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 14
Filtering by
- Creators: Bay, Sarah
- Creators: Tharalson, Erin
Description
Falls are prevalent among those aged 65 years and older and may result in minor to debilitating injuries in this vulnerable population. Frailty, unsteady gait, and medication side effects all contribute to fall risk as well as dementia, a type of cognitive impairment that disrupts memory and judgment leading to an underestimation of fall risk. Fall prevention evidence suggests that interventions aimed at decreasing fall rates begin with a fall risk assessment and tailored fall prevention measures that promote safety.
To examine the effectiveness of a fall prevention program in dementia care, an evidence-based pilot was conducted in a long-term care facility focused on dementia care. A convenience sample of 16 nurses received a fall prevention education intervention. A fall prevention knowledge instrument measured pre and post-fall prevention knowledge. There was a significant increase in fall risk knowledge from the pre-test (p < .001). The participants then conducted a fall risk assessment of 50 dementia patients using the Morse Fall Scale.
Of the 50 dementia patients, 28 were identified as high risk for falls. The nurses then instituted tailored fall risk prevention measures for those high risk for falls. As a result of the pilot, 40 fall events were noted within a three-month time period, reflecting a significant reduction in falls (p < .001) from the previous year. The institution of a fall prevention program in dementia care incorporating nursing education, a fall risk scale, and measures to promote safety can reduce fall risk in dementia patients.
ContributorsEbea, Kate Ndudi (Author) / Tharalson, Erin (Thesis advisor)
Created2020-05-06
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
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
Objective
Health care transition (HCT) for adolescents without special health care needs in the primary care setting has received inadequate attention, as represented by national surveys, when compared to adolescents with special health care needs. Barriers to transition such as lack of knowledge and preparation have been known to hinder HCT despite the knowledge gap and weak evidence related to non-special needs adolescent transition. Application of anticipatory guidance education related to care transition may improve transition readiness scores of adolescents without special health care needs.
Methods
Utilizing Meleis’ transition theory with the Plan-Do-Study-Act framework, a quasi-experimental study was conducted comparing transition readiness scores between baseline and intervention groups of adolescents 14 years or older attending their well checks at a small pediatric primary care site. The intervention consisted of two videos developed from Got TransitionTM's (n.d.) Six Core Elements for specific adolescent age ranges.
Results
Statistical analysis reveals that the subgroup and overall transition readiness scores for both age groups, 14-15 and 16-18 years of age, when comparing the baseline groups to the intervention groups, have mixed significance (p = .419, p = .074, respectively). However, when asking the respondents about their understanding of the transition process and their role in that process, 75% and 62.5%, respectively, at minimum agreed the intervention was helpful.
Conclusion
The findings were mixed, indicating the educational videos did have a short-term impact on adolescent transition readiness scores for the 16-18 years old group only. Future focus on long-term follow up throughout the adolescent period may yield better data.
ContributorsJones, Benjamin Keith (Author) / Bay, Sarah (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
Preventing deaths from uncontrolled bleeding remains a national priority, as mass causality events in communities and schools continue to rise. National initiatives have been set in motion by the Department of Homeland Security, to teach laypersons hemorrhage control techniques while waiting for emergency personnel to arrive. A full and growing body of evidence supports the use of hemorrhage control training classes among adult laypeople and is growing steadily in the adolescent population. With the majority of shooting events occurring at high schools, the implementation of a hemorrhage control training curriculum can increase survival rates among high school students in the event of an active shooter. The purpose of this paper is to investigate current knowledge and hemorrhage control practices among high school students and the implication of implementing a hemorrhage control educational intervention by evaluating current knowledge of hemorrhage control as well as their willingness, confidence, and perceived value in hemorrhage control education. This evidenced-based assessment is proposed utilizing the Social Learning Theory and Rosswurm and Larrabee’s implementation framework.
ContributorsMaddaluna, Christina (Author) / Bay, Sarah (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-03
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
Harm reduction in cardiovascular disease is a significant problem worldwide. Providers, families, and healthcare agencies are feeling the burdens imparted by these diseases. Not to mention missed days of work and caregiver strain, the losses are insurmountable. Motivational interviewing (MI) is gaining momentum as a method of stimulating change through intrinsic motivation by resolving ambivalence toward change (Ma, Zhou, Zhou, & Huang, 2014).
If practitioners can find methods of educating the public in a culturally-appropriate and sensitive manner, and if they can work with community stakeholders to organize our resources to make them more accessible to the people, we may find that simple lifestyle changes can lead to risk reduction of cardiovascular diseases. By working with our community leaders and identifying barriers unique to each population, we can make positive impacts on a wide range of issues that markedly impact our healthcare systems.
ContributorsStephens, Alexus A. (Author) / Bay, Sarah (Thesis advisor)
Created2020-04-28