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 15
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- Creators: Sebbens, Danielle
- Creators: Tharalson, Erin
- Creators: Bain, Ilyssa D.
Description
Sedation exists along a continuum; and, it is impossible to predict a patient’s exact response to a medication administered to induce any level sedation. Under the direction of a licensed independent practitioner (LIP), registered nurses (RN) in the Emergency Department (ED) have been permitted to administer propofol for time-sensitive, moderate sedation procedures (e.g. orthopedic reductions). In 2019, this changed when a Board of Nursing (BON) in the Southwestern United States posted an Advisory Opinion (AO) limiting the circumstances under which acute care RNs could administer propofol. The purpose of this doctoral project was to revise the 2019 AO to remove specific medication names and to generate recommendations for aligning hospital-based adult sedation policies and procedures (P&P) with the revised AO. In May 2020, the BON enacted the revised AO. Enactment endorses RNs practicing at the top of their scope and justifies amending existing hospital-based sedation P&Ps. Not restricting nurses’ scope of practice according to medication name supports medication selection based on patient condition and clinical situation and safeguards provision of timely, personalized healthcare to communities statewide.
ContributorsBonefield, Brittany A. (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-18
Description
Solo private physician-owned clinics report lower rates of electronic health record (EHR) use. Lack of use of an EHR results in billing penalties, revenue losses, and may affect quality of care. An EHR provides a concise recollection of a patient’s complete medical history, and any pertinent exam information clearly and succinctly. The aim of this pilot project was to support a small solo private physician-owned clinic transition from paper-based charting to an EHR. The pilot assessed through a validated survey EHR readiness and confidence of the employees at the beginning of the change process (pre-intervention) and at 16 weeks (post-intervention). During the 16-weeks, interventions in the form of transition assistance included vetting an EHR modality for the practice, virtual training via EHR modules, weekly check-ins with stakeholders, and organizational planning and scheduling with staff. EMR-based goal setting with EHR rollout deadlines was also provided. Results noted confidence decreased pertaining to EHR transitioning over the 16 weeks. Unforeseen barriers and challenges likely led to reduced confidence and provided information on future transition supports needed for the practice. The findings of this pilot are beneficial in gaining insight on how to enhance readiness in an outpatient clinic for EHR readiness. This information is utilized as a guide for small privately-owned outpatient clinics in their organizational transition from paper-charting to EHR. The results of this pilot project provide evidence-based data on the demands of system-wide organizational change.
ContributorsLong, Dana (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22
Description
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.
ContributorsBain, Ilyssa D. (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-23
Description
Extracorporeal membrane oxygenation (ECMO) is a high-risk, but highly successful intervention for the survival of critically ill neonatal and pediatric patients. Patients supported by ECMO require continuous infusions of anticoagulant medications to prevent clotting of the ECMO circuit, thrombotic events in the patient, and other bleeding complications. Close monitoring, care, and management of the ECMO circuit and its components, with specific focus on systemic anticoagulation, is vital as many factors may influence the efficacy of the anticoagulant and ultimately the patient condition. Globally accepted guidelines exist for the correct management of anticoagulation while supported on ECMO; however, health care centers frequently deviate from these recommendations. This project report synthesizes the most current literature on anticoagulation management in the pediatric ECMO supported population, discusses the limitations in current research, and demonstrates the necessity to use standardized anticoagulation protocols for the safest and most successful outcomes. To implement these findings, this project report suggests the need for an evidence-based project that focuses on the quality improvement of current ECMO anticoagulation guidelines.
ContributorsHolmes, Lauren Michelle (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Introduction: The purpose of this project was to evaluate a tablet-based documentation application for massive transfusion protocols (MTPs).
Methods: 13 trauma nurses at a level-one pediatric trauma center were randomly assigned to use paper documentation (n=5) or the tablet-based application (n=8) during simulated MTPs. Documentation completeness was compared using an independent t-test. Tablet users completed a system usability survey (SUS).
Results: Documentation of blood product volumes and times significantly improved with the tablet (p=<0.001 and p=0.001 respectively). The tablet received a mean SUS score of 89%.
Discussion: A tablet-based application has potential to improve real-time documentation of MTPs.
ContributorsShoop, Morganne (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
Description
A federally qualified health center in the southwest United States serves low-income, uninsured communities. By provider reports, unprescribed antibiotic use is common in this clinic’s population, promoting development of antibiotic resistant bacteria. Antibiotics are widely available in Mexico and may be sold illegally in the United States without a prescription. This project’s purpose is to identify social risks and opportunities for antibiotic education. A telephone survey was administered to patients at least 18 years of age. The 32-item survey included a demographic questionnaire created for this project, the PRAPARE social determinants of health questionnaire, and the Eurobarometer antimicrobial resistance questionnaire. Any social risks identified were forwarded to clinic staff for referral. The survey was completed in English or Spanish, per the participant’s preference. A total of 20 surveys were completed. Low education level and unemployment were the most common social risks identified. Spanish language, housing and food insecurity, and difficulty meeting basic needs were associated with overall higher social risks. An antibiotic knowledge gap was identified, and self-medication with antibiotics was confirmed as a behavior within the population. Although no determinants for antibiotic misuse were identified, all participants indicated preference for provider-based education. This FQHC has an opportunity to develop a provider-based educational intervention. The length of the survey and the telephone format, required due to COVID-19 restrictions, were significant limitations, impacting recruitment. Further research is needed to determine the most effective way of delivering education. The clinic is continuing to administer the PRAPARE survey, expanding data on social risks.
ContributorsMiranda, Sarah (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
Description
As the incidence of acute and chronic wound conditions rises and wound dressing protocols become more complex, uninsured patients lacking access to specialty wound care are challenged to manage their own wounds. Understanding multistep dressing change protocols may be inhibited by low health literacy. Low health literacy is associated with reduced disease knowledge and self-care. Little evidence of health literacy effects on wound patients is available nor are literacy-sensitive educational interventions that address wound knowledge and self-care. Improved outcomes occur in all health literacy levels in other diseases with the use of literacy-sensitive educational interventions that incorporate more than one literacy strategy over multiple sessions. To examine the effectiveness of a literacy-sensitive wound education intervention on wound knowledge and self-care, an evidence-based pilot project was conducted in an urban wound clinic.
A convenience sample of 21 patients received a literacy-sensitive wound education intervention consisting of spoken and written communication over several sessions. Instruments measured health literacy level, wound knowledge, dressing performance, and wound healing status. There was a significant increase in wound knowledge scores in all literacy groups from baseline to visit two (p < .01) and four (p < .01). Dressing performance scores remained consistently high through visit four in all literacy levels. All participant’s wounds progressed toward wound healing significantly from baseline to visit two (p < .01) and four (p < .01). Incorporation of a literacy-sensitive education intervention with supportive literacy aids over several sessions supports improved wound knowledge and dressing self-care and can affect healing in patients of all health literacy levels.
ContributorsTharalson, Erin (Author) / Root, Lynda (Thesis advisor)
Created2018-04-20
Description
Background: Traumatic brain injury (TBI) is a leading cause of death and long-term disability among children. The Brain Trauma Foundation (BTF) guidelines integrate initiation of early enteral nutrition which is essential for achieving best clinical outcomes. Gaps in knowledge, consistency, and collaboration when managing these patients hinder adherence to the guidelines and puts the patient at risk.
Objective: This project purpose was to review the updated BTF guidelines and implement a rounding checklist to increase the early initiation of enteral feeding following a TBI.
Methods: This quality improvement project was conducted in the pediatric intensive care unit (PICU) at a level one pediatric trauma center and included all patients admitted with severe TBI. A pre- and post-test accompanied education regarding the guidelines and instructions for checklist completion. The checklists included all BTF guidelines, with a primary focus on early initiation of feeds. Checklist data was presented by the bedside nurse during rounds.
Results: Using descriptive statistics, the average pre-test score was 69% and average post-test score was 93%. Prior to the education, 82% of registered nurses believed a bedside checklist would help manage patients with severe TBI and increased to 95% after education. The checklist was used on 7 (100%) patients and 43% had feeds initiated within 72 hr post-injury (n = 3).
Conclusions: Early initiation of feeding in critically ill patients impacts patient outcomes. A rounding checklist can improve interprofessional communication and healthcare quality by delivering standardized pediatric TBI care. Research regarding enteral nutrition is needed to ensure nutrition is provided in a safe, timely manner.
ContributorsMichael, Holly N. (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
Description
All-terrain vehicles (ATVs) are a leading cause of pediatric trauma. Children may experience a range of injuries from concussion and fractures to severe traumatic brain injury and even death. ATV safety is a priority. Research emphasizes the importance of helmet use while riding an ATV and adhering to manufacturing guidelines for ATVs. These findings have led to the initiation of an evidence-based project to identify behavioral changes within the pediatric population, specifically children 12-18 years of age who are on the Trauma Service of Phoenix Children’s Hospital. Each patient was given a pre-test survey to assess their knowledge regarding ATV safety. After the pre-test survey was completed, an educational component was implemented, the participant used teach-back to the project personnel to demonstrate understanding, and a post-test survey immediately followed. The posttest had several open-ended questions that identified the patient’s intention to follow the safety recommendations when riding their ATV in the future.
ContributorsO'Donnell, Elly (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-25
Description
Introduction: Palliative care can significantly benefit children managing a life-limiting illness; unfortunately, services are generally reserved for end of life. The aim of this project was to demonstrate how established guidelines coupled with provider education could impact referrals.
Methods: Educational sessions developed using information processing theory and outlining referral recommendations were offered to providers in the NICU, PICU, and Center for Cancer and Blood Disorders at a tertiary care facility. Presurveys and postsurveys were administered at the time of the intervention and referral numbers for the organization were collected for two months prior and two months following.
Results: Descriptive statistics and paired t-tests were used to compare survey data and referral rates.
Discussion: Palliative care is imperative for meeting patient goals and optimizing quality of life. Provider knowledge of referral criteria ensures that patients receive this service early in their disease trajectory and can benefit from its inclusion within their care team.
Methods: Educational sessions developed using information processing theory and outlining referral recommendations were offered to providers in the NICU, PICU, and Center for Cancer and Blood Disorders at a tertiary care facility. Presurveys and postsurveys were administered at the time of the intervention and referral numbers for the organization were collected for two months prior and two months following.
Results: Descriptive statistics and paired t-tests were used to compare survey data and referral rates.
Discussion: Palliative care is imperative for meeting patient goals and optimizing quality of life. Provider knowledge of referral criteria ensures that patients receive this service early in their disease trajectory and can benefit from its inclusion within their care team.
ContributorsNewton, Katelyn A. (Author) / Sebbens, Danielle (Thesis advisor)
Created2018-04-27