” (Very Satisfied). Current residents’ average satisfaction score was M = 3.77. They were most satisfied with challenge and autonomy, M = 4.28, and least with collegiality, M = 3.26. Providers' one-year post-residency average satisfaction score was M = 3.98. They were most satisfied with benefits, M = 4.53, and least with time, M = 3.04. Providers' two-year post- residency average satisfaction score was M = 3.49. They were most satisfied with benefits, M = 4.56, and least with time, M = 2.90. Using Pearson Correlation tests there was no correlation between average satisfaction and average performance on Uniform Data Systems (UDS), r = 0.01, p = 0.968. Conclusions: Overall providers were “minimally satisfied.” Opportunities to make program improvements were identified and could help improve retention and reduce costs and provider shortages.
Created2022-04-29
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Aim: To evaluate the impact transformational leadership (TFL) behaviors and What Matters to You conversations have on RNs finding meaning and joy in work (MJW) and turnover. Background: The nursing profession is plagued by burnout - a precursor to loss of MJW. Loss of MJW was exhibited as low

Aim: To evaluate the impact transformational leadership (TFL) behaviors and What Matters to You conversations have on RNs finding meaning and joy in work (MJW) and turnover. Background: The nursing profession is plagued by burnout - a precursor to loss of MJW. Loss of MJW was exhibited as low morale and increased turnover among acute care RNs at a small hospital in Southwest Arizona. Addressing loss of MJW aligns with caring for the caregiver, the fourth aim of the quadruple aim initiative. Methods: This was a quasi?experimental mixed methodology evidence-based project. The target populations were core RNs and leaders working in the intensive care unit, care unit, and emergency department. Intervention was multimodal – survey using Meaning and Joy in Work Questionnaire, TFL education, and steps one and two of the IHI four steps for leaders model. Results: Final sample was 18 RNs. Statistical analyses did not reveal significant impact; pre- and post-survey MJWQ scores remained above four. Themes from the What Matters to You conversations included making a difference, coworkers/connections, staffing, and negativity. Turnover trended positively in two of the three units. Conclusion: This project heightened awareness about MJW and illuminated the impact TFL behaviors can have on RNs finding MJW and turnover. The coronavirus pandemic and acute nursing shortage were significant limitations of the project. Implications: Healthcare organizations are encouraged to view MJW as a system asset, embed it in their cultures, invest in innovative solutions, and continually evaluate outcome measures of MJW.
Created2022-04-28
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Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a

Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos. Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins. Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
Created2022-04-29
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Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated,

Objective: Pediatric patients with asthma are frequently cared for in the emergency department (ED). Many studies show early administration of corticosteroids (CS) can improve outcomes for children experiencing an asthma exacerbation. Despite the evidence, delays in care remain. The purpose of this study is to streamline the process for nurse-initiated, triage-based CS administration and determine the effect on overall length of stay (LOS). Methods: For this quality improvement initiative, ED nurses at a large, freestanding, children’s emergency department in the southwestern United States were given education on inclusion and exclusion criteria for nurse-initiated CS in ED triage. Time to CS administration, LOS, and whether the ED nurse or provider ordered the CS were evaluated through chart reviews of patients presenting with a chief complaint of difficulty breathing. These metrics were compared to charts from the previous year during the same timeframe to evaluate for improved timeliness of CS delivery. Results: Time to CS administration decreased from a mean of 98.6 minutes to 57.6 minutes. LOS decreased from an average of 259.3 minutes to 169.6 minutes. The effect of timely CS on LOS was significant for December p =.003, January p =.002, and February p = <.001. Conclusion: A streamlined process for CS delivery to pediatric patients experiencing an asthma exacerbation can enable providers to achieve efficient and effective care in the ED and decrease a patient’s overall LOS.
Created2021-04-23
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Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each

Background: Vaccination is an effective public health tool; however, immunization rates are low in American adults, with disparities existing for Hispanics compared to non-Hispanic Caucasians, uninsured individuals, undocumented immigrants, and low-income individuals (Lu et al., 2014; Lu et al., 2015; Williams et al., 2016). Consequently, 42,000 adults still die each year in the United States (US) from vaccine-preventable diseases, and nine billion dollars are spent on associated healthcare costs and lost productivity (ADHS, 2015; Wilson et al., 2019). To improve adult vaccination rates, the National Vaccine Advisory Committee recommends the Standards for Adult Immunization Practices, including regular assessment, recommendation, delivery or referral, and documentation during follow-up on vaccination (Orenstein et al., 2014; CDC, 2016). Local problem: A free clinic in Arizona serving uninsured, undocumented Latin American immigrants had low vaccination rates and a deficiency in vaccination documentation in electronic medical records. Methods: An evidence-based quality improvement project was conducted to address low vaccination rates and provider practices using a multi-component intervention. The effect and usage were evaluated through chart audits and pre- post-intervention surveys. Interventions: A vaccination questionnaire was administered at all in-person primary care visits. Brief educational videos were provided to providers and office staff before the intervention addressing the questionnaire's use, purpose, and goals. Adult immunization schedule printouts were made available in all patient rooms and provider charting areas. Additionally, a resource sheet on local free immunization programs was created for providers and patients. Results: The intervention's effect was unable to be determined due to a breakdown in the protocol after the second week of implementation. However, 92% of completed questionnaires reviewed indicated the patient needed one or more vaccination. Sixty-five percent of electronic medical records reviewed had no vaccination documentation historically for assessment, recommendation, referral, follow-up, or scanned vaccination records. No charts reviewed had these areas documented regularly. Conclusion: Vaccination rates and the Standards of Adult Immunization Practices are low at the free clinic. Further quality improvement measures are indicated addressing barriers present.
Created2021-04-27
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Objective: Mental health illnesses are complex conditions that afflict many university students. International students are uniquely vulnerable to these conditions due to challenges such as adjusting to the new environment and culture of American universities. They are also less likely than domestic students to receive mental health services. Research indicates

Objective: Mental health illnesses are complex conditions that afflict many university students. International students are uniquely vulnerable to these conditions due to challenges such as adjusting to the new environment and culture of American universities. They are also less likely than domestic students to receive mental health services. Research indicates that there are obstacles for international students when it comes to seeking mental health services, but these obstacles are typically over-generalized and less applicable to each specific university setting. The purpose of this paper was to assess the barriers in seeking mental health services by international students. Participants: International students at a large university located in Southwestern United States. Students 18 years of age or older, enrolled as an international student, proficient in English, exhibiting mental health symptoms, and refusal of primary care physician’s referral to mental health services. Method: Physicians at Health Services verbally recruited the participants during routine visits. Participants did not provide any personal information, and completion of the questionnaire indicated their consent. This project was guided by the model of mental health help-seeking, where a questionnaire was administered to students, allowing them to identify what specifically prevents them from receiving mental health services. Result: Due to the COVID-19 pandemic, only 1 questionnaire was completed, but it was rejected as it was filled by domestic student. Conclusion: The data gathered through this questionnaire was intended to be provided to university healthcare providers to better understand how they can connect with international students with mental health concerns.
Created2021-04-27
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Early and effective end-of-life care are associated with increased quality of life for those patients who may be nearing the end-of-life (EOL). However, evidence suggests that most non-palliative healthcare providers lack the skills and confidence to initiate EOL conversations. Consequently, about 70% of Americans would prefer to die at home

Early and effective end-of-life care are associated with increased quality of life for those patients who may be nearing the end-of-life (EOL). However, evidence suggests that most non-palliative healthcare providers lack the skills and confidence to initiate EOL conversations. Consequently, about 70% of Americans would prefer to die at home with their families, yet only 25% die according to their wishes (State of California Department of Justice, n.d). In alignment with the Peaceful End of Life Theory, the purpose of this evidence-based project is to increase primary healthcare providers’ level of skills and confidence in end-of-life discussions.

This project utilized a pre and post study design. A total of 11 participants were recruited using convenience sampling from three primary care clinics in Phoenix, Arizona. Due to the small sample size and assumption of a non-normal distribution of the data, Wilcoxon Signed Ranks test and Pearson correlation coefficient were used for statistical analysis. There were clinical and statistical significant improvements in the EOL knowledge of the participants after the implementation of the two-and-a-half-hour Serious Illness Care Program (Z = -2.950, p = .003) with a large effect size (r = -0.62).

The project evaluation also demonstrated that most participants deemed that the intervention was effective. A brief and systematic education session, such as the SICP can be utilized to improve non-palliative healthcare providers’ skills in having more and effective end-of-life conversations.

ContributorsManalese, Rey Jericoh (Author) / Ochieng, Judith (Thesis advisor)
Created2019-05-02
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Introduction: Pre-exposure prophylaxis (PrEP) is a critical development in HIV prevention, yet females at risk of contracting HIV have lower rates of PrEP use compared to their male counterparts. Insufficient knowledge on PrEP indications for women has been a key barrier in health care providers (HCP) utilization of PrEP in

Introduction: Pre-exposure prophylaxis (PrEP) is a critical development in HIV prevention, yet females at risk of contracting HIV have lower rates of PrEP use compared to their male counterparts. Insufficient knowledge on PrEP indications for women has been a key barrier in health care providers (HCP) utilization of PrEP in this population. Prior research has revealed educational interventions improved providers’ use of PrEP in at risk populations. Methods: A 1-hour, educational session was developed for eleven HCPs at a university-based clinic. The educational session was guided by the Cognitive Learning Theory and included information on clinical practice guidelines for PrEP implementation in women. The effects of the intervention were analyzed using a pre/post-survey design, with post surveys delivered at two and eight weeks. The 16-item survey evaluated outcomes including provider discussion and prescription rates of PrEP with female patients and perceived knowledge and perceptions of PrEP in women, utilizing a Likert scale. All procedures were given exempt status by the university IRB. Results: Paired sample t tests were used to analyze provider reported conversations and prescription rates, while matched ordinal data were analyzed utilizing Wilcoxon signed rank tests and descriptive statistics. At two-weeks post intervention there was a significant increase in provider’s reported likelihood of prescribing to at risk cis gender females in the next six months (Mdn= 2 [pre-survey], Mdn = 3 [post-survey], α= 0.05, V = 0.00, z = -2.53, p = .011). At eight weeks postintervention, there was a statistically significant decrease in provider’s beliefs that HIV risk assessment was an essential component of a primary care visit for female patients (Mdn = 3.00 [pre], Mdn = 2.00 [eight-week], α= 0.05, V = 10.00, z = -2, p = .046). The results of the data analysis have been shared with the leadership team of the health clinic and used to inform future practice on provider educational sessions on PrEP. Conclusion: Women at risk of contracting HIV are a key demographic missed for the utilization of PrEP. Limited statistically significant findings from the intervention have prompted further research to focus on interventions that promote long-term behavior change and improve providers implementation practices of the preventive measure in at-risk female identifying patients.
Created2021-04-25
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The purpose of this project is to look at the relationship between education about Autism Spectrum Disorder (ASD) and knowledge, attitudes and beliefs in adult primary care providers. The project addresses the transition challenges adults with ASD have in finding a primary care provider who is comfortable and competent with

The purpose of this project is to look at the relationship between education about Autism Spectrum Disorder (ASD) and knowledge, attitudes and beliefs in adult primary care providers. The project addresses the transition challenges adults with ASD have in finding a primary care provider who is comfortable and competent with ASD. Education was provided to adult primary care providers in a multi-site primary care clinic in a large metropolitan city in the Southwestern United States. The Modified Knowledge/Attitudes/Belief instrument was used. A pre-test was administered prior to the education session, then a post-test and a one-month post-test were given afterward.

The results of the education program showed that attitudes and beliefs increased after the education and continued to increase more in the month following. Knowledge improved after the education session but declined after a month although scores were not back to the pre-education level. Primary care providers who receive education about ASD may be more comfortable in caring for this population and more likely to welcome adults with ASD into their practice. Education for primary care providers is key to improving health outcomes for adults with ASD.

ContributorsChesebrough, Geri Anne (Author) / Mangold, Kara (Thesis advisor)
Created2018-04-30
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The health benefits of breastfeeding are well documented and exclusive breastfeeding for at least the first six months of life is the target of national and global health care organizations. Although initial breastfeeding is on the rise, the percentage of infants still breastfeeding at six months drops significantly. In the

The health benefits of breastfeeding are well documented and exclusive breastfeeding for at least the first six months of life is the target of national and global health care organizations. Although initial breastfeeding is on the rise, the percentage of infants still breastfeeding at six months drops significantly. In the population of newly delivered mothers of an obstetric practice, there is no readily accessible breastfeeding support offered following hospital discharge. A review of relevant literature revealed that lack of support is often cited as a key factor in the discontinuation of breastfeeding, whereas the evidence shows that participation in peer support has a positive effect on breastfeeding self-efficacy, which can have a positive effect on breastfeeding duration.

To address this problem, the initiation of a breastfeeding closed social network Facebook group for this practice setting population was developed and implemented to provide readily accessible peer support and have a positive effect on the outcome of breastfeeding self-efficacy. Three months after initiation of the Facebook group, an anonymous voluntary survey was offered to group members, and 25 members participated in the survey. Responses demonstrated that peer support is helpful with breastfeeding confidence and that, following participation in the group, the respondents wanted to continue breastfeeding.

ContributorsStorto, Pamela (Author) / Mangold, Kara (Thesis advisor)
Created2018-05-03